bluuebunny/crossref_metadata_2025 huggingface dataset:
Do social and environmental factors affect level of stress during COVID-19 among nursing students? Results from single center cross-sectional study in Malaysia
Authors: Sa’at Siti Fatimah , Gill Annabelle Dimple Kharisha , Damianus Bernard Jordan , Saibun Jeremy Dominic , Ukim Gill Lerrkey , Bin Sidek Ahmad Zulkhairul Naim
Published: December 2022

Introduction: Stress in nursing students has been documented in many studies and this will lead to various health problems. However, there is scanty research assessing the level of stress among nursing students during Covid-19 in Malaysia.  Hence, this study aimed to assess the level of stress and its association with social and environmental factors amongst nursing students in Universiti Malaysia Sabah, Malaysia.
Methods: A cross-sectional study was conducted by random sampling among nursing students in Universiti Malaysia Sabah between March and May 2021. The primary outcome was stress symptoms, derived from the validated Perceived Stress Scale-10 (PSS) questionnaire. Socio-demographic, social, and environmental factors were also assessed. T-test was used to assess the associations between level of stress and social and environmental factors.
Results: A total of 115 responses were received with the mean (SD) age of the students being 20.5 (1.3) years old. Of all the students, 84.9% were female, 54.6% received financial support from National Higher Education Fund Corporation and 46.2% were in nursing Year 2 followed by the nursing year 1 (28.6%) and nursing year 3 (25.2%). The students in this study reported a higher level of stress. The students who reported most or all the time being trapped in a hostel (p<0.01), challenges of online classes (p=0.03), and catching up with class projects (p=0.03) had a higher level of stress compared to those who reported none or little or some of the factors.
Conclusion: This study showed that social and environmental factors may play a role in determining the stress level among nursing students. Hence, authorities should foster supporting strategies to lower student stress and tackles the unwanted consequences.
Nomophobia: A new disease epidemic among students during the era of online learning
Authors: Sulistiyani Endang , Tyas Sasmi Hidayatul Yulianing , Novanuari Muhamad , Dwisapta Muhammad Rizqi
Published: December 2022

Introduction: The Covid-19 pandemic has brought changes to the education system, one of which is the implementation of online learning. This condition makes students like students have to use digital devices, even with a more intense frequency. Therefore, this study aims to determine the level of nomophobia in students as participants in online learning. 
Methods: This research is descriptive research with a quantitative approach. The study was conducted with a one-time survey (cross-sectional survey). The research was conducted through 3 stages: preparation of the nomophobia measurement instrument, data collection, and measurement of the level of nomophobia.
Results: 287 respondents were obtained, then the demographics of the respondents can be grouped by gender, age, internet fund source, and online learning media used. Most of the respondents were female (71%) and teenagers (12-25 years) (99%). In addition, the results show that nomophobia has become a new disease epidemic among students, especially in online learning, that requires an increase in the frequency of smartphone access. There are no respondents who are not nomophobia. The respondents have mild nomophobia (6%), moderate nomophobia (40%), and severe nomophobia (54%).  
Conclusions: Most of the respondents had a severe level of nomophobia. In addition, the students feel uncomfortable when communicating and accessing information via smartphones or other gadgets, lose connectivity, and cannot use smartphones as desired. Their lives are very dependent on smartphones or other devices. One of the triggers is online learning, where all processes are carried out through digital media. At least students who are not nomophobia also show that nomophobia has proven to be one of the negative impacts that students have to face as participants in online learning.
The effect of knowledge and attitude of family planning acceptances on iud contraception selection during the COVID-19 pandemic
Authors: Safitri Yati Isnaini , Zuwariah Nur
Published: December 2022

Introduction: Although several studies on the influence of knowledge and education of family planning (KB) acceptors on the selection of intrauterine contraceptive devices (IUDs) have been carried out previously, research on knowledge and attitudes of family planning acceptors towards the selection of IUDs during the COVID-19 pandemic is still limited. The purpose of this study was to assess the effect of knowledge and attitudes of family planning acceptors on the selection of an intrauterine device (IUD) during the Covid-19 pandemic.
Methods: The data used in this study were obtained from filling out questionnaires involving 162 respondents. This study was analyzed descriptively analytically with the parameters of knowledge and attitudes towards the selection of intrauterine devices (IUD) using a bivariate table.
Results: This study showed that 38.4% had sufficient knowledge, only 1.2% chose to use the IUD with a p-value of 0.348 > 0.05 and of the 66% who had a positive attitude only 2.5% chose to use the IUD with a p-value 0.146 > 0.05.
Conclusion: Although family planning acceptors have sufficient knowledge and a positive attitude, it does not affect the selection of the IUD as an effective long-term contraceptive, so the use of other contraceptives is still recommended as an effort to control fertility according to the needs of the acceptor during the Covid pandemic.
Clinical characteristics of confirmed patients with COVID-19: A perspective from tropical region
Authors: Bistara Difran Nobel , Ainiyah Nur , Umamah Farida , Septianingrum Yurike , Fitriasari Andikawati , Wijayanti Lono , Wardani Erika Martining , Susanti  , Pereira Domingas Da Silva S.
Published: December 2022

