bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of self-control and sociability capability of medical students: A multi-year study in Bali, Indonesia
Authors: Manuaba Ida Bagus Amertha Putra , Made Violin Weda Yani  , I Putu Gede Septiawan Saputra  , Ida Ayu Widya Anjani  , Gede Setula Narayana  , I Gede Putu Supadmanaba  , I Gusti Ayu Sri Darmayani
Published: January 2025

Introduction: Emotional intelligence (EI) is often defined as the ability to perceive, express, understand, and manage emotions and consists of several components. The ability to identify and control one's emotions, including self-control and sociability is well-known as the component of EI. Self-control ability can be used as a predictor of symptoms arising from mental instability, ranging from anxiety to depression, among medical students. The higher self-control can benefit medical students due to its positive correlation with academic achievement and clinical skills. This study aims to explore the association between self control with sociability among medical undergraduates.
Method: This cross-sectional study was conducted in the Faculty of Medicine, Udayana University, from August until October 2023. It compared the self-control and sociability capability of first, second, third, and fourth-year medical students at Udayana University. The data was collected using the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF). Data analysis was carried out using SPSS ver. 25.
Result: This research collected 312 samples of 1st – 4th year medical students. The self-control dimension showed a fluctuation trend of self-control during medical student, where the highest was observed in the 3rd year (26,83±4,06) and then slightly decrease in 4th year (25,79±3,90). The Same result also observed regarding sociability skill, where there was an uptrend from the baseline 20,50±3,32 in 1st year and 21,12±3,65 in 4th year medical student. Still, it was also no significant differences (p>0.05).  Post-hoc analysis of the overall level of emotional intelligence as assessed by the self-control and sociability dimension showed no significant association with different grades (p<0.005).
Conclusion: Self-control and sociability dimension showed that there was no significant association.
Intrauterine insemination and in vitro fertilization in serodiscordant couples with HIV-negative female partners
Authors: Gita Pratama  , Yunihastuti Evy , Wiweko Budi , R Muharam  , Harzif Achmad Kemal , Maidarti Mila , Lestari Silvia Werdhy , Ezekia Kevin
Published: January 2025

Introduction: Couples with HIV-infected male and non-HIV-infected female partners, also known as HIV serodiscordant couples, have a greater risk in planning a pregnancy. Assisted reproductive technology (ART), such as intrauterine insemination (IUI) and in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI), is considered efficient in minimizing the risk of HIV transmission to female partners who are not infected with HIV; however, the success rate of ART in HIV serodiscordant couples remains unclear. This study aims to determine the success rate of using IUI and IVF-ICSI in serodiscordant couples with HIV-negative female partners at the Reproductive Cluster of Dr. Cipto Mangunkusumo Hospital (RSCM) Kencana, Jakarta, Indonesia.
Patients and Methods: This study is a descriptive observational study with a retrospective design. Data were obtained through the medical records of serodiscordant couples with HIV-negative female partners who underwent IUI and IVF-ICSI in the Reproductive Cluster of RSCM Kencana (2016-2020).
Results: A total of 47 serodiscordant couples with HIV-negative female partners were included in this study, among whom 31 couples underwent IVF-ICSI and 17 couples underwent IUI. Out of 31 couples undergoing IVF-ICSI, 17 (54.8%) patients had singleton pregnancies, and 4 (12.9%) patients had multiple pregnancies. Of 16 serodiscordant couples undergoing IUI, 3 (17.6%) patients had singleton pregnancies, and none of them had multiple pregnancies.
Conclusion: This study demonstrates that both IVF-ICSI and IUI are considered effective for serodiscordant couples with HIV-negative female partners in achieving pregnancy, as their pregnancy rates were similar to those in HIV-negative couples.
High-fat diet combined with streptozotocin in creating diabetic achilles tendinopathy models in Sprague-Dawley rats
Authors: Oesman Ihsan , Dilogo Ismail Hadisoebroto , Antarianto Radiana Dhewayani , Siregar Nurjati Chairani , Pasaribu Merci Monica , Wuyung Puspita Eka
Published: January 2025

Introduction: Streptozotocin (STZ), a widely used diabetogenic agent, induces diabetes in animal models, yet crucial details like its preparation and dosage are often overlooked. We induced diabetic Achilles tendinopathy in rats using streptozotocin and excess body fat, assessing Transforming Growth Factor-beta (TGF-β) and interleukin-6 (IL-6) blood levels. This study aimed to create diabetic Achilles tendinopathy model in Sprague-Dawley rats using combination of high-fat diet (HFD) and streptozotocin.
Methods: In this study, 8 male Sprague-Dawley rats were divided into control group (containing 2 rats), 26 g/kgBW of STZ dose group, and 30 g/kgBW of STZ dose group (each containing 3 rats). Over 8 weeks, they underwent a high-fat diet and daily 55% fructose administration. Achilles tendon tissue was histopathologically evaluated using the Bonar score after formalin preservation. Blood serum was analyzed via ELISA to reveal TGF-β and IL-6 levels.
Results: A significant difference in mean Bonar Scores can be observed among the three groups (p = 0.004), despite having no significant results in the post-hoc analysis. However, analysis of TGF-β and IL-6 each did not yield significant results with p = 0.402 and p = 0.236, respectively. Combining HFD, which induces insulin resistance, with low-dose STZ injections, which cause early-cell dysfunction, permits the development of an animal model of T2D. Combining HFD with low-dose STZ injections produces an effective T2D animal model with significant Bonar Score outcomes. The Bonar Score revealed substantial tendon damage in the STZ 26 and STZ 30 treatment groups.
Conclusion: Doses of 30-35 mg/kg of STZ are commonly used, with successful T2D induction observed at lower doses of 15-30 mg/kg in various rat models. The tendon evaluation scale revealed significant damage in the STZ 26 mg/kg and STZ 30 mg/kg groups, confirming the efficacy of this T2D model despite the insignificant result in TGF- β and IL-6 analysis.
Comparison of one-stage and two-stage surgery on quality of life and recurrence rate of stage III left colon cancer patients at Dr. Soetomo General Hospital, Surabaya
Authors: Setyaningrum Aisyah Dewi , Danardono Edwin , Wibowo Marjono Dwi
Published: January 2025

