Introduction: The use of pharmacotherapy as a first-line treatment for premature ejaculation (PE) is recommended by EAU guidelines. However, no study had analyzed multiple treatment comparisons among available on-demand therapy. Therefore, we aimed to perform a network meta-analysis (NMA) to characterize the comparative efficacy and tolerability of on-demand therapy for PE.

Methods: We systematically searched randomized controlled trials (RCTs) in several databases at any period up to November 2019. NMA was performed to estimate efficacy and tolerability outcomes using intravaginal ejaculation latency time (IELT) and overall adverse effects (AEs), respectively. We ranked each outcome using the surface under the cumulative ranking curve (SUCRA) and presented the two outcomes as a clustered ranking plot.

Results: A total of 19 RCTs comprising 5950 patients were included in this NMA. All active treatments showed significant improvement compared to placebo. Among the available on-demand treatment, the combination of SSRI plus PDE5i showed the highest efficacy (MD: 3.06; 95%CI 1.84-4.29) followed by tramadol 100 mg and vardenafil 10 mg (MD 2.9, 95%CI 1.63-4.16; MD 2.36, 95%CI 1.2-3.52; respectively). Based on the SUCRA, the combination of SSRI plus PDE5i had the highest score (91.7%) in efficacy, while dapoxetine 30 mg had the highest score (73.3%) in terms of tolerability.

Conclusion: The combination of SSRI plus PDE5i was the treatment of choice for individuals who prioritize efficacy. For those who prioritize tolerability, dapoxetine 30 mg and vardenafil 10 mg became alternative treatments. Various on-demand therapy options require careful discussion with patient expectations of treatment effects.

Background: Involutional entropion is the inward turning of the eyelid margin and commonly happens in the inferior eyelids in elderly people. The prevalence is as high as 2.1% in people ≥ 60 years old and more common in women than men. This condition may cause ocular surface irritation and discomfort secondary to contact between cilia and the ocular surface. Several etiological factors are suspected to be important causes of involutional entropion. One of them was horizontal eyelid laxity. Quickert Procedure is one of the surgical interventions recommended to correct involutional lower eyelid entropion in the elderly Asian population with 0% of recurrent entropion in a recent study by Miyamoto et al.

Methods: This is a descriptive retrospective study of 16 involutional lower eyelid entropion patients (18 eyelids) that needed surgical correction.  About ten males and six females were undergone Quickert procedure to correct the involutional entropion. Patients were assessed postoperatively for 24 months to evaluate the recurrence entropion, cosmetic, and functional improvement. Data were analyzed by SPSS version 20 for Windows.

Results: This study included 16 patients, with mean age was 69.8 years old which range from 62-85 years old. They consisted of 9 (56.0%) patients were male, and the rest was female (44.0%). Eleven (61.0%) patients were with left eye laterality, and 10 (63.0%) patients found without anticoagulant consumption. All patients (100.0%) had positive snapback test and achieved >6 mm in distraction test. After surgical intervention, no patients (0.0%) were found to experience recurrence of involutional entropion nor ocular discomfort due to prior surgery.

Conclusion: A detailed assessment of the etiology, accurate preoperative evaluation, and precision in addressing patients underlying eyelid anatomic abnormalities are needed in the selection of appropriate surgical procedures to correct entropion.

Introduction: The use of vascular access (AV-fistula) for long-term hemodialysis is still served as the primary choice. The fact that there is still a high rate of failure of arteriovenous fistulas procedure is one of the obstacles in the treatment of chronic kidney disease problems. This study aims to assess the risk factors for AV-fistula or AV-shunt failure and develop a risk scoring system for the failure of the AV-fistula procedure in patients with chronic kidney disease.

Methods: This study is a prospective study conducted at Dr. Soetomo Hospital, Surabaya, Indonesia. The analysis focuses on the risk factors for AV-fistula failure and performs a scoring order using multiple logistic regression methods.

Results: Based on this study, three variables were found to have significant values in determining the risk of AV-fistula failure scoring, namely local arterial condition (p<0.1), local venous condition (p<0.1), and arterial diameter (p<0.1). The scoring system for normal arteries, normal veins, and artery diameter >1.8 mm was scored 1. Scoring for veins and arteries with a history of puncture was 1. Arteries with stiff sensation with weak pulses and veins with a history of intravenous catheters scored 2.

Conclusion: The use of scoring based on parameters of arterial diameter, local venous condition, and local arterial condition becomes a scoring system for predictors of the risk of failure of the AV-shunt procedure, with three scoring categories, namely low risk (score 0-1), medium risk (score 2 -3), and high risk (score 4-5). This study is only a preliminary study for arteriovenous fistula scoring (PAVAS Score) due to the limited sample size so that a large-scale follow-up study is needed to assess the validity of the proposed PAVAS score.

Background: TLR4-NADPH Oxidase-4 or TLR4-Nox4 signaling pathway uric acid (UA)-induced oxidative stress is involved in urate nephropathy pathogenesis, which can culminate into renal fibrosis, a common feature of chronic kidney disease (CKD). Based on the hyperuricemic and antioxidant effect of anthocyanin on the kidney, we assumed that Balinese purple sweet potato (Ipomoea batatas L.) tuber in its ethanolic extract form (PSPEE) could suppress the activation of renal TLR4-Nox4 signaling. This study was aimed to investigate the renoprotective effect of PSPEE via renal Nox4 downregulation, using a murine model induced with a high-purine diet.

Methods: This study was an experimental laboratory study using a post-test only with a control group design among 38 male Swiss mice. The Male Swiss mice (20-30 g) were randomly allocated into 2 groups, namely, the control group (treated with a high-purine diet for 7 days) and the PSPEE group (treated with a high-purine diet for 7 days and PSPEE for 14 days). The serum uric acid (sUA) level was quantified using the UA phosphatase method. Meanwhile, the renal Nox4 level was quantified using ELISA. Data were analyzed using SPSS version 20 for Windows.

Results: Our study found that the renal Nox4 levels were 18.65±1.67 ng/mL and 15.14±1.66 ng/mL for the control and PSPEE groups. Based on the statistical analysis, there was no statistically significant difference between control and PSPEE groups (p>0.05).

Conclusion: Balinese PSPEE tends to decrease renal Nox4 level in high-purine diet-treated mice, but fails to show a significant effect.