Introduction: There is a growing number of studies on coronavirus disease 2019 (COVID-19) but data analysis focusing on clinical characteristics in the tropics has not been widely carried out. This study aimed to analyze demographic characteristics, symptoms, length of stay, laboratory results at hospital admission, and the final outcome of infected patients in the tropics in confirmed COVID-19 patients.
Methods: This retrospective study analyzed medical records including socio-demography, clinical manifestations, length of stay, comorbidities, laboratory data, and disease outcomes of 128 COVID-19 patients hospitalized, with confirmed COVID-19 infection results. Existing data were compared using Fisher's Exact Test or Chi Square (X2), determining the difference in the median value which was then assessed using Mann-Whitney.
Results: The mean age of the patients was 50 years, the most common comorbidity was diabetes mellitus 18.8%, the most common symptom was dyspnea 36.7%.
Conclusion: In general, studies conducted to analyze the clinical characteristics of confirmed COVID-19 patients show that the clinical picture of COVID-19 patients in the tropics is generally similar to previous studies. Older age, comorbid patients and patients with dyspnea may help identify a higher risk of death.
Microbial blood culture patterns and antibiotic susceptibility in pediatric febrile neutropenia at Sanglah General Hospital Bali
Authors: Clearesta Kartika Eda , I Wayan Gustawan  , Ketut Ariawati  , Ni Nengah Dwi Fatmawati  , Made Gde Dwi Lingga Utama  , Anak Agung Ngurah Ketut Putra Widnyana  , Kadek Ayu Yani Lastariana
Published: December 2022

Background: Febrile neutropenia is defined as a fever with a temperature more than or equal to 38.3°C in two measurements within 24 hours and accompanied by severe neutropenia (≤500/μL). Gram-positive bacteria have been the most common cause of febrile neutropenia in children for the previous two decades. However, the contradiction in some studies reported that gram-negative bacteria were the main pathogens causing infection. Because there are differences and shifts in the bacterial spectrum, information on the bacterial pattern and antibiotic susceptibility is critical to reaching the optimal management of febrile neutropenia patients.
Methods: This observational, descriptive study was conducted in Sanglah Hospital, Bali, Indonesia, involving pediatric patients (<18 years old) with febrile neutropenia. Data on antibiotic susceptibility and microbial patterns were collected retrospectively from the blood culture registry taken from febrile neutropenia patients from October 2017 to August 2020. Collected data were analyzed using the SPSS program for Windows, version 21.0. Univariate analysis was conducted, and data with a categorical scale were reported in frequency distribution and percentage, then displayed in a table and graph.
Result: A total of 180 episodes of febrile neutropenia were collected from 89 patients. Among 180 blood cultures, there were found 44 (24.44%) blood cultures with positive results. A higher proportion of gram-negative organisms (33; 75%) is found compared to gram-positive organisms (11; 25%). The susceptibility rates were 100% for Azithromycin, Amoxicillin Clavulanate, Cefoperazone Sulbactam, Meropenem, Linezolid, and Doxycycline, while Cefepime, the previous empirical antibiotic, was susceptible at 79.31% isolates.
Conclusion: Gram-negative bacteria were the most frequent cause of infection among febrile neutropenic patients. Although the research evidence is still weak due to the small sample size, Cefoperazone Sulbactam could be a better option to replace Cefepime as an empirical antibiotic due to its significantly higher susceptibility.
Expression of Matrix Metalloproteinase-8 (MMP-8) and Tissue Inhibitors of Metalloproteinase-1 (TIMP-1) after cryotherapy in Aspergillus flavus keratitis at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Authors: Awina Rayungsista  , Gatut Suhendro  , Dyah Fauziah  , Hari Basuki Notobroto  , Ismi Zuhria
Published: December 2022

Background: Fungal keratitis is one of the most difficult forms of microbial keratitis to treat successfully. Aspergillus flavus is a type of filamentous fungus that often causes suppurative keratitis. Complications that often arise from fungal keratitis are corneal perforation and blindness due to scar tissue formation.
Methods: Aspergillus flavus was injected into the corneas of 28 Sprague Dawley rats intrastromal and divided into 4 groups, with each group consisting of 7 rats, fungal injection into the cornea as a fungal injection without therapy, natamycin therapy, cryotherapy, and combination therapy. Therapy was given five days after the fungal injection into the cornea and the formation of keratitis and corneal central thinning. After four days of therapy, the eyes were enucleated to determine the effect of cryotherapy on MMP-8 and TIMP-1 expression in the cornea with an immunohistochemistry (IHC) staining examination. The differences in MMP-8 and TIMP-1 expressions between groups were analyzed using the Kruskal Wallis test and Mann-Whitney post hoc test with a significant p <0.05. Data were analyzed using SPSS version 26 for Windows.
Results: The highest MMP-8 expression was found in the natamycin therapy group (3), and the lowest was in the negative control group and cryotherapy (1). There were no significant differences in MMP-8 expression in the 4 groups (p=0.482). The highest TIMP-1 expression was found in the negative control group (8) and the lowest was in the cryotherapy group (2). There were significant differences in TIMP-1 expression in the 4 groups (p=0.002).
Conclusion: It was found that the expression of TIMP-1 and MMP-8, although the last one was not significant, were lower in the cryotherapy group than in the non-cryotherapy group.
Complications of repeated percutaneous transhepatic biliary drainage (PTBD) for palliation of obstructive jaundice in cholangiocarcinoma patient
Authors: Juniawan Radhitya Farizky Deta , Maimunah Ummi , Sugihartono Titong , Kholili Ulfa , Widodo Budi , Thamrin Husin , Miftahussurur Muhammad , Vidyani Amie
Published: December 2022

