bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-care Experience in Hypertensive Patients
Authors: Afik Al , Fikriana Riza
Published: December 2022

Introduction: Self-care is an important component to control blood pressure in people with hypertension. Low self-care ability will have an impact on increasing the risk of complications. The purpose of this study was to explore the experiences of hypertensive patients in self-care.Methods: The study used a qualitative method with a phenomenological approach. Nine hypertensive patients were taken by purposive sampling technique. The data collection was using semi-structured interviews. Thematically analyzed data based on transcribed interview data.Results: The results of the study obtained six themes related to self-care, namely perceptions of the causes of recurrence, emotional responses, social support, accessibility of health-care services, self-care behavior and barriers of self-care.Conclusions: Self-care in hypertensive patients is influenced by the availability of social support from both family and health workers as well as the affordability of health-care services. The implication of this study is the need to improve a good support system, especially from nurses to be able to minimize the barriers felt by patients so as to improve self-care abilities
Features of COVID-19 adult patients and the treatment in Indonesia: a retrospective cohort study
Authors: Nugrahaningsih Dwi Aris Agung , Purnomo Eko , Siswanto  , Reviono  , Yasmina Alfi , Prenggono Muh Darwin , Fajari Nanang Miftah , Rudiansyah Mohammad , Harsini  , Syarif Rul Afiyah , Sholikhah Eti Nurwening
Published: December 2022

Background: Coronavirus disease of 2019 (COVID-19) is a new disease that causes clinical symptoms that vary from mild to severe. As a new disease, there is no standard treatment for the disease. Several drugs are used to treat COVID-19, most of which were previously used for other diseases, and the efficacy in COVID-19 is not yet known. This study aimed to evaluate COVID-19 therapy in the early phase of the pandemic.
Methods: In this study, we evaluate data on the characteristics of hospitalized COVID-19 patients in several hospitals in Indonesia from March until December 2020. We also evaluate the therapy given and the results of the therapy.
Results: Most hospitalized patients in this study were mild to moderate COVID-19 patients. The most common combination therapy was chloroquine/ hydroxychloroquine + Azithromycin (79.4%). A small number of patients received chloroquine/ hydroxychloroquine without Azithromycin (9.3%), and only a few did not get chloroquine/ hydroxychloroquine therapy (10.8%). The clinical outcome appeared to be better in the chloroquine/ hydroxychloroquine + azithromycin group than in the other groups. The mortality rate was lower in the chloroquine/ hydroxychloroquine + azithromycin group (2.6%) compared to those in the chloroquine/ hydroxychloroquine group (52%) and the group without chloroquine/ hydroxychloroquine (38%). However, the chloroquine/ hydroxychloroquine + azithromycin group had better baseline characteristics and received more additional medications, such as oseltamivir, corticosteroid, and levofloxacin, rather than levofloxacin, the other groups.
Conclusion: Hospitalized COVID-19 patients in Indonesia from March until December 2020 mostly had mild to moderate COVID-19. Most of them received treatment combinations consisting of chloroquine/ hydroxychloroquine and Azithromycin. The most common combination therapy for hospitalized COVID-19 patients was chloroquine/ hydroxychloroquine + Azithromycin. The clinical symptom improvement was seen mainly in this group.
Seroprevalence SARS-CoV-2 among the academic population of Universitas Gadjah Mada Yogyakarta
Authors: Sianipar Osman , Intansari Umi Solekhah , Ratnaningsih Tri , Wahyuningsih Arum Tri , Anshori Fuad , Dwiputro Alfin Harjuno , Arjana Adika Zhulhi
Published: December 2022

Background:  Many academicians in Yogyakarta, Indonesia, face the increased potential for Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) transmission in academic populations. Seroprevalence data can represent the number of infections showing the proportion of people exposed and those potentially immune to the virus and provide evidence for public health policymakers. The seroprevalence of SARS-CoV-2 in the academic population of Universitas Gadjah Mada (UGM) remains unknown, raising concerns about the immune status among the academic population. A cross-sectional study was conducted to estimate the seroprevalence rate of SARS-COV-2 infection in the UGM academic population.
Methods: We conducted a descriptive study of 406 subjects of the UGM academic population. In the cross-sectional analysis of data collected, we performed serological testing for SARS-COV-2 infection for random academicians willing to participate voluntarily. Subjects were categorized as high and low-risk based on SARS-CoV-2 exposure and work history. Data normality was tested with Kolmogorov-Smirnov test. Proportion differences were analyzed with chi-squared tests with a significance set as P<0.05.
Result: 406 subjects were included in this study, with most of the subjects (55.91%) being female. The majority of the subjects were students (82.27%). Most of the subjects were categorized as high-risk (51.72%). Eight subjects (1.97%) had reactive antibody testing. The prevalence of SARS-COV-2 infection was higher in the high-risk group than in the low-risk group (3.57% vs. 0.48%; p=0.01). The high-risk subjects had 7.5 times more incidence of reactive antibody results than low-risk subjects based on the prevalence ratio.
Conclusion: The seroprevalence of SARS-COV-2 immunity in the general academic population of the Universitas Gadjah Mada is 1.97%. These low proportions reflect that more strategies are needed to protect the high-risk group against SARS-CoV-2 exposure.
The relationship between diabetes distress and HbA1C level in type 2 diabetes mellitus therapy patients: a systematic review
Authors: Wibowo Zefo Kiyosi , Mudjanarko Sony Wibisono , Khairina Khairina
Published: December 2022

