bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between the expression of Ki-67 and distant metastases in patients with well-differentiated thyroid cancer
Authors: Khuzaini Khuzaini , Sahudi Sahudi , Susilo Dwi Hari
Published: January 2025

Link of Video Abstract: https://youtu.be/27JVmnJSgbY
 
Background: Thyroid carcinoma, which accounts for 1% of all cancers, is the most common malignancy of the endocrine organ and has a high mortality rate. One of the risk factors for prognosis in thyroid carcinoma is distant metastasis and pathological differentiation. Ki-67 is a marker in determining tumor prognosis and determining the rate of recurrence after radiotherapy in patients with carcinoma. This study aims to determine the relationship between Ki-67 expression and distant metastases in well-differentiated thyroid cancer patients at Dr. Soetomo General Hospital Surabaya.
Methods: This is a cross sectional study conducted during May 2022 – June 2023 at Division of Surgery and Anatomical Pathology Department of Dr. Soetomo General Hospital from medical records of thyroid cancer patients with histopathology results of papillary thyroid carcinoma (PTC) or follicular thyroid carcinoma (FTC). The data was then analyzed using the Mann Whitney test.
Results: In bivariate analysis, it was found that the difference between positive and negative distant metastases for Ki-67 was statistically significant (p<0.05), the difference between positive and negative distant metastases for Ki-67 in cases of anatomical pathology samples of Papillary Carcinoma was statistically significant ( p<0.05), and the difference between positive and negative distant metastases for Ki-67 in cases of Follicular Carcinoma anatomical pathology samples was not statistically significant (p=0.480). The accuracy rate for distant metastases with Ki-67 was 76.5% with a cut off value of 6. There was a statistically significant relationship between distant metastases and the value of Ki-67 (P<0.05).
Conclusion: Thyroid cancers with a higher Ki-67 have a much greater chance of metastases compared to those with a lower Ki-67. Ki-67 expression can be a prognostic and diagnostic indicator in well-differentiated thyroid cancer.
Efficacy of synbiotics supplementation in hemodialysis patients with chronic constipation: A randomized controlled trial
Authors: Widiasih Esti , Subagio Hertanto Wahyu , Lestariningsih
Published: January 2025

Link of Video Abstract: https://youtu.be/b-Xvr4HxEuw
 
Introduction: Constipation is prevalent in routine hemodialysis patients. Gut-dysbiosis in hemodialysis patients causes increased proteolytic bacterial activity, leading to increased production of uremic toxins and worsening of constipation symptoms. Improvement of gut microbiota dysbiosis is expected to improve this condition. This study aims to evaluate the effect of synbiotics on gut dysbiosis and symptoms of constipation.
Methods: This is a double-blind, randomized control trial, pre-test and post-test design. We included hemodialysis patients with gastrointestinal complaints, difficulty defecating, stools with a hard consistency, or defecation frequency of less than three times per week. Subjects were randomly divided into two groups. The synbiotic group was given twice daily capsules containing Lactobacillus acidophilus, Bifidobacterium longum 5x109 Colony Forming Unit (CFU), and Fructooligosaccharides (FOS) 500 mg, and the control group was given maltodextrin in the same capsule packaging. The intervention was carried out for 45 days. Results were measured using fecal Short Chain Fatty Acid (SCFA) levels to assess gut dysbiosis, the Bristol scale, and the constipation questionnaire to assess the degree of constipation complaints.
Results: We included 46 subjects for both groups. There was a significant increase in the amount of SCFA in the synbiotic group (p=0.01), and there was an improvement in stool consistency (p<0.001) and a significant reduction in the degree of constipation complaints (<0.001) in the synbiotic group compared to the control group.
Conclusion: Synbiotic supplementation for 45 days is efficacious in improving gut dysbiosis stool consistency and reducing the severity of constipation in hemodialysis patients.
Study of effectiveness of chitosan in the process of wound bleeding on Wistar (Rattus novergicus) rats
Authors: Noviana Heri , Saputro Iswinarno Doso , Hariani Lynda
Published: January 2025

