bluuebunny/crossref_metadata_2025 huggingface dataset:
Penile Intraepithelial Neoplasia (PeIN) in a young man with the clinical appearance of Buschke Lowenstein Tumor
Authors: Wongkar Fiona , Sutrini Ni Nyoman Ayu
Published: May 2024

Background: The incidence of penile cancer in the general population is rare. Epidemiologically, penile cancer occurs less than 1% compared to other types of cancer. Penile Intraepithelial Neoplasia (PeIN) is a precancerous lesion of invasive squamous cell carcinoma characterized by dysplastic changes of squamous epithelium with the intact basement membrane. This case report aims to increase understanding of Penile Intraepithelial Neoplasia (PeIN), especially with the clinical appearance of the Buschke Lowenstein Tumor, diagnosis, examination, and appropriate management.
Case Presentation: A 21-year-old Balinese man presented with a lump on his genitalia without itching, pain, and a lesion that bleeds easily, which has appeared since January 2022. He complained that the lump was getting bigger and bigger. Physical examination showed multiple hyperpigmented papules and plaques with well-defined oval and corn shapes that vary in size with a dense consistency and a verrucous surface. Laboratory tests showed negative on Hep-B and HIV tests. The patient also had a biopsy of the lump where the results showed Penile Intraepithelial Neoplasia. The patient was treated with 6 cycles of TCA 80% once a week, but it did not improve, so circumcision and surgical excision were carried out on June 2022. Fourteen days after surgery, multiple lumps appeared, recurred, and increased in number and size. On 1-month observation after the second surgery, the patient denied complaints of the genitals. Venerological status was within normal limits.
Conclusion: HPV-related Penile Intraepithelial Neoplasia (Warty subtype) with the clinical appearance of Buschke Lowenstein Tumor was reported in a 21-year-old Balinese man treated with Glans Resurfacing surgical excision with satisfactory results characterized by no functional abnormalities both during urination or erection.
The significance of immunoexpression of Polo Like Kinase 1 (PLK1) in retinoblastoma
Authors: Kusuma Yan Adhitya , Fauziah Dyah , Rahaju Anny Setijo
Published: May 2024

Background: Retinoblastoma is an intraocular malignant neoplasm of retinal neurosensory origin and often occurs in childhood. The average global survival rate is less than 50%. An increase in the pT stage is associated with worse survival. Through its distinct protein-binding and phosphorylation activities, Polo Like Kinase 1 (PLK1) is essential in mitotic activity. PLK1 protein expression has been proposed as a novel prognostic marker for many cancers. This study aims to analyze the correlation between PLK1 with pT stages of retinoblastoma.
Methods: An observational analytic study with a cross-sectional approach was conducted on 56 formalin-fixed paraffin-embedded tissue of patients diagnosed with retinoblastoma from January 2016 - December 2020 in Dr. Soetomo General Academic Hospital, Surabaya. The samples were divided into four groups based on pT-stage retinoblastoma. Immunohistochemistry for PLK1 was applied to all models and evaluated semi-quantitatively using an immunoreactivity score.
Results: There were significant differences in PLK1 expression in each pT stage of retinoblastoma (p=0.000014). There was a significant correlation between PLK1 and the pT stage of retinoblastoma (p=0.0001).
Conclusion: The increase of PLK1 expression in retinoblastoma is associated with an increased pT stage. PLK1 plays a role in the proliferation of retinoblastoma tumor cells, hence increasing the pT stage.
The radiologic findings, positivity rate of culture method examinations, correlation with the type of lower respiratory secretion of adult pulmonary Tuberculosis (TB) patients
Authors: Yana Dewi , Mertaniasih Ni Made , Koendhori Eko Budi , Setiawati Rosy
Published: May 2024

Background: There are active and latent tuberculosis types, a global public health concern. Test confirmation is required to distinguish between active tuberculosis and nontuberculous mycobacterial infection. This study aims to evaluate the relationship between the type of lower airway secretion specimen, Mycobacterium tuberculosis positivity rate of MGIT-LJ, as well as the relationship between the Mycobacterium tuberculosis positivity rate in MGIT-LJ and radiological findings.
Methods: This study is cross-sectional with a prospective design. The sample is the result of the examination of the MGIT-LJ method and medical record data of patients suspected of Pulmonary TB at Dr. Soetomo Academic Hospital Surabaya Indonesia that meets the inclusion criteria, analysis of the culture results of MGIT-LJ method and radiological findings were carried out to assess the relationship between the character of sputum, the positivity rate of Mycobacterium tuberculosis and radiological findings.
Result: A total of 137 from June 2022 till November 2022 found 88 (64.2%) with spontaneous sputum, 6 (4,4%) aspirate ETT, and 43 (31.4%) BAL. The positivity rate of the MGIT-LJ culture method of the spontaneous sputum specimen to detect Mycobacterium tuberculosis was 20.5% higher than ETT or BAL specimens because the implementation of clinical indication to request MGIT-LJ culture method of ETT and BAL specimens is still confusing. The specificity of the chest radiography diagnostic test from all specimens type of 61.86%, with a weak accuracy rate.
Conclusion: In this study, the positivity rate of the MGIT-LJ culture method of the spontaneous sputum specimen to detect Mycobacterium tuberculosis was 20.5% higher than ETT or BAL specimens. Chest radiography has a weak accuracy level and must be complemented test with the culture method.
Clonidine premedication was better in preventing hemodynamic response changes post laryngoscopy and endotracheal intubation compared to fentanyl premedication
Authors: Wicaksono Satrio Adi , Nugroho Rio Kristian , Nugroho Taufik Eko , Sutiyono Doso , Leksana Ery , Utami Sulistiyati Bayu
Published: May 2024

Background: Airway control under general anesthesia can be performed using laryngoscopy and endotracheal intubation. Laryngoscopy and endotracheal intubation produce mechanical and chemical stimuli that increase sympatho-adrenergic activity, causing an increased hemodynamic response. Various pharmacological and non-pharmacological methods have been used to reduce the response of hemodynamic changes in laryngoscopy and endotracheal intubation, such as fentanyl and clonidine. This study aimed to compare the effectiveness of fentanyl and clonidine in reducing hemodynamic response changes after laryngoscopy and endotracheal intubation.
Methods: A double-blind randomized clinical trial was conducted on 48 elective surgery patients in the Surgical Installation of Dr. Kariadi General Hospital and Diponegoro National Hospital Semarang who were planned for laryngoscopy and endotracheal intubation procedures. Subjects were randomized and divided into 2 groups. Group 1 was administered with 2 µg/kgBW intravenous fentanyl premedication and group II was administered with 1 µg/kgBW intravenous clonidine premedication 5 minutes before the laryngoscopy and endotracheal intubation procedure. At baseline and at 1, 3, and 5 minutes after laryngoscopy and endotracheal intubation, the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded simultaneously.
Results: Both fentanyl and clonidine could maintain SBP, DBP, MAP, and HR within normal range. However, clonidine premedication seemed to be better in preventing hemodynamic response changes post-laryngoscopy and endotracheal intubation compared to fentanyl premedication. Clonidine premedication showed lower SBP, DBP, and MAP, but not HR, at the 1st and 3rd-minute post laryngoscopy and endotracheal intubation in comparison with fentanyl premedication (p<0.05).
Conclusion: If confirmed by further findings, clonidine premedication may be preferable to prevent hemodynamic changes after laryngoscopy and endotracheal intubation.
Low dose mannitol versus high dose mannitol to achieve brain relaxation in brain tumor surgery: a meta-analysis
Authors: Putra Gunna Hutomo , Haq Irwan Barlian Immadoel , Susilo Rahadian Indarto , Wahyuhadi Joni
Published: May 2024

Background: Brain edema is one of the common intraoperative problems in neurosurgery. Brain edema is usually treated by administering a hypertonic solution such as mannitol. Some studies mentioned the use of high-dose mannitol (> 1 g/kg), but it is important to note that mannitol has several drawbacks. This meta-analysis aims to identify the most effective mannitol dose to reduce intraoperative brain edema among brain tumor cases.
Methods: We searched for all randomized-controlled trials (RCTs) published in English, which compared various doses of mannitol for brain tumors published between 2010 - 2020. The studies should include adult patients with intracranial tumors who received mannitol to reduce brain edema before opening the dura mater. The primary and secondary outcomes are satisfactory brain relaxation and the need for additional treatment to achieve adequate relaxation, respectively.
Result: Three RCTs were identified using an agreed-upon search strategy. A total of 354 patients were included in the meta-analysis. Satisfactory brain relaxation occurred in 70 of 152 and 154 of 202 patients who received low-dose and high-dose mannitol, respectively (RR 0.64 (95% CI, 0.48 – 0.86, p=0.003). There were 59 of 152 and 71 of 202 patients who needed additional treatment to make the brain adequately relax (RR 1.33, 95 % CI 0.97 – 1.83, p=0.08).
Conclusion: A mannitol dose of ≥ 1g/kg achieves better brain relaxation. And it required fewer additional measures to relax the brain. These conclusions are drawn from low-quality evidence. Further research on the safety of high-dose mannitol is warranted to ensure its benefit outweighs its harm.
Which are the best in protecting the upper respiratory tract, KN95® or Acchadana®-herbal masks on IL-6 perspective?
Authors: Resti Ariani  , Awal Prasetyo  , Rina Puspita  , Fathur Nur Kholis  , Udadi Sadhana  , Ika Pawitra M  , Hermawan Istiadi
Published: May 2024

Background: In the new normal era, face masks are very important for everyday use. Masks began to be developed involving herbal plants with anti-inflammatory and antibacterial potential. This study aims to prove the potential of KN95 masks and Acchadana® Herbal Masks.
Methods: This randomized control trial has 50 laboratory workers as subjects. Subjects were divided into two groups. The control group wore KN95® masks (n=25), and the treatment group wore Acchadana® herbal masks (n=25, 1 dropout). Each group wore a mask for 60 days. Then a nasal wash sample was taken for a laboratory test for IL-6 levels using the ELISA method.
Result: There was no significant comparison of IL-6 levels between the KN95® mask group and the herbal mask group in the Mann Whitney test (p=0.242). When viewed from the high and low levels of IL-6 in the respiratory tract of laboratory workers after 60 days of wearing masks, IL-6 levels in the Acchadana® mask group experienced a greater decrease compared to the KN95 mask group. However, the protection of the two masks was not significantly different (KN95®= -0.604 pg/ml and Herbal= -1.026 pg/ml; p>0.05).
Conclusion: KN95® masks and Acchadana® herbal masks have equal ability to protect the respiratory tract.
Non-Hodgkin's lymphoma treatment in early pregnancy: dilemmas between risks and benefits
Authors: Musirroh Siti , Bintoro Siprianus Ugroseno Yudho
Published: May 2024

Background: Malignancy during pregnancy can cause medical complications and quandaries therefore it necessitates careful consideration of the risks and benefits of therapy for the mother's and fetus's safety, as well as the impact on the fetus's health and development. In this case report, we highlight important aspects of a pregnant woman with second trimester who had non-Hodgkin's lymphoma (NHL) receiving chemotherapy.
Case presentation: A 20-years old pregnant woman was referred to One-Stop Oncology Outpatient clinics (POSA) at Dr. Soetomo General Academic Hospital. The patient complained that during the first semester, the patient felt a lump in the right neck with the size of a marble (±1.5 cm), dense, supple, sticky, firm boundaries, and growing over time. The patient reported tired and nauseous almost every day, had lost 5 kg in one month, and also had night sweats. The patient slept in a sitting position to reduce complaints of shortness of breath and a feeling of chest tightening. Based on CT scan, cytology of fine needle aspiration biopsy (FNAB) and immunohistochemistry (IHC) examination the patient was diagnosed with NHL of right neck and mediastinum, stage IIB+ superior vena cava syndrome (SVCS) and microcytic hypochromic anemia. The patient was treated using the CHOP chemotherapy regimen, with doses based on body surface area: C (cyclophosphamide): 1.065 mg/iv, H (doxorubicin): 71 mg/iv, O (vincristine): 1.98 mg/iv and P (prednisone): 100 mg/day and discharged on the 13th day of the admission. However, four months after hospital admission, the patient had an obstetric ultrasound and the fetal had reduced heart rate. Pregnancy was terminated with a cesarean section resulting in a live baby with 2300 g body weight.
Conclusion: Chemotherapy on pregnant women should be considered after evaluating the benefits and negative effects for both mother and fetus. The consideration should be based on the evaluations from multidisciplinary aspects.
CYP1A1 rs464903 increased the risk of undifferentiated type nasopharyngeal carcinoma among the Balinese population
Authors: Nuaba I Gde Ardika , I Wayan Weta  , Wayan Suardana  , Desak Made Wihandani  , I Gede Putu Supadmanaba  , Ni Nyoman Shinta Prasista Sari
Published: May 2024

Introduction: Nasopharyngeal carcinoma is a tumor that arises from epithelial cells covering the surface of the nasopharynx. In terms of malignancy, NPC is number 1 in the OHNS and number 5 in Indonesia. Certain risk factors that can predispose an individual to NPC include an EBV infection, salted fish consumption, and smoking. Previous studies also show that the polymorphism of CYP1A1 rs4646903 affect the risk factor and mechanism of NPC incidence.
Methods: This is a case-control study conducted at Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar. The study used 62 samples. The sample then underwent DNA isolation and amplification using PCR and afterward, visualization, DNA sequencing, and analysis.
Results: Bivariate analysis shows that CYP1A1 have a significant relationship with NPC incidence with a p-value of 0.007 (OR: 1.48 ; 95% CI 4.87 (1.5-15.9)).
Conclusions: The polymorphisms of CYP1A1 rs4646903 is proven to be the risk factors in the mechanism of undifferentiated NPC among the Balinese population.
Unmet need for Family Planning (FP) in 7 national development areas in Indonesia
Authors: Musafaah Musafaah  , Tris Eryando  , Meiwita Paulina Budiharsana  , Martya Rahmaniati  , Hadrianti Lasari
Published: May 2024

Introduction:  Unmet need for Family Planning (FP) was conducted to measure the achievement of the FP program. Since decentralization, each region has the flexibility to implement certain policies according to regional needs, including family planning program policies. This study aimed to describe the unmet need for FP in 7 regions in Indonesia in 2018-2021.
Methods: This research is an ecological study using data derived from the National Population and Family Planning Agency Field Control Report in 2018-2021 and descriptively analyzed based on 7 development areas of the 2020-2024 National Medium-Term Development Plan. Unmet need for FP is the percentage of married couples whose wife is between the ages of 15 to 49 years and aren’t using contraception, those who still wanted children but have postponed it for up to 2 years and those who decided that they didn’t want any more children.
Result: The results showed that the unmet need for FP in the Nusa Tenggara, Kalimantan, Sulawesi, Maluku, and Papua regions continued to decline in 2018-2021. The largest decrease in unmet need for FP occurred in Papua (7.6%) while the smallest decrease occurred in Sumatra (0.9%).  
Conclusion: The magnitude of the decrease in the unmet need for FP varies by region. Region-specific FP program interventions are needed to increase the need for contraception in couples of childbearing age (EFA).
Comparison of trauma scoring system in predicting post-surgical fixation outcomes of traumatic rib fracture
Authors: Yasa Ketut Putu , Satria Raymen , Harta I Komang Adhi Parama , I Wayan Sudarma  , Semadi I Nyoman
Published: May 2024

Background: Several trauma scoring systems have been widely used to determine the prognosis of trauma patients, but their use for post-surgical fixation of traumatic rib fracture patients has not yet been reported. This study aimed to compare several trauma scoring systems in predicting post-surgical fixation outcomes of traumatic rib fractures.
Methods: A retrospective analytical study was conducted at a single tertiary hospital. Inclusion criteria were patients who suffered multiple rib fractures and were eligible for surgical rib fixation from January 2019 to July 2022. The outcomes of the study were the length of hospitalization (LHS) and intensive care unit stay (LICU), duration of thoracostomy tube insertion (DTT), the need for mechanical ventilation (NMV), and mortality post-surgery. The correlations of trauma scoring systems and measured outcomes were evaluated by bivariate and multivariate analysis. Cut-off values were determined utilizing a receiver operating characteristic curve.
Results: The study involved 110 patients. All measured trauma scores were significantly correlated with the measured outcomes. Injury Severity Score (ISS) performed better to predict LHS (p=0.004) and DTT (p=0.007). Revised Trauma Score (RTS) was a good predictor of LICU (p≤0.001) and NMV (p=0.001; OR=0.39). Thoracic Trauma Severity Score (TTSS) was independent predictor of mortality (p=0.015; OR=2.28) and the NMV post-surgery (p=0.047; OR=1.320).
Conclusion: Patients who have suffered severe thoracic trauma should be assessed using trauma scores, which may predict various in-hospital outcomes and should be used complementarily with other trauma scoring systems to minimize the incidence of mortality and morbidity.
Effectiveness of topical turmeric extract compared to topical zinc on fibroblast count and collagen density in clean-contaminated wound: a study on new zealand white rabbit
Authors: Walmiky Budi Made , Hariastawa Adria , Matulatan Fendy
Published: May 2024

Introduction: Wound dehiscence increased the average mortality and morbidity, patient care cost and health services. Therefore, a more effective and lower-cost therapy is needed for wound healing. Zinc is a trace element which is important in the wound-healing process, while curcumin is an active component of turmeric which can also help the wound-healing process. This study aims to compare the effectiveness of topical turmeric extract with topical zinc on fibroblast count and collagen density in clean-contaminated wounds in New Zealand white rabbits.
Material and Methods: This study was a randomized experimental study in 30 New Zealand white rabbits with clean contaminated wounds divided into 3 groups. One control group (treated with NaCl 0.9%) and two treatment groups (treated with topical turmeric extract and with topical zinc). Appendectomy was performed to all samples and surgical wounds were treated until day 4 postoperative. On the fifth day, histopathology observation at the edge of the surgical wound was done to see the fibroblast count using Haematoxylin Eosin staining and collagen density using Masson Trichrome staining.
Results: There was a significant difference in the number of fibroblasts between the control group (NaCl 0.9%), the topical zinc group and the topical turmeric extract group (Kruskal-Wallis p=0.000). The collagen density score also had significant differences in the three groups (Kruskal-Wallis p=0.003). Although the Mann-Whitney test in the topical zinc group and the topical turmeric extract group showed no significant difference in the collagen density score (p=0.074).
Conclusion: Topical administration of turmeric extract has been shown to affect the number of fibroblasts and collagen density in clean-contaminated wounds in New Zealand white rabbits, as well as topical zinc administration.
Development of preconceptions health modules in adolescents based on information and communication technology
Authors: Ani Luh Seri , Darmayani I Gusti Ayu Sri , Mogi I Komang Ari , Utami Ni Wayan Arya
Published: May 2024

Background: Preconception health is a behavioral and social health intervention for women and couples before conception occurs. Intervention starts from adolescence to improved health and readiness in pregnancy. This research is aimed at the development of preconception health modules for adolescents based on Information and Communication Technology (ICT).
Method: Qualitative study of exploration conducted on adolescents in the working area of Sidemen Health Center data collection was conducted in August 2020 against 4 informants consisting of 2 adolescents, 1 head of Public Health Center, and 1 obstetrician specialist. Data is collected by in-depth interview methods online. The data of the results of the study is analyzed thematically. 
Result: The results of the interview obtained 4 (four) themes that are preconception health problems in adolescents, the content of the material of modules, methods of dissemination of information and the place of preconception health services.  The teen had never heard of preconception health. Suitable materials presented in the preconception health module in adolescents are the introduction of reproductive devices, menstrual cycles, pregnancy cycles, premarital screening preparations, and preconception health interventions. Preconception health services are provided in private health services, hospitals and public health centers. Nevertheless, preconception health services in adolescents have not been optimally provided. Precisely the media chosen in the dissemination of knowledge about preconception health is face-to-face, lectures, video and book.
Conclusion: Based on this, it can be concluded that this module is expected to improve the teen's knowledge of preconception health.
Helicobacter pylori detection in gastric biopsy: immunohistochemistry and toluidine blue comparison
Authors: Paramita Ayu Lidya , Setiawan Firman , Sandhika Willy , Mertaniasih Ni Made , Kawilarang Arthur Pohan , Utomo Budi
Published: May 2024

Link of Video Abstract: https://youtu.be/E3KoLryYLng
 
Background: Helicobacter pylori is a bacterium often found in the stomach and can cause several diseases, including gastritis, gastric ulcers, MALT-lymphoma, and gastric carcinoma. An invasive and direct gastric biopsy is a more appropriate way to see the presence of these bacteria. Microscopy of Helicobacter pylori on gastric biopsy specimens can be seen using several tissue stains. This study aimed to analyze the concordance of immunohistochemistry and toluidine blue tissue stain results on gastric biopsies in detecting Helicobacter pylori at Dr. Soetomo Hospital.
Methods: This study was a retrospective study with a cross-sectional design to detect Helicobacter pylori in paraffin-block of gastric biopsy specimens at Dr. Soetomo Hospital, Surabaya. Each sample would be stained by immunohistochemistry and toluidine blue. Data were analyzed using SPSS version 25 for Windows.
Results: Helicobacter pylori have been found in all 45 samples by immunocytochemical staining and in 66.67% of them by toluidine blue staining. The Kappa test indicated a significant difference between immunohistochemical staining and toluidine blue (p=0.000; p<0.05).
Conclusion: There are significant differences between the two methods for detecting Helicobacter pylori in gastric biopsy. Their concordance is at 66,67%. Some factors should be considered for the future routine process.
The important role of multi-sector partnership in stunting management in east java: a literature review
Authors: Dini Setiarsih  , Sa'bania Hari Raharjeng  , Rizki Nurmalya Kardina  , Paramita Viantri  , Fildzah  , Pratiwi Hariyani Putri  , Achmad Syafiuddin  , Rizki Amalia  , Karina Widowati
Published: May 2024

In order to integrate cross-sectoral activities in stunting prevention, the East Java provincial government developed a Regional Action Plan for Food and Nutrition (RAPFN). The integration of multi-sectoral activities is predicted to be leveraged in stunting prevention. This study aims to obtain an overview of the important role of multi-sectoral partnerships in stunting prevention in East Java. This study is a literature review with the stages of problem formulation, literature search, data extraction and data analysis and interpretation. The results of the search and study show that the East Java Provincial Government partnerships are carried out with non-governmental institutions, including universities, civil society organizations, companies, and the community itself. Partner universities include Universitas Nahdlatul Ulama Surabaya, Universitas Airlangga, and Universitas Jember. Partners from civil society organizations include various non-profit organizations coordinated in one program such as Micronutrient Supplementation for Reducing Mortality and Morbidity (MSRMM), initiated by Nutrition International and organizations with their programs. Partners from private companies are also under the direction of the government and among them is a program coordinated by PT Indofood Sukses Makmur Tbk. With the diverse backgrounds of partners, the programs that are run can vary but remain integrated with the direction of the government. The government's partnership with non-government institutions is expected to be a leverage to accelerate stunting reduction.
Thyroid storm in a postpartum and uncontrolled graves' disease patient: the challenges of accurate and multidisciplinary disease management
Authors: Fatih Raditya Rahma , Novida Hermina
Published: May 2024

Background: Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although pregnancy hyperthyroidism is a relatively uncommon, thyroid crisis is a medical emergency caused by hyperthyroidism exacerbation with symptoms of organ decompensation in one or more organs. Therefore, managing this disease in pregnant women is critical as well as the safety of using antithyroid drugs for pregnant women and the foetus.
Case presentation: A 26-year-old woman presented to the Dr Soetomo General Academic Hospital Surabaya, Indonesia with complaints of shortness of breath that had worsened one hour before the admission as well as sudden fever, diarrheal, anxiety, and decreased consciousness. The patient had hyperthyroidism for three years, and the controls were inconsistent. The patient was diagnosed with P1101 postpartum day 1, thyrotoxicosis due to Graves' disease, thyroid crisis, hypertension, microcytic hypochromic anemia, hypoglycemia, hypoalbuminemia, keratitis, and lagophthalmos. The patient was treated with supportive therapy with an oxygen mask 8 liters per minute (lpm), intravenous fluids, and antipyretic acetaminophen 500 mg every 8 hours. Propylthiouracil 400 mg loading dose followed by maintenance 6x100 mg, 8 drops of Lugol's solution after propylthiouracil administration, intravenous (IV) dexamethasone 2 mg every 6 hours, and oral propranolol 20 mg every 6 hours. The patient was discharged from the hospital after presented favorable improvement.
Conclusion: This case demonstrates that the stage of the disease determines the management of Grave's disease during pregnancy, and that multidisciplinary involvement could improve the success and reduce the patient mortality.
Comparison between the time to detection of pathogenic and nonpathogenic microorganisms from blood culture specimens using the BACTECTM FX machine to determine the optimal incubation time
Authors: Dewi Yana  , Widodo Agung Dwi Wahyu , Pepy Dwi Endraswari
Published: May 2024

Introduction: Bloodstream infections can lead to a high rate of life-threatening sepsis, morbidity and mortality, requiring early and accurate detection. The gold standard for diagnosing bacteremia is blood culture. The recommended incubation time of blood cultures is five days minimum, but studies have shown that five-day incubation is unnecessary. This study aims to determine the optimal blood incubation time on the BACTECTM FX machine.
Methods: This is an analytic observational study with a cross-sectional retrospective approach. The samples resulted from tests in the Clinical Microbiology Laboratory and medical record data of patients at Dr. Soetomo Regional Public Hospital, Surabaya, with suspected bacteremia and fungemia-positive blood cultures based on tests with the BACTECTM FX machine who met the inclusion criteria. Samples were analyzed for Time to Detection (TTD) and identification results. TTD of 96–120 hours was analyzed to assess the occurrence of Laboratory-Confirmed Bloodstream Infection (LCBI).
Results: From a total of 2,221 samples, 875 (39.4%) pathogenic microorganisms and 1,346 (60.6%) nonpathogenic microorganisms were identified. At TTD < 24 hours, the number of pathogenic microorganisms was higher, reaching 86.6%, than that of nonpathogenic microorganisms, reaching 68.8%. Whereas at TTD of 24–< 48 hours, nonpathogenic microorganisms had a higher count, reaching 23.1%, than pathogenic microorganisms, reaching 10.1%. A total of 2,203 (99.2%) microorganisms were identified at TTD < 96 hours, and as many as 18 (0.8%) microorganisms with TTD > 96 hours.
Conclusion: There is no difference in the distribution of pathogenic and nonpathogenic microorganisms at TTD < 96 hours and TTD 96–120 hours. Based on tests using the BACTECTM FX machine, five LCBI-group microorganisms based on NHSN criteria were found with TTD of 96–120 hours, namely Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Trichosporon asahi, and coagulase-negative Staphylococcus, and thirteen non-LCBI-group microorganisms were identified.
Relationship between angiopoietin-like-protein-2 levels and anti-mullerian hormone levels in polycystic ovary syndrome of reproductive age
Authors: Dyan Asih Rachmawati  , Ashon Sa’adi  , Budi Utomo  , Arif Tunjungseto
Published: May 2024

Introduction: Polycystic Ovary Syndrome (PCOS) is the most prevalent metabolic disease affecting reproductive-age women and is often present with insulin resistance. Angiopoietin-like-protein-2 (ANGPTL2) is an angiogenic factor influencing insulin resistance in PCOS, manifesting in the anti-mullerian hormone (AMH). There are no previous studies regarding the relationship between ANGPTL2 levels and AMH in PCOS. The study aims to analyse the relationship between ANGPTL2 and AMH levels in PCOS and to compare ANGPTL2 and AMH levels between PCOS phenotypes.
Methods: This cross-sectional study on 43 women aged 18-40 diagnosed with PCOS according to the Rotterdam criteria. Subjects were recruited consecutively and categorized into four PCOS phenotypes. Serum levels of ANGPTL2 and AMH were measured and analysed by correlation and comparison test using SPSS 26.
Results: A total of 43 PCOS samples were included in the study within 4 months. Based on the severity, phenotype A (anovulation, hyperandrogenic and polycystic ovaries) showed the highest levels of ANGPTL2 and AMH. There was no significant difference in ANGPTL2 levels between the PCOS phenotypes. There was a significant difference in AMH levels between phenotypes, where the highest value was between phenotypes A and B. There was a positive correlation between ANGPTL2 and AMH levels.
Conclusion: There is a positive relationship between ANGPTL2 and AMH serum levels. The ANGPTL2 serum levels were not significantly different. In contrast, the AMH serum levels significantly differed across the four PCOS phenotypes, with the highest level found in phenotype A.
Acute Lymphoblastic Leukemia (B-ALL) with co-expression of CD33 and CD13
Authors: Kustiah  , Hernaningsih Yetti
Published: May 2024

Link of Video Abstract: https://www.youtube.com/watch?v=AC472eZBXII
 
Background: Most acute leukemias can be classified into myeloid or lymphoid strains based on the expression of several specific phenotypes. However, some cases of acute leukemia express both phenotypes (myeloid and lymphoid phenotypes). To establish the diagnosis of acute leukemia with co-expression of myeloid markers or mixed phenotype acute leukemia (MPAL), we need a system that can differentiate between the two, namely by using the scoring system from The European Group for the Immunological Characterization of Leukemias (EGIL) and The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues 2016.
Case Presentation: A 10-year-old boy was admitted to the hospital because of repeated nosebleeds for 3 weeks before entering the hospital. Patients also complain of decreased appetite, nausea, vomiting, and joint pain. On physical examination, anemic conjunctiva was found, and no abnormalities were found on other physical examinations. Hemoglobin examination: 8.2 g/dl, leukocytes 112.10×103/µl, platelets 10×103/µl. Examination of peripheral blood smear: acute lymphoblastic leukemia. Examination results of bone marrow aspiration acute lymphoblastic leukemia (ALL L1). Immunophenotype analysis found blast cells with positive expression for CD34, CD79a, CD10, HLA-DR, CD33 and CD13.
Conclusion: The diagnosis in this patient was B-ALL with myeloid marker co-expression based on the EGIL and WHO scoring systems.
Risk factors and clinical outcomes of ventilator associated pneumonia in neonates in the Neonatal Intensive Care Unit of Dr. Soetomo Hospital Surabaya
Authors: Ratna Deni Widya , Ni Made Mertaniasih  , Risa Etika  , Pepy Dwi Endraswari  , Naritha Vermasari
Published: May 2024

Link of Video Abstract: https://youtu.be/Si_Vw_cWchk
 
Introduction: Ventilator-associated pneumonia (VAP) is a hospital-acquired infection in mechanical ventilation for more than two consecutive days, resulting in increased mortality and treatment costs. This study aimed to analyse the risk factors and clinical outcomes of neonatal with ventilator associated pneumonia in the neonatal intensive care unit (NICU).
Methods: A case-control study was conducted on neonates who had mechanical ventilators installed for more than two consecutive days, from January 2020 to December 2021, at Dr. Soetomo Hospital, Surabaya. The risk factors studied were duration of stay in the NICU, reintubation, duration of ventilation before VAP, rate of prematurity, low birth weight, enteral feeding, and underlying disease. The clinical outcomes studied were the duration of hospital stay and the total ventilation duration.
Results: The study subjects were 135 neonates consisting of 45 cases of VAP and 90 non-VAP. Significant risk factors were duration of NICU stay (p<0.001), duration of ventilation before VAP (p=0.002), and rate of prematurity (p=0.024). Multivariate analysis found no independent risk factors for VAP. Hospital stay duration (p<0.001) and ventilation duration were significantly correlated with the incidence of VAP (p<0.001).
Conclusion: Risk factors for neonatal VAP were the duration of NICU stay, duration of ventilation prior to VAP occurrence, and degree of prematurity. The impact of VAP was longer   duration of hospitalisation and duration of ventilation.
Bacteriocin potency test of lactic acid bacteria (LAB) isolated from rumen of Bali cattle against low pH and bile salt
Authors: Suharsono Hamong , I Wayan Suardana  , Komang Januartha Putra Pinatih
Published: May 2024

Background: Lactic acid bacteria (LAB) are a group of probiotic bacteria, which are not at risk and can even have a positive impact on human and animal health. As a source of probiotics, the application of these bacteria must be resistant to environmental conditions such as resistance to low pH and gastrointestinal bile acids. This study aimed to determine the probiotic potential of lactic acid bacteria isolated from the rumen and colon of Bali cattle by testing their resistance to low pH and bile salts.
Methods: The study began with the cultivation of isolates from the rumen and colon of Bali cattle including growth on liquid MRS media, catalase test, and Gram staining. The second stage involved testing the isolate's resistance to low pH (pH 2, 3, and 4) and testing NaDC with concentrations of 0.2 mM, 0.4 mM, and 0.6 mM.
Results: Tests showed that of the 10 isolates from Bali cattle rumen tested, it was found that all had high tolerance at low pH, namely growing well at pH 2 and NaDC levels up to 0.6 mM. The results obtained corroborate the results of previous studies on the resistance of lactic acid bacteria isolates from the gastrointestinal tract of Bali cattle to low pH and bile salt levels as a condition for application as a probiotic.
Conclusion: The resistance of the isolate to low pH and NaDC shows that LAB isolates from the rumen of Bali cattle have the potential to be used as a reliable source of probiotics.
Effectiveness of Small Group Discussions (SGD) to Improve Learning Outcome and Critical Thinking in Medical Student: a Literature Review
Authors: Darmayani I Gusti Ayu Sri
Published: May 2024

The challenges in the health sector are getting tougher with the opening of the ASEAN Economic Community. Health workers do compete not only domestically but also abroad. To create Indonesian health workers who have good knowledge and skills, think critically, and can make good use of technology, the education process since undergraduate must be continuously improved. Various innovations have been made to form graduates who can compete in the future, including implementing SGD. This review aims to assess the effectiveness of SGD in improving student learning outcomes and critical thinking. The method in this study was a literature review, with 16 articles that met the inclusion criteria. A review of several studies found that SGD can improve medical students' learning outcomes and critical thinking if the process is carried out effectively.
The difference of depression level in pregnant women based on the acceptance of pregnancy during the COVID-19 pandemic: a study on pregnant women in Bontang, East Kalimantan
Authors: Wijaya I Putu Satrya , Wihastuti Titin Andri , Wiyasa I Wayan Arsana , Effendi Muhammad Chair
Published: May 2024

Background: Antenatal depression in pregnant women becomes less of a concern, leading to the worse condition of developing postpartum blues, ranging from moderate to severe degrees. In this study, antenatal depression was detected as a psychosocial impact on pregnant women, and their perspective on accepting pregnancy may alter due to the COVID-19 pandemic.
Methods: This study used a cross-sectional study design. A total of 257 pregnant women were enrolled in this study with a purposive sampling technique. Inclusion criteria: healthy pregnant women (over 18 years) from trimester I until trimester III. Antenatal depression was measured using a PHQ-9 scale questionnaire. Data were analyzed using SPSS version 20.0 for Windows.
Results: The prevalence of antenatal depression of 257 pregnant women was: 80.95% had mild depression, 14.12% had moderate depression, 4.69% had moderate or severe depression, and 0.79% had severe depression. The factor analysis results indicated that refusal of pregnancy had the highest correlation coefficient (coef. 0.586; p=0.000) on the incidence of antenatal depression compared to the history of abortion, parity, financial deficits, and conflicts with partners. During the assessment, pregnant women who reported refusal of their pregnancy felt that their pregnancy was a burden because it occurred at a challenging time.
Conclusion: Changes in psychosocial status through determinants of antenatal depression in pregnant women in East Kalimantan during the COVID-19 pandemic are expected to be the initiation of policy and antenatal depression screening formulation for each pregnant woman and mental health improvement during pregnancy.
Correlation between burnout and patient safety culture on nurses at private hospital in Yogyakarta, Indonesia
Authors: Febriani Rizky Amelia , Musharyanti Lisa
Published: May 2024