Introduction: The success of therapy did not follow the increasing number of type 2 diabetes mellitus patients. This systematic review aimed to evaluate the relationship between diabetes distress and HbA1c in type 2 diabetes mellitus patients during therapy.
Methods: The authors systematically searched databases (PubMed, Cochrane library, and ScienceDirect) up to January 2021. Articles were screened according to PRISMA 2020 statements. The selection criteria of this study were patients’ characteristics, type of therapy, and outcomes.
Results: The search started from 1.303 articles to 17 eligible articles. Furthermore, seventeen studies included 11,976 patients. The mean HbA1c level was around 6.4% to 9.9%. The result of diabetes distress scores were five studies with low scores, eight moderate scores, and two high scores. Emotional burden and regimen-related distress were the highest domain score. Age, health facilities, and type of therapy affected diabetes distress. The correlation between diabetes distress and HbA1c was dominant in the range of 0.15 to 0.26.
Conclusion: Diabetes distress had a low-moderate correlation with HbA1c. The dominant domains were emotional burden and regiment-related distress. There were two mechanisms of effect, direct by hormones and indirect through medication adherence, self-management, and 12 months of quality of life.
The similarity of a desmoid tumor with parasitic leiomyoma: a very rare case report and literature review
Authors: Hasanuddin Hasanuddin , Hendryan Derevie
Published: December 2022

Introduction: Desmoid tumors are rare cases that arise from aponeurotic tissue. Parasitic leiomyoma is a rare type of leiomyoma that grows in reproductive age, but differential diagnostics have something in common.Case report: A case of a 34-year-old Asian woman, secundigravida, outpatient clinic, referred from surgery division with chief complaint of a lump in the stomach that has become bigger in the past 4 years. There was no menstrual complaint, and the patient had a history of one previous cesarean section. Computed Tomography (CT) revealed a mass on the abdominal wall that extends to the abdominal cavity, and the patient underwent a mass biopsy and the histopathology results were obtained in the form of uterine leiomyoma or fibroid. During the operation, the mass was obtained from the abdominal wall and had no connection to internal reproductive organs, and due to the large mass, we consulted to digestive surgery division for mass resection, and a mesh graft was placed. Based on the results of tissue examination, the desmoid fibromatosis tumor was obtained from histological findings.Conclusion: Preoperative management by performing magnetic resonance imaging (MRI) can be useful to evaluate the difference between both diseases. Immunohistochemistry stain should be performed to differentiate between both diseases in case the MRI unavailable.
The clinical pictures of COVID-19 pediatric patients in dr. R. Soedarsono Regional General Hospital, Pasuruan, East Java, Indonesia
Authors: Hsieh Peter Prayogo , Kristian Hans , Permana Allison Joseasta Marsya , Wongsodiharjo Monique , Nugraheni Pramita Anindya , Charisti Pherenice , Diarsvitri Wienta
Published: December 2022

Background: COVID–19 cases in children are not as prevalent as in adults and tend to be milder. However, clinical profiles in pediatric COVID–19 cases in Indonesia have not been extensively studied. This study aims to know clinical profiles of pediatric COVID–19 cases in dr. R. Soedarsono General Hospital Pasuruan City from April–July 2020.
Methods: This descriptive study used medical records of pediatric patients who were diagnosed with suspected, probable, confirmed, and close contact with COVID – 19. Total populations with complete data in medical records were included in the study.
Results: Of 78 respondents, 41 (53%) were male, 42 (54%) were hospitalized, 18 (23%) were 1 until under 12 months and 12 until under 18 years old consecutively, 32 (41%) had moderate symptoms, and 31 (39%) had close contact with positive cases at home. The most common symptoms were cough (59%) and fever (54%). Most cases showed normal laboratory and radiologic findings. There were eight children with comorbidities, and most patients showed satisfying outcomes.
Conclusions: Most pediatric patients with COVID–19 at dr. R. Soedarsono General Hospital from April to July 2020 showed moderate symptoms with good outcomes.
Human umbilical cords mesenchymal stem cells for kidney diseases
Authors: Harahap Dianita Halimah , Irdam Gampo Alam
Published: December 2022

Stem cell therapy is an emerging therapy in the medical field. Recent studies show that stem cell therapy gives promising results. One of the stem cell sources is the human umbilical cord that has many potential, not only for therapy alone but also for banking. Human umbilical cord mesenchymal stem cells (HUCMSCs) have greater advantages than bone marrow and adipose tissue-derived stem cells in isolating the cells and the shortest culture period. Studies on animal models showed improvement of kidney disease in the various mechanism. Human studies regarding human umbilical cord mesenchymal stem cells as therapy for kidney disease have not been conducted on a large scale, but MSC therapy appears safe.
The relationship between catheter placement and the incidence of urinary tract infections in Condong Catur Hospital, Yogyakarta
Authors: Kusbaryanto Kusbaryanto , Diana
Published: December 2022