Background: Cholangiocarcinoma, a malignancy of the biliary duct system, has been recognized as the second most common cause of biliary tract and primary liver malignancies. The incidence has increased in the last three decades worldwide. Percutaneous transhepatic biliary drainage (PTBD) has been considered a highly important palliative therapy for bile duct obstruction due to its high success rate and low incidence of cholangitis. However, bleeding and catheter dislodgment are still found during the procedure. This case discusses the complications of repeated PTBD stent placement as palliative therapy in a patient with obstructive jaundice due to cholangiocarcinoma.
Case Presentation: A 58-year-old female presented with a chief complaint of weakness and pain on the right side of the abdomen, particularly at the site of PTBD stent installation three days before being admitted to Dr. Soetomo General Hospital. In 2017, the patient was diagnosed with cholangiocarcinoma­ with obstructive jaundice and had undergone PTBD procedure five times during the period of July 2017 to March 2018 due to biliary leakages. Laboratory investigation indicated elevated bilirubin, decreased potassium, increased random blood sugar, increased blood urea nitrogen, high levels of the 2-hour postprandial blood glucose, and elevated HbA1c, suggesting the conditions of cholangiocarcinoma with obstructive jaundice complicated with hypokalemia, acute kidney injury and type-2 diabetes. The blood smear also indicated normochromic normocytic anisopoikilocytosis anemia and leukocytosis. The patient improved after PTBD replacement, antibiotics treatment, packed red cells transfusion, and rehydration therapy.
Conclusion: This case highlights that the complication of PTBD could occur relatively frequently and to prevent the complications in patients with post-PTBD regular medical check-up is therefore recommended. In addition, it is also critical to improve the patient knowledge on how to prevent the bleeding and to avoid the conditions that are potentially increase the chance of catheter dislodgment.
Correlation between Polymorphisms Interleukin-1 Receptor Antagonist (IL-1RA) And Melasma Severity: A Study of Javanese Female Population in Yogyakarta
Authors: Ekawati Suryanigsih Betty , Sadewa Ahmad Hamim , Wirohadidjojo Yohanes Widodo , Soebono Hardyanto
Published: December 2022

Background: IL-1 is postulated as a cytokine that plays a fundamental role in the pathophysiology of several skin disorders or diseases. Melasma is a form of hyperpigmentation with a symmetrically distributed predilection for facial features. Due to its elusive pathogenesis, it is believed that the inflammatory factor plays a role in melasma. Increased or decreased IL-1RA concentrations may correlate with the severity of melasma. Therefore, this study aimed to examine the correlation between the IL-1RA (86bp VNTR) polymorphisms and the severity of melasma among a Javanese female population.
Methods: The study involved 79 individuals with melasma and used a cross-sectional design. The severity of melasma was assessed using the MASI (Melasma Area and Severity Index). The data were analyzed using a Chi-square test and Odds Ratio (OR). The genomic DNA from the patients' blood was examined and analyzed using the polymerase chain reaction (PCR) method.
Results: There was an increase in the frequency of IL-1Ra*1/1(410/410) genotype in melasma with a mild severity and of IL-1Ra*1/2(410/240) genotype in melasma with moderate severity (OR: 0.74, 95%CI: 0.26- 2.13, p: 0.42). The allele frequency of IL-1Ra*1/1 was 55.70% at a mild degree and 44.30% at a moderate degree (OR: 0.29-2.11, p: 0.65). 
Conclusions: There was no correlation between IL-1Ra VNTR and the severity of melasma; however, it was found that the IL-1Ra*1/1(410/410) genotype and allele frequency tended to be higher in mild melasma, although it was statistically insignificant.
The association between oral antibiotics with the decreased severity index of acne vulgaris in the medical cosmetics division dermatovenereology outpatient clinic of Dr. Soetomo General Teaching Hospital Surabaya from 2017- 2019
Authors: Farah Meriana Fajrin  , Citra Dwi Harningtyas  , Rahmadewi  , Afif Nurul Hidayati  , Sawitri  , Diah Mira Indramaya  , Rebekah Juniati Setiabudi  , Muhammad Yulianto Listiawan
Published: December 2022

Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous unit. AV therapy is given based on the severity of AV. Oral antibiotic therapy is routinely prescribed to treat moderate to severe inflammatory acne. The purpose of this study is to determine the relationship between systemic antibiotic administration and the decrease in the severity of acne vulgaris.

Methods: This was a retrospective study with an analytical design, carried out on 49 medical records that met the inclusion criteria for acceptance of the sample; new AV patients come with grades 2, 3, and 4 to the Medical Cosmetics division Dermatovenereology Outpatient Clinic of Dr. Soetomo General Teaching Hospital Surabaya in the period January 2017 - December 2019.

Results: This study was conducted on 49 patients with acne vulgaris grade 2,3,4 who came to follow-up in a week 2,4,8 treatment. Data from the first follow-up group, 26 subjects (53.1%) experienced a decrease in grade; from the second follow-up group, 25 subjects (51.0%) experienced a decrease in grade; from the third follow-up group, 38 subjects (77, 6%) experienced a decrease in the group comparing with condition patient before treatment. Analytic comparative showed that the condition of the first visit compared to the first, second and third follow-up groups were 0,180, 0,000, and 0,000, respectively. The significance test results showed a value of 0.000 (p ≤ 0.05) in the second and third follow-up groups, which is statistically significant.