Introduction: The high workload of nurses can cause burnout. Burnout can occur if the number of patients admitted does not match the number of available nurses and facilities, and occurs for a long time. Burnout in nurses causes a lack of attention to the application of patient safety culture. This study aims to find out the correlation between burnout and patient safety culture among nurses at Private Hospital in Yogyakarta.
Methods: Research design was descriptive cross-sectional method. There were 58 nurses, acquired by total sampling technique. We used the MBI-questionnaire to measure burnout levels and the HSOPSC questionnaire to measure patient safety culture.
Results: The results of this study indicate that the burnout level is low as many as 58 people (100.0%), patient safety culture is fairly good as many as 41 people (70,7%) and burnout has a negative effect on patient safety culture, but has no significant relationship (p 0,200 and r -0,171).
Conclusion: The burnout level of nurses is in low category, the patient safety culture of most nurses is fairly good and burnout has a negative effect on patient safety culture, this is because when burnout is felt by an individual, it will affect all individual activities both physically and mentally. Nurses are expected to be able to manage the workload so that they can avoid burnout and cooperate with hospital management to improve patient safety culture.
The activity of Matrix Metalloproteinase-2 (MMP-2) and Tissue Inhibitors of Metalloproteinase-2 (TIMP-2) that are associated with the degree of endometrioma tissue invasion transplanted onto the Chorioallantoic Membrane (CAM)
Authors: Tri Agung Wahyu Cahyono  , Shofwal Widad  , Cahyono Hadi  , Agung Dewanto  , Riris Jenie
Published: May 2024

Background. One of the fundamental pathogenesis of endometriosis to grow and develop is to carry out a cellular invasion of the surrounding tissue where it attaches. The invasion process of endometriotic focus is linked with the activity of matrix metalloproteinases-2 (MMP-2) and tissue inhibitors of metalloproteinases-2 (TIMP-2). In this study, we used endometrioma tissue to be implanted in chick chorioallantoic membrane (CAM) as a medium culture model to reconstruct and evaluate the invasion process of endometriosis. Then the MMP-2, TIMP-2 and invasion pattern can be invitro observed.
Methods. Endometrioma tissue fragments were taken from ovarian endometrioma patients, reproductive age, no medication and no malignancy who underwent laparoscopic surgery. Sample research was taken in consecutive and non-probability sampling. The tissue fragments were divided into 4-8 strips, each dimension of 2 x 2 mm2. Two strips were assessed for the activity of MMP-2. Two remaining strips were transplanted onto the CAM. After incubation for five days, the transplanted tissues were harvested for assessment of MMP-2 by gelatin zymography, TIMP-2 by western blot and histological assessment by hematoxylin-eosin staining. The assessment was carried out by two qualified biologists as an observer.
Result. Twenty-four fragments of endometrioma have been collected from 24 endometrioma patients who underwent laparoscopy surgery. The average age was 31±5 years, the BMI was 22±3 kg/m2, the duration of infertility was 58 ± 3 months, and r-ASRM was 67±35. In CAM of transplanted endometriomas tissue, MMP-2 activity was positively correlated with TIMP-2 in a moderate relationship (rô = 0.56, p-value < 0.05), very weak positive correlation with invasion level (rô = 0.08, p-value >0.05). TIMP-2 expression was negatively correlated with invasion level in a strong relationship (rô = -0.35, p-value <0.05). The ratio between MMP-2/TIMP-2 was positively correlated with invasion level in a very strong relationship (rô = 0.72, p-value < 0.05). ICC (intraclass correlation coefficient) value was 0.96, and p-value= 0.01, CI 95%. It shows that there was high reliability between observers.
Conclusion. The invasion level of endometrioma transplanted onto CAM was determined by the balance between MMP-2 and TIMP-2.
Evaluation of the severity of striae distensae using the new scoring system
Authors: Amal Alviera Yuliandra , Putra Imam Budi , Jusuf Nelva Karmila , Nasution Khairina
Published: May 2024

Background: Striae distensae (SD) is a harmless skin disorder that can cause cosmetic and psychological problems. Until now, no easy-to-use, useful and non-invasive method can be used to determine the severity of SD. The scoring system can be used as a guide for selecting and administering effective therapy for striae distensae. This study aimed to assess the severity of striae distensae using INA score.
Methods: This research was a descriptive observational study with a cross-sectional approach involving 72 female health workers at the Universitas Sumatera Utara Hospital. The diagnosis of stretch marks is made through history and physical examination. We did the whole body examination for scoring of striae distensae. This research has been approved by the Research Ethics Commission of the Universitas Sumatera Utara.
Results: A new scoring system, namely the INA score, to assess the severity of striae distensae at the mammae, axilla, abdomen, femoral, gluteus, and popliteal locations. The assessment of the INA score based on the entire region of the study subjects was obtained at a mild degree (54.2%). The characteristics of majority of the subjects were in the age range of 18-25 years (93.1%) and had a family history of striae distensae (54.2%). The distribution of the majority of striae distensae locations is in the femoral and gluteus region (47.2%). Based on each region, the majority of the subjects had striae distensae with severe degree in the mammae (20.8%), abdomen (8.3%), femoral (90.3%), gluteus (94.4%), and popliteal (22.2%);. In comparison, the axilla was dominant with a moderate degree (5.5%).
Conclusion: The new scoring system named INA score assesses the severity of striae distensae at the mammary, axillary, abdominal, femur, gluteus and popliteal locations.