bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Ropivacaine Subcutaneous Infiltration on Surgical Skin Defects
Authors: Katherine Inomy Claudia , Sahudi  , Ghaib Husnul
Published: January 2025

Background: Pain and the process of post-operative wound recovery are potential complications of surgery. No scientific evidence supports the claim that ropivacaine's infiltration effect on wound healing stimulates fibroblasts during the healing process and has an anti-inflammatory effect. This research aims to investigate the impact of ropivacaine infiltration on wound healing in experimental Wistar rats by quantifying fibroblasts.
Methods: This study was an experimental study using a sample of 32 Wistar rats (Rattus norvegicus), which were randomly divided into two groups, namely the treatment group with 2 cm full-thickness wound incisions with 1 ml of 0.2% ropivacaine infiltration, while the control group was given infiltration of 0.9% NaCl 1 ml. Furthermore, wound tissue samples were taken on day 5 to calculate fibroblasts.
Results: There were differences in the fibroblasts in the treatment group with ropivacaine infiltration and the group without infiltration (p = 0.00). The average number of fibroblasts in the control group was 29.13 per field of view, while the treatment group had 35.25.
Conclusion: Administration of ropivacaine affects fibroblasts of skin defects performed surgically in Wistar rats
Neutrophil Lymphocyte Ratio (NLR) as a predictor of outcome in children with Acyanotic Congenital Heart Disease (ACHD) after open heart surgery
Authors: Raharjo Fumansha Cipto , Soebroto Heroe , Utamayasa I Ketut Alit
Published: January 2025

Background: Congenital heart defects are structural abnormalities that occur in the heart and/or major blood vessels in newborns. In congenital heart surgery, procedures can be performed using a cardiopulmonary bypass (CPB) machine. While CPB helps surgeons in completing surgical procedures, it has negative effects, one of which can trigger acute inflammatory responses.
Methods: This study is a retrospective research based on secondary data from medical records of acyanotic congenital heart surgery patients at Dr. Soetomo Hospital Surabaya from 2018 to 2022. The sample for this study includes patients aged 1 month to 18 years with acyanotic congenital heart defects who underwent heart repair procedures at Dr. Soetomo Hospital.
Results: The study involved 156 research subjects, children with Acyanotic Congenital Heart Defects (ACHD) who underwent repair surgery at Dr. Soetomo Hospital Surabaya. The Mann-Whitney test analysis showed a significant difference with a P-value of 0.000 (0 < 0.05) between the increased neutrophil-to-lymphocyte ratio in patients who experienced mortality and those who did not. The average increase in the neutrophil-to-lymphocyte ratio in subjects without mortality was 5.44. The increase in the neutrophil-to-lymphocyte ratio also had a significant relationship with CPB time, AOX time, CPB temperature, extubation, and ICU length of stay.
Conclusion: There is a significant relationship between the increase in neutrophil-to-lymphocyte ratio and mortality in the post-operative period of acyanotic congenital heart surgery patients.
Micronutrients for the brain in school feeding, gaps for completing stunting, bibliometric studies
Authors: Yurisaldi Arman , Yogi Saputra Dwi Arwandi
Published: January 2025

Background: The condition known as stunting is a persistent dietary issue that has an effect on the growth and development of children. School feeding is an intervention that can improve the nutritional intake and health of schoolchildren. Bibliometric studies can be used to analyze research trends and gaps in certain fields. This research aims to map potential gaps in school feeding to resolve stunting based on bibliometric studies.
Methods: This research uses a literature study method by collecting data from the Scopus with the keywords: school feeding and stunting. Data were analyzed using Biblioshiny and VOSviewer software to produce visualizations and bibliometric maps.
Results: The research results show that the number of publications about school feeding and stunting increases from year to year, with developing countries as the main contributors. The visualization map shows that the main topic studied is the relationship between school feeding and children's nutritional, cognitive, and educational status. The identified niche theme is micronutrients for the brain, while the research that has been saturated is micronutrients for growth.
Conclusions: This research found that there is still a potential gap for developing research on school feeding and stunting, especially regarding the impact of micronutrients on the brain in schoolchildren. This research can be a reference for researchers and practitioners who are interested in studying this topic further.
Continuity of care and socio-demographic predictors of postpartum family planning utilization among women with a high-risk pregnancy in Indonesia: case-control study
Authors: Kusuma Inggar Ratna , Damayanti Rita , Prasetyo Sabarinah , Andriani Helen
Published: January 2025