Introduction: Catheter-related urinary tract infections for one-third of all health-care related infections in the United States, and have also been shown to increase morbidity, mortality, and length of stay. Various problems are associated with urinary catheter insertion, namely trauma, complications, and patient discomfort. The purpose of this study was to analyze the relationship between catheter placement and the incidence of urinary tract infections in hospitalized patients in Condong Catur Hospital Yogyakarta.
Methods: The design of this study was an analytic observational study using a cross sectional design. The sample was patients diagnosed with UTI for 12 months from August 2019 to July 2020 and inclusion and exclusion criteria. The sample selection was done by consecutive sampling. There were 98 samples of inpatients at the Condong Catur Hospital. The data were taken from the medical records of patients who had UTIs or those with a catheter installed.
Results: There are 98 patients in the Condong Catur Hospital, 18 of them have had UTIs, ten of which were caused by catheter insertion. In this study, bivariate analysis was used to compare the two groups with partners and found a significant association between catheter use and urethral infection, with a p-value of 0.001.
Conclusion: There is a significant relationship between catheter placement and the incidence of urinary tract infections in hospitalized patients in Condong Catur Hospital.
Diphteria’s Outbreak Control in Blitar District
Authors: Alfiansyah Gamasiano , Swari Selvia Juwita , Santi Maya Weka
Published: December 2022

Introduction: Diphtheria is an acute bacterial disease that attacks the pharynx, tonsils, larynx, nose, and sometimes attacks the mucous membranes or skin, conjunctiva, and vagina. Implementing diphtheria control in the Blitar district is constrained by program implementation management, with the number of diphtheria cases still high. This study aimed to analyze the implementation of the prevention of diphtheria outbreaks during the preparation, surveillance, investigation, and response stages.
Methods: This study was qualitative on health workers in charge of managing diphtheria outbreaks at both the health office and community health centers. Data were collected through in-depth interviews and observations and analyzed using content analysis methods.
Results: The results showed that the availability of human resources to deal with diphtheria was inadequate both in terms of numbers and educational background, surveillance training has not been conducted, supplies of Anti-Diphtheria Serum and erythromycin were depleted, limited room isolation, active surveillance has not been carried out, some communities refuse immunization, disinfection has not been carried out, and lack of public knowledge about diphtheria.
Conclusion: This study recommends several suggestions. The Health Office should provide specific surveillance training to health workers, sufficient supply of Anti Diphtheria Serum and erythromycin, establish regulations for supervising close contact and create an isolation room in a private hospital. Community health centers should supervise close contact, disinfection of patients' houses, increase education, and conduct community empowerment in carrying out surveillance.
Effects of audio-visual affirmations on toddlers tantrum behavior
Authors: Handayani Nanik , Rahayu Esty Puji
Published: December 2022

Introduction: Tantrums are a normal condition that occurs in children aged 1-3 years. If not handled properly, Tantrum behavior will affect the formation of the next child's personality. In Indonesia, 23-83% of children aged 2 to 4 years have experienced temper tantrums. One way to overcome tantrums in toddlers is to provide sound to children. However, not all mothers can do sounding to their children; another alternative is to provide sounding using media. The alternative media is audio-visual affirmation. This study aimed to analyze the effect of audio-visual affirmation on tantrum behavior in toddlers.
Methods: This study uses a quasi-experimental study with one group pre-test-post-test. The population is toddlers who attend Raudlatul Jannah Preschool, namely 98 children, then sampling is done with simple random sampling, a sample of 78 respondents is obtained. The data used in this study is data on the temper tantrums of children aged 1-5 years before and after being given an audio-visual affirmation. This data was analyzed by comparing the temper tantrums in toddlers before and after being given audio-visual affirmation therapy.
Results: The results of data analysis using the Paired T-test showed a significant effect between before and after being given the audio-visual affirmation treatment with p = 0.000 (p < 0.05). This study shows that audio-visual affirmation affects tantrum behavior in toddlers.
Conclusion: Audio-visual affirmation affects tantrum behavior in toddlers.
The role of revascularization on short-term Heart Rate Variability (HRV) and Signal Averaged Electrocardiogram (SAECG) in Stable Coronary Artery Disease (CAD)
Authors: Pangemanan Janry , Panda Agnes Lucia , Rooroh Victor Giovannie Xaverison , Gunawan Evan Jim
Published: December 2022

Background: Revascularization in patients with stable coronary artery disease (SCAD) can reduce myocardial ischemia and improves the autonomic nervous system, which can be measured by heart rate variability (HRV) and signal-averaged electrocardiogram (SAECG). This study aimed to investigate the effect of revascularization on HRV and SAECG in patients with SCAD.
Methods: This is a single-center prospective cohort study. Revascularization refers to percutaneous coronary intervention (PCI). The primary outcome of this study is the change in short-term HRV and SAECG from before revascularization to after revascularization. HRV and SAECG measurement was performed for 10 minutes before PCI and one-month post-PCI. Data were analyzed using SPSS version 23 for Windows.
Results: There are 30 patients included in this study, and 46.7% underwent incomplete PCI. There was no significant difference in HRV parameters in the time domain method. In the frequency domain, only the LF/HF ratio changed significantly from 3.5±2.6 before PCI to 2.16±1.9 after PCI, with a 1.33 decrease in LF/HF (p=0.007). Subgroup analysis was performed for patients receiving complete and incomplete revascularization. In patients who received complete revascularization, there was a significant difference in LF/HF ratio change of 1.6±2.28 (p=0.013). In patients that receive incomplete revascularization, there is a significant increase in HF 37.8±57.3 (p=0,028). In terms of SAECG parameters, there is no significant difference between before and after PCI in both primary and subgroup analysis.
Conclusion: Revascularization resulted in a significant reduction in LF/HF ratio assessed by short-term HRV. There was no benefit of revascularization in terms of SAECG parameters.
Diagnostic challenges in Waldenstrőm macroglobulinemia: a case report
Authors: Pravita Stella , Bintoro Ugroseno Yudho , Putu Niken Ayu Amrita
Published: December 2022