Conclusion: An oral antibiotic can effectively reduce the severity degree of acne vulgaris in four to eight weeks after treatment with an oral antibiotic.
A success of lipomyelomeningocele resection with intraoperative neurophysiological monitoring (IONM) guidance in a 10-year-old child: A case report
Authors: Indriyani Yurima , Tiara  , Ardiansyah Djohan , Fadil
Published: December 2022

Introduction: Lipomyelomeningocele is one of closed spinal dysraphism, inherently associated with tethered cord. Its prevalence ranges between 0.3 and 0.6 per 10.000 live births. Deterioration of bladder and bowel function often manifests before the motor and sensory function. Intraoperative neurophysiological monitoring (IONM) is often used in lipomyelomeningocele surgery to facilitate safe resection of lipomatous components and detethering of the spinal cord due to the absence of a clear boundary between the lipoma and neural placode.This case highlights the critical role of adequate IONM to reduce the complications of lipomyelomeningocele resection surgery.
Case Presentation: Here we present a 10-year-old boy with a lump over the back since birth, progressively increased in size, and with a history of urinary and faecal incontinence since one year before admission. There was also hypoesthesia on lumbar 2 spinal cord level. Physical examination of the lumbosacral region revealed a single lump measured about 4.5 x 1.9 x 3.2 cm in size, soft consistency, and immobile. Magnetic resonance imaging of the lumbosacral region revealed a lipomyelomeningocele with tethered cord protruded into the anatomical defect from sacral vertebrae S1-S4. Surgery was indicated because of the neurological symptoms and it was safely performed with the assistance of IONM. There were no postoperative complications after surgery and there was an improvement in the patients' neurological symptoms.
Conclusion: IONM in spinal surgery has been proven useful to reduce the postoperative neurological complication by providing identification of neural structures topographically and functionally, therefore, giving a warning alarm during surgery, which can be immediately responded by the surgeons.
Whitening Effect of Manalagi Apple (Malus sylvestris) Extract on Tea-Induced Tooth Discoloration
Authors: Hardini Nadia , Alikhlash Rahmania , Retnoningrum Dwi , Setiawan Limijadi Edward Kurnia
Published: December 2022

Introduction: Tooth discoloration is a change in color that occurs on the enamel and dentin surfaces of a tooth due to the habit of drinking tea. Some fruits are used as natural teeth whitening ingredients, such as Manalagi Apple (Malus sylvestris), which contains malic acid.
Method: This study was an experimental study with a pre-and post-test control group design involving 27 samples divided into three groups, Control (K), P1, and P2. We immersed tooth samples from three groups in tea solution for two weeks. After that, the P1 group was immersed with 50% Manalagi Apple extract three times a day for one week and the P2 group three times a day for two weeks, while the Control group (K) did not get any treatment. We analyzed the tooth discoloration before and after immersing 50% of Manalagi Apple extracts utilizing a Colorimeter, with hunter L, a, and b color scales. The color difference value was obtained using the formula of ⧍E(Lab) = [(L)2+(a)2+(b)2]1/2].
Results: The ANOVA test results showed significant differences between the three sample groups (p = 0.00). Besides, the Post-hoc test revealed a significant difference between the K group and the P1 group with a p-value of 0.00 (p <0.05). It also indicated a significant difference between the K group and the P2 group with a p-value of 0.00 (p <0.05).
Conclusions: Color changes occurred after immersing the teeth in Manalagi Apple extract for one and two weeks. Immersing the teeth for two weeks caused whiter teeth compared to immersing the teeth for one week.
Combination of thyroid ultrasound examination (TIRADS) and survivin gene mRNA expression to determine the type of thyroid nodule
Authors: Ma’ruf Fauzy , Suanjaya Made Agus , Murtala Bachtiar , Ilyas Muhammad , Hatta Mochammad , Mulyadi Rahmad , Natzir Rosdiana , Idris Irfan , Cangara M. Husni , Muis Mirna , Zainuddin Andi Alfian , Anjarwati Dewi , Wiwik Suri Aprianturi
Published: December 2022

Background: Ultrasound plays a significant role in determining the diagnosis of thyroid nodules. The thyroid ultrasound examination is operator dependent, so the Thyroid Imaging Reporting and Data System (TIRADS) method were developed. However, until now TIRADS has not been able to replace the Fine Needle Aspiration (FNA) examination in determining the type of benign or malignant thyroid nodule, so it is necessary to find alternative biomarkers that can be used to increase the sensitivity and specificity of TIRADS. In this study, the mRNA expression of the survivin gene in thyroid nodules was examined in combination with TIRADS so that it is expected to increase the diagnostic value.
Method: This study is a diagnostic test with a cross sectional design on 51 patients with thyroid nodules in 5 hospitals on the island of Lombok. Subjects who met the inclusion and exclusion criteria were subjected to TIRADS examination using an ultrasound machine and mRNA expression of the survivin gene using cubital vein blood samples with polymerase chain reaction (PCR).
Result: The characteristics of the research subjects were dominated by female sex with age 40 years, TIRADS 3 and histology of benign thyroid nodules. Analysis using the ROC curve obtained TIRADS has a sensitivity of 94.4%, specificity 39.4%, accuracy 58.82%, Positive Predictive Value (PPV) 45.9%, Negative Predictive Value (NPV) 92.9%. While Survivin has 100% sensitivity, 60.6% specificity, 58.1% accuracy, 58.1% PPV, 100% NPV. In the serial combination of TIRADS and survivin, there was an increase in the diagnostic value, namely sensitivity 94.4%, specificity 75.8%, accuracy 82.35%, PPV 68%, NPV 96.2%.
Conclusion: The combination of TIRADS and survivin can increase the diagnostic value in determining the type of thyroid nodule
Acute myocardial infarction (AMI) in a patient with Human Immunodeficiency Virus infection
Authors: Rampengan Starry Homenta , Untu Victor Billy F. Putra
Published: December 2022