Introduction: Postpartum Family Planning (PPFP) coverage in Indonesia has reached only 23%, which has an impact on the risk of an unwanted pregnancy. Pregnant women with too young, too old, and too many children are one of the factors that cause high maternal and infant mortality rates. This study aims to analyze factors influencing PPFP in mothers with high-risk pregnancies.
Methods: A case-control study of 496 respondents in 66 health centres in Banyumas and Cilacap, Central Java, was selected through random cluster sampling using a researcher-made questionnaire. This research was conducted in 2022.
Results: Factors that influence the use of PPFP are continuity of care (aOR 4.83; 95%CI 1.52-6.81; p=0.001), medical history during pregnancy and childbirth (aOR 3.31; 95%CI 1.39-5.48; p=0.021), parity (aOR 3.49; 95%CI 0.94-13.04; p=0.030), prior contraception (aOR 6.88; 95%CI 3.92-11.91; p=0.001),  Information Education and Communication (aOR 17.72; 95%CI 10.73-20.15; p=0.001), husband support (aOR 8.92; 95%CI 5.1-15.92; p=0.001), health service satisfaction (aOR 4.21; 95%CI 1.26-5.78; p=0.001). In contrast, several factors like the mother's age, mother's educational status, and lactational amenorrhea method do not influence the use of PPFP.
Conclusion: A history of high-risk pregnancies, births, and postpartum heavily influences PPFP. It has been demonstrated that PPFP considerations can lower maternal and newborn mortality rates. Programs to increase the coverage of PPFP participation need to consider various factors, both internal to the mother and external to program readiness.
Profile of arterial blood gas analysis of COVID-19 patients based on severity, ICU admissions, and clinical outcomes
Authors: Iriani Anggraini , Prabowo Ichsandiaz , Fatina Marsya Kaila , Armenia Dhinasty , Putri Dian Eka , Gemilang Rizka Kurnia
Published: January 2025

Introduction: Arterial Blood Gas parameters (ABG) describe the adequacy of oxygenation and ventilation in COVID-19 patients. This study aims to assess the profile of ABG parameters to assess COVID-19 severity, ICU admissions, and clinical outcomes in hospitalized COVID-19 patients.
Methods: A retrospective cohort study was conducted on 152 adult patients who confirmed COVID-19 during the pandemic. Patients were grouped based on disease severity, need for ICU care and patient outcome. Blood gas analysis was carried out namely pH, pCO2, pO2, HCO3, and O2 saturation.
Results: A total of 152 COVID-19 patient data were collected. There were 84 male and 68 female subjects. Most of the subjects were in the age group > 60 years old (47.3%). There 57.9% of subjects were treated within 1-10 days, and 38.8% were treated within>10 days. A total of 117 (77%) subjects had severe or critical symptoms, 50% of subjects required ICU care, and 82 (54%) subjects were not survived. A total of 97 (64.1%) subjects experienced a decrease in SO2. Subjects had an acidotic pH of 19.1% and alkalosis of 30.9%.  Lower PO2 values were found in patients with severe/critical symptoms and patients with non-survived clinical outcomes (p<0.001). Lower pH (p<0.002) and HCO3 values were found in the group of non-survived subjects (p<001).
Conclusions: The significant decrease in PO2 and oxygen saturation parameters occurred based on the patient’s severity and clinical outcome. Decreased HCO3 levels are only significant in non-survived subjects, while most of the subjects have normal pH levels.
Single coronary artery anomaly mimicking Coronary Artery Disease (CAD): a case report
Authors: Yoshinta The Veronica , Setiadi Benny Mulyanto , Rampengan Starry Homenta , Jim Edmond Leonard
Published: January 2025

Background: A single coronary artery (SCA) is a rare congenital anatomical anomaly in which only one artery provides blood supply to the entire myocardium. It can be isolated or in conjunction with other congenital cardiac anomalies. Some SCA patients show symptoms of myocardial ischemia to sudden death without evidence of atherosclerosis. Herein, we describe a female patient with a single left coronary artery with typical chest pain of ischemia, which is treated conservatively.
Case Presentation: A 41-year-old woman presented to our clinic with typical chest pain of ischemia. She had been hospitalized with unstable angina five days ago and underwent thyroidectomy three months ago. She was obese with normal findings of vital signs. Electrocardiography showed sinus rhythm, right axis deviation, and poor R progression. The laboratory showed unremarkable findings. The echocardiogram showed left ventricular hypertrophy with normal ejection fraction. The calcium score was zero, but coronary computed tomography angiography found that the left circumflex artery was long and gave origin to the right coronary artery with no significant stenosis. The patient was treated conservatively with single antiplatelet therapy and statin with risk factor modification of coronary artery disease.
Conclusion: A single coronary artery is a rare congenital abnormality of the coronary artery. Coronary computed tomography angiography is a non-invasive imaging technique that can delineate complex coronary artery anatomy, unlike coronary angiography, which is more invasive.
Chronic Total Occlusion (CTO) revascularization: a review on pathophysiology, the process, and outcome
Authors: Subiyanto  , Jim Edmond Leonard , Rampengan Starry Homenta
Published: January 2025

Background: Chronic total occlusion (CTO) is a 100% blockage of a coronary artery (TIMI flow score 0-1) for ≥3 months, occurring in approximately 15-20% of patients undergoing coronary angiography. This study aims to review CTO revascularization.
Methods: This study is a literature review conducted by searching articles regarding chronic total occlusion published on the online database. Data were analyzed using narrative synthesis regarding the eligible literature provided.
Results: Chronic total occlusion begins with the atherosclerosis process, which is then followed by plaque rupture, accumulating thrombotic material. This process repeats over time, ultimately forming a hard thrombus that occludes the entire vessel lumen. Efforts to revascularize CTO lesions are generally reserved for patients with refractory angina symptoms and high ischemic burden. However, the indications stated from these clinical guidelines do not automatically endorse revascularization intervention; instead, careful assessment is needed to determine the risk and benefit the patient would receive if revascularization intervention were performed.
Conclusion: We describe the preparations for CTO lesion revascularization and provide information about the outcomes of revascularization interventions based on clinical guideline recommendations and conducted clinical trials.
Correlation between vitamin D level and FRAX score in chronic kidney disease patient on maintenance hemodialysis
Authors: Faisal  , Tjempakasari Artaria , Djoko Santoso
Published: January 2025