Introduction: Colorectal cancer is the most common malignancy of the gastrointestinal tract and ranks third in cancer incidence. The primary treatment for colorectal cancer is surgery. One-stage surgery is usually done only by resection. Two-stage surgery is done with decompression with a stoma, then planned resection of the tumor at the second stage. This research aims to compare one-stage and two-stage surgery on the quality of life and recurrence rate of colorectal cancer patients.
Methods: This research is an observational retrospective cohort study of stage III colorectal cancer patients who experienced acute abdomen and underwent surgery at Dr. Soetomo General Hospital,  Surabaya, from January 2017 to May 2022. The total sample is 40 patients; 20 patients underwent one-stage surgery, and 20 patients had two-stage surgery.
Results: Stage III colorectal cancer patients who underwent two-stage surgery had an average quality of life better than those single-stage surgeries (68.16 ± 0.88 vs  64.61 ± 0.44) but with no statistically significant relationship (p = 0.187). Stage III colorectal cancer patients who underwent two-stage surgery had a recurrence rate 10% lower than single-stage surgery 40% but with no statistically significant relationship (p = 0.36).
Conclusion: Although not statistically significant, stage III colorectal cancer with acute abdomen who underwent two-stage surgery had a better quality of life and lower recurrence rate compared to patients who underwent two-stage surgery.
Manifestation spectrum of pulmonary metastasis from gynaecological cancer in 2068 subjects over 5-years-observation: what radiologist should consider?
Authors: Sadono Ratya K , Mardiyana Lies , Tjokroprawiro Brahmana A , Wulandari Laksmi
Published: January 2025

Introduction: Gynaecologic cancer can disseminate to distant organs, such as the lungs, represented by various metastatic patterns. Cytology may aid in detecting metastasis; however, the reported false negative rate is considerably high. Lung biopsy is not always readily accessible, depending on the patient's general condition. Moreover, tumour biomarkers may assist in diagnosing cancer, although not applicable in several types of cancer. In such a situation, radiology plays a substantial role in detecting, characterizing, and restaging the metastatic findings in the thoracal cavity.
Methods: We collected 2068 medical records of patients with gynaecologic cancer between January 2017 and November 2021, supported by histopathologic results from a preoperative sampling method or surgical biopsy during operation. Primary data were extracted from the documents along with the chest radiographs and evaluated using a retrospective descriptive manner.
Results: Four hundred and thirty patients with metastasis findings were assessed. Pleural effusion dominated the metastatic patterns in ovarian cancer; lymphangitic feature in uterine cancer with adenocarcinoma histology and pleural effusion in clear cell cancer; lymphangitic feature in squamous cell carcinoma cervical cancer and pleural effusion in adenocarcinoma; solitary nodule, lymphangitic feature, and pleural effusion in vaginal cancer with squamous cell carcinoma histology; lymphangitic feature in squamous cell carcinoma vulval cancer; and multiple nodules in malignant trophoblastic disease.
Conclusion: Lung metastasis behaviour of gynaecologic cancer can vary widely from pleural effusion to multiple nodules. Radiologists and clinicians are to distinguish those patterns to facilitate diagnosis.
Reduced levels of apoptosis observed in the placenta accreta spectrum
Authors: Pahlevi Deyna Primavita , Attamimi Ahsanudin , Hariyanto Didik Setyo
Published: January 2025

Background: Genetic expression changes associated with trophoblast cell apoptosis regulation have been proposed to play a role in the occurrence of the placenta accreta spectrum (PAS). This study aims to evaluate the BAX (pro-apoptosis) and BCL-2 (anti-apoptosis) gene expressions at the mRNA level, BAX/BCL-2 ratio, and cycle threshold (CT) value of DNA fragmentation (apoptosis index) in PAS.
Methods: The mRNA expression of BAX and BCL-2 was quantified using quantitative real-time polymerase chain reaction (qRT-PCR) from placental histopathology tissue of patients diagnosed with PAS (n = 30) and compared to normal pregnancies (n = 30). Cell apoptosis assays by examining DNA fragmentation through the CT value were performed using the ligation-mediated real-time PCR (LM-RT-PCR) method. Spearman correlation was performed for statistical analysis.
Results: The BAX and the BAX/BCL-2 ratio were significantly higher (P < 0.001) in the normal pregnancy group compared to the PAS group. In contrast, BCL-2 expression and the CT value of DNA fragmentation were higher in the PAS group than in the normal pregnancy group. There was a moderate positive correlation between BCL-2 expression and CT value of DNA fragmentation (r = 0.415). However, the correlation between BAX expression and BAX/BCL-2 ratio with CT value of DNA fragmentation showed a weak negative correlation, although not statistically significant (P > 0.05).
Conclusion: This study provides new insights into the molecular mechanisms in PAS. There is a decrease in pro-apoptosis genes, an increase in anti-apoptosis genes, and an increase in the CT value of DNA fragmentation, indicating apoptosis decrease in PAS.
The effect of exposure to electro-capacitive cancer treatment on JNK2α2 expression and the number of glioblastoma cells
Authors: Parenrengi Muhammad Arifin , Haq Irwan Barlian Immadoel , Wahyuhadi Joni , Darlan Ditto , Utomo Budi , Purwati  , Taruno Warsito Purwo
Published: January 2025