Background: Waldenstrom macroglobulinemia (WM) is a rare, dormant hematologic disease. It often manifests in people over 60 years of age and considered a hereditary disorder with MYD88 and CXCR4 genes mutation. In Indonesia, WM medical records is limited, causing potential misdiagnose or mistreatment. This article reported a case of WM patient and its challenging diagnosis establishment.
Case Presentation: A 67-year-old woman was referred with chief complaints of extremities swelling with recurrent anemia, bone pain, and elevated renal function. Protein electrophoresis indicated monoclonal gammopathy, suspected as multiple myeloma. However, further examinations did not support the diagnosis of multiple myeloma as the results revealed increased B2 microglobulin (5.65mg/L). IgM immunofixation suggested IgM lambda monoclonal gammopathy. Bone marrow aspiration (BMA) showed dominant lymphoplasmacytic cells (68%) and flowcytometry test of serum plasma indicated positive CD10 and CD34, whereas CD5 and CD19 were negative. The differential diagnoses have also been ruled out one by one to provide appropriate treatment for the patient. After all examinations, the patient was finally diagnosed with WM and treated with bortezomib, low-dose dexamethasone, and rituximab (BDR) regimen for five cycles.
Conclusion: WM is rare case of hematologic disease and the diagnosis of the case could face challenges due to diagnostic difficulty. Protein electrophoresis and BMA could help to improve the diagnosis process.
Profile of melasma patients in dermatology and venerology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Authors: Devi Aprilin Krista , Utomo Budi , Indramaya Diah Mira , Listiawan Muhammad Yulianto , Sawitri  , Murtiastutik Dwi , Prakoeswa Cita Rosita Sigit
Published: December 2022

Background: Melasma is characterized by symmetrical brownish macules with well-defined borders. The etiology of melasma is still unknown, but factors that are thought to influence include genetic predisposition, ultraviolet radiation, hormonal factors, thyroid disorders, use of cosmetics, and drugs. This study aimed to determine the epidemiological data, evaluate risk factors, management, and follow-up in new melasma patients.
Methods: The medical records of patients with melasma attending Dermatology and Venereology Outpatient Clinic over a 4-year period from 2015 to 2018 were analyzed retrospectively for this descriptive, observational study. Data were analyzed using SPSS version 23 for Windows.
Results: This study found 739 new melasma patients from January 2015 to December 2018, with the proportion of women 734 patients (99.3%) more than men only 5 patients (0,7%). The age of most patients who were treated was 46-55 years in 320 patients (43.3%), with the highest age of onset being 37-45 years in 308 patients (41.7%). About 561 patients (75.9%) had a melasma duration of more than 1 year. The most common job of melasma patients was housewives in 366 patients (49.5%). The most frequent risk factor for melasma was ultraviolet radiation in 258 patients (34.9%). The most common melasma was malar type in 482 patients (65.2%) and mixed melasma in 617 patients (83.4%). The most widely administered therapy was sunscreen in 735 patients (99.5%) and Tretinoin 0.05% in 235 patients (31.8%). Most patients did not make repeat visits as many as 448 patients (60.6%).
Conclusion: The most common disease in women of childbearing age with ultraviolet radiation is the most precipitating risk factor. The low number of patient repeat visits can be caused by a lack of doctor education or a lack of patient adherence to treatment due to chronic and recurrent diseases.
Clinical and radiological profiles of metastatic brain tumor in Indonesia: A study at Dr. Soetomo Hospital, Surabaya
Authors: Anandito Nur Akbaryan , Ardiansyah Djohan
Published: December 2022

Background: Brain metastases have increased over time, and imaging has been considered an important diagnostic tool. In Indonesia, the record of metastatic brain tumors is limited. Therefore, understanding the epidemiology and the imaging characteristics of brain metastases will provide insights into a better diagnosis, management, and therapy towards the disease. This study aimed to evaluate the characteristics of patients with metastatic brain tumors.
Methods: A cross-sectional study was conducted in Neurology Unit at Dr. Soetomo Hospital in Surabaya, Indonesia from August 2018 - July 2019. Patients with metastatic brain tumors were enrolled in the study. Data demographics, clinical, and brain imaging characteristics were collected from the patients’ Brain Tumor Registry. Computerized tomography (CT) scan and magnetic resonance imaging (MRI) was used to assess the images of the brain metastases. Mini-Mental State Exam (MMSE) was used to assess the patient's cognitive function.
Results: Of the total 22 subjects, 14 (63.6%) were male, 13 (59.1%) aged ≥50 years. Headache was the most common clinical symptom, reported by 78.2% of patients. Most of the patients (63.3%) had MMSE score of ≤ 23. CT-scan and MRI imaging suggested that multiple lesions were the most common, 57.8% and 71.4%, respectively. The brain tumor's most frequent was in the parietal and temporal lobes (CT-scan imaging) and temporal and cerebellar lobes based on MRI. Lung tumors were the most common source of brain metastases (50%), followed by breast and nasopharynx cancers (13.6% each); 9% had unknown sources.
Conclusions: Our study suggests that the frequency of metastatic brain tumors is gender and age-specific. Headache with early stage of dementia is common among patients with metastatic brain tumor. Multiple lesions in parietal and temporal lobes with lung cancer as the source are common.
Ondansetron and metoclopramide: a comparative analysis of effectiveness and cost in hospitalized patients with hyperemesis gravidarum
Authors: Lonah  , Purwantyastuti  , Nafrialdi  , Irwinda R  , Via Dolorosa Halilintar
Published: December 2022