Background: Increased production of reactive oxygen species (ROS), causing accumulation of oxidative damage. Carbontetraclorida (CCl₄) is known as a toxic material and causing hepatocellular damage initiated by oxidative stress, which increased blood serum glutamic pyruvic transaminase (SGPT) concentration. Cacao beans (Theobroma cacao L.) extracts have antioxidant properties from flavonols, consisting of catechin, epicatechin, and procyanidin. This study aims to investigate the effect of hepatoprotective of cacao beans (Theobroma cacao L.) extracts in oxidative stress mice induced by CCL₄. 

Methods: The study was conducted at the Department of Biochemistry and Department of Pharmacology and Therapy, Faculty of Medicine Udayana University using the Pretest-Postest Control Group Design. About 20 male mice were divided into 4 groups, as control or placebo group (P0), intervention group by 15 mg extracts of cacao beans (P1), 30 mg (P2), and 60 mg (P3) for 7 days. On the eight-day induced by 0,55 mg/gram mice bodyweight of CCl₄. All groups were examined for blood SGPT concentration before and after the intervention. Data were analyzed using SPSS version 20 for Windows.

Results: The SGPT level prior to the administration of cacao bean extract and CCl4 was 18.56±0.19 µ/L in P0 group, followed by 18.41±0.28 µ/L (P1), 18.36±0.21 µ/L (P2), and 18.16±0.47 µ/L (P3), but statistically not significant (p=0.260). However, after CCl4 administration, the SGPT levels were 38.63±0.37 µ/L in P0 but significant decrease in the P1 (28.14±0.34 µ/L), P2 (20.72±0.35 µ/L), and P3 (18.68±0.25 µ/L) following cacao beans whole extracts administration (p=0.000).

Conclusion: This study concluded that cacao beans extracts administration could inhibit the oxidative stress and protect hepatocellular damage induced by CCl₄ by decreasing the blood SGPT concentration.

Background: Uremic pruritus or more accurately termed ‘chronic kidney disease-associated pruritus’ (CKD-aP) is chronic itch in patients with advanced or end-stage renal disease without evidence of any other active disease that could explain the pruritus. The pathogenesis of CKD-aP is complex and not fully clarified. Some preliminary studies indicate that CKD-aP is a systemic inflammatory disease with a deranged balance of T helper (TH) cell differentiation toward TH1 predominance especially IL-2. This study aimed to elucidate further the association of interleukin-2 serum levels with CKD-aP in patients undergoing regular hemodialysis (HD).

Methods: This was an analytical cross-sectional study. Sampling was taken with consecutive sampling technique. This study was carried out on 72 patients on regular HD consist of 36 patients with CKD-aP and 36 patients without CKD-aP after meeting the inclusion and exclusion criteria. Blood samples were obtained at Hemodialysis Unit Sanglah General Hospital and IL-2 serum levels were measured at Clinical Pathology Laboratory Sanglah General Hospital Denpasar between July 2019 and August 2019. Mann-Whitney U Test was used to compare IL-2 serum between CKD-aP and non-CKD-aP group.

Results: Results in this study we found higher median IL-2 level (17.1 ng/l) on pruritus group versus those without pruritus (13 ng/mL) (p<0.05).

Conclusion: IL-2 serum levels on CKD-aP patients are higher than those without CKD-aP in patients who undergo regular hemodialysis.

Background: Around 68.6% of women who have breast cancer seek medical treatment at a locally advanced stage (LABC), where the neoadjuvant chemotherapy (NAC) modality is the initial choice therapy. Luminal A was recorded as the subtype with the chemotherapy response being the most resistant among others. The cause of chemoresistance is multi-factorial, and several studies correlate this condition with several anti-apoptotic agents expressed in the nucleus of cancer cells, especially nuclear factor-kappa B (NF-кB). The NF-κB transcription factor as an anti-apoptotic agent in some cancers blocks the apoptotic pathway through the extrinsic and intrinsic pathways. NF-κB plays a vital role in the development of chemoresistance. Understanding the NF-κB pathway and perceiving more about the cellular characteristics of LABC is very important to develop NF-κB inhibitors as therapy. NF-κB as a transcription factor can be considered a promising research target because it can affect oncogenes' transcription and play an essential role in prognostic and predictive biomarkers. This study was conducted to determine whether NF-κB overexpression is a risk factor for anthracycline-based neoadjuvant chemoresistance in Luminal A subtype LABC patients at Sanglah General Hospital.

Methods: An unpaired case-control study was conducted at Sanglah General Hospital. The research subjects were 40 people, divided into case groups (chemoresistance) and control groups (chemosensitive). Hereafter the NF-κB H-Score was carried out by IHC examination. Data are presented in table form and analyzed by Chi-square test or Fischer exact.

Results: Samples of cases with NF-κB overexpression were obtained 13 (65%), compared with the control group 7 (35%) (p<0.05). Multivariate analysis has shown that NF-κB overexpression is an independent factor against anthracycline-based chemotherapy resistance in advanced LABC patients with local luminal subtypes with p=0.013; OR 3.45 (95% CI=2.94-12.65).

Conclusion: NF-κB expression in Luminal A subtype LABC can be used as a predictor for anthracycline-based neoadjuvant chemoresistance. NF-κB overexpression is a predictor factor for NAC chemoresistance in luminal A subtype LABC.

Introduction: The ACL injury has commonly occurred in a greater number of athletes, less publication is about poor knee function and ACL injury in the patient with non-operative treatment. This study aimed to describe the characteristics of patients with ACL injury non-operative, which are associated with poor knee function on daily living activities.

Methods: We included patients with ACL injury that has been diagnosed for ACL injury by an orthopedic surgeon or physiotherapist in a hospital or private clinic. All participants were recruited from February 2019 to April 2019. The inclusion criteria were patients who at least 18 years old. We used the KOOS ADL function cut-off score ≤80 to dichotomous the patient with knee problems, and score >80 have no statistical analysis problem. We calculated using binary logistic regression on the KOOS ADL function for each variable.

Results: The mean score of KOOS daily living was 72.8 points, of which 66 participants had poor scores, and 37 were acceptable. Women were 9.2 times more likely to had poor KOOS daily living scores than men in non-operative ACL injury patients (p=0.044), and non-elite athletes had a higher possibility by 8.5 times higher than those who were participated in sports only for leisure or recreation (p=0.002).