Background: Glioblastoma is a malignant primary brain tumor most commonly found in primary astrocytoma, accounting for 60% of all brain tumors in adults. Membrane receptors on the glioblastoma cell membrane have a biomolecular effect on exposure to electro-capacitive cancer treatment (ECCT), which involves low-intensity and medium-frequency electrostatic wave energy. JNK is the dominant part of MAPK in the process of tumorigenesis, and JNK2α2 is the isoform that plays the most dominant role in the process of glioblastoma cell proliferation. This study aims to assess the effect of ECCT exposure on JNK2α2 expression and the number of glioblastoma cell lines in vitro as a basis for developing additional therapy in patients with glioblastoma.
Methods: This is an experimental in vitro study. The glioblastoma cell line was exposed to ECCT treatment at different intensities, namely 10, 30, and 50 PPV, with a frequency of 100 kHz. The exposure duration is divided into 24 hours, 48 hours, and 72 hours. The dependent variables are JNK2α2 expression and the number of glioblastoma cell lines.
Results: In JNK2α2 expression, the Shapiro-Wilk Normality Test indicates a normal distribution. Mauchly's Test of Sphericity yielded a significance value of P = 0.002, and the Greenhouse-Geisser Test produced a significance value of P = 0.008. The Pairwise Test found a significant relationship between the control group and the group exposed to 10 PPV, as well as between the 10 PPV group and the 50 PPV group, with significance values of P = 0.023 (95% CI: 0.024–0.365) and P = 0.008 (95% CI: 0.066–0.476), respectively. In cell count analysis, the Shapiro-Wilk Normality Test indicates a normal distribution. Mauchly's Test of Sphericity yielded a significance value of P = 0.041, and the Greenhouse-Geisser Test produced a significance value of P = 0.001. The Pairwise Test found a significant relationship between the 24-hour group and the 72-hour group, as well as between the 48-hour group and the 72-hour group, with significance values of P = 0.002 (95% CI: 283,804–1,212,862) and P = 0.003 (95% CI: 152,710–748,956).
Conclusions: Exposure to ECCT affects JNK2α2 expression and the count of glioblastoma cell lines in vitro.
Development of polycystic ovary syndrome – Insulin resistance of rat model using a combination of letrozole and a high-fructose high-cholesterol diet
Authors: Wahyuni Alfaina Wahyuni , Mudigdo Ambar , Soetrisno  , Wasita Brian , Retno Budi Uki , Widyaningsih Vitri
Published: January 2025

Background: Developing a representative PCOS with insulin resistance (PCOS-IR) animal model is critical for research in PCOS therapy. This project aims to identify a PCOS rat model with hyperandrogenic symptoms and insulin resistance using a combination of letrozole and a high-fructose, high-cholesterol diet. Letrozole, as an enzyme aromatase inhibitor, will induce hyperandrogenemia, while a high-fructose, high-cholesterol diet moisturizes insulin resistance. Both conditions play a role in the pathogenesis of PCOS.
Methods: The study employed the Posttest Only Control Group Design methodology. As samples, 25 female rats were utilized. The control group received only a regular diet, whereas the PCOS-IR model group received 1 mg/kg B.W./day of letrozole orally with a high-fructose, high-cholesterol diet. The treatment was administered on days 18, 21, 24, and 27. Following a 12-hour fast, glucose, insulin, and androgen levels were also determined using the ELISA method. The Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was evaluated. A histological image of ovarian tissue stained with hematoxylin and eosin (H & E) was observed. Image J Application was used to count the number of primers, preantral and antral follicles, corpus luteum, and follicular cysts.
Results: HOMA-IR and androgen levels significantly increased between the control and PCOS groups (p<0.05). The HOMA-IR score and androgen levels significantly increased on days 21, 24, and 27 (p<0.05).  There was an increase considerably in the number of corpuses luteum and follicular cysts (p<0.05) on days 18, 21, 24, and 27.
Conclusion: The combination of letrozole and a high fructose high cholesterol diet at 21, 24, and 27 days successfully formed a rat model of PCOS-IR with distinctive endocrine and histological characteristics.
Effect of omega-3 fatty acids on endometriosis: A systematic review
Authors: Harzif Achmad Kemal , Ummah Nafi'atul , Puspawardani Aisyah Retno , Nurbaeti Putri , Wiweko Budi
Published: January 2025