Introduction: Recent studies have shown that in HIV patients, the incidence of acute myocardial infarction is up to two times higher than in people who are not infected with HIV. HIV patients presenting with the first episode of the acute coronary syndrome are, on average, a decade younger than the general population, more frequently in men and current smokers.
Case Report: We report a case report of a 33-year-old man with a diagnosis of anteroseptal STEMI and recent HIV on first-line ART, a combination of zidovudine 300 mg and lamivudine 150 mg, plus efavirenz 600 mg. The patient had typical angina complaints and had risk factors, namely smoking and a history of dyslipidemia. Patients were treated according to acute coronary syndrome guidelines, given DAPT, heparinization for five days, statins, anti-ischemia, ACE-I, and DCA-PCI. The DCA-PCI result in this patient was CAD 1 VD with 1 DES installed in the proximal LAD (complete revascularization). The patient was discharged from the hospital after seven days of treatment. Prognosis in these patients is still quite good, but preventing recurrent myocardial infarction needs risk factors and control for successful myocardial infarction therapy and ART.
Conclusion: Special attention should be given to the risk of myocardial in HIV patients. Early diagnosis and prompt treatment could significantly lower mortality and improve patients' quality of life.
Correlation between clinicopathological factors and clinical outcomes of recurrent epithelial ovarian cancer at a tertiary hospital in Surabaya, Indonesia
Authors: Prabowo Adityo , Tjokroprawiro Brahmana Askandar , Utomo Budi
Published: December 2022

Introduction:  Ovarian cancer is one of the leading causes of cancer death in women globally. The objective of this study was to determine the correlation and the association between age, stage, histopathology, grade, ascites, tumor residual, CA-125 level, and type of surgery on recurrence, disease-free survival, overall survival and mortality of epithelial ovarian cancer patients.
Methods: An analytical retrospective study using medical records and interviews of epithelial ovarian cancer patients was conducted in Dr. Soetomo Hospital. The study included the data from January 2016-December 2020. Kaplan-Meier and log-rank test were used to assess the factors associated with disease-free survival (DFS) and overall survival (OS).
Results: A total of 358 patients with epithelial ovarian cancer from 2016 to 2020 were included in the study of which 153 of recurrence cases. Clinicopathological factors that correlated with disease-free survival were stage, histopathology, grade, ascites, tumor residual, CA-125, and type of surgery (p<0.05). The factors that correlated with overall survival were stage, histopathology, grade, ascites, residual tumor, and CA-125 value (p<0.05). The most significant factors associated with recurrence and mortality were stage, grade, and ascites. Stage II and III had an HR (hazard ratio) of 1.9 and 2.1 for recurrence compared to stage I, respectively. Grade II and III patients had HRs of 2.1, and 3.4 for recurrence compared to stage I, respectively. The presence of ascites had an HR of 1.5 compared to those had no ascites. Stage III had an HR of 1.9 for mortality compared to stage I, respectively. Grade II and III patients had HRs of 3.6, and 5.0 for death compared to stage I, respectively. The presence of ascites had an HR of 1.6 compared to patients with no ascites. Compared to serous type, those patients with mucinous and clear cell had HR of 1.8 and 3.1 for mortality, respectively
Conclusion: Stage, grade, and ascites were the most significant factors in the incidence of recurrence and mortality of epithelial ovarian cancer.
Overview of transfusion reactions in patients with incompatible crossmatch at Sanglah General Hospital, Denpasar, Bali, Indonesia
Authors: Betti Bettavia Hartama Pardosi  , Ni Kadek Mulyantari  , Ida Ayu Putri Wirawati  , Anak Agung Wiradewi Lestari  , Ni Nyoman Mahartini
Published: December 2022

Background: Transfusion reaction is a side effect of giving complete blood or one of the components. They vary in severity, ranging from reactions that can occur during a transfusion (acute transfusion reactions) or reactions occurring days to weeks later (delayed transfusion reactions) and can be immunological and non-immunological. This study investigated the description of transfusion reactions in patients who received blood with incompatible crossmatch results at Sanglah General Hospital

Methods: This research is a descriptive study with a cross-sectional approach. Several parameters were assessed in this study to determine the transfusion reaction in patients who receive blood with incompatible crossmatch. Data were analyzed using SPSS version 20 for Windows.

Results: In this study, from 72 patients who received incompatible blood, 75.0% were found for women and 25.0% for male patients, most of whom were aged 41-65 years (65.0%). Most blood type is blood type O (52.0%). In this study, 6 patients (8.3%) got transfusion reactions such as fever accompanied by chills, urticaria, hypotension, and shortness of breath.

Conclusions: Incompatible crossmatch blood administration can be given. If a reaction is given to a crossmatch transfusion that is not suitable, symptomatic therapy can be given because the response provided is only acute and mild.
Characteristics of patients with acute lymphoblastic leukemia in 2016-2020 at Sanglah General Hospital, Bali
Authors: Evelin Vianetha Prima Snak  , Ni Nyoman Mahartini  , Sianny Herawati  , Ni Kadek Mulyantari  , Anak Agung Wiradewi Lestari
Published: December 2022

Background: Acute lymphoblastic leukemia (ALL) is a bone marrow malignancy that is the most common cause of death in children. This study aims to determine the characteristics of ALL patients in 2016-2020 at Sanglah Hospital Denpasar, Bali.