Conclusion: This study confirmed that patients who did not undergo the ACL reconstruction had a poor knee function in daily living. It was associated with women and non-elite athlete participants, yet the concomitant injuries were possibly confounder for the association.

Purpose: Sepsis is life-threatening organ dysfunction caused by the dysregulation of the host response due to infection. Sepsis is caused by an imbalance between pro-inflammatory and anti-inflammatory cytokines. Moringa oleifera (Mo) leaves naturally contains antiinflammation and antioxidant. We aim to investigate Mo leaves in sepsis.

Patients and methods: This is an experimental laboratory study with Post Test Only Control Group Design. 30 Winstar males rats were divided into four treatment groups; each consist of 6 rats. The negative group, the positive control group received an injection of LPS dose of 0.25 mg/kg BW, and the interventional group with Mo-EA dose of 10, 20, 40 mg/kg BW. The Annova and Kruskal-Wallis test was used in this study. The significant p-value<0.05. The measured outcome were neutrophil levels, malondialdehyde (MDA) levels, and Serum Glutamic Pyruvate Transaminase (SGPT) / Serum Glutamic Oxaloacetic Transaminase (SGOT).

Results: The neutrophil, MDA, SGOT, and SGPT levels were decreased significantly within the treated group. MO Fraction can decrease the serum of MDA, Neutrophil, and SGOT/SGPT levels in days 3 and 7 (p<0.05).

Background: Platelets have been associated with the pathogenesis of atherosclerosis by excreting various chemokines (i.e. PF4), which systematically interact with multiple molecules. The formation of circulating heparin-platelet factor-4 (PF4) complexes have been observed in heparin-induced thrombocytopenia (HIT) cases, raising questions about the role of PF4-derived atherosclerosis in the predisposition of HIT.  

Methods: An in vivo model of atherosclerosis was generated by feeding rabbits with a high-cholesterol diet for six weeks and a normal rabbit as a control group. HIT was induced by injecting heparin subcutaneously for ten days twice daily. Platelets count before and after heparinization was performed by hemocytometer, PF4 measurement was determined by ELISA assay. Histopathology examinations for artery thickness, foam cell, and endothelial denudation were conducted by Hematoxylin and Eosin (H&E) staining.

Results: There was no significant difference in the IgG PF4/heparin complex between the atherosclerotic and the normal groups (43.84±2.07 ng/mL vs. 41.87±3.44 ng/mL), platelet count was significantly reduced only in the atherosclerotic group (p=0.01; mean differences 7162.00±57311.02/mm³), endothelial denudation and foam cell formation were observed in the atherosclerotic group. Also, a significant difference observed in endothelial thickness between the atherosclerotic group compared to the normal group (470.32 ± 131.15 µm vs. 332.05±50.82 µm; p=0.032).

Conclusion: Our results suggest that atherosclerosis was significantly associated with the development of heparin-induced thrombocytopenia. However, atherosclerosis is not a risk factor for the formation of PF4-heparin complex in HIT.

Background: Postherpetic neuralgia (PHN) is the most common complication seen in herpes zoster patients. Its clinical manifestations consist of persisting sharp pain even when the initial exanthema has disappeared. These patients experienced stress from the conditions and from the treatment process, which in turn affect their families’ quality of life.

Patients and Methods: This study was an observational analytic study with a cross-sectional design involving 30 PHN patients and their families. Patients were required to fill out the Perceived Stress Scale (PSS-10) questionnaire to assess their stress levels. Their respective families were required to fill out the Family Dermatology Life Quality Index (FDLQI) questionnaire to assess their quality of life. Statistical analysis was performed on both data with the Spearman correlation test (data were not normally distributed). ANOVA test was performed to assess the average difference between the stress levels experienced by PHN patients and the quality of life of their families.

Results: The families of PHN patients who experienced severe stress levels had worse or lower quality of life compared to the families of patients with moderate or mild stress levels. The lowest average score of quality of life is 27.20 (severe stress level) and the highest average score of quality of life is 14.33 (mild stress level).

Conclusions: The stress level of PHN patients was significantly related to the quality of life of their respective families in the aspects covered in the FDLQI questionnaire (p <0.005). There was a significant difference in the family's quality of life score based on the patient's stress level (p<0.001)

Purpose: To assess the impact of open reduction on quality of life in patients with maxillofacial fractures.

Methods: A prospective study of 15 patients admitted to a general hospital in Bandung for maxillofacial trauma from October 2017 through February 2018 was conducted. Trauma severity was assessed using facial injury severity scale (FISS) score, while the quality of life was assessed using Oral Health Impact Profile (OHIP) -14 questionnaires at one day before surgery (T₀) and 14 (T₁) and 60 days (T₂) after surgery.

Results: Male (3.92±1.89) and younger patients (3.89±1.69) had a greater mean FISS score than their respective counterparts. The most common areas involved in maxillofacial fractures were mandible body (80%) and dentoalveolar (46.67%). The overall quality of life was worse in younger patients as indicated with a higher mean OHIP-14 score. There was a disparity in the domain of interest where younger patients (17-30 years) had more concern over psychological discomfort, whereas older patients (31-50 years) were more concerned about physical disability. Both qualitative and quantitative improvement in quality of life was observed in the follow-up period. Consistent and statistically significant improvement in mean OHIP-14 score before intervention (20.80±5.94), 14 days post-intervention (17.93±4.68), and 60 days post-intervention (14.67±3.42) was observed.

Conclusion: Open surgery approach yielded a good outcome in quality of life improvement. Further study on demographic factors, timing, and quality of life domain affected in maxillofacial fractures is recommended.

Background: Anal human papillomavirus (HPV) is one of the most common sexually transmitted infection. Men who have sex with men (MSM) are commonly affected by anal HPV infection. Until now, there is no data available on the prevalence of HPV genotype in the MSM in Indonesia

Purpose: This study aimed to determine the prevalence and risk factors of anal HPV infection among MSM in Bali, Indonesia.

Patients and methods: A cross-sectional study was conducted among MSM in Sanglah Hospital, Bali, Indonesia. Blood samples were collected for HIV serological testing and syphilis serological screening, and anal swabs were collected for HPV genotyping. Risk factors associated with anal HPV infection were assessed by univariate and multivariate logistic regression. Anal HPV infections were also being categorized into any anal HPV types, HR HPV types, LR HPV types, and multiple HPV types.