Introduction: Endometriosis is a term for an inflammatory condition where endometrium tissue develops outside the uterus. Endometriosis affects about 190 million reproductive-aged women. While medical and surgical therapies are essential, adding dietary supplementation may increase the effectiveness of treatment. This study aims to provide evidence on the effect of omega-3 in endometriosis.
Method: We searched PubMed, Scopus, and Cochrane databases for articles published up to November 2023 with keywords related to omega-3 and endometriosis. The inclusion criteria are clinical trials and in vivo studies investigating the effect of omega-3 on endometriosis. Exclusion criteria are studies not exclusive to omega-3 intervention and non-English articles.
Results: Our study included six articles comprising two RCTs and four animal studies. The animal studies demonstrated that omega-3 reduced the volume and weight of endometriosis lesions, reduced inflammatory cytokines (TNF, IL-1b, IL-6), and reduced total oxidant status and oxidative stress index levels. However, omega-3 has no significant effect on pain severity and quality of life of endometriosis patients.
Conclusion: Omega-3 fatty acids possess anti-inflammatory properties and have been suggested as a potential therapeutic option for endometriosis. Previous studies have shown that omega-3 positively impacts animal models of endometriosis. However, clinical trials have yet to show any significant benefits. Further randomized controlled trials are needed to evaluate the clinical effectiveness of omega-3 for endometriosis.
Allogeneic human umbilical cord mesenchymal stem cell secretome effect on apoptosis of HeLa cells
Authors: Erfiandi Febia , Harsono Ali Budi , Faried Ahmad , Winarno Gatot Nyarumenteng Adhipurnawan , Salima Siti , Mantilidewi Kemala Isnainiasih , Anggraeni Tricia Dewi , Sartika Cynthia Retna , Mulyantari Ayu Insafi , Kireina Jessica , Chouw Angliana
Published: January 2025

Introduction: Cervical cancer treatment typically involves surgery, chemotherapy, and radiotherapy. However, exploring novel treatment approaches is crucial. Stem cell secretome therapy provides new insights as an additional option in the treatment of gynecological cancer. The present study evaluated the impact of the human umbilical cord mesenchymal stem cell (hUCMSC) secretome on cervical cancer, utilizing the HeLa cell line under normoxic and hypoxic conditions.
Patients and methods: HeLa cell apoptotic index was analyzed through flow cytometry at 24 and 48 h post-secretome (at concentrations of 25% and 50%) under normoxic and hypoxic conditions, while the cell viability was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. 
Results: The results of the present study revealed that, under normoxic conditions at both incubation periods, secretome treatment at various concentrations resulted in an increased apoptotic index, with a corresponding reduction of cell viability compared with the control. By contrast, secretome administration for 24 h under hypoxic conditions resulted in a reduced apoptotic index and enhanced cell viability. However, after 48 h incubation, the apoptotic index increased and the cell viability diminished following administration of a 50% secretome concentration.
Conclusion: The present study offers insights into how the allogeneic hUCMSC secretome may affect apoptosis in cervical cancer cells under different oxygen levels. These findings highlighted that the anti-cancer effects of secretome were concentration-, oxygen-, and time-dependent. However, its impact in hypoxic environments requires further investigation.
Pediatric multiple myeloma and diagnostic challenges in a resource-limited setting: a case report
Authors: Cong Tzeto Han , Mulyantari Ni Kadek , Lestari Anak Agung Wiradewi , Herawati Sianny , Ariawati Ketut
Published: January 2025

Background: Multiple myeloma (MM) is a malignant plasma cell disorder characterized by clonal proliferation of malignant plasma cells derived from B cells in bone marrow. MM is more common in adults, but in children patients, only 0.3% of cases were diagnosed before age 30. MM had milder symptoms in pediatric patients. In 2014, the International Myeloma Working Group (IMWG) updated the disease definition of MM, including validated biomarkers and existing requirements of attributable CRAB features (hypercalcemia, renal failure, anemia, and bone lesions). In a resource-limited setting, there were challenges in diagnosing and treating MM.
Case Presentation: A 12-year-old female patient was referred to our hospital with chronic anemia and bleeding symptoms with several transfusion histories. The CBC and biochemistry blood test results showed pancytopenia with a high ferritin level, normal kidney function, and normal corrected calcium. Serum protein electrophoresis showed a chronic inflammatory disorder pattern with a slight increase in total globulin concentration. In the bone marrow aspiration, plasmacytosis was found with 12% plasma cell count and myeloma cells. In X-ray examination, no osteolytic lesion was found. To our knowledge, this is the first Indonesian pediatric case diagnosed with multiple myeloma using clinical judgment.
Conclusion: In multiple myeloma, especially in pediatric patients, a collaboration between pediatricians and pathologists needs to overcome challenges because the diversity of plasma cell proliferative diseases, their secreted proteins, and the concentration of M-protein make no single assay effectively diagnose and monitor this disease
Relationship between serum Glial Fibrillary Acidic Protein (GFAP) levels and severity of traumatic brain injury as measured by Glasgow Coma Scale (GCS) and Rotterdam Computed Tomography (CT) score
Authors: Chandra David , Airlangga Prananda Surya , Hamzah  , Santoso Kohar Hari , Sumartono Christrijogo
Published: January 2025

Background: Traumatic brain injury is a serious physical injury that can cause brain function impairment. Evaluating the severity of traumatic brain injury is crucial for patient management. Glial Fibrillary Acidic Protein (GFAP) has been identified as a potential biomarker for brain injury. This study aims to evaluate the relationship between serum GFAP levels and the severity of  traumatic brain injury measured using the Glasgow Coma Scale (GCS) and Rotterdam Computed Tomography (CT) score.
Methods: This study was conducted using a cross-sectional design to analyse the relationship between GFAP, GCS, and Rotterdam CT score. Data were collected from traumatic brain injury patients in the Emergency Department, Dr. Soetomo Surabaya Regional Hospital during the period from July 1, 2023, to November 30, 2023. GFAP levels were measured using the enzyme-linked immunosorbent assay (ELISA) method from blood serum samples.
Results: Patients with traumatic brain injury showed an average increase in GFAP levels of 1.65 µg/L and an increase in Rotterdam CT score with an average score of 4. GFAP levels increased with decreasing GCS score, indicating a relationship between GFAP and the severity of brain injury. There was a positive correlation between increased GFAP and increased Rotterdam CT score, indicating a pathological response to brain injury.
Conclusion: This study demonstrates that serum GFAP levels correlate with the severity of traumatic brain injury measured using GCS and Rotterdam CT score.
Proceeding Article of National Scientific Seminar in Periodontology (NASSiP 7)
Authors: National Scientific Seminar in Periodontology (NASSiP 7)
Published: January 2025