Link of Video Abstract: https://youtu.be/K0slXOP7Ll4
 
Background: The general way to treat bleeding using topical epinephrine has been widely used, but if there are large capillaries, the effectiveness of epinephrine still needs to be improved, and bleeding still occurs. This study aims to prove the effectiveness of chitosan in treating bleeding compared to epinephrine 1:100,000. This research aimed to know the difference in the efficacy of giving Chitosan compared to Epinephrine 1:100,000 in stopping bleeding.
Methods: This research used an experimental research design, a randomized post-test-only group design. The subjects in this study were mice treated with wounds measuring 3x3 cm on their backs with a full thickness depth (±1.3 mm). A total of 36 consecutive subjects were randomly grouped into two treatment groups: the group given epinephrine and the group given chitosan. The coagulation time in the bleeding wounds of rats in groups 1 and 2 was immediately calculated with a stopwatch after topical epinephrine and chitosan were administered. Then, coagulation was evaluated after 3 minutes.
Results: There was a significant difference (p<0.05 )in the time needed to stop bleeding between the Epinephrine and Chitosan groups, where the time needed to stop bleeding in the Epinephrine group was higher than the Chitosan group.
Conclusion: Chitosan provides a faster cessation of bleeding than epinephrine use in experimental mice with acute wounds.
GPi pallidotomy versus pallidothalamic tractotomy forel h-1 in Parkinson's disease: a systematic review in outcome and complication
Authors: Ismail Arif , Fahmi Achmad , Turchan Agus , Utomo Budi , Fauzi Asra Al , Subianto Heri , Wisnawa I Wayan Weda , Brilliantika Surya Pratama
Published: January 2025

Link of Video Abstract: https://youtu.be/118qmW5u19E
 
Background: Parkinson's disease (PD) is a neurodegenerative disorder with the main motor symptoms of tremor, rigidity, bradykinesia/akinesia, and postural instability. Stereotactic brain lesioning is a therapeutic option for Parkinson's disease. The development of imaging modalities, such as MRI, has made Forel H-1 Pallidothalamic Tractotomy begin to be reconsidered as a treatment for Parkinson's disease besides GPi Pallidotomy. This study aims to compare the effectiveness and complications of the two procedures.
Methods: This research is a qualitative analytical study in the form of a systematic review. This research database comes from a literature search in PubMed, Science Direct, and The Cochrane Library with the keywords ((("Parkinson's Disease") OR ("Parkinson") OR ("Parkinsonism") OR ("PD")) AND ("Pallidothalamic Tractotomy") AND ("GPi Palidotomy") AND (("UPDRS") OR ("outcome")). This study used a sampling technique to filter literature search results from Pubmed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow. (PRISMA)
Results: This systematic review included 343 patients, with males predominating at 46.9%. The remaining 28.8% were women, and some studies did not explain the gender of the patients. The number of patients who did not have gender data was 24.1%. In this study, the average age was 58.9 ± 7.1 years from 286 patients whose age data was known. The drug most commonly used was levodopa in 271 patients, followed by dopamine agonists in 45 patients, and COMT-inh in 17 patients. The average dose of levodopa used was 7,04.4 ± 257.7 mg. The procedures performed were GPi Pallidotomy in 206 patients, Pallidothalamic Tractotomy in 52 patients, and others in 16. The most widely used approach was the unilateral approach in 268 patients and the bilateral approach in 63 patients. There were improvements in UPDRS I, II, and III scores and total scores in all GPi and PTT cases.
Conclusion: The GPi and PTT methods improve UPDRS I, II, and III scores and total UPDRS scores in PD patients. Permanent complications are more frequently reported in GPi Pallidotomy procedures than PTT procedures.
Corpus alienum in urinary bladder due to Intrauterine Device (IUD) translocation: a case report
Authors: Fadli Muhammad Yogie , Ferdian Vicky
Published: January 2025