Results: Mean age of participants was 31.4 years. The prevalence of HPV infection was 89.3% and 61.3% for coinfection between LR and HR types. Almost half of our participants had at least two HR anal HPV and they were co-infected with HPV 16, 39, and 51. Participants with HIV infection were associated with anal HPV, LR HPV, and multiple HPV types of infections.

Conclusion: HIV status were associated with anal HPV infection among MSM in Bali, Indonesia. Since all of the participants with at least two anal HPV genotypes were co-infected with HPV 16, 39, and 51, it is to be hoped that HPV vaccination can be introduced into MSM communities in Bali, Indonesia.

Purpose: Tuberculous lymphadenitis is one of the most common presentations of extrapulmonary tuberculosis. The diagnosis can be challenging due to its varying clinical manifestations and the low sensitivity of conventional bacteriological methods for confirming the causative agent, Mycobacterium tuberculosis. Early secretory antigenic target 6 (ESAT-6), which is released early during M. tuberculosis infection and plays a role in granuloma formation, determines the pathogen’s invasion, its severity, and virulence factors related to the immune response. This study aimed to analyze the potential diagnostic value of ESAT-6 using real-time polymerase chain reaction (RT-PCR) and compare it with histopathologic diagnostics.

Materials and methods: This retrospective observational study with the cross-sectional design was conducted using consecutive sampling. A total of 50 formalin-fixed, paraffin-embedded lymph node tissue samples from lymphadenectomy consisted of 25 tuberculous lymphadenitis and 25 granulomatous lymphadenitis were collected. The specimens were diagnosed with tuberculous and granulomatous lymphadenitis based on histopathologic features. Analyses using conventional PCR from commercial kit to detect TB and RT-PCR to determine the expression of ESAT-6 were performed. Statistical analysis of the categorical data was performed using the Mann-Whitney test. Statistical significance was set at p < 0.05.

Results: The mean age of the patients was 35.66 years old (range: 6–85 years). The age group between 16 and 30 years was the most common (40%). Almost two-thirds (62%) of the patients were female. Sixteen (64%) tuberculous lymphadenitis and 13 (52%) granulomatous lymphadenitis samples were positive by PCR TB. ESAT-6 expression was significantly higher in tuberculous lymphadenitis (p = 0.004).

Conclusion: ESAT-6 as a potential predictor of tuberculous lymphadenitis can be used in patients for whom histopathologic diagnostics fail to confirm the presence of M. tuberculosis.

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by increased blood glucose (hyperglycemia). Stress and family’s support in managing diabetic Mellitus are two critical external factors that influence blood glucose levels. This research aimed to analyze the relationship between stress level and family’s support with fasting blood glucose levels and 2 hours post prandial in T2DM patients.

Method: Study design using cross sectional model. Eligible T2DM patients in Tabanan II primary health care center, between period September 2017- February 2018 were evaluated for fasting and post prandial blood glucose and stress level (Depression Anxiety Stres Scale-14) and family support. Spearman correlation test was used to determine correlation between family support and stress level toward fasting and post prandial glucose levels in T2DM patients.

Result: The result suggested that 29 respondents (36.3%) get severe stress levels, 51 respondents (63.85%)  get high family support, fasting blood glucose level was 168.42±63.57 and post prandial glucose level was 229.18±88.593. There was a positive correlation between family support and stress level toward fasting glucose level (r=0.341; p<0,001) and post prandial glucose level (r=0.276; p<0,001).

Conclusion: Stress level and family support in diabetic mellitus management can influence fasting and post prandial glucose level T2DM patients. Managing stress and family support can assist in stabilizing fasting and post prandial glucose level.

Introduction: Maximum voluntary contraction (MVC) of handgrip strength is considered a reliable subjective global assessment tool and has been used as predictive tools for human body performance. The usefulness MVC for continuous assessment of muscle strength in chronic kidney disease (CKD) patient's hemodialysis patients need to be investigated.

Methods: The research involved 100 CKD patients that underwent routine hemodialysis in Jordan. The subject's demographic and anthropometric data were collected. Subjects also tested for MVC using a dynamometer. The data was analyzed to find the relationship between each of the independent factors, including age, body mass index (BMI), handgrip circumference (HGC), forearm circumference (FAC), to the maximum voluntary contraction (MVC). Linear and nonlinear modeling were generated to estimate the effect of each independent variable.

Results: Subjects ages varied from 20-70 years old, for males mean age was 46.48 years old, mean weight 83.74 kg, mean height 167.24 cm, mean BMI 30.28 kg/m², mean handgrip circumference 21.34 cm, and mean forearm circumference 26.13 cm. For females, the mean age was 47.62 years old, weight 77.28 kg, mean height 162.96 cm, mean BMI 29.24 kg/m², mean handgrip circumference 20.09 cm, and mean forearm circumference 24.83 cm. For males, the highest MVC Value was 49.3 lbf, while for females, the highest MVC Value was 38.6 lbf, and both from the group aged <30 years old. ANOVA revealed that age was the primary factor that was significantly associated with MVC.

Conclusion: The age has major and significant effects on maximum voluntary contraction in CKD patients.

Introduction: Proteinuria is a risk factor for the progression of Nephrotic Syndrome. Xerosis cutis is a disorder of the skin due to reduced fluid or oil content in the skin that moisture the surface of the skin layer. The three primary keys that play a role in the incidence of Xerosis Cutis are the lack of moisture-binding substances, lack of skin fat and ceramics and the latter lack of skin moisture wiring in the viable epidermis mediated by the aquaporin water channel. Reduced protein content and impaired collagen maturation, for example due to proteinuria, might influence the mechanism behind preservation skin moisture. This study aimed to determine the relationship between the severity of proteinuria and Xerosis Cutis in children with Nephrotic Syndrome.

Method. This is a cross-sectional analytic study involving 50 patients with Xerosis Cutis with Nephrotic Syndrome. Kruskal Wallis test is used to determine the association of proteinuria severity with Xerosis Cutis in children with Nephrotic Syndrome.

Result: The median value of age was 8 (3-16) years, with the most range at 6-10 years old (52%). It consists predominantly of male patients (68%). The duration of the Nephrotic Syndrome has a median value of 2 (1-7) years. Subject with +1 proteinuria (36%), +2 (32%), +3 (28%) and +4 (4%). Skin moisture level was dry (Xerosis Cutis) (36%), normal (56%), and moist (8%).  There was a significant association between skin dryness and the severity of proteinuria (p = 0.002).