Background: Hyperemesis Gravidarum (HG) is nausea and vomiting which interfere pregnant women’s daily activities.Ondansetron (ODN) is often used off label for the treatment of hyperemesis gravidarum. This study aimed to analyze theefficacy and cost of ondansetron versus metoclopramide (MCP), a drug that has been used in the standard regimen for thetreatment of HG. patients in the largest hospital in Jakarta during year 2012 to 2016.Method: The research was conducted with a cross-sectional study design on respondents with criteria, namely pregnantpatients hospitalized with HG at Dr. Cipto Mangunkusumo Hospital from 2012-2016. Assessment of clinical effectiveness wascarried out by looking at the day’s duration until the symptoms of nausea and vomiting stopped. Furthermore, a cost analysiswas carried out by calculating the average direct medical costs associated with the HG’s condition.Result: The effectiveness of both antiemetics was not statistically significant (p = 0.370). The average cost per patient withondansetron compared to metoclopramide was not significantly different (p = 0,966).Conclusion: There was no difference in the effectiveness and cost of ODN versus MCP for the treatment of hyperemesisgravidarum.
Comparison of serum and vitreous TGF-β1 levels in proliferative diabetic retinopathy with and without panretinal photocoagulation laser therapy
Authors: Muhiddin Habibah Setyawati , Abidin Rosmiaty Zainal , . Budu , Sirajuddin Junaedi , Islam Itzar Chaidir , Ichsan Andi Muhammad
Published: December 2022

Introduction: A long-term diabetic retinopathy will cause an increase in several growth factors expression like Transforming Growth Factor β (TGF-β). This multipotent cytokine is involved in the process of endothelial cell proliferation. Therefore, this study aims to observe the relationship between TGF-β1 levels in serum and vitreous fluid of Proliferative Diabetic Retinopathy (PDR) patients given Pan Retinal Photocoagulation (PRP) laser therapy.
Method: This was a cross-sectional study involving 14 patients with PDR. TGF-β1 levels of vitreous and peripheral blood were measured using Enzyme-linked Immunosorbent Assay (ELISA) method. The data were statistically analyzed using SPSS software for Windows ver. 23.0 for Mann-Whitney and the Spearman correlation test.
Results: Our subjects consisted of 57.1% males with a mean age of 51.8 years, where dyslipidemia was the most common comorbid disease. Mean serum TGF-β1 level was 12,821.43 ± 5,253.16 pg/ml, while the mean value in vitreous was 3,692.86 ± 333.89 pg/ml. Meanwhile, there was no significant difference in serum and vitreous TGF-β1 levels between subjects with and without PRP laser therapy (p>0.05).
Conclusion: There was no significant correlation between TGF-β1 levels in proliferative diabetic retinopathy patients with and without panretinal photocoagulation laser therapy. However, there was a decreasing trend in TGF-β1 levels in the vitreous fluid, indicating that PRP laser therapy has a positive effect on preventing the formation of neovascularization in the eye.
Turner syndrome and tuberculosis in adolescent: a case report
Authors: Trisnawan Nyoman Titamarita , Sindhu Florencia Christina , Hsieh Peter Prayogo , Ratnasari Arya Putri , Afrian Alberto , Limantara Ancelia , Christian Han's , Dewi Made Ratna , Suryawan I Wayan Bikin
Published: December 2022

Background: Turner syndrome is characterized by abnormality of one X chromosome. Those with Turner syndrome are at risk of developing tuberculosis infection due to decreased immune function.
Case: A 17-year-old girl came with complaints of short stature, amenorrhea, and no signs of secondary sexual growth. She also felt weak. On physical examinations, she weighed 24 kg, and her height was 119 cm. Her conjunctiva looked pale. She had a low set hairline, small mandible, short 4th metacarpal, and wide-spaced nipple. Her breast and genitalia did not grow (1st stage of Tanner classification). There was a lesion between her breasts. Laboratory results showed Hemoglobin 7 g/dL, MCV 62,6 fL, MCH 18,2 pg, MCHC 29 g/L, FSH >170 IU/L, LH 95,3 IU/L, Estradiol 11 pg/mL, Iron Ferrozine 7 mg/dL, TIBC 186 μg/dL, and Ferritin 50 ng/mL. Her Mantoux test showed induration with a diameter of 20-23 mm, and the Xpert MTB-RIF test showed low detection of MTB. Her bone age was appropriate for a 13-year-old girl. Histopathology test of her lesion showed chronic granulomatous inflammation. Her chromosome analysis showed Mos 45,X(56)/46,XX(44). She was diagnosed with Turner syndrome and tuberculosis. She received Progynova® 2 mg every 24 hours for 21 days, stopped for 10 days, and continued again for 21 days. She also got anti-tuberculosis drugs (pediatric regime).
Conclusion: The clinical spectrums of Turner syndrome vary widely. Decreased immune function in Turner syndrome can lead to infections such as tuberculosis. Early diagnosis and treatment can prevent further morbidity.
The relationship of tumor necrosis factor alpha levels and neutrophils with skin wound age caused by sharp trauma
Authors: Cangara M. Husni , Sari Indah Wulan , Nelwan Berti Julian , Kaelan Cahyono , Arsyadi Gunawan
Published: December 2022