Background: Vitamin D (Vit-D) deficiency is common in CKD on hemodialysis patients. Vitamin D deficiency can cause decreased bone density, increasing osteoporosis and fracture risk. The World Health Organization has developed a new fracture risk assessment tool (FRAX score) that has become increasingly popular in osteoporosis diagnostics and risk of fracture assessment in many countries. This study evaluates the correlation between vitamin D level and FRAX score in end-stage renal disease (ESRD) patients on hemodialysis.
Method: A cross sectional study was conducted on 68 CKD patients on routine hemodialysis in Dr.Soetomo General Hospital , Surabaya, in 2023. Sample taken through consecutive sampling. Calculation of FRAX score including age, gender, weight, height, history of fracture, parent's hip fracture status, smoking status, use of glucocorticoids, history of rheumatoid arthritis, secondary osteoporosis, alcohol, and BMD. A blood vein sample was taken to measure the serum vitamin D levels (25[OH]D) using a Human Vitamin D ELISA examination. Pearson correlation analysis was done using SPSS version 25 for Windows.
Results: The mean age of the study subjects was 51.24±10.50 years old, with most of the study subjects being female (61.8%). The mean serum vitamin D levels (25[OH]D) level was 18.82±8.94 ng/mL. We obtained two risk fractures from the FRAX score calculation, risk for hip fracture and risk of major osteoporosis. The mean risk for hip fracture was 1.52±1.22%, while the risk for major osteoporosis was 4.12±2.82%, ranging from 0.5-15.0%. We found a negative correlation between serum vitamin D level with the risk of hip fracture and risk of major osteoporosis with r value -0.762 and -0.740, respectively, with p-value <0.001.
Conclusion: There is a significant negative correlation between serum of vitamin D level and FRAX score as a marker of hip fracture and major osteoporosis in hemodialysis patients at Dr.Soetomo General Hospital, Surabaya.
The effectiveness of online versus face-to-face continuing professional development (CPD) for doctors during the COVID-19 pandemic
Authors: Tjandra David Christopher , Wibisono Ledwin Meikel , Wijaya Janice , Yunus Yovilia Tio , Saraswati Gusti Agung Ayu , Ghosali Fernando , Widhiani Komang Ayu , Edgar Christine , Putra I Nyoman Satya Mahayana , Susanto Nevinne Nathania , Lawi Marta Vitti , Kusuma Amanda Devasya , Amanda Nyoman Ayu Medhira , Sasmana I Gede Aswin Parisya , Pramesemara I Gusti Ngurah
Published: January 2025

Background: The COVID-19 pandemic has impacted the development of the Indonesian medical learning system, especially Continuing Professional Development (CPD). CPD is a coaching session for doctors or medical doctors constantly to be updated on developments in medical knowledge. The pandemic brings innovation by holding the CPD system virtually. Some doctors argue that online CPD is less effective than face-to-face, while others believe it enhances focus, saves costs, and provides access to international CPD opportunities. Therefore, this study aims to study the effectiveness of online and face-to-face CPD for doctors during the COVID-19 pandemic.
Methods: This study used a cross-sectional method with total population sampling, distributing Google forms to doctors ranging from general practitioners to doctoral levels. It focused on their experiences with online and face-to-face CPD. Inclusion criteria were doctors with an eligible and active medical license in Indonesia, willing to answer honestly, and physically and spiritually healthy. Exclusion criteria included doctors who disagreed with the informed consent or had conflicts of interest. The survey was conducted from September 6th to 8th.
Results: A total of 62 participants enrolled in the study. About 69.4% feel very interested in participating in the Online CPD. About 72.6% had only done Online CPD for the past 1-2 years, which is during the pandemic period. Regarding the effectiveness of Online CPD, based on the survey we conducted, it can be seen that 29% said Online CPD is not as effective as face-to-face CPD, about 45.2% answered that Online CPD is as effective as face-to-face CPD and the other 24.2% said that Online CPD is more effective than face-to-face CPD.
Conclusion: CPD's overarching goal is to motivate medical professionals to become more professional and realize their full potential as providers of high-quality healthcare. The respondents chose online CPD as the most dominant CPD system because it offers time and cost-effectiveness and can be accessed effectively.
Adipose-derived stem cells (ADSCs) impact on the formation of epidural fibrosis in a wistar rats’ experimental laminectomy
Authors: Natakusuma Tjokorda Istri Sri Dalem , Mahadewa Tjokorda Gde Bagus Mahadewa , Putra Made Bhuwana Putra , Monica Maria , Awyono Steven , Saapang Glen Sandi , Prakoso Dicky Teguh , Sriwidyani Ni Putu Sriwidyani
Published: January 2025