Conclusion: There is a significant relationship between the severity of proteinuria and Xerosis Cutis. The higher the severity of proteinuria associated with having skin dryness and thus indirectly describing the more protein wasted through urine.

Background: Obesity in children has the potential to increase the risk of morbidity and even death in the future. One of the diseases that are at risk due to obesity is hypertension and also impaired kidney function. Glomerular filtration rate differences in obese and normal-weight children are somehow contradictory. This study aims to prove the difference in blood pressure and kidney function in adolescents with obese and non-obese.

Methods: A cross-sectional study was conducted among high school children in Denpasar. Subjects were classified as obese and non-obese. The Mann-Whitney test was used to assess the mean difference of blood pressure, whereas the Independent t-test was used to determine the mean difference of GFR. Multivariate analysis was performed with logistic regression and ANCOVA. Data were analyzed using SPSS version 20 for Windows.

Results: A total of 68 subjects with obese and 52 subjects with non-obese were included in this study. Systolic and diastolic blood pressure in the obese group was higher than in a non-obese group, with the mean difference in systolic and diastolic blood pressure was 29 mmHg (P<0.001) and 18 mmHg (P=0.002), respectively. Obesity increases the risk of hypertension 9.78 times (95% CI: 1.86-51.39; P=0.007), and obese adolescents have an average GFR of 11.51 lower than non-obese (95% CI: 17.32 – (-5.69); P<0.001).

Conclusion: Hypertension is higher in obese adolescents than non-obese, while glomerular filtration rate is lower than non-obese adolescents.

Background:  The aim of epilepsy surgery is to improve the quality of life of people with epilepsy. Temporal lobe epilepsy (TLE) is the most common form of intractable epilepsy with a risk of low quality of life due to uncontrolled seizures. In this study, we evaluated the quality of life among TLE patients who underwent amygdalohippocampectomy between those who were free from seizure and those who were not.

Methods: This was a cross-sectional observational study. The postoperative quality of life was measured by QOLIE-31 questionnaire followed-up at least 12 months since the surgery.

 

Results: Among 31 patients, 21 patients (67.7%) were free from seizures after 12 months of follow-up. We observed significantly higher quality of life of those seizure-free patients either as overall quality of life (p=0.001) or among domains such as seizure anxiety (p=0.003), emotional well-being (p<0.001), fatigue (p<0.001), cognition (p=0.002), medication effects (p=0.01) and social function (p<0.001).

Conclusion:  TLE patients who were seizure-free had better quality of life compared to those who were not after amygdalohippocampectomy.

Background: Premature rupture of membranes (PROM) is rupture of membranes amniotic membrane prior to the labor. PROM is associated with an increased incidence of preterm labor and infection.

Aim: To compare maternal leukocyte count in premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM)

Methods: This cross-sectional design was conducted at Dr. Kariadi General Hospital Medical Center and Kartini General Hospital Jepara from September 2019 to January 2020. The study sample was pregnant women with premature rupture of membranes that came to Emergency Department. Samples were divided into two groups, PROM and PPROM. All samples were subjected to leukocyte count examination.

Results: This study has a total of 40 samples, with 20 samples each. In PROM, 8 (40%) leukocytosis and 12 (60%) were normal, while in PPROM 7 (35%) leukocytosis and 13 (65%) were normal. There were no significant differences in maternal leukocyte levels in PROM and PPROM (p=0.229).

Conclusion: There were no significant differences in maternal leukocyte levels in PROM and PPROM.

Purpose: To investigate the correlation of serum fibroblast growth factor-23 (FGF-23) with urinary fractional excretion of phosphate (FEPi) in predialysis chronic kidney disease (CKD).

Methods: This cross-sectional study involved 75 patients with CKD stage 2-4. Blood and 24-hour urine samples were taken from eligible participants to measure key variables using standard commercial assays. FGF-23 concentration was measured using enzyme-linked immunosorbent assay (ELISA). The correlation between FGF-23 serum level and urinary FEPi was analyzed using the Spearman correlation test.

Results: Of 75 eligible subjects, the majority had the characteristics of male gender, CKD stage 3, with mean age and body mass index of 50±10.8 and 23.51±3.3, respectively. The median FGF-23 level was 108.7 (13.6-1226.2) RU/ml, while the median urinary FEPi was 24.3% (4.04%-65.9%). There was a moderate positive correlation between FGF-23 and FEPi (r = 0.44, p<0.001).

Conclusion: The result confirmed the correlation between serum FGF-23 level with urinary FEPi in predialysis CKD.

Introduction: Quercetin (3, 3'4', 5.7-pentahydroxyflavone) within Moringa oliefera leaves is known to prevent cellular damage and dermal inflammation due to ultraviolet light exposure. However, its administration in Nanoemulgel form, which gives the cosmetics a good stability and compound release, is not yet evaluated. Therefore, this study aimed to characterize and develop a nanoemulgel sunscreen preparation containing Moringa oliefera leaves.

Methods: Design and optimization using simplex lattice design were performed. The optimum formulation for three independent variables involved propylene glycol- (X3), tween 20- (X2), and oleic acid oil- (X1) with a percentage ratio at 11.31; 77.50 and 11.19, respectively.

Results: The results showed that the optimum nanoemulgel formulation yielded an SPF value at 33.35, with a percentage of transmittance at 88.03. The emulsification time was recorded at 19.19s with droplet diameter at 138.0-nm with zeta potential at -37.1mV and polydispersity index at 0.537.

Conclusion: This study concluded that the moringa leaf nanoemulgel sunscreen was successfully formulated with a high SPF value.

Introduction: Wound is the result of physical trauma that severs skin continuities. The damage typically causes an inflammatory reaction marked by increase ROS and tissue inflammation. However, this process is still needed to be further investigated. Therefore, this study aimed to evaluate plasma MDA, IL-6, TNF-α, Caspase-3 and VEGF levels, and the granulation tissue thickness at different time points during the wound healing process.

Methods: An experimental post-test only control group study was conducted using white male rats (Rattus Norvegicus) and the rats were wounded and assessed on day 5 (K1), day 10 (K2), and day 15 (K3). The level of plasma MDA, IL-6, TNF-α, Caspase-3 and VEGF level was assessed as well as the granulation tissue thickness.