Background: Sharp force injuries are the second most common cause of trauma after blunt force injury. TNF- α is a cytokine that triggers the expression of adhesion molecules, other cytokines and chemokines by endothelial cells, stopped and migrated to damaged tissues or infections that trigger inflammation. Furthermore, the initial population of leukocytes leading to the wound comprises mostly neutrophils. This study aimed to assess the correlation between TNF-α levels in the blood and skin tissues and neutrophils number with the wound age of wounds caused by sharp trauma.
Methods: This study is an experimental study using animal models.  The samples were divided into the control group and the group in which the blood and the skin tissue samples were taken 1-, 3-, 12-, 24-, 48- and 72 hours after being sharp traumatized.  The Elisa method examined the samples from the blood, and the skin of the right back of the mice was examined for TNF-α levels.  Others from the left-back skin of the mice were microscopically examined to assess the number of neutrophils.
Results: The TNF- α level from the skin samples were detected in wound tissue as the peak levels were in the 24 hours post-traumatic group. The TNF-α levels from blood samples indicated a significant difference in TNF-α levels in each group (p < 0.05). However, TNF-α levels from skin samples showed no significant difference between each group. From the microscopic examination, there was a significant difference in the infiltration of neutrophil cells in all groups (p<0,05). The neutrophils peak at 24 hours post-traumatic.
Conclusion: There was no significant correlation between the TNF-α levels and the number of neutrophils with the wound age in wounds caused by sharp traumas.
Predictive factors and the relationship between the early detection of osteoporosis and pathological fractures in Indonesian menopausal women
Authors: Supriyatiningsih  , Meiky Fredianto  , Muhammad Arifuddin  , Amalia Rizki Hanif  , Salwa Nabilah Cholfa  , Sulistiari Retnowati  , Ima Rismawati
Published: December 2022

Background:  Estrogen deficiency in menopausal women induces bone loss and makes them prone to pathological fractures. Age, body mass index (BMI), parental history of osteoporosis, and smoking tobacco also increase bone loss and pathological fractures. This study aims to determine whether age, BMI, parental history of osteoporosis, and smoking tobacco can predict pathological fractures in menopausal women. Moreover, the relationship between the early detection of osteoporosis with pathological fracture incidence will also be determined.
Methods: This is an analytic observational epidemiological research with a cross-sectional retrospective design that involved 40 menopausal women. The data were collected from the patients' medical records 2020 in Obstetrics and Gynecology Clinic, Asri Medical Center (AMC) Muhammadiyah Hospital, Yogyakarta. The predictive factors for pathological fracture (age, BMI, parental history, smoking tobacco) were analyzed by using Fisher's exact test and the relationship between osteoporosis early detection, including bone mineral density (BMD) value, parathyroid hormone (PTH) levels, osteocalcin levels, and osteoporosis self-assessment tool for Asians (OSTA) score, with pathological fractures were investigated by using the chi-square test.
Result: Age has a significant relationship with the occurrence of pathological fractures in menopausal women (OR = 6.6, 95% CI: 1.128-8.604, p = 0.042), while BMI, parental history of osteoporosis, and smoking tobacco did not have a significant relationship with pathological fractures (p > 0.05). Early detection of BMD and PTH was also found to have a significant relationship to fracture incidence. Additionally, menopausal women with high PTH levels and osteoporosis BMD values are eight times and four times greater risk of acquiring fractures than menopausal women with normal BMD values and PTH levels.
Conclusion: Age can be a predictive factor for pathological fractures, and the early detection of PTH and BMD is related to the occurrence of pathological fractures in menopausal women.
Gastrointestinal bleeding as a life-threatening complication of liver abnormality in a Turner syndrome patient
Authors: Enggar Soffy , Widodo Budi
Published: December 2022