Methods: This study used a retrospective descriptive study with secondary data from 166 patients. Variables assessed in this study included: demographic characteristics (age, gender, place of origin), complete blood count results include of hemoglobin levels, leukocyte (white blood cell) count, absolute neutrophil count, absolute lymphocyte count, thrombocyte count, and morphology subtype of ALL based on FAB classification from bone marrow aspiration (BMA).

Results: From demographic characteristics: most patients' age was in school-age children (>6 - <18 years) about 59.7%, dominated by male (60.2%), place of origin from Bali (71.7%) which is from Denpasar city (23.5%). From the laboratory results, complete blood count found that the most results are moderate anemia in children (54.7%), in adult female (70%), and in adult male (52.9%); leukocytosis in children (41%), in adult (77.8%); neutropenia in children (61.2%), in adult (59.3%); lymphocytosis in children (43.2%), in adult (81.5%); thrombocytopenia in children (97.1%), in adult (100%). From the results of the BMA examination, based on the FAB (French, American, and British) classification, the most common morphology of ALL was L2 subtype (78.9%).

Conclusion: Characteristics of patients with ALL at Sanglah General Hospital are dominated by children, male, from Denpasar, Bali, with laboratory results showing moderate anemia, leukocytosis, neutropenia, lymphocytosis, thrombocytopenia, and the most common morphological variants are ALL-L2 subtype.
Dermoscopic imaging of melasma on various skin colors
Authors: Ananda Zulfa Riefka , Imam Budi Putra  , Nelva Karmila Jusuf
Published: December 2022

Background: Melasma is an acquired hyperpigmentation disorder characterized by pigmented macules and patches scattered on the forehead, cheeks, and chin area exposed to sunlight. Dermoscopy is a non-invasive technique that allows fast and clear observation of melasma in vivo with morphological visualization that is not visible to the naked eye. The color bar tool is an economical and simple tool that can be used to determine skin color. This study aims to determine the dermoscopic appearance of melasma on various skin colors.
Methods: This study is a descriptive observational study with a cross-sectional method of all patients with melasma who came to the outpatient department of the cosmetic dermatology division, Department of Dermatology and Venereology, Universitas Sumatera Utara Hospital, Medan, Indonesia, from September 2020-October 2021. The assessment was carried out by dermoscopy and color bar tools.
Results: This study included 50 melasma patients in total. Most participants (n=23, or 46 %) were between the ages of 36 and 45. Based on clinical features, 42 subjects (84%) presented with centrofacial pattern. In epidermal type melasma, 21 subjects (42%) were associated with color bar 3. In dermal type melasma, color bar 3 is found in 2 subjects (4%); in mixed type melasma, three subjects (6%) were found in color bar 3.
Conclusion: The dermoscopy of melasma in various skin colors has a similar distribution of skin color. Color bar 3 is the most dominant skin color. There were no color bars 5 and color bars 6 in this study.
Chronic rhinosinusitis patient with nasal polyps at Dr. Soetomo General Academic Hospital Center
Authors: Mohammad Lukmanul Hakim  , Irwan Kristyono
Published: December 2022

Background: Nasal polyps are benign chronic inflammatory masses with epithelial tissues of the nasal mucosa and paranasal sinuses. The clinical diagnosis is made based on sinonasal symptoms for more than three months and the presence of polyps in the nasal cavity. The classification of nasal polyps based on the histopathological structure is divided into three types, i.e., oedematous, eosinophilic polyps, inflammatory polyps, and chronic seromucous inflammatory polyps. This study aims to describe the profile of patients with nasal polyps at Dr. Soetomo Public Hospital Surabaya.
Methods: This study applied a descriptive method with a retrospective approach by obtaining data from the medical records of the outpatient unit in the Ear, Nose, Throat, and Head-Neck (ENT-HN) Department of Dr. Soetomo Public Hospital Surabaya for the period January 2017-December 2018 based on age, gender, clinical symptoms, symptoms duration, polyp types, location of nasal polyp, and comorbidities.
Results: The number of patients with nasal polyps was slightly more in women, as many as 13 patients or 52%, mostly aged 51-60 years old, amounting to 11 patients or 44%. The most common clinical symptom experienced by patients was nasal obstruction, as many as 24 patients or 96%. Patients who experienced symptom duration for one to three years before treatment amounted to 13 patients or 52%. Patients with histopathology of inflammatory nasal polyps were 19 patients or 76%, while patients of nasal eosinophil polyps were six patients or 24%. Additionally, patients with comorbidity in nasal polyps of allergic rhinitis medical history were 11 patients or 44%. Also, bilateral nasal polyps were mostly experienced by patients, reaching 14 patients or 56%.
Conclusion: This study reveals nasal polyps in women aged 51-60 years with clinical symptoms of nasal obstruction with the results of a histopathological examination of the inflammation type at bilateral polyps.
Cervical invasion and lymphovascular space invasion as the most associated risk factors for lymph node metastases in endometrial cancer
Authors: Devita Kurniawati  , Tjokroprawiro Brahmana Askandar , Primandono Perbowo
Published: December 2022