Results: The OneWay ANOVA test results showed significant differences in plasma MDA, IL-6, TNF-α, Caspase-3 and VEGF levels (P <0.05). The Tukey HSD test results showed significant differences between (P <0.05) K1 with K2, K1 and K3 and K2 with K3 on MDA plasma, IL-6, TNF-α, Caspase-3 and VEGF. However, the granulation tissue thickness was only slightly different between groups and was not significant.

Conclusion: The inflammation and angiogenesis were steadily increased overtime during the wound healing process while oxidative stress and cell death were decreasing. However, none of those factors were related to granulation thickness.

Background: Hip fracture is considered a major health problem worldwide. The current study aimed to investigate hip fracture characteristics among older people in Iraq and factors involving postoperative mortality.

Method: A single cohort study was carried out in Sulaimani and Shar Teaching hospitals in Sulaimani from the 1^st of July 2018 to 30^th of June 2019.  Hip fracture was diagnosed by a specialist physician using an X-Ray. The data was collected by the researcher through direct interviews and filling a prepared uniform questionnaire. The data analyzed by SPSS and p-value<0.05 was significant.

Results: From the total of 100 hip fracture patients included, the average age of patients was 74.45±8.18 years. Fifty-nine patients aged 60 to 75 years, while the rest were older than 75 years. Female consisted of 59.0% of the total samples. Non-mechanical falls accounted for (84%) of all falls. Most patients had intertrochanteric fractures (65%), while 35% had femoral neck fractures. The Proximal femoral nail (PFN) operation was the primary type of operation (77%) performed. Most patients (94%) were discharged after two days. There was a significant association between gender and postoperative mortality; female patients had worse prognosis and higher mortality, relative risk (95%CI) 0.18 (0.0424 to 0.7788). Older patients aged 75 and more had a remarkably poorer prognosis than younger patients, relative risk (95%CI) 0.30 (0.10 to 0.93). There was a strong relationship between poor cognitive function (moderate to severe depression) and postoperative mortality rate with relative risk (95%CI) 0.04 (0.006 to 0.36). Finally, patients on three or more medications also had an outstanding worse prognosis, relative risk (95%CI) 0.022 (0.001 to 0.37).

Conclusion: Hip fracture was more common among women and people aged above 75 years. The prevalence of intertrochanteric fractures was nearly double the femoral neck fractures. Age, female, depression, and polypharmacy had a statistically significant association with three-month mortality in hip fracture patients.

Background: Although the complicated interplay of Malassezia, keratinocytes and the immune response against a modified lipid composition in the skin have a vital role in the pathogenesis of Seborrheic Dermatitis (SD), the pathophysiology itself is still inadequately understood.  The association of SD with metabolic syndrome like dyslipidemia can be explained by inflammation in both conditions' pathogenesis. The present study was aimed at evaluating the relationship between the lipid profile abnormality and the SD. 

Methods: A prospective cross-sectional study was conducted in the Dermatology teaching center in Sulaimani, Iraq, from 1/9/2019 to 1/3/2020. This study used a structured data collection format comprised of items concentrating on socio-demographic characteristics, duration of the disease, level of SD, the severity of SD, and lipid profile. The data were analyzed by STATA 14 statistical software and summarized in tables and figures. The Chi-square test was done to detect the association between categorical variables. P-value <0.05 was significant.

Results: A total of 100 patients with seborrheic dermatitis with the average age of patients was 37.5 ±13.06 years, and 61 were females. The mean fasting total cholesterol (219.72 mg/dl vs.114.83 mg/dl), LDL-C (123.92 mg/dl vs. 85.08 mg/dl) and triglycerides (170.38 mg/dl vs.102.17 mg/dl) levels were higher for the high-level cases than the normal level cases.  The HDL-C level (31.06 mg/dl vs. 38.94 mg/dl) of the high-level patients was lower than normal patients. Age, total cholesterol level, LDL-C, triglycerides, and HDL-C had a statistically significant association with the disease's level and severity. The duration of the disease had a statistically significant association with only the level of disease.

Conclusion: Lipid profile has a statistically significant association with the level and severity of SD. Finally, we recommend a large observational study to depict the causal relationship between serum lipid abnormality and SD.

Turmeric is the most commonly studied herbal ingredient because it has antioxidant, anti-inflammatory, antimicrobial, and anticancer activity. Considering that most inflammatory skin diseases are localized, it is considered that the topical application of turmeric extract can be beneficial because it has a local effect on the skin. The topical application of turmeric extract has limitations because the active ingredient content of curcumin (CUR) has poor solubility in water, low absorption, and rapid elimination of metabolites, which results in low bioavailability of the drug. Recent studies have focused more on nanoparticle formulations that can improve the stability and bioavailability of CUR.

Hypertension is currently still a global problem in the cardiology and vascular fields with an increasing trend. One of the emergency conditions related to an increase in blood pressure is emergency hypertension. Emergency hypertension is a condition where blood pressure rises rapidly and severely, resulting in new or progressive organ damage. Symptoms can range from chest pain, shortness of breath to delirium. The heart is one of the organs that can be damaged by hypertensive emergencies. The availability and demand for oxygen from the coronary blood vessels to the heart muscle cells will experience an imbalance due to a sudden increase in blood pressure. Lack of oxygen that occurs can cause heart muscle cells' death affected heart structure and its function. The symptoms that appear can be in the form of acute coronary syndrome or acute heart failure. Some modalities can detect heart structure changes, like electrocardiography for general and echocardiography for specific examination. Hypertensive emergencies can be treated by several rapid-acting antihypertensive agents, which can be selected based on the clinical manifestations. As the symptoms related to heart damage are acute coronary syndrome and acute heart failure, so the treatment will be specific, respectively. Good knowledge related to emergency hypertension management and early treatment will reduce patient morbidity.

Introduction: Neuroendocrine carcinoma of the uterine cervix is a rare type of cancer in the female reproductive system, accounting for only about 1% of all malignancies in the uterine cervix. Mixed Adenoneuroendocrine Carcinoma (MANEC) is a combination of neuroendocrine components and non-neuroendocrine components, with each component contribute >30% of the tumor cells. This rare type of tumor is aggressive, high recurrence rates, and early distant metastases.