Background: Turner syndrome is a rare condition with high morbidity and mortality rates, it leads to multiple organ damage when left untreated. Meanwhile, liver involvement in this condition ranges from asymptomatic to severe such as cirrhosis with massive gastrointestinal bleeding. This study presents a case of gastrointestinal bleeding due to cirrhosis in Turner syndrome where the patient showed third-grade esophageal varices as a sign of portal hypertension.
Case Presentation: A 26-years old female came to the Emergency Department of Dr. Soetomo General Hospital in Surabaya with massive gastrointestinal bleeding. The patient was a Turner syndrome, diagnosed ten years ago. The patient was negative for hepatitis B surface antigen (HbsAg) and anti-hepatitis C virus (anti-HCV). The gastric lavage was performed to reduce active bleeding with blood transfusion. The upper gastrointestinal endoscopy indicated portal hypertension with third-grade esophageal varices, fibro scan indicated cirrhosis hepatic and abdominal CT-scan showed early cirrhosis and splenomegaly supporting the presence of portal hypertension. Since the patient refused to endoscopic varices ligation, hematemesis repeated three times after the first visit resulting death of the patient.
Conclusion: This is a Turner syndrome patient who experienced life-threatening gastrointestinal bleeding as complication of liver abnormality. This case highlights that liver cirrhosis should be evaluated in individuals with Turner syndrome to prevent such complications.
TB community empowerment model instruments in finding tuberculosis (TB) suspects
Authors: Ro’isah Ro’isah , Anies  , Sakundano Matius , Jazuli Nur
Published: December 2022

Introduction: Tuberculosis is still a public health problem. Indonesia is the third rank of highest TB in the world. Community empowerment is one of the strategies for finding TB suspects. Community empowerment in Probolinggo Regency is carried out by forming the local TB Association. Evaluation of the role of this TB community has never been done. There is no available measure of community empowerment in this TB community. A measuring tool for community empowerment models is needed for the TB community to increase empowerment. This study aimed to develop a measuring tool for community empowerment through the TB community in finding TB suspects.
Methods: This type of research is quantitative with a cross-sectional design. The population and sample are all local TB communities in Probolinggo Regency are about 325 people. Determination of the sample using simple random sampling according to the inclusion criteria of 128 respondents. Instruments using questionnaires and data analysis with exploratory factor analysis.
Results: The results showed that the measuring instrument for community empowerment was personal factors, knowledge, communication, motivation, self-efficacy, motivational incentives, group factors, and community empowerment factors in finding TB suspects, participation, leadership, and organizational structure having a Bartlett test of sphericity value P < 0.001, Reliability of Life Satisfaction Questionnaire with Cronbach Alpha > 0.800.
Conclusion: This instrument is valid and reliable to be applied to measure local TB community empowerment in finding TB suspects.
Relationship between demographics and patient infographics of company guarantees on utilization of inpatient services
Authors: Setianto Budhi , Pulih Asih Akas Yekti , Adriansyah Agus Aan , Bistara Difran Nobel , Setiyowati Eppy , Sa'adah Nikmatus
Published: December 2022

Introduction: Based on the low interest in inpatient visits by company insurance, only 11.4% of employees utilize inpatient facilities at CMH. This study aimed to find the relationship between demographics and infographics of company insurance patients on the use of inpatient services.
Methods: This study was conducted on 95 respondents from a customer's company. Ninety-five customers are divided into actual customers who have used inpatient services (58 people) and potential customers who have not utilized (37 people). The data is processed by grouping some between actual and potential customers and processed descriptively using a chi-square of several variables, including demographics and infographics.
Results: This study informs that the distance from home and the length of time known to the hospital did not affect inpatient care. At the same time, knowledge of cooperation and socialization of HRD influences the utilization of inpatient services. Repeated socialization and the hospital's proximity to HRD can cause more patients to visit and take advantage of inpatient services
Conclusion: In carrying out inpatient services, the company's role as a guarantor is very decisive in directing customers to CMH. Utilization of inpatient services is not influenced by distance from home and length of time with CMH but by customer knowledge regarding collaboration with CMH and socialization by HRD.
Phytochemical screening and toxicological evaluation using Brine Shrimp Lethality Tes (BSLT) of ethanolic extract of Morinda citrifolia L.
Authors: Wulandari Devyana Dyah , Risthanti Reine Risa , Sari Elviana Adhaini Puspita , Anisa Hikmatun , Filia Sisca
Published: December 2022

Introduction: Noni, which has the scientific name Morinda citrifolia L., is a plant often found in Indonesia and has many properties used for generations. However, this noni fruit has potential toxicity that needs to be studied further. This study aimed to determine the phytochemical compounds and determine the toxicity of the ethanol extract of noni fruit using the Brine Shrimp Lethality Test (BSLT) method.
Methods: The research was conducted at the Chemistry Laboratory, Universitas Nahdlatul Ulama Surabaya. This research includes experimental research. Artemia salina L. larvae aged 48 hours were put into a test tube containing a solution of noni fruit extract with concentrations of 10, 50, 100, 250, 500, 750, and 1000 ppm, then observed after 24 hours.
Results: In the phytochemical screening results, noni fruit ethanol extract contains tannins, saponins, flavonoids, and terpenoids. The test results obtained an LC50 value of 17.78 ppm, which indicates that the ethanol extract of the noni fruit is toxic.
Conclusion: The ethanol extract of the noni fruit contains tannins, saponins, flavonoids, and terpenoids and has toxicity to Artemia salina L. larvae. It can be concluded that the ethanolic extract of noni fruit has the potential as an anticancer.
Endorphine massage decreases cortisol during menstruation
Authors: Septianingrum Yurike , Hatmanti Nety Mawarda , Fitriasari Andikawati , Ainiyah Nur , Bistara Difran Nobel , Wardani Erika Martining
Published: December 2022