Background: Epidural fibrosis is the most prevalent cause of failed back surgery. Adipose-derived stem cell provides a possible means of regulating and preventing excessive fibroblast proliferation, stimulating tissue vascularization, and yielding an optimal environment for tissue healing. This preliminary study evaluated the role of adipose-derived stem cell administration on post-laminectomy epidural fibrosis formation, macroscopically and microscopically.
Methods: Laminectomy was performed on the thoracic and lumbar region of ten Wistar rats. The thoracic region received 10 µl of 0.9% Sodium chloride administration over the laminectomy site and was considered the control group. The lumbar region received adipose-derived stem cells with a dose of 2 x 105 cells (10 µl) and was determined as the treatment group. The rats were killed thirty days after surgery; the thoracic and lumbar columns were resected en bloc. Qualitative analysis consisting of macroscopic and microscopic examinations was carried out in the control and treatment groups.
Results: The grading of epidural fibrosis macroscopically and microscopically was lower in the treatment group with adipose-derived stem cell administration than in the control group.
Conclusion: ADSCs might reduce the formation of epidural fibrosis after the laminectomy procedure by modulating the fibroblast formation and inflammatory cytokine during the healing process.
The analysis of determinant factors influencing the functional outcome of lower extremity fractures treated at Dr. Wahidin Sudirohusodo General Hospital
Authors: Kurniawan Tri , Biakto Karya Triko , Nong Ira , Usman Muhammad Andry , Arifin Jainal
Published: January 2025

Introduction: Fractures occurring in the lower limb comprise approximately one-third of all fractures and can significantly contribute to both mortality and morbidity. These injuries exert multifaceted impacts on individuals' functional status, influencing various aspects of their mobility and daily activities, and 50% of patients fail to recover their pre-injury level of function fully. This study analyzes the factors contributing to the functional outcome of lower extremity fractures.
Methods: This is an analytic-observational study with a cross-sectional approach, with the samples being all patients who underwent surgery for lower extremity fractures from January 2019 to December 2021. This study evaluates the location of the fracture, AO classification, injury severity, associated injury, and definitive treatment as determinant factors for the functional outcome of lower extremity fractures, as shown by the Lower Extremity Functional Scale (LEFS).  
Result: Seventy-five patients meeting the specified inclusion and exclusion criteria were included in the study. A statistically significant relationship was observed between the fracture location and LEFS score (p = 0.03), with diaphysis fractures having the most important effect compared to fractures around joints (p = 0.00). In contrast, no significant relationship was found between the fracture configuration, injury severity, associated injury, definitive treatment, and LEFS score.
Conclusion: The location of the fracture significantly influences the functional outcome, especially on diaphysis fractures compared to around joint fractures, whereas factors such as the configuration of the fracture, injury severity, associated injuries, and definitive treatment did not show significant effects on the functional outcome.
Electrical burn injury in a 12-year-old male: a case report
Authors: Karamoy Ovi Octavia , Edwar Pesta Parulian Maurid
Published: January 2025

Background: Burns in children remain a devastating concern on critical care as leading to high rates of morbidity and mortality. Among all the causes of burn injury globally, 4-5% of burns are caused by electrical accidents. Electrical injuries can cause damage to deep tissue that extends beyond the obvious skin injury correlated with the electric field strength of its voltage and amperes. This case report aims to present electrical burn injury in a 12-year-old male.
Case Presentation: A 12-year-old male presented to the Emergency Department of Dr. Soetomo General Hospital referred from Mojokerto General Hospital with burns spanning from nine hours before to hospital admission, involving half of his face, neck, chest, stomach, back, both hands, and both legs. Burns brought on by kite ropes getting caught in power pole cables. Patient was assessed preoperatively with severe combustio grade IIA 8%, IIB 57.7%, III 3% (68.5%) et high voltage electrical injury accompanied by ocular thermal injury dextra et sinistra. Patient underwent debridement  and wound dressing at the emergency department operating theatre, then continuous fluid resuscitation, ventilation support, enteral nutritional feeding, and prophylaxis antibiotic administration in the intensive care unit. Blood and urine culture results were sterile. Patient condition has been stable upon the treatment.
Conclusion: Electrical voltage contributed to a small percentage of burn injury in children with significant physiological and psychological differences compared to adult counterparts. Management approaches of severe electrical burn injury mainly consists of fluid resuscitation, ventilation, surgical treatment, antibiotic therapy, and nutritional support.
Correlation of triple diagnostic (clinical, thyroid ultrasound, and FNAB) with histopathology in thyroid cancer patient
Authors: Priyono Sasongko Hadi , Subagiyo Hari , Sikumbang Kenanga Marwan , Putera Husna Dharma , Budiwinata Winardi , Ardansyah Audi , Huldani
Published: January 2025

Background: A thyroid nodule is a thyroid gland lesion that can be benign or malignant. The diagnosis was made based on clinical, radiological, and pathological findings, including McGill Thyroid Nodule Score (MTNS) for risk estimation, ultrasound using TIRADS criteria, and also fine needle aspiration biopsy (FNAB), which detected malignancy. However, the accuracy varied. The combination of these 3 diagnostic methods provides a better accuracy. This study aims to determine the correlation of triple diagnostics with histopathology in thyroid cancer patients.
Method: This is a retrospective observational analytical study of thyroid nodule patients in Ulin Hospital from 2018 to 2022. Inclusion criteria in this study include patients with complete triple diagnostic data (clinical symptom, USG thyroid, and FNAB). Patients with incomplete data were excluded. Variables collected included demography, histopathology, symptom, ultrasonography (USG), and FNAB results. Data was analyzed with SPSS software using Spearman correlation and logistic regression tests.
Results: A positive and statistically significant correlation between thyroid cancer with MTNS (r = 0.352, p = 0.002) and Bathesda (r = 0.240, p = 0.034) was discovered. A positive correlation was also found between TIRADS and thyroid cancer (r = 0.158) but not statistically significant (p>0,05). The combination of MTNS, TIRADS, and FNAB produced a strong positive and significant correlation (r = 0.510, p = 0.008) with thyroid cancer.
Conclusion: MTNS and Bathesda categorization significantly correlated with thyroid cancer histopathology, while the TIRADS category presented a meaningless relationship. Triple diagnostics revealed a stronger and more significant correlation with histopathology in thyroid cancer patients.
The comparison between peripheral perfusion index (PPI) with capillary refill time (CRT) in detecting fluid responsiveness in sepsis and septic shock patients
Authors: Suyata Maya Permatasari , Arif Syafri Kamsul , Hisbullah  , Zainuddin Andi Alfian , Muchtar Faisal , Nurdin Haizah
Published: January 2025