Link of Video Abstract: https://youtu.be/5HVCQHXhpdc
 
Background: The intrauterine device (IUD) is a widely utilized reversible contraceptive method. While generally considered safe, a rare yet severe complication involves uterine perforation, leading to IUD migration into the abdominal or pelvic organs. Uncommonly, migration of the IUD to the bladder has been reported.
Case Presentation: We present the case of a 47-year-old woman experiencing lower urinary tract symptoms with a 29-year history of IUD insertion. Ultrasonography revealed a hypoechoic shadow within the urinary bladder, indicative of IUD translocation from the uterus, a finding later confirmed by X-ray examination. Remarkably, the IUD surface exhibited stone formation, successfully addressed through cystoscopic extraction.
Conclusion: This case underscores the rare occurrence of IUD migration to the bladder, emphasizing the importance of considering such complications in patients with prolonged IUD use. The successful management of this case through cystoscopic extraction highlights the efficacy of a minimally invasive approach in addressing IUD translocation complications.
Narrative review: current update on the management of refractory thrombocyte
Authors: Hotimah Siti , Fuadi Muhamad Robiul
Published: January 2025

Refractory thrombocyte or platelet refractoriness or platelet transfusion refractoriness (PTR) is an inadequate posttransfusion platelet increment (PPI) response after two or more consecutive platelet transfusions of adequate allogeneic platelet doses. In the clinical setting, it is expected to observe 24-hour increments of < 5 x 109/L on two or more occasions to indicate a refractory condition to random platelet donors. The diagnosis approach of refractory thrombocyte begins with examining the platelet transfusion response using several formulas such as PPI, corrected count increment (CCI), and percentage platelet recovery (PPR). Refractory thrombocyte management continues to develop, including several available therapeutic options. Platelet transfusion refractoriness has been diagnosed using current laboratory tests. The laboratory diagnosis of refractory thrombocytes depends on the underlying cause. This literature review will discuss the current update on managing refractory thrombocytes.
Neutrophil-to-lymphocyte ratio (NLR) as a severity predictor of leprosy reaction
Authors: Rusyati Luh Made Mas , Sawitri Putu Dyah , Darmaputra I Gusti Nyoman , Karmila I Gusti Ayu Agung Dwi
Published: January 2025

Background: Leprosy can lead to progressive disability by leprosy reactions. There is no gold standard to diagnose leprosy reactions nor guidance to determine patients' risk of leprosy reactions. This study aims to study the diagnostic value and accuracy of neutrophil-to-lymphocyte ratio (NLR) on leprosy reactions.
Methods: A retrospective cross-sectional study was conducted by Prof. dr. I, Goesti Ngoerah Gde Ngoerah General Hospital used secondary data from January 2018 to December 2021 from patients diagnosed with leprosy with/without leprosy reaction. The neutrophil-to-lymphocyte ratio was calculated for all patients, and a receiver operating characteristic curve (ROC) was generated to identify the NLR cut-off point. The Chi-square/Fisher exact test was performed to determine the risk ratio.
Results: The NLR cut-off point to reversal reaction (RR) was 2.81 (sensitivity: 73.7% and specificity: 74.2%), while the NLR cut-point to erythema nodosum leprosum (ENL) was 3.97 (sensitivity: 93.8% and specificity: 91.4%). A high NLR value showed a significantly increased risk to RR and ENL. The correlation test between NLR and severe RR (r:0.389; p<0.001) and severe ENL (r:0.394; p<0.001) both showed a significant result.
Conclusion: Increased risk of RR and ENL in leprosy patients who had high NLR. High NLR was weakly positively correlated to severe RR and ENL reactions of leprosy patients at Prof. dr. I Goesti Ngoerah Gde Ngoerah General Hospital.
The effect of giving snakehead fish extract capsules on increasing albumin levels in burn patients at RSUD Dr. Soetomo Surabaya
Authors: Setya Aldy Mulia Hati , Saputro Iswinarno Doso , Zarasade Lobredia Zarasade
Published: January 2025