Case description: A 37-year-old female patient referred for evaluation after a previous finding of a cervix mass and a clinical diagnosis of cervical carcinoma IB2. Ultrasonography examination concluded a cervical mass, suspicious of malignancy. On macroscopic examination, it was found white-grey colored, huddle, and brittle mass filled the entire cervix with a size of 5x4 and 5x1 cm. Routine histopathological examination shows neoplastic cells forming a trabecular pattern, organoid, part with rosette formation, infiltrative between the connective tissue and a large area of necrosis. These cells conform to a uniform morphology, small oval to round nucleus, partially composed of molding, narrow cytoplasm, salt and pepper chromatin, and mitotic figure > 25/10 HPF. At some other focus, neoplastic cells appear cribriform, solid, and tubular, with a round to oval hyperchromatic nuclei, increased N/C ratio, severe nuclear pleomorphism, eosinophilic cytoplasm, mitotic figure 5/10 HPF. The metastatic cell was found in four right pelvic lymph nodes, and five left pelvic lymph nodes. Immunohistochemistry examination of chromogranin-A and CEA shows positive, focal distribution on tumor cells cytoplasms. Synaptophysin shows positive, diffuse distribution on tumors cell cytoplasm. Ki-67 was positive in 90% malignant cell nuclei.

Background: Until May 2020, Indonesia is still on COVID-19 emergency status. South Jakarta is part of the Special Capital Region of Jakarta that has applied large-scale social restrictions. The Indonesian government has extended Jakarta's large-scale social restrictions to Friday, May 22^nd, 2020 to curb the spread of the corona-virus that causes COVID-19.

Case report: Patients with diabetic ketoacidosis and hypertension were infected with SARS-CoV-2. He had traveled from Saudi Arabia a week before and already has a fever. Arriving in Indonesia, the patient showed symptoms of worsening disease, experienced coughing, shortness of breath, and sore throat. The patient does not inject insulin due to loss of appetite. On March 30^th, 2020, a laboratory examination showed high blood sugar levels (369 mg/dL) followed by positive ketones bodies. On April 2^nd, 2020, the patient was designated as a confirmed case of COVID-19 after a positive polymerase chain reaction test. The rapid diagnostic test also showed a positive IgM.  Management of patient includes giving O₂ through the non-rebreathing oxygen mask, infusion of sodium chloride, 20 IU Apidra®, 12 IU Lantus® injection, Oseltamivir orally, Levofloxacin, Paracetamol, Vitamin C, Candesartan, Concor. This therapy was continued until April 5^th, 2020. On April 5^th, the patient complained about a cold sensation all over his body. The patient died on the afternoon of April 6^th, (8 days of hospitalization) due to sudden cardiac arrest and acute respiratory distress syndrome. Cardiopulmonary resuscitation was done with standardized protocol with no avail.

Conclusion: Diabetic ketoacidosis and hypertension worsen the condition of COVID-19 patients. There are many unknown disease progression outcomes in these patients.

Background: The best timing for the soft tissue reconstruction procedure in the mangled lower extremity is still controversial. Despite the advantages of acute treatment, delayed soft tissue reconstruction are often inevitable for various reasons. This case report aims to present three cases of delayed reconstruction to treat lower extremities soft-tissue defects in mangled lower extremity following high-energy trauma.

Case Series: This study included three cases that underwent delayed reconstruction for the mangled lower extremity. The definitive reconstructions were done in 15, 30, and 60 days after injury and all cases underwent serial debridement before the definitive procedure. The reconstruction methods used were skin graft and free flap. There was no graft/flap loss observed in this study.

Conclusion: We believe that soft tissue reconstruction of mangled lower extremities following high-energy trauma may also be safely done in a delayed setting if the wound debridement is adequately done, and the basic reconstructive principles are fulfilled.

Introduction: The principle of treatment for degenerative spinal diseases when conservative modality failed is surgery. Unilateral pedicle screw fixation is a less invasive methods with clinical outcomes that were similar to a bilateral fixation, especially for lumbar degenerative disease. Improvement of symptoms, neurological outcome and spinal stability is the utmost priority. This was a case series study with five patients with degenerative spine disease from January 2019 - January 2020. The aims are to evaluate unilateral pedicle screw surgery outcomes and elucidate the effectiveness of this method clinically.

Case Description: Five patients aged 40-64 years old involved in this series. Four patients presented with lumbar radiculopathy and one patient with cervical radiculopathy. All experienced weakness (MMT score 2-4) and pain along the affected extremities. Three patients diagnosed with concomitant Herniated Nucleus Pulposus (HNP) and Foraminal Stenosis (FS) based on clinical examination and Magnetic Resonance Imaging result. The rest of two patients each diagnosed with FS and HNP. Surgery initiated with a midline incision. Muscle ipsilateral to the symptomatic side was dissected and retracted to expose the facet joint and the vertebral lamina. Screws were inserted into the vertebral body and the rod used to connect the screws was bent following the vertebral curvature. Facetectomy or Hemilaminectomy was done to expose and decompress the ipsilateral side's nerve root and intervertebral space. The incision site is then irrigated and closed. All operation was done by the same surgeon. Postoperative clinical outcomes were evaluated for six months after surgery. All patients showed a complete motor improvement and fully relieved from pain.

Conclusion: Unilateral pedicle screw fixation is considered as a less invasive instrumentation system with clinical outcome comparable to bilateral screw fixation.

Introduction. COVID-19 protocol and the unavailability of proper instruments in the isolation room had complicated the usual protocol to diagnose and manage the medical and surgical conditions.  This article is about the first ruptured ectopic pregnancy cases encountered during the COVID-19 pandemic in Sanglah General Hospital. Considering the unique circumstances and the difficulty during establishing the diagnosis and conducting the management, we ought to present our experience through this article.

Case Description. This case report reviews a 24-years-old female, an asymptomatic COVID-19 case, who was diagnosed with ruptured ectopic pregnancy during appendectomy surgery in Sanglah General Hospital, Denpasar, Bali-Indonesia. The patient complained about mild lower right abdominal pain, with a clinical picture that supports acute appendicitis. However, the history taking revealed a history of post-curettage 15 days prior to admission due to vaginal bleeding suspected for incomplete abortion. Except for a positive pregnancy test, the clinical picture did not support a pregnancy nor a ruptured ectopic pregnancy. We still consider an ectopic pregnancy as no histopathological examination result was available to supports the previous vaginal bleeding was an intrauterine pregnancy. Further to complicate the problem, the patient was reactive for the COVID-19 screening test, thus requiring a COVID-19 protocol. As an ultrasound device was unavailable at the time in the isolation room, we could not assess for extrauterine pregnancy. Only during the surgical procedure for appendectomy, our surgical college notified us of the accompanying presence of sign of ruptured right ampullary pregnancy.