Introduction: Numerous relaxing techniques have been used with endorphin massage. There is not much proof that it affects blood cortisol levels, though. Therefore, this study set out to analyze the implementation of endorphin massage decrease cortisol during menstruation.
Methods: Cortisol data measured involving 46 respondents was obtained by taking venous blood and analyzed using the Enzyme-linked Immunosorbent Assay method. Data analysis used Paired and independent T-test to determine changes in cortisol levels before and after the implementation of endorphin massage and the mean difference between the endorphin massage group and the control group. Analysis of covariance (ANCOVA) was used to examine the mean difference between the two groups compared to baseline.
Results: Based on previous research, this study found that age, weight, and age at menarche did not significantly affect cortisol levels during menstruation. The endorphin massage resulted in a drop in cortisol levels (p=0,0000), and there was a significant difference in mean between the two groups (p=0,0000). When compared to the starting point, blood cortisol levels in both groups were significantly lower (p=0,000).
Conclusion: This study has found that generally endorphin massage could reduce cortisol level in final year nursing students.
Successful alopecia universalis treatment with the combination of cyclosporine and oral corticosteroid: a case report
Authors: Darmaputra I Gusti Nyoman , Tirka Putu Shinta Widari , Ramaswari Putu Ayuni Yayas , Mahariski Pande Agung
Published: December 2022

Background: Alopecia universalis is an autoimmune condition on hair follicles with the characteristics of ovoid or round-shaped hair loss (focal) that develops into multiple hair losses and is the most severe form of alopecia. The pathogenesis of alopecia universalis is unclear. However, the most accepted hypothesis is based on the immunologic factor, especially T-cell mediated autoimmune process.
Case: A 19-year-old male Indonesian complained of hair loss all over his body. Efflorescence of the whole body showed an alopecia patch. The Severity of Alopecia Tool (SALT) score showed 100%. Skin dermoscopy indicated yellow dots. The patient was given 8 mg of intraoral methylprednisolone every 8 hours and 100 mg of intraoral cyclosporine every 12 hours for four weeks and slowly tapering off. The patient experienced acneiform eruption and was topically treated with 2% sulfur lotion every 12 hours. After 51 days of observation, an improvement was found in terminal hair growth on the head, eyelashes, and eyebrows, visible growth of vellus hair on the body, and a SALT score of 40%.
Conclusion: Alopecia universalis is rare and can cause significant damage and psychological pressure to the affected individuals. Treatment with corticosteroid and cyclosporine resulted in good therapy response.
The effect of fear of falling towards falls incidence among knee osteoarthritis patients in Malang, Indonesia: a cross-sectional study
Authors: Rakhmad Rosadi  , Sri Sunaringsih Ika Wardojo
Published: December 2022

Introduction: One serious effect of knee osteoarthritis (OA) is falling. Some predictors caused its vulnerability, one of which was fear of falling. However, few studies investigated how fear of falling leads to falling among the elderly. This study analyzed the fear of falling towards falls incidence among knee OA patients in Malang, and the results of this study might have a significant recommendation for the geriatric fall prevention system policy in Indonesia
Methods: This is a cross-sectional study with 53 participants recruited using the purposive sampling technique from Puskesmas Rampal Celaket and Posyandu Lansia Samaan Malang from March-April 2021. Measurements were the Falls International Efficacy Scale (FES-I) to assess fear of falling, the John Hopkins Grading Scale to measure fall incidence, and the self-reported sociodemographic questionnaire. Data analysis used were the Chi-Square test, Independent T-test, and multivariate logistic regression to analyze significant predictors of falling.
Results: From the bivariate analysis, it was found that the falling group tends to have a higher fear of falling than the non-falling group (34% and 1.9%, respectively). For BMI, the falling group tends to have a higher BMI than the non-falling group (27.2±2.8 and 25.7±3.9, respectively). While multivariate analysis showed that only fear of falling has a significant effect on falling incidence among the elderly (p<0.05), with participants having the risk 2.32 times (OR=2.32; 95%CI= 0.96-4.87) of falling compared to others.
Conclusion: As there was a significant positive correlation between fear of falling and falling incidence among knee OA patients, thus it gives a significant recommendation for the Health Department to design a fall prevention program for the elderly, focusing on managing its predictor.
Systematic literature review: potential anti hyperglycemia Imperata cylindrica
Authors: Sulistyowati Erna , Aziz Muhammad Rofif
Published: December 2022

Introduction: Imperata cylindrica or cogon grass can be found throughout the world. This wild plant, which is considered a weed, has several properties including antidiabetic, antihypertensive, antidiuretic, anti-inflammatory, and antioxidant properties. This review article aimed to discuss the antidiabetic effects of I. cylindrica.
Methods: There were 12 full text articles published from 2005 to 2021 which were relevant for review. Through in vitro and in vivo studies which show that the active compounds of I. cylindrica have the potential to be antidiabetic agents.
Results: Several studies have shown that I. cylindrica has phenolic compounds, flavonoids and tannin which have antioxidant effects. Flavonoids as antioxidative properties prevent cell damage caused by free radicals reactive. By donating their hydrogen atoms or the ability to adhere metals, in the form of glucosides or a form called aglycones so that they can reduce blood glucose levels. I. cylindrica was processed as extracts or decoction.
Conclusion: It was concluded that I. cylindrica is the potential to have an anti-diabetic effect.