Background: Burns are injuries to the skin or other organic tissue caused by heat or due to heat radiation. Burns that cause loss of the skin barrier also result in loss of albumin through damaged skin. From several studies, giving snakehead fish extract to post-surgical patients was found to be more effective than giving egg whites in increasing serum albumin levels. The aim of this study was to determine the effect of snakehead fish extract capsules on albumin levels in burn patients.
Methods: This is a randomized experimental study using pre and post-test control group design. This experiment was done on burn patients in treatment and control groups. The control groups were given standard burn care. The treatment group was given snakehead fish extract capsules orally 500 mg three times a day for 10 days. The albumin levels in both groups were checked on day 0 and day 11.
Results: The results of the paired t-test in the control group obtained a significance value of 0.243 (p>α), which means that there was no difference in albumin levels before and after placebo administration, but in the treatment, group obtained a significance value of 0.020 (p <α), which means there is a difference in albumin levels before and after administration of snakehead fish extract.
Conclusion: Snakehead fish extract capsules can increase albumin levels in burn patients. Snakehead fish extract can be given as an alternative form of treatment to increase albumin levels and is a safe and feasible agent.
Comparison of serum folic acid and calcium levels in pregnant women based on preeclampsia screening in rural and urban areas
Authors: Aspiannur Syaiful , Prasetyo Budi , Sulistyono Agus , Yusuf Muhammad
Published: January 2025

Introduction: Preeclampsia risk factor screening in pregnant women is done as a primary prevention effort to make it easier to screen for risk factor preeclampsia incidence and give recommended treatment for preeclampsia prevention. Several predictor risk factors, including nutritional status and micronutrients, can be modified to prevent preeclampsia. The study aims to analyze the difference between folic acid and calcium in pregnancy based on screening preeclampsia in rural (Bangkalan) and urban (Surabaya) areas.
Methods: This observational analytic study with a cross-sectional design was conducted at healthcare facilities specified in the two regions (Bangkalan and Surabaya) from May to August 2023. A total of 102 pregnant women from both areas were included in this study. Inclusion criteria are pregnant women with 12-20 weeks of gestational age with and without preeclampsia risk factors. Blood sample analyses have been done to measure the folic acid (ELIS) and calcium levels (Arsenazo III).
Result: On folic acid levels, there was no difference between positive and negative preeclampsia subjects in rural (p=0.580) and urban areas (p=0.567). At serum calcium level, no difference was observed between the sample with screening preeclampsia positive and negative in rural areas (p=0.243) and urban areas (p=0.763).
Conclusion: This research showed no difference in the level of folic acid and calcium based on preeclampsia screening in rural and urban areas. The risk factors based on the preeclampsia screening in the two regions were varied.
Effectiveness of dextrose prolotherapy injection on chronic knee osteoarthritis patients
Authors: Nofiansyah Rian , Susila Dedi , Kriswidyatomo Prihatma , Belindo Wirabuana
Published: January 2025

Background: Osteoarthritis (OA) of the knee is a chronic, degenerative, and disruptive joint condition that frequently reduces quality of life and imposes a significant socioeconomic burden on patients and caregivers. The purpose of this study is to compare pain scale and functional ratings before and after dextrose prolotherapy injection in individuals with persistent osteoarthritis of the knee.
 Methods: This study is an observational analytical study using retrospective data involving 61 samples of patients with a diagnosis of knee osteoarthritis based on the clinical criteria of the American College of Rheumatology who were injected with 20% dextrose prolotherapy 6 ml intra-articularly and 12.5% dextrose 6 ml peri-articularly. Each patient was injected with prolotherapy 4 times with an interval of 2 weeks at the same injection point. Patients were evaluated for pain scale and functional score at pre-injection, 6 weeks, and 20 weeks. All data processing was performed using SPSS version 26, with a significance level (p-value) set at 0.05.
 Results: Demographic characteristics of this study: subjects aged 45 to 75 years with an average of 62.38 ± 8.14 years. 85.2% of subjects were female, 67.2% of subjects had a BMI ≥25 kg/m2, and 75.4% of subjects experienced pain for more than 1 year. There was a significant difference in pain scale and functional score (p-value <0.05) at pre-injection compared to 6 weeks and 20 weeks.
Conclusion: Dextrose prolotherapy injection is effective in improving pain and functional improvement in patients with chronic knee osteoarthritis patients.
Outcome of single tracer methylene blue for breast cancer sentinel lymph node biopsy in resource-limited country
Authors: Panigoro Sonar Soni , Sobri Farida Briani , Wibisana I Gusti Ngurah Gunawan , Gustada Hardya , Halim Odetta Natatilova , Harinda Fadlika
Published: January 2025