Conclusion. The COVID-19 isolation protocol and the unavailability of essential equipment and diagnostic tools in the isolation room could hinder the usual protocol used to diagnose and manage various medical and surgical problems. We hope this article could illustrate how COVID-19 had complicated unusual cases, thus reflect how important clinical judgment and infrastructure in our health care system.

Background:  Stridor due to upper airway obstruction in a COVID-19 positive patient is a big challenge to the medical team, especially anesthetists and otolaryngologists. In this condition, performing aerosol-generating procedures (AGP) is time-sensitive and increases virus transmission risk. The dilemma of treating a stridorous patient with laryngeal carcinoma and concurrent COVID-19 positive with pneumonia is possibly become a new normal in this era.

Case Report: A 66-year-old male, chronic smoker, completed six days of in-patient treatment for community-acquired pneumonia when the RT-PCR for COVID-19 was found to be negative. He was seen in the otorhinolaryngology (ORL) clinic two weeks later due to hoarseness for two months associated with worsening shortness of breath and cough. He had soft stridor at rest and was mildly tachypnoeic. Flexible endoscopy revealed a mass on the right immobile vocal cord with a small glottic airway. A repeat nasopharyngeal swab for COVID-19 on the same day was positive. A detailed discussion involving a multidisciplinary team lead to the decision to secure the patient's airway by first intubating him with a small endotracheal tube and followed by tracheostomy in the same setting. Here, the experience in managing upper airway obstruction due to laryngeal carcinoma (at least T3) in a patient with stage 4 COVID-19 is presented and discussed. The challenges emerged due to the inevitable series of AGPs that need to be performed. Multidisciplinary team involvement comprises ORL surgeon, anesthetist, infectious disease, and respiratory physician is pertinent.  

Conclusion:  This is the first case in the literature on a stridorous COVID-19 positive patient with laryngeal carcinoma that requires emergency tracheostomy. The case highlights the challenges and decision-making in managing such cases that are supposed to be straightforward before the COVID-19 pandemic era. This shall be the new normal for otorhinolaryngologists, anesthetists, and maybe any other specialties who deal with AGPs.

Introduction. Snoring in a child is not uncommon and is frequently caused by adenotonsillar hypertrophy, or rarely, by some sinister lesions. High clinical suspicion for head and neck malignancy is warranted in a child with atypical snoring presentation associated with neck swelling.

Case. We present a case of parapharyngeal Lymphoma in a child who presented with progressively worsening snoring. Clinical examination revealed swelling on the left side of the neck, with medialization of the left lateral pharyngeal wall, suggesting a left parapharyngeal tumor. A subsequent biopsy confirmed the diagnosis of Lymphoma. Chemotherapy was initiated immediately.

Conclusion. The presentation of head and neck Lymphoma in a child can be vague. Early recognition and treatment are crucial to improve the survival of a child.

Introduction: Globally, oral cancer is the eighth most common malignancy with over 300,000 people are diagnosed in each year. It is also the third most common cancer in South East Asia. The tongue is the most common intraoral site for cancer. The aim of this study is to highlight the relevance of mutilating surgery of head and neck cancer in the current minimally invasive and robotic surgery era.

Case description: We present four case series of tongue carcinoma who underwent combined mandibulectomy, neck dissection (COMMANDO), resection of tumours and reconstruction with anterolateral thigh flaps. All cases showed remarkable outcome in which the flap was viable and healthy, with good tongue mobility postoperatively. All patients were discharged from ward two weeks after operation with tracheostomy tube decannulated.

Conclusion: COMMANDO operation with anterolateral thigh flap reconstruction is relevant in the current era, especially for the late and advanced stages of oropharyngeal carcinoma. Therefore, multidisciplinary trained surgeons are required to perform these cases, i.e. qualified head and neck surgeon with reconstructive teams. 

All praises to Allah, the most merciful, beneficent and compassionate, for His blessing that this conference could be organized today. I would like to express my greatest gratitude to Prof. Dr. Yos Johan Utama, S.H., M.Hum; Rector of Universitas Diponegoro, Dr. dr. Dwi Pudjonarko, M.Kes, Sp.S (K); Dean of Faculty of Medicine Universitas Diponegoro, Prof. Dr. Jamari, S.T., M.T.; Director of LPPM, Dr. dr. Hermina Sukmaningtyas, M.Kes., Sp.Rad and Dr. dr. Udadi Sadhana, M.Kes, Sp.PA, Vice Deans of Faculty of Medicine for all of their kind supervision during the preparation of this event. I would like to express my sincere gratitude to all of the committee members for all of your hard work, kind help, and best effort as a solid team work, by which this event can be held successfully even during the COVID-19 pandemics. I would like to thank all of the honorable speakers for your willingness to give lectures and all of participants from various institutions in the world. Welcome to the 4^th International Conference on Translational Medicine and Health Sciences (ICTMHS) 2020.  It is a great pleasure to announce that this is the first virtual ICTMHS, which is traditionally held in Semarang, Indonesia. ICTMHS is an annual routine program that began in 2017 initiated by the faculty to support the university's vision of becoming a world class university. The theme of this conference is "Unraveling the New Normal Guideline Treatment of Diseases in COVID-19 Pandemic". This difficult time has pushed us to strengthen our collaborative practices in the health sectors including Interprofessional Education and Research, Collaborative Practice, Translational Medicine, and Nutrition, Dietetic and Food. This is an interesting theme that invites all health workers to unite to increase collaboration in various aspects to tackle the pandemics affecting our country and beyong. Through this conference, we hope to contribute in introducing and educating the scientific community on the recent advances in the medical, dentistry, nursing, pharmaceutical, and nutrition sciences field. As a major goal of this event, we hope that it can be an excellent chance to discuss interesting ideas and develop fruitful project in the future, network opportunities with old and new colleagues, coordination new partnerships which advance collaboration either about the research field or not, as well as the careers of all participants. Please enjoy your participation in ICTMHS 2020.

 

 

 

dr. Muhamad Thohar Arifin, PhD, Sp.BS(K), PA

Chief of Organizing Committee