Background: Endometrial cancer is the second most common type of gynecologic malignancy. Studies on factors of lymphatic metastases are few. This study aimed to determine the clinical and pathological characteristics that can predict lymph node metastases.
Purpose: To determine the correlation of clinicopathological characteristics with LNM (Lymph Node Metastases) in Endometrial Cancer (EC).
Methods: This study used observational analysis and a cross-sectional methodology to examine medical records of endometrial cancer patients who underwent lymphadenectomy sampling surgery in 2018-2020. The risk factors are determined using multivariate analysis.
Results: The stage IB and IIIC1 patients accounted for the most (17.27%) of the 63 research participants. Only one patient (1.1%) is in stage IIIB. The rests are stage IA and IIIA, each including eight patients (8.13%), and stage II, which has twelve people (12.19% ). There were 17 patients with endometrial cancer who had lymph node metastases (27% ). The incidence of LNM is 23.2% in endometrioid types, while the incidence of metastases is 57.1% in non-endometrioid kinds. The incidence of LNM in EC was not linked with the patient's age (p=0.628), BMI (p=0.190), parity (p=0.194), or menopausal status (p=0.970). The study found no correlation between LNM and histological kinds (p=0.078), histopathological degrees (p=0.514), or myometrium invasion (p=0.134) in EC. The risk factors most linked with LNM in EC are LVSI (+) (OR = 0.10; IK 95% 0.19–0.56; p = 0.009) and cervical invasion (OR = 0.07; IK95 percent 0.008–0.64; p = 0.019) according to the results of multivariate analysis.
Conclusion: Cervical invasion and LVSI (+) are the risk factors most associated with the incidence of LNM.
The role of transdermal carbon dioxide on changes in malondialdehyde levels as a marker of ischemia-reperfusion injury in patients with placenta accreta spectrum underwent temporary abdominal aortic cross-clamping as an adjunct procedure during cesarean hysterectomy
Authors: Pagehgiri Hari Daswin , Puruhito Ito , Aditiawarman  , Lestari Pudji , Sembiring Yan Efrata , Jiwangga Dhihintia , Hakim Arief Rakhman , Aryananda Rozi Aditya
Published: December 2022

Background: Temporary abdominal aortic cross-clamping is often applied as an adjunct procedure to control bleeding in patients with placenta accreta spectrum during cesarean hysterectomy. It is claimed to reduce the blood loss need for transfusion and improve visualization of the operating field. After the cross-clamp is removed, the tissue distal to the occlusion, which was initially in an ischemic state, gets a sudden blood flow causing ischemia-reperfusion injury due to the release of ROS. Transdermal administration of carbon dioxide is expected to reduce the release of ROS through the Bohr Effect to protect against ischemia-reperfusion injury, which can be seen from the level of malondialdehyde.
Method: This experimental study recruited all patients with placenta accreta spectrum who underwent temporary abdominal aortic cross-clamping during cesarean hysterectomy from January to June 2022. Subjects were divided into control groups and treatment groups. The treatment group was given transdermal CO2 immediately after the aortic cross-clamp was removed. The plasma MDA levels were examined before and after aortic cross-clamping.
Results: The number of subjects in each group was 7 subjects. There was an increase in MDA levels from 19.779+0.870nmol/ml to 21.104+1.053nmol/ml after cross-clamp in all groups, with an average increase of 1.325+0.801nmol/ml (p=0.00). The treatment group that received transdermal CO2 had a lower tendency to increase MDA levels, 1.063+0.803nmol/ml, compared to the control group at 1.586+0.766nmol/ml.
Conclusion: There was an increase in MDA levels as a predictor of ischemia-reperfusion injury in patients undergoing temporary abdominal aortic cross-clamping. The administration of transdermal CO2 tends to suppress ischemia-reperfusion injury.
Peroneal tendon subluxation: A case report
Authors: Suehandika Caksana Putu , Wien Aryana I Gusti Ngurah , Zainarda Dr
Published: December 2022

Background: Dislocation of the peroneal tendons is uncommon and is frequently misdiagnosed as an ankle sprain usually in young and active patients. The most common mechanism is a dorsiflexory force on the ankle associated with a rapid and strong contraction of the peroneal tendons and with eversion of the hindfoot, rapid contraction can also lead to injury to the superior peroneal retinaculum.Case Report: We reported a case of traumatic dislocation of the peroneal tendons. The patient was a 32-year-old who complained of right ankle pain and a feeling of dislocation after suffered an accident while playing football.Discussion: There have been many options reported for surgical repair of peroneal subluxation or dislocation. These include direct repair of peroneal retinaculum, reconstruction of peroneal retinaculum, bone block (lateral malleolus, sliding graft), and groove deepening and rerouting procedures.Reconstruction of the peroneal tendon can be accomplished using the peroneus brevis, plantaris, and/or Achilles tendons. Complications associated with these techniques include graft fracture, tendonitis, pain, and re-subluxation.Conclusions: Acute peroneal tendon dislocation is a challenging entity because it may mimic and frequently be misdiagnosed as an ankle sprain. Conservative treatment may be considered for acute dislocation but may be associated with high failure rate. There have been many options reported for surgical repair of peroneal subluxation or dislocation include direct repair of peroneal retinaculum, reconstruction of peroneal retinaculum, bone block (lateral malleolus, sliding graft), and groove deepening and rerouting procedures.Â Keywords: Peroneal Tendon, Subluxation, Dislocation, Ankle Injury.
Acute aortic dissection Stanford A DeBakey type III in patient with suspected Marfan Syndrome: a case report
Authors: Pandhika Karen , Mustika Aulia , Shodiq Muhammad Ali
Published: December 2022