Introduction: Sentinel lymph node biopsy (SLNB) has been developed as a new early-stage breast cancer management method. In developing countries, SLNB tracer that is relatively easy to obtain and less expensive is intravenous Methylene blue (MB). This study aimed to evaluate the outcome of SLNB using MB tracer (MB-SLNB) compared to axillary lymph node dissection (ALND) in early-stage breast cancer patients in terms of survival and complications.
Methods: This study was a retrospective cohort that was carried out in Jakarta, Indonesia, at the Cipto Mangunkusumo Hospital and the Metropolitan Medical Center Hospital. MB-SLNB or ALND operations performed on female patients with early-stage breast cancer between January 2015 and June 2019 were included in our study. For every SLNB operation, Metiblo®, a methylene blue agent, was used. Five years after the operation, survival is the main result.
Results: The study had 78 patients in total; 21 (26.9%) received MB-SLNB and 57 (73.1%) underwent ALND. After correcting for possible confounders, we saw no difference in the two groups' overall 5-year survival rates (100 vs. 90.5%; log-rank test p-value = 0.573 and HR 0.63 95%CI 0.07-5.58; p-value = 0.674). There was no discernible change in the frequency of recurrence or complications. In addition, there was no arm pain or breast skin oversensitivity in the SLNB patients.
Conclusions: The MB-SLNB procedure is not inferior to conventional ALND for the 5-year survival and recurrence event parameters. SLNB shall stand as the standard of care for early-stage breast cancer patients as long as it can be supported to be widely accessible in resource-limited countries.
Survey on the current status of discharge readiness of parents of children with liver transplantation and analysis of influencing factors
Authors: Ting He , Hua Tang Li , Xiaobo Huang , Sa’at Siti Fatimah
Published: January 2025

Background: The objective of this study is to gain insight into the present state of discharge preparedness among parents of pediatric liver transplant recipients, as well as to examine the many variables that contribute to this readiness.
Methods: This is a cross-sectional analytic study. The researchers employed a convenience sampling technique to gather data from 103 parents with children who underwent liver transplants. The data was collected using a general information questionnaire and a Chinese version of the Discharge Readiness Scale. To examine the factors that influenced the discharge readiness of parents in this population, the researchers conducted a multiple linear regression analysis.
Results: The study found that the mean total readiness to discharge score for parents of children who underwent liver transplants was 83±35.5. Multiple linear regression analysis revealed that several factors significantly influenced the readiness to discharge of these parents. These factors included the average monthly family income, daily nursing hours, whether the child was an only child, and whether the child experienced postoperative complications. The statistical significance of these factors was determined to be P<0.05.
Conclusion: The discharge preparedness of parents of pediatric liver transplant recipients is found to be poor, indicating a need for healthcare providers to adopt focused interventions aimed at enhancing the quality of discharge orientation services.
Evaluation of laboratory parameters in pregnant women with covid-19 infection
Authors: Hadi Cahyono , Purna Anggraini Nutria Widya , Edwin Eric , Savitri Sheila , Purnomo Adi
Published: January 2025

Introduction: Pregnant women with COVID-19 had clinical and laboratorial differences conditions than non-pregnant women. The pregnant woman with COVID-19 had higher neutrophil rates, lower hemoglobin levels, and an increased risk of preterm birth. This study aimed to determine the relationship between the laboratory parameters of pregnant women in the second first trimester and the third trimester and predict the possibility of requiring intensive care.
Methods: This was a retrospective study that analyzes the laboratory findings that were collected in pregnant patients with COVID-19. Laboratory parameters performed at the beginning of the patient's treatment include hemoglobin, leukocytes, platelets, random blood sugar, serum creatinine, ureum, serum glutamic oxaloacetic transaminases (SGOT), and serum glutamic pyruvic transaminases (SGPT).
Result: Data on 391 pregnant women patients with COVID-19 infection, consisting of 25 first and second trimester patients and 366 third trimester patients. There was an increase in leukocyte values in the I-II trimester group (8%) and the III trimester (10.1%); SGOT in the I-II trimester (32%) and the III trimester (12.3%); and SGPT in the I-II trimester (12%) and III trimester (14%). There were significant variations in the values of hemoglobin (p =0.013), platelet count (p = 0.002) and random blood glucose (p = 0.008). This comparison was not significant enough in distinguishing the laboratory parameters of leukocyte count, SGOT, SGPT, ureum and creatinine in the study group.
Conclusions: Two parameters were consistently significant in both gestational age and ICU treatment. Leukocyte, glucose, and platelets counts showed a higher mean compared to the non-ICU treatment group.
Oral Gabapentin's effect on the expression of cytokines IL-6 and IL-10 in the dorsal column of spinal cord following experimental partial sciatic nerve ligation in rats
Authors: Ismail Arif , Turchan Agus , Sudiana I Ketut , Utomo Budi , Parenrengi Muhammad Arifin , Suryaningtyas Wihasto
Published: January 2025