Dear Colleagues,
It was a true honor that we accept colleagues at the National Scientific Seminar in Periodontology (NASSiP 7) that was held on Pulau Serangan, Bali, Indonesia on September 29-30th 2023.
The theme of this conference was "Recent Innovation and Applications in Periodontal Therapy". This seminar aims to invite all Indonesian dentists to continuously update their knowledge and skills, including the latest understanding and advancements in the field. The speakers for this seminar involve diverse experts from either national speakers or abroad. The activity in this seminar including seminar, hands on, talk show, charity, scientific and non-scientific competition, Ti-Oss award, and gala dinner. It is hoped that there will be an improvement in professional services to the community in the era of globalization.
The proceeding article contains articles that were accepted for publication to Bali Medical Journal.
Finally, we would like to thank the committee, reviewer, and another scientific team who dedicating to finalized this proceeding article. We hope to be able to meet with all of you soon on the next event.
When leprosy takes an unexpected turn: A case of vasculonecrotic type 2 leprosy reaction in a child
Authors: Karna Ni Luh Putu Ratih Vibriyanti , Rusyati Luh Made Mas
Published: January 2025

Background: The prevalence of leprosy among children is crucial for determining the disease's spread to the broader population. In rare cases, individuals with lepromatous and borderline lepromatous leprosy may develop necrotizing erythema nodosum leprosum as a type 2 reaction. This case report will discuss a rare occurrence of vasculonecrotic ENL in a child to improve understanding of the spectrum of leprosy and its management especially in the paediatric population.
Case: A 14-year-old boy presented with complaints of reddish, painful nodules and ulcers accompanied by fever, joint pain, and decreased appetite. He lived with eight other family members, three of whom also had leprosy. A dermatological examination revealed multiple erythematous nodules and ulcers with yellow-black crusts. He had claw hand deformities on both hands. The Mycobacterium leprae bacterial index showed 4+ on both earlobes. He was diagnosed with borderline lepromatous leprosy with vasculonecrotising erythema nodosum leprosum and grade II leprosy deformities. She was admitted and treated with multibacillary-type multi-drug therapy, methotrexate, and prednisone. After completing MDT-MB packages, the condition improved, hoewever the nodules persist.
Conclusion: Children living in families with a history of leprosy are particularly susceptible to infection with M. leprae. Inadequate immunity means that Mycobacterium leprae infection can progress to a lepromatous type, causing leprosy reactions and deformity. Childhood leprosy can have a devastating impact on a child's future. Proper diagnosis and therapy monitoring are required until the condition and infection improve.
The effect of low-intensity intradialytic aerobic exercise using a cycle ergometer on lower extremity muscle strength in end-stage renal disease patients undergoing hemodialysis
Authors: Dewi Dilia Ratna , Andriati  , Narasinta Inggar , Widodo  , Melaniani Soenarnatalina
Published: January 2025

Background: End Stage Renal Disease (ESRD) patients undergoing hemodialysis (HD) tend to be less active, experience decreased exercise capacity, and have poor physical function when compared to the general population. Decreased lower extremity physical performance in ESRD is associated with an increased risk of death. Intradialytic exercise is the most feasible option and intradialytic exercise programs are mostly aerobic exercise. This study aims to determine the effect of low-intensity intradialytic aerobic exercise using a cycle ergometer on lower extremity muscle strength with a 30 second sit to stand test in patients with ESRD undergoing HD.
Method: This study is a quasi-experimental design with a pre and post-test randomized control group. The research is performed in the Hemodialysis Installation of Dr. Soetomo General Academic Hospital Surabaya from March to June 2021. From the total of 30 ESRD patients undergoing HD randomly assigned to either treatment or control group, 2 subjects dropped out, leaving 28 ESRD patients. The treatment group received light-intensity intradialytic aerobic exercise with a cycle ergometer, performed during the first two hours of HD, twice weekly, for 12 weeks. The 30-second sit-to-stand (30 STS) test was evaluated at baseline and after 12 weeks in both groups. The data were analyzed in the SPSS package program.
Result: There was no significant difference between of 30 STS results for both groups at baseline.  There was a significant increase in the mean of 30 STS results before and after the intervention in the treatment group with a large effect.
Conclusion: Low-intensity intradialytic aerobic exercise using a cycle ergometer for 12 weeks in ESRD patients undergoing hemodialysis increases lower extremity muscle strength.
Comparison of salivary cortisol levels and obstetric quality of recovery score (ObsQor-10) in caesarean section patients with and without the immersive virtual reality: a study protocol
Authors: Zaki Mokhammad Dzulfikar , Airlangga Prananda Surya , Andriyanto Lucky , Sumartono Chritrijogo , Semedi Bambang Pujo
Published: January 2025