Background: Patients with Marfan syndrome can experience acute aortic dissection 77% with type A and 23% with type B, and 64% suffer from an aneurysm.Case Description: A 45 year old female admitted to intensive care with chest pain onset since 1 day ago, ECG examination shows sinus rhythm with normal axis. Chest x-ray shows dilatation and elongation of aorta with aorta aneurysm suspected. MSCT scan of thoracal shows dilatation of ascending aorta â€“ distal of left subclavian artery â€“ aortic arch â€“ descending aorta â€“ the thoracoabdominal aorta â€“ right and left common iliac artery. On blood examination, we found elevation of D-dimer (3570 Âµg/L). Patient was given beta-blockers to control heart rate 60 beats per minutes, CCB and ACE inhibitor was given to control systolic below 110 mmHg. After putting so much thought, patient was scheduled for TEVAR procedure.Conclusion: Patients with Marfan syndrome tend to have thoracic aortic aneurysms involving aortic root, ascending aorta, arch, and descending thoracic aorta. TEVAR is minimal invasive procedure and Â have good outcome in patient with aortic dissection.
EFFECT OF ORAL IRON TABLET ADMINISTRATION ON SERUM FERITIN AND HEMOGLOBIN CONCENTRATION OF PRE-PREGNANT WOMEN WITH MILD IRON DEFICIENCY ANEMIA IN BALI
Authors: Seri Ani Luh , Bakta I Made , Suryadhi INT , Agus Bagiada IN
Published: December 2022

Iron deficiency anemia (IDA) is still to be a problem of pregnant women healthrelated to its high prevalence and its negative effects on health. Prevention efforts by ironsuplementation in pregnant woman have not reducing IDA problem in pregnant women yet.Â This failure is probably due to the assumption that IDA have been seen pre-pregnant. Totest this hypothesis, a quasi experimental study was conducted by randomized pre and posttest control group design. Sample were collected by multistage sampling random technicconsist of 47 women in treated group and 52 in control group. Both group were serumferritin and hemoglobin value test untill 3 time, pre-pregnant, early pregnant and duringpregnant. Iron tablet was administrated to treated group from the beginning of pre-pregnantperiod, continued until the first 3 months of pregnancy, while in control group iron tabletwas only given during the first 3 months of pregnancy. T-group result shown that meanserum ferritin and hemoglobin concentration at pregnant women on treated group(33,45Â±14,12 ?g/dL dan 12,25Â±1,20 g/dl) more high than control group (19,65Â±8,99 ?g/dLdan 10,91Â±0,67 g/dl), p<0,05. Mean difference serum ferritin and hemoglobinconcentration at pregnant women is 13,8 ?g/dL dan 1,34 g/dl (p<0,05). Benefid analysisresult shown that iron suplementation since pre-pregnant more benefid than ironsuplementation during pregnant (BCR >1). Based on these results, it can be concluded thatiron supplementation to IDA women starting from pre-pregnant period results in a bettereffect compare to oral iron supplementation during pregnancy only.
PERBAIKAN KONDISI KERJA DENGAN PENDEKATAN ERGONOMI TOTAL MENURUNKAN KELUHAN MUSKULOSKELETAL DAN KELELAHAN SERTA MENINGKATKAN PRODUKTIVITAS DAN PENGHASILAN PERAJIN PENGECATAN LOGAM DI KEDIRI-TABANAN
Authors: Adiatmika I P G , Manuaba A. , Adiputra N. , Sutjana D.P.
Published: December 2022

Perubahan ekonomi dunia menuntut daya saing setiap perajin khususnya di Bali. Salah satudaya saing yang diusahakan adalah produksi tepat waktu. Produksi tepat waktu sebagianbesar dilakukan dengan kerja lembur seperti perajin pengecatan logam di Kediri Tabanan.Hal ini disebabkan produktivitas dan penghasilan mereka masih di bawah standar. Untuk itudperlukan suatu perbaikan dengan pendekatan ergonomi sehingga mampu bersaing,manusiawi dan berkelanjutan. Banyak perbaikan sudah dilakukan tetapi masih terjadimasalah sehingga diperlukan perbaikan secara komprehensif. Salah satu cara perbaikanadalah dengan melalui pendekatan ergonomi total. Tujuan untuk mengetahui pengaruhpendekatan ergonomi total terhadap keluhan muskuloskeletal dan kelelahan sertaproduktivitas dan penghasilan perajin. Subyek penelitian adalah 24 karyawan pengecatankerajinan logam di Kediri Tabanan pada bulan September 2007 â€“ Maret 2007 denganrancangan sama subyek. Kondisi kerja diperbaiki dengan model pendekatan ergonomi totalsehingga diperoleh bentuk perbaikan yang paling optimal. Hasil menunjukkan adapenurunan keluhan muskuloskeletal 5,53 % dan penurunan kelelahan 6,79 % secarabermakna (p<0,05). Produktivitas karyawan meningkat 61,36% dan penghasilan perajinmeningkat 55,29% secara bermakna (p<0,05). Perubahan yang terjadi sebagai dampak dariperbaikan kondisi kerja dengan model pendekatan ergonomi total lebih besar terjadi padaproduktivitas dan penghasilan. Disimpulkan pendekatan ergonomi total menurunkankeluhan muskuloskeletal dan kelelahan serta meningkatkan produktivitas dan penghasilanperajin. Disarankan untuk menerapkan model pendekatan ergonomi total pada industri yanglain dan mendorong partisipasi aktif karyawan dalam perbaikan kondisi kerja.