Background: Neuropathic pain remains challenging to treat with pharmacotherapy. One treatment option for neuropathic pain is gabapentin. Interleukin 6 (IL-6) is an inflammatory cytokine that has a vital role in pain. This study aims to determine the effect of oral gabapentin on the pro-inflammatory cytokines interleukin-6 (IL-6) and anti-inflammatory interleukin-10 (IL-10) in the dorsal column of the spinal cord with models of peripheral neuropathic pain.
Methods: Twenty-three Rattus norvegicus strain Sprague-Dawley rats with peripheral nerve neuropathic lesion model achieved using a partial sciatic nerve ligation (PSL) procedure. Rats were divided into three groups, namely the normal group (negative control), the PSL group without Gabapentin (positive control), and the PSL group with Gabapentin (treatment). The treatment group was given 50 mg/kg BW/day oral Gabapentin on days 8 to 14. The rats were sacrificed for 15th days. The spinal cord was stained with immunohistochemistry for IL-6 and IL-10 cytokines. The results were analyzed using the SPSS application.
Results: The results showed a significant difference in IL-6 expression between groups (p<0.05). Mann-Whitney analysis showed no significant difference between the treatment and positive control groups (p>0.05). There was no significant difference in IL-10 expression groups between the treatment group and the positive control group (p>0.05)
Conclusion: Oral Gabapentin does not alter the expression of IL-6 and IL-10 in the dorsal horn of the spinal cord following neuropathic lesions of peripheral neurons.
Combination of small dosage midazolam and ketamine as intravenous premedication in pediatric patients: Comparative study of high dose vs. small dose
Authors: Jatmiko Heru Dwi , Manapa Chandra Hermawan
Published: January 2025

Introduction: Anesthesia and surgery cause anxiety in approximately 70% of children and are associated with many negative effects during and after surgery. High-dose premedication can expose children to various side effects. This study was aimed to compare the effectiveness of the combination of a small dose of midazolam 0.025 mg/kg and a dose of ketamine 0.25 mg/kg with a dose of midazolam 0.1 mg/kg and ketamine 1 mg/kg as intravenous premedication in pediatric patients.
Methods: This study was an experimental analytical study. The study population was pediatric patients undergoing surgery under general anesthesia at RSUP DR. Kariadi Period October – November 2021. The research sample was 34 subjects obtained by simple random sampling technique and then divided into 2 groups. The research subjects were assessed on the Sedation Scale, Behavioral Scale and Parental Separation Scale before and after giving premedication and assessed the Anesthesia Mask Acceptance Scale and side effects, then compared between groups.
Results: There was a significant difference in sedation score (p value 0.000), insignificant difference in behavior score and parental separation score in both groups (p value 0.786), a significant difference in mask acceptance score in group B (p value of 0.000). There was no difference in side effects in the two groups (p value > 0.05).
Conclusion: The combination of low dose of midazolam and ketamine has been shown to be effective as an intravenous premedication in pediatric patients.
A case report of de Winter ECG pattern that evolved to anterior ST-Elevation Myocardial Infarction (STEMI) within two hours
Authors: Budiono Daniel , Japanto Ameliya Secil , Rampengan Starry Homenta , Jim Edmond Leonard
Published: January 2025