Background: Immersive virtual reality (IVR) produces a virtual experience that envelops patients in a soothing setting and diverts their attention from the anxiety that precedes surgery. Cortisol levels are the indicator measure of adaptive stress and are frequently used when evaluating anxiety. This study protocol aims to understand how patients undergoing caesarean sections with and without IVR comparison in terms of salivary cortisol levels and obstetric quality of recovery score (ObsQor-10) values.
Methods: This study protocol used a prospective analytical experimental research design with a randomized posttest-only parallel group design at Universitas Airlangga Hospital, Surabaya, Indonesia. The ObsQor-10 components will be assessed were physical comfort, emotional status, physical independence, pain, and correlation between postoperative salivary cortisol and ObsQor-10 in patients who underwent C-section delivery with and without IVR.
Discussion: Immersive virtual reality (IVR) offers a comprehensive visual and auditory stimulus because, during operation, the stimulation from IVR creates a pleasant and comfortable feeling; this enhances the quality of the healing process after surgery. The ObsQoR-10 instrument, which consists of 10 question items, would evaluate the quality level of postpartum recovery outcomes. Four primary variables were evaluated in this questionnaire: pain following a caesarean delivery, emotional state, physical independence and newborn care, and physical comfort. Nonetheless, a number of non-physical elements, including history, sociocultural context, personality, beliefs, and history of chronic pain, might affect the recovery of patients with caesarean delivery.
Conclusion: The difference value between ObsQor-10 and salivary cortisol levels in patients undergoing caesarean section delivery with and without immersive virtual reality is still unknown therefore, needs to be assessed.
Impact of inferior vena cava filters on venous thromboembolism management in malignancy: A Systematic review
Authors: Darwis Patrianef , Raden Suhartono  , Dedy Pratama  , Akhmadu Muradi  , Satria Mula Habonaran Simatupang  , Hamzah Alif
Published: January 2025

Individuals diagnosed with the disease have a notably greater impact on growth clots, known as venous thromboembolism. Traditional blood thinners may not be appropriate for some cancer patients to optimize the bleeding effect. As an alternative, Inferior Vena Cava Filters have been suggested. We conducted a thorough review following established guidelines because it improves the situation and effectiveness of IVCF in managing VTE among people with the disease. We searched significant databases for relevant articles and identified ten studies involving 1,191 participants. Complications associated with IVCF included migration of filter (0.9%), thrombosis of cava vein (3.7%), recurrent pulmonary embolism (PE) (2.8%), fracture of filter (0.9%), and penetration of IVCF (0.9%). Notably, no deaths were linked to IVCF complications. IVCF insertion effectively reduced PE rates but connected to more significant events of deep vein thrombosis (DVT) compared to traditional treatment (35.7% vs. 27.5%). However, the risk of Pulmonary embolism is significantly lower with IVCF (6.2% vs. 15.1%). Six studies did not observe a significant rise in deaths related to pulmonary embolism (PE) associated with using Inferior Vena Cava Filters. Overall, IVCF seemed to be a safe determination of use managing VTE for a person suffering from the disease, especially for individuals who are unable to use anticoagulants due to contraindications. In conclusion, our review suggests that IVCF can be a valuable tool in managing VTE in malignancy patients, offering a safe alternative for those who cannot tolerate anticoagulant therapy.
Clinical benefits of platelet rich plasma therapy in thin endometrium: A systematic review and meta-analysis
Authors: Chilmawati Laili , Dewanto Agung , Lutfi Muhammad , Chandra Lukman Ade
Published: January 2025

Introduction: Endometrium is one of the primary components of embryo to implant. Adequate endometrium is necessary for embryo to implant successfully. Inadequate endometrium increased the probability of unsuccessful embryonic implantation attempt. Platelet rich plasma (PRP) was recently proposed as therapy option for thin endometrium. The study aimed at evaluating the clinical benefits of PRP therapy by examining the impact the PRP therapy on the thickness of endometrium, chemical and clinical pregnancy rates.
Methods: Recovered randomized controlled trial (RCT) was subjected to investigational study. We conducted a thorough search across the Cochrane Central Register of Controlled Trials, PubMed, and Google Scholar until December 31st, 2022, to locate studies on the application of PRP in female frozen-thawed embryo transfer (FET) as a component of assisted reproductive technology (ART). Both the common effect and random effect models were used to extract and to evaluate the data heterogeneity. The risk of bias 2 (RoB2) tool was employed to assess bias potential.
Results: The endometrial thickness outcome was based on four RCTs of 245 participants. There was a significantly high probability that the thickness of the endometrium in the PRP therapy would increase as compared to the group without any intervention (MD=0.84; 95% CI=0.28-1.39).  Significantly higher chemical pregnancy rates were found in the PRP therapy (RR=2.73; 95% CI=1.41-5.27). Also, significantly more cases of clinical pregnancy were found in the PRP therapy (RR=3.16; 95% CI=1.82-5.46).
Conclusions: PRP was a beneficial therapy option for thin endometrium in FET and ART. Particularly, the PRP helped to increase the thickness of endometrium, chemical pregnancy rates and clinical pregnancy rates.
Dominant gut microbiota in gastric ulceration
Authors: Muhammad Ranushar  , Parewangi AM Luthfi , Bachtiar Rini Rachmawarni , Bakri Syakib
Published: January 2025

Background: A gastric ulcer (GU) is a damage to the gaster's mucous layer that penetrates the muscular mucosa and is more than 5 mm in diameter. The study in Indonesia revealed that GU about 37.4% of the bleeding incidence in patients aged >60 years undergoing upper gastrointestinal tract endoscopy. The sequencing technology has strengthened the hypothesis that gastroduodenal diseases such as GU are not just the result of H. pylori infection, but that dysbiosis has a role to play.
Methods : This study was conducted involving a suspected GU in 72 patients, who underwent endoscopy from December 2023 to March 2024. 56 people met the research inclusion criteria used in this study. The participants signed an informed consent form. We analyzed the types of microbiota by extracting DNA samples from gastric tissue biopsies using the 16S rRNA gene sequencing method to identify the most dominant microbiota.
Result : The distribution of microbiota in gastric ulcers revealed that the most prevalent species were E. coli and S. maltophilia, each at 17.9%, followed by Acinetobacter sp and Prevotella sp at 12.5% each. E. cloacae accounted for 10.7%, K. pneumoniae for 8.9%, and Bacteroidetes sp for 3.6%. The species Agrobacterium tumefaciens, Atlantibacter subterranea, Burkholderia sp, Citrobacter freundii, Leclercia adecarboxylata strain, Rahnella sp, Salmonella enterica, Segatella oris, and Streptomyces sp each represented 1.8%.
Conclusion: In gastric ulcers, the dominant microbiota are E. coli, S. maltophilia, Acinetobacter sp., Prevotella sp., E. cloacae, K. pneumoniae, and Bacteroidetes sp.
A correlation study of Magnetic Resonance Spectroscopy (MRS) metabolite ratios with cognitive function in ischemic stroke patients
Authors: Carrey Michael , Bintang Andi Kurnia , Akbar Muhammad , Muis Abdul , Soraya Gita Vita , Tammasse Jumraini , Muis Mirna , Bachtiar Nur Amelia
Published: January 2025

Background: Post-stroke cognitive impairment (PSCI) is one of the complications of ischemic stroke that can highly impact the patient’s quality of life and requires prompt detection and management for optimal outcomes. Magnetic resonance spectroscopy (MRS) may be a potential diagnostic tool for PSCI due to its capacity to evaluate metabolite parameters. The aim of this study was to assess the correlation of various MRS metabolite ratios with cognitive function in ischemic stroke patients.
Methods: A cross-sectional study was performed on ischemic stroke patients with an onset of 24 hours – 7 days at Dr. Wahidin Sudirohusodo Central General Hospital, Makassar. MRS was used to determine metabolite ratios (NAA, Cho, Lac, and mIns to Cr) by voxel placement in ischemic lesions. Cognitive function was evaluated using the Montreal Cognitive Assessment Indonesian version (MoCA-Ina) instrument. Spearman’s test was used to determine the correlation.
Results: The study included 23 patients, with a mean age of 54.61 years (SD = 11.96) and 65.22% male. The Cho/Cr ratio had a significant, moderate correlation with cognitive function (r = 0.47; p = 0.02). Other metabolites, such as NAA/Cr, Lac/Cr, and mIns/Cr, did not correlate with cognitive function.
Conclusion: In ischemic stroke patients, the Cho/Cr ratio was significantly correlated with cognitive function.
Significance of tumor height, size, and Total Mesorectal Excision (TME) in the discrepancy between POLARS and actual LARS score in rectal tumors post Low Anterior Resection (LAR)
Authors: Bassyarah Yusuf Arif , Handaya Adeodatus Yuda , Setyawan Nurcahya , Barmawi Agus , Sofii Imam
Published: January 2025

Background: The number of cases of rectal tumors is increasing. Currently, colorectal cancer ranks third in terms of incidence and the second cause of cancer-related deaths in the world. Low Anterior Resection (LAR) surgery apparently still causes postoperative complications, namely LAR Syndrome, which has an effect on a patient's quality of life. Pelican Cancer Foundation released an application, namely POLARS. In several studies, the POLARS results are different from the actual LARS. It is necessary to carry out research regarding this matter. The aim of this study was to determine whether the POLARS score corresponds to the actual LARS. Next, examine which factors are the main causes of LARS so that they can be considered for curative or preventive measures.
Methods: The research was conducted in a retrospective cohort. The actual LARS score was obtained using a questionnaire. Complete sample data was obtained from 75 patients. Data were analyzed using IBM SPSS version 22 for Windows.
Results: After analyzing the bivariate correlation test, the factors that individually play a role in the actual LARS are TME, Tumor Height, Tumor Level, Tx, dan Tumor Size with p<0.05. In multivariate analysis, only Tumor Height and Tumor size play significant roles in LARS (p<0.05).
Conclusion: There is a significant difference between POLARS and Actual LARS score. POLARS Score does not match LARS Actual Score. The main risk factors for LARS are tumor height and size. Other risk factors are TME, tumor level, and Tx. It is necessary to revise or modify the POLARS tools to implement them in our center.
Inhibition potential of the ethanol extract of grapefruit peel (Citrus maxima) on the growth of Streptococcus mutans causing dental caries in-vitro
Authors: Artawa I Made Budi , Kencana I Gede Surya , Gejir I Nyoman , Sirat Ni Made , Rusminingsih Ni Ketut , Sali I Wayan
Published: January 2025

Introduction: Caries is an infection that occurs in the hard tissue of teeth, caused mainly by Streptococcus mutans. The caries process can be inhibited mechanically, chemically, or both. A natural ingredient known to have antibacterial effects is grapefruit (Citrus maxima). It is unknown whether ethanol extract from grapefruit peel can inhibit the growth of Streptococcus mutans, which causes dental caries. This research aimed to determine the inhibitory power of ethanol extract from grapefruit peel (Citrus maxima) on the growth of Streptococcus mutans, which causes dental caries in vitro.
Method: This research design was quasi-experimental; the number of samples was 30 from six treatments. Each treatment consisted of five bacterial culture samples added with 20%, 50%, and 75% ethanol extract of grapefruit peel, negative control, and positive control. A 100% grapefruit peel extract was diluted with distilled water to obtain concentrations of 25%, 50% and 75%. Each extract concentration, positive control (chlorhexidine 0.2%), and negative control (sterile water) were saturated on a blank disk for 1 hour at room temperature. The Streptococcus mutans bacterial suspension was spread on a petri dish containing Mueller Hinton Blood (MHB) agar media. Then, place each blank disc containing the saturated extract, positive control, and negative control on the petri dish. Next, incubation was carried out at 37oC for 24 hours. After the incubation time is complete, the clear zone formed around the blank disc is observed, and its diameter is measured using a caliper. Then, the results of the observation are recorded. ANOVA tests were used to evaluate differences among groups, all values were considered significant if p<0.05.
Result: The results showed that the ethanol extract of grapefruit peel positively contained flavonoids of 102.92 ± 1.96 mg/100g QE, tannins of 6,867.61 ± 167.95 mg/100g TAE, phenols of 4,865.65 ± 106.83 mg/100g GAE. The results of the 25% concentration inhibition test were 6.7517. Meanwhile, 50% concentration is 7.2583, and 75% concentration is 7.7550 (difference among group ANOVA test p<0.05).
Conclusion: The ethanol extract of grapefruit peel can inhibit the growth of Streptococcus mutans bacteria, which causes dental caries in vitro.
Descending necrotizing mediastinitis secondary to an oral phlegmon: a case report
Authors: Lamerkabel Victor , Santoso Kohar Hari
Published: January 2025

Background: Rare complications of odontogenic infection can lead to a life-threatening and fatal consequence of descending necrotizing mediastinitis The mortality rate is still between 20 and 40 percent despite improvements in surgical care, diagnostic imaging, and antibiotics. This case report presents a case of descending necrotizing mediastinitis as a secondary complication of oral phlegmon.
Case Presentation: A 51-year-old male patient presented with chief complaints of swelling and pain in the lower right jaw. The patient underwent incision drainage and submandibular dissection which obtained 100 cc of pus and necrotic tissue that originated from submandibular and sublingual region. Laboratory examination showed leukocytosis, in addition the X-ray photo and CT-scan supported diagnosis of mediastinitis. The patient was assessed with oral phlegmon post re-incision drainage and descending necrotizing mediastinitis with jugular vein rupture in the area of infection. The patient received intravenous steroids, fluids, analgesia and broad-spectrum empirical antibiotics. The patient's condition has improved afterwards.
Conclusion: Descending necrotizing mediastinitis is rare but has a serious complication of oral phlegmon therefore the principal management surgical drainage, antibiotics, and  airway management needs to be performed accordingly.
Diagnostic values analysis of SARS-CoV-2 antibodies using Mindray CL-900i at Dr. Soetomo Hospital Surabaya
Authors: Savitri Binar Larasanti , Aryati
Published: January 2025

Background: rRT-PCR is one of the definitive diagnostic tests for COVID-19 infection. The antibody (serological) assay is another method used to diagnose COVID-19 infection. This assay is quick and easy to perform, but it needs a high level of sensitivity and specificity. The objective of this research is to analyse the diagnostic values of SARS-CoV-2 IgM and IgG antibodies produced by patients with confirmed COVID-19 infection using the Mindray CL-900i.
Methods: This study design was an analytic observational study using a cross-sectional design with a diagnostic test approach. rRT-PCR-confirmed COVID-19 infection patients' serum samples were collected between day one and day twenty-one following the onset of symptoms. The positive sample population was divided into three groups: days 1-7 of illness, days 8-14 of illness and days 15-21 days of illness. Anti-SARS-CoV-2 IgM and IgG levels in each sample were evaluated using Mindray CL-900i to determine positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity utilising a Mindray CL-900i.
Results: The anti-SARS-CoV-2 IgM serological assays using Mindray CL-900i showed that IgM has 89.09% sensitivity, 88.57% specificity, 92.45% PPV, and 83.78% NPV. The sensitivity of IgM serology examinations was 87.09% in the  days 1-7 of the illness group, 100% in the  days 8-14 of the illness group, and 85.71% in the  days 15-21 of illness group. Meanwhile, the anti-SARS-CoV-2 IgG serological assays using Mindray CL-900i showed that IgG had 88.9% sensitivity, 94.4% specificity, 96% PPV, and 85% NPV. The sensitivity of IgG serology examinations was 80.64% in the  days 1-7 of the illness group, 100% in the  days 8-14 of the illness group, and 100% in the  days 15-21 of the illness group. Antibodies were detected on days 0-7 following the initiation of symptoms; anti-SARS-CoV-2 IgM demonstrated a higher rate of sensitivity compared to anti-SARS-CoV-2 IgG. The sensitivity of anti-SARS-CoV-2 IgG increased and stayed higher than that of anti-SARS-CoV-2 IgM starting on the eighth day after the onset of symptoms. Detectable IgG was found in the group from the first week of illness; this could be the result of a cross-reaction with previous infections with corona viruses other than SARS-CoV2.
Conclusion: Anti-SARS-CoV-2 IgM and IgG serological assays using Mindray CL-900i were found to be sensitive and specific for diagnosing patients with probable COVID-19 infection.