Introduction: The high mortality rate and organ dysfunction in septic shock indicate the need for early intervention and research on septic shock patients. Therefore, the study of peripheral perfusion index (PPI) and capillary refill time (CRT) is expected to be used as a reference for assessing fluid responsiveness in septic shock patients in the Intensive Care Unit (ICU). The study aimed to discuss peripheral perfusion index (PPI) and capillary refill time (CRT) for assessing fluid responsiveness in septic shock patients in the Intensive Care Unit (ICU).
Design: The study design was an analytical cross-sectional study, conducted from from May 1st, 2022 to September 1st, 2022. All patients with clinical sepsis and septic shock were admitted to the ICU ward and served as population of the study. The intervention given was a mini fluid challenge with a dose of 4 ml/kgBW is administered over 15 minutes. The PPI and CRT variables will be grouped based on fluid response, and diagnostic test analysis will be conducted by assessing sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.
Results: The validity of the PPI examination based on mean arterial pressure (MAP) in detecting fluid responsiveness yielded a sensitivity of 66.6%, a specificity of 31.6%, a negative predictive value of 94.7%, a positive predictive value of 4.87%, and an accuracy of 33.3%. The validity of the CRT examination in detecting fluid responsiveness showed a sensitivity of 33.3%, a specificity of 75.4%, a negative predictive value of 95.5%, a positive predictive value of 6.66%, and an accuracy of 73.3%, and it varies in the analysis based on heart rate, ΔpCO2, and lactate values.
Conclusions: In detecting fluid responsiveness in sepsis and septic shock patients, the PPI has better sensitivity, while CRT exhibits better specificity.
The outcome of infratentorial tumor patients who had surgery at Dr. Soetomo General Hospital during the 2014-2018 period
Authors: Prasetya Galan Budi , Wahyuhadi Joni , Susilo Rahadian Indarto
Published: January 2025

Background: Infratentorial tumors are cases of brain tumors that are common in children. The importance of early detection of infratentorial tumors so that resection can be done as early as possible so that it is hoped that it can reduce morbidity and mortality rates. Epidemiological data on infratentorial tumors is still limited in Indonesia, especially in East Java, so researchers consider it important to conduct this research.
Methods: The design of this research is retrospective observational with an analytic observational design. The research was conducted at Dr. Soetomo General Hospital from February 2023 to February 2024. The population of the study were all infratentorial tumor sufferers who underwent surgery at Dr. Soetomo General Hospital during 2014-2018 period.
Results: Bivariate tests were conducted based on age and gender, with the comparison variable being WHO grade, which was divided into high grade and low grade. Based on the WHO Grade, the hazard ratio with a value of 4.48 was obtained with p < 0.05, which indicates that the male gender has a 4.48 times higher risk factor for getting WHO High-Grade grading than female. In the age parameter against WHO grade, the relative risk is 6.25 with P<0.001, so it can be concluded that age under 18 years have a 6.25 times higher risk than age over 18 years in terms of getting WHO high-grade grading. The overall survival of 3 and 5 years is obtained as follows: overall survival of 3 years is 88.8 + 0.31%, and overall survival of 5 years is 60.8 + 0.49%.
Conclusion: Based on the recent findings, gender and age are risk factors for high or low WHO grades.
High levels of soluble endoglin (sEng) are a risk factor for severe preeclampsia
Authors: Kusuma Anak Agung Ngurah Jaya , Darmayasa I Made , Putra I Gede Mega , Suardika Anom , Harry Wijaya Surya I Gede Ngurah , Kumara I Gede Indra , Setiawan William Alexander
Published: January 2025

Introduction: Preeclampsia is new-onset hypertension accompanied by organ dysfunction, including proteinuria, that occurs after twenty weeks of gestation. The pathogenesis of preeclampsia begins in the early stages of pregnancy, where there is disruption of the angiogenesis process which then causes disruption of spiral artery remodeling in the uterus, abnormal placental vascular development, and leads to endothelial dysfunction. sEng is the N-terminal cleavage product of the extracellular domain of endoglin (Eng) which is formed by the activity of matrix metalloproteinases released by the placenta into the maternal circulation. The role of increased sEng levels in the pathogenesis of endothelial injury as the basic process of preeclampsia is essential. This study aims to elaborate the role of sEng in preeclampsia.
Method: A case-control study on pregnant women with preeclampsia was carried out at Prof IGNG Ngoerah Hospital by tracing serum sEng. Receiver operator characteristics curve (ROC) curve analysis, calculation of odds ratio values were used to evaluate serum sEng values on the risk of severe preeclampsia.
Results: There were no differences in maternal age, gestational age, and body mass index characteristics between the case group and the control group (p>0.05). Serum sEng more than 15.75 ng/mL is a risk factor for severe preeclampsia (OR 46.0; 95% CI 5.228-404.74; p<0.001).
Conclusion: High sEng levels are a risk factor for severe preeclampsia.
Internal quality analysis of hematology examination using Westgard rules and six sigma, quality goal index, and root cause analysis at the remote clinical laboratory
Authors: Dau Daniel , Marpaung Ferdy Royland , Wardhani Puspa
Published: January 2025

Introduction: The complete blood count (CBC) results are very important in clinical diagnosis decisions for patients. Imprecision and inaccuracy may lead to errors in patient diagnosis and treatment. To ensure a valid result, it is critical to evaluate the laboratory quality control (QC). However, QC evaluation in very remote areas remains scarce. This study aims to analyze the presentation of blood count quality control in a remote laboratory.
Methods: The study collected 90 samples of quality control measurements in August 2023. The research data were analyzed using Westgard guidelines, Six Sigma, the Quality Goal Index (QGI), and Root Cause Analysis (RCA).
Results: Westgard rules analysis identified 12s warning rules for six CBC parameters. Random errors were discovered in two parameters. In addition, there were systematic errors in nine parameters. Six Sigma analysis identified five factors with performance scores ranging from ≥ 3 Sigma to 5 Sigma, and ten parameters with performance of less than 3 Sigma. The QGI analysis revealed that four parameters performed imprecisely, while one performed inaccurately.
Conclusion: In this remote laboratory, we found imprecise and inaccurate QC results in some parameters. Therefore, it is vital to conduct laboratory QC training to improve the QC in the laboratory.
Case Report: Diagnosis of Extrapulmonary Manifestation of Tuberculosis in Knee Bones/Joints by Using Radiopharmaceutical 99mTc-Ethambutol and Side Effects Monitoring
Authors: I Gede Made Wirabrata  , Achmad Hussein Sundawa Kartamihardja  , Syamsudin  , Yusi Anggraeni  , Hendig Winarno
Published: January 2025

Introduction: Tuberculosis (TB) is an infectious disease caused by Mycobacterium Tuberculosis (M.TB). M.TB can infect lung parenchyma and other body organs (extrapulmonary), such as knees/joints. Indonesia is a country with the second largest number of TB cases in the world. The problem of TB diagnosis methods, especially in detecting extrapulmonary M.TB with a higher accuracy, is a serious concern for all parties. This research aims to diagnose extrapulmonary TB in the knee bones/joints by using the radiopharmaceutical 99mTc-ethambutol and monitor side effects.
Case description: Nuclear medicine procedures are used to conduct medical procedures on several subjects (ethambutol examination). The radiopharmaceutical 99mTc-ethambutol was injected intravenously into the body, and then imaging was performed using a gamma camera. The imaging results are visualized by observation of the capture of radioactivity in the knee bone/joint organs infected with M.TB. We found 3 exciting cases of subjects suffering from extrapulmonary TB disease of the knee bones/joints in a series of post-marketing surveillance studies. In case 1, the ethambutol examination diagnosed M.TB in the genu sinistra projection. In case 2, ethambutol examination diagnosed M.TB in the lungs and extrapulmonary simultaneously, infection in the left lung, and genu dextra. In case 3, ethambutol examination diagnosed M.TB in the left bilateral genu. The results of side effects monitoring using the radiopharmaceutical 99mTc-ethambutol indicated no changes in blood hematology examination, peripheral blood hematology, or complaints in the three subjects, both before and after the ethambutol examination. This indicates no side effects before and after administering the radiopharmaceutical 99mTc-ethambutol.
Conclusion: This report presents three cases with suspected pulmonary and/or extrapulmonary TB in the knees/joints, which was detected by nuclear medicine methods using the radiopharmaceutical 99mTc-ethambutol. Different side effects are carried out through a complete blood laboratory examination and monitoring complaints of each patient.
Exploring Estrogen Hormon Among Perimenopause Women and Its Impact on Aging Isues: A Mixed Method Study
Authors: Arsani Ni Luh Kadek Alit , Purnamayanti Ni Kadek Diah , Purnomo Ketut Indra , Wahyuni Putu Dewi Sri
Published: January 2025

Introduction: Menopause is emerging concern of global trend due to the increase number of women's aging. Global women health movement shifting approach to active aging in earlier stages during menopause transition. Menopause transitions known as perimenopause demand more access to healthcare regarding gradual aging process impacted productivity and quality of life. The aims of this study were conduct perimenopause diagnosis and explore the experience of aging issues.
Methods: This was an explanatory mixed method study conducted in 2 phases. First phase was a quantitative study. Data collection related sociodemographic characteristic,estradiol level test, and perimenopause diagnosis using STRAW+10. Descriptive analysis was conducted during the quantitative phase. Second phase was qualitative study. Data collection was done by semi structured interview among selected participants. Thematic analysis was conducted during the qualitative phase.
Result: A total 9 womens participants included. Based on the first phase study revealed the majority participants were at early and late perimenopause stage. The estradiol level were varies but the pattern shown the highest level at the younger age. Second phase study revealed variance of typical aging issues among the participants including perceived aging, physical and emotional changes. The severity of aging issue significant found related to lower estradiol.
Conclusion: Perimenopause is part of a woman's life crisis related to progressive physical and emotional changes due to the aging process. Estradiol is part of the estrogen hormone which plays a major role in regulating the hypothalamus which has systemic implications. The decrease in estradiol goes hand in hand with the aging problems experienced.
Characterization and fractionation of SARS-CoV-2 specific IgG from COVID-19 convalescent and post-vaccine group
Authors: Purwati  , Nora Ertanti  , Deya Karsari  , Aristika Dinaryanti  , Eryk Hendrianto  , Igo Syaiful Ihsan  , Asa Ardiana  , Nanis Nurdiyati  , Adita Ayu Permanasari  , Bagus Satrio Nurwito  , Andang Miatmoko
Published: January 2025

Purpose: This study aimed to explore the method for characterization and fractionation of SARS-CoV-2 IgG specific from convalescent COVID-19 patients, post-inactive, and post-mRNA vaccines
Patients and methods: The procedures include blood sample collection, SARS-CoV-2 specific IgG content screening, IgG fractionation, and validate specific IgG. Statistical analysis was carried out to evaluate the significance value of SARS-CoV-2 IgG presence in each sample group.
Results: The results showed that the post-mRNA vaccine samples had the highest levels of SARS-CoV-2 IgG antibodies. Furthermore, the validation was confirmed to be specific to SARS-CoV-2 IgG, as indicated by the heavy and light chains marked at ~50kDa and 25kDa, respectively.
Conclusion: A significant difference between the SARS-CoV-2 IgG content between the three sample groups is indicated by a P value of 0.0043.
Fascial biotensegrity
Authors: Setiaji Adrian , Prabowo Tertianto , Novitri  , Tanuwidjaja Deta
Published: January 2025

Fascia is a part of connective tissue that consists of irregular, three-dimensional collagen fiber plating that infiltrates into bone, muscle, joint, and nerve fiber. Fascia also provides an ideal environment for the organ system to function properly. Myofascial refers to the structure of muscle tissue (myo-) and connective tissue (fascia) distributed all over the body. Myofascial continuity is the longitudinal and transversal connection of two adjacent structures in a braided structure. The concept of fascial adaptation is imperative in movement execution during daily activities. Anatomically fascia is divided into superficial and deep, the latter then divided into aponeurotic and epimysial fascia. Fascia is also divided into lines; superficial, consisting of anterior superficial front and superficial back line; lateral, spiral, arm, and FL. Fascial biotensegrity is defined as a biomechanical function, from cell to tissue, but without considering bodily fluid as another information transportation mechanism that can affect cellular function such as force transmission, mechano-transduction, sliding, and applied in daily applications such as yoga, soccer, and martial arts.
COVID-19 reinfection with beta-thalassemia and insulin-dependent diabetes mellitus: a clinical pathology perspective
Authors: Rahmawan Prafa Alif , Indrasari Yulia Nadar
Published: January 2025

Background: The complexity of COVID-19 management increased as we further identified how the infection shifts human physiology response to infection. Reinfection is also a common occurrence in particular populations.
Case Presentation: We report a diagnosis of a 20-year-old male with COVID-19 and other diseases as comorbid. COVID-19 PCR has been confirmed on the first and second infection. The patient has not been vaccinated. Typical COVID-19 lab markers were also obtained. Beta-thalassemia suspicion was also obtained by blood smear evaluation and haemoglobin electrophoresis. The patient's insulin-dependent condition has also been identified with C-peptide, HbA1C, and insulin examination. The patient's condition was not improving despite optimal supportive treatment.
Conclusion: This case report showed that diabetes mellitus and beta-thalassemia might exacerbate inflammation and worsen the patient's condition and shows that unvaccinated individuals have worse responses to the second infection.
The Effectiveness of Manuka Honey in Increasing Osteoblasts and Chondrocytes and Reducing Osteoclasts in the Healing Process of Rabbit Mandibular Symphysis Fractures
Authors: Herjuno Ponti , Wibowo Maryono Dwi , Susilo Dwi Hari
Published: January 2025

Background: Mandibular fractures often occur in accidents or trauma. Healing of mandibular fractures can occur in 2 ways: primary and secondary healing. Honey has many benefits, such as anti-inflammatory and antimicrobial which are useful in healing wounds. This research wants to study the activity of Manuka honey in bone mandibular bone healing process as one of the alternative modalities to accelerate the bone healing process by increasing the number of osteoblasts and chondrocytes as well as reducing the number of osteoclasts in New Zealand White Rabbit.
Methods: This research is an experimental study with a randomized control trial study design involving New Zealand white rabbits that have been selected aged 6-9 months with a body weight of 1,900 grams to 2,500 grams and no visible anatomical abnormalities and taken from the laboratory animal unit of the Faculty of Veterinary Medicine, Airlangga University. In total, 16 rabbits will be involved in this study. Data analysis was performed using SPSS software.
Results: Regarding osteoblast parameters, the control group had a mean of 8.425, while the treatment group had a mean of 11.95 (p=0.004). Osteoclasts in the control group had a mean of 3.9, while the treatment group had a mean of 1 (p=0.001). In addition, the number of chondrocytes in the control group had a mean of 1.5, while the treatment group had a mean of 11.1 (p=0.000).
Conclusion: The application of Manuka Honey effectively increased the number of osteoblasts and chondrocytes and reduced the number of osteoclasts on day 14 of rabbit mandibular bone healing.
Comparison of remifentanil and fentanyl usage in outpatient endoscopic procedures
Authors: Kurniawan Nuri , Takdir Musba Andi M , Arif Syafri Kamsul , Salam Syamsul H. , Wirawan Nur Surya , Palinrungi, Ari Santri
Published: January 2025

Background: Endoscopic procedures in the gastrointestinal tract are associated with patient discomfort and pain, thus requiring analgesia to prevent this. The combination of propofol and fentanyl is frequently used for endoscopic anesthesia. However, in outpatients, the use of analgesia needs to be adjusted by choosing quick-acting analgesia. Remifentanyl has been reported to provide that fast-acting effect but has not been widely compared with other analgesia regimens. This analysis aims to compare the effectiveness of two µ-opioid agonists (fentanyl vs. remifentanyl) for endoscopic procedures.
Methods: This Analysis is a randomized, double-blind, controlled trial conducted on patients undergoing endoscopic procedures at RSUP Wahidin Sudirohusodo, Makassar, Indonesia. A total of 38 patients were equally divided into two groups: Group A (receiving remifentanyl + propofol) also Group B (receiving fentanyl + propofol). Onset, recovery, hemodynamic response, and mobilization time were recorded and compared. The data was then analyzed in SPSS version 25 software using independent sample T and Chi-square tests.
Results: Onset time, recovery time, also mobilization were faster in Group A than in Group B (p-value = 0.001). This group demonstrated similar mean arterial pressure and lower, more stable heart and respiratory rates compared to the fentanyl and propofol combination in outpatients undergoing lower gastrointestinal endoscopic procedures.
Conclusion: Remifentanyl provides faster recovery and mobilization effects compared to fentanyl in the management of outpatients undergoing endoscopic procedures.
Chemotherapy management of breast cancer patients according to the clinicopathological characteristics at Dr. Kariadi General Hospital, Semarang 2020-2022
Authors: Sidabutar Dwi Feris , Budijitno Selamat
Published: January 2025

Background: Breast cancer has different histopathological features and can be classified into two, namely invasive and non-invasive breast cancer. Management that can be given to breast cancer patients includes surgery (surgery), chemotherapy, radiation therapy, and hormonal therapy. This study aims to evaluate the chemotherapy management of breast cancer patients according to the clinicopathological characteristics at Dr. Kariadi General Hospital, Semarang 2020-2022.
Methods: A cross-sectional study was conducted among 45 patients at Dr. Kariadi General Hospital with a total sampling technique during 2020-2022. Several parameters assessed include age, gender, Body Mass Index (BMI), histopathology characteristics, differentiation grade, stage, immunohistochemistry subtype, and chemotherapy management. Data were analysed using SPSS version 25.0 for Windows.
Results: Most of the respondents >50 years age group (44.4%), followed by females (100.0%), obesity type II (48.9%), invasive ductal carcinoma (53.3%), grade 2 differentiation (77.8%), Stage II (A and B) (71.1%), Luminal B-type breast cancer (44.4%), and FAC (44.4%) as chemotherapy management. Pacli-Doxo was the predominant chemotherapy management in the invasive ductal carcinoma (24.4%) and Luminal B subtypes (31.1%) of breast cancer, followed by FAC chemotherapy in grade 2 (31.1%) and stage II (A and B) (24.4%).
Conclusion: Pacli-Doxo was the predominant chemotherapy management in the invasive ductal carcinoma and Luminal B subtypes of breast cancer, followed by FAC chemotherapy in grade 2 and stage II (A and B).
Comparison Of HbA1C Measurements Using Ion Exchange-High Performance Liquid Chromatography (IE-HPLC) Method On Biorad D10 Instrument With Tosoh HLC-723GX
Authors: Sutrisnani Catur Suci , Adisaputra Arnaz
Published: January 2025

Introduction: HbA1c has been established as a fundamental parameter in establishing a diagnosis of diabetes mellitus (DM). The Ion Exchange High-Performance Liquid Chromatography (IE-HPLC) method has been standardized by both the NGSP and DCCT. Numerous vendors offer NGSP-certified HbA1c IE-HPLC analyzers, necessitating meticulous evaluation by users to select instruments that are accurate, reliable, effective, and efficient in accordance with the specific requirements of their respective laboratories. This research was conducted to ascertain the comparative outcomes of HbA1c level assessments between the BioRad D-10 and Tosoh HLC-723GX instruments.
Methods: Using an observational cross-sectional approach, patients from inpatient and outpatient settings were consecutively sampled. IE-HPLC measured HbA1c from 5 cc EDTA blood samples on both instruments. The researcher calculated the coefficient of variance (CV) for the Tosoh instrument before comparing it with the D-10 instrument. Correlation tests, the coefficient of concordance, and Passing-Bablok regression were performed to compare the performance of these two instruments
Result: The results of the correlation test show that the Tosoh instrument has a strong correlation with the BioRad instrument in determining the HbA1c level, with r=0.979 (p=0.000). The coefficient of concordance analysis indicates strong agreement between the two instruments. Passing-Bablok regression results confirm that there is no significant difference in the HbA1c levels tested with both instruments.
Conclusion: The study revealed no significant disparity in performance between the BioRad D-10 and Tosoh HLC-723GX instruments concerning the determination of HbA1C levels.