Background: The De Winter ECG pattern is a rare ECG pattern that can be misdiagnosed by physicians who are unfamiliar with it. Although this pattern does not meet standard criteria for STEMI, it is considered a STEMI equivalent caused by the occlusion of the LAD artery. There is a suggestion that the de Winter ECG pattern should be treated as STEMI equivalent and undergo emergent coronary angiography.
Case Presentation: A 43-year-old male patient presented with chest pain and a Winter ECG pattern that evolved to Anterior ST Elevation Myocardial Infarction after 120 minutes. Based on ECG and clinical manifestations, patients were diagnosed with de Winter Syndrome that evolved into Anterior STEMI and underwent emergent coronary angiography. Coronary angiography reveals subtotal occlusion in proximal LAD with grade III thrombus, Stenosis 70-80% Proximal-Mid LCx, and Stenosis 80-90% at mid-RCA. A Drug-eluting Stent of 2.75x16 mm was deployed at proximal LAD without any intraprocedural or periprocedural complications.
Conclusion: It is critical to be aware of the de Winter ECG pattern when evaluating patients with acute coronary syndrome.
Immediate effect of proprioceptive neuromuscular facilitation stretching of calf muscle on peak plantar pressure in type 2 diabetes mellitus patients with diabetic neuropathy
Authors: Aritonang Ricky Shubhan , Subadi Imam , Pawana I Putu Alit , Mudjanarko Sony Wibisono , Utomo Budi
Published: January 2025

Background:  Diabetic peripheral neuropathy (DPN) is a significant contributor to the development of foot ulcers and limb loss by increase in peak plantar pressure (PPP). Proprioceptive neuromuscular facilitation (PNF) techniques has a good impact on PPP has been investigated before.  The objective of this study was to elucidate the importance of decreasing PPP in type 2 diabetes mellitus patients with diabetic neuropathy. This was achieved by investigating the immediate impact of PNF stretching of the calf muscles on peak plantar pressure during gait.
Methods: This was a pre-experimental study with one group pretest-posttest without a control group with a quasi-experimental study design at Dr. Soetomo Hospital Surabaya from February to November 2023. The intervention began with the examiner passively stretching the subject calf muscle until they experienced slight discomfort, maintaining the stretch for 10 seconds. When this position was attained, the subject was instructed to engage in an isometric contraction of the calf muscle against the physician's resistance, exerting a maximal voluntary contraction (MVC) of 50-60% for 6 seconds. Then, the subject was taught to relax the calf musculature completely. Afterward, the physician proceeded to stretch the calf muscle back to the newly acquired joint ROM for 10 seconds. Following a one-minute rest, this PNF stretching method was repeated for 3 sets and carried out on both legs.
Results: The mean value of PPP was significantly decreased at the midfoot, big toe, and toe area (p<0.05). There is also a significant reduction in the total peak plantar pressure value obtained after given PNF stretching of calf muscle (p<0.05). Whereas in the hindfoot and forefoot areas, after being given a PNF stretching intervention there was an increase in the mean value of PPP (p>0.05).
Conclusion: The immediate effect of PNF stretching of the calf muscle significantly reduces peak plantar pressure values in the total peak pressure, midfoot, big toe, and toe areas among type 2 diabetes mellitus patients with diabetic neuropathy
High Vitreous TNF-Alpha and Vascular Endothelial Growth Factor Levels as Risk Factor for Proliferative Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients
Authors: Suryathi Ni Made Ari , Suastika Ketut , Andayani Ari , Pantjawati Ni Luh Diah , Surasmiati Ni Made Ayu , Manuaba Ida Bagus Putra
Published: January 2025

Introduction: Type-2 diabetes mellitus is a metabolic disease that can cause various complications. One of the complications of type 2 DM that can occur in the eyes is Proliferative Diabetic Retinopathy (PDR). PDR can cause a sharp decrease in vision and even blindness. The global prevalence of DM is 8.3%, and the prevalence of DM in Bali is 5.9%. PDR complications occurred in 26.3% of type 2 DM patients. Therefore, this study aims to prove the role of TNF-α in the inflammatory pathway and the role of VEGF in the angiogenesis pathway as risk factors for PDR in type 2 DM.
Methods: This study is a case-control study, and matching is carried out for age and gender. A total of 38 subjects were enrolled in this study, where the case group was type 2 DM patients with PDR who underwent vitrectomy, and the controls were patients without type 2 DM who underwent vitrectomy according to medical indications. The levels of TNF-α and VEGF in the vitreous were measured using the Enzyme-Linked Immunosorbent Assay (ELISA) technique.
Result: TNF-α and VEGF's cut-off points are 15.795 pg/ml and 22.980 pg/ml. OR of TNF-α was 5.13; 95% CI: 2.88-6.95; p= 0.001 (<0.05). OR of VEGF was 3.86; 95% CI: 1.83-3.79; p=0.017 (<0.05). The multinominal logistic regression analysis test showed that OR TNF-α was dominant as a risk factor for PDR, followed by VEGF. OR TNF-α=5.88; 95% CI: 2.36-6.79; p=0.008 (<0.05). OR VEGF= 3.1; 95% CI: 1.02-3.37; p=0.015 (<0.05).
Conclusion: This study proves that high vitreous levels of TNF-α and VEGF are risk factors for PDR in type 2 DM. These findings strengthen the theory of PDR pathogenesis through the inflammatory pathway (TNF-α) and the angiogenesis pathway (VEGF) in type 2 DM.
Predictors of depression among patients with cervical cancer in Bali Indonesia
Authors: Aryani Putu , Mahendra I Nyoman Bayu , Djelantik Anak Agung Ayu Manik Jantine , Lesmana Cokorda Bagus Jaya , Wirawan I Made Ady , Suastika Ketut , Januraga Pande Putu
Published: January 2025

Introduction: Mental distress has been highlighted as one of the biggest concerns, particularly for people with chronic diseases, such as cervical cancer. To date, it is unknown what the prevalence and predictors of depression in patients with cervical cancer are in Bali, Indonesia. This study assessed the proportion of depression and its predictors among patients with cervical cancer who were treated at the largest referral hospital, Prof. dr. I.G.N.G Ngoerah Hospital, in Bali, Indonesia.
Methods: This is a cross-sectional analytic study, which was conducted from March to December 2018 at the Gynecology Policlinic of  Prof. dr. I.G.N.G Ngoerah Hospital Bali. A consecutive sampling technique was applied to select 121 patients with cervical cancer at the center. All patients who agreed to participate were interviewed to collect data on sociodemographic and clinical characteristics. They were then screened for the presence of depression symptoms using the Hospital-based Anxiety and Depression Scale (HADS) questionnaire which has been translated into Bahasa Indonesia. Based on the scale, depression was categorized into depression, borderline case, and normal. Predictors of depression were identified using a chi-square test followed by logistic regression using SPSS 2.0.
Results: This study found that 24% of the respondents had probable depression and 9% had depression. This is significantly higher than the depression rate in the general population. Factors that were significantly associated with probable depression and depression were lower education levels (p=0.017). Other variables: age, occupation, marital status, level of knowledge toward cervical cancer, type of therapy, and co-existing disease were not significantly associated with depression among cervical cancer patients.
Conclusions: Depression and probable depression were quite prevalent among patients with cervical cancer. Mental health care responses targeting patients with cervical cancer, particularly those with low education levels should therefore be prioritized, especially during their intensive chemotherapy or radiotherapy.
The relationship between animal protein consumption and stunting in children in Gianyar, Bali, Indonesia
Authors: Windiani I Gusti Ayu Trisna , Adnyana I Gusti Agung Ngurah Sugitha
Published: January 2025

Background: Stunting remains a major health challenge in developing countries. Low protein consumption is one of its well-known risk factors. Tulikup in Gianyar district, Bali, Indonesia, is listed as an assisted village program of the Child Health Department Faculty of Medicine Universitas Udayana, Prof. I.G.N.G. Ngoerah Hospital and top priority of the stunting management program in 2018-2021. This study aims to determine the relationship between stunting and animal protein consumption in children under 2 years old.
Methods: Cross cross-sectional study involving 80 children aged 6-24 months in Tulikup village Gianyar, Bali, Indonesia, was done in June 2021. Stunting (length for age < -2 SD) was found in 7 children, whereas the rest 73 children were normal. Stunting as a dependent factor was assessed with WHO Anthro® software, and the independent factor was assessed with Ironcheq Questionnaire. Data was analyzed using an independent t-test and multiple regression test in SPSS.
Results: The majority of children with stunting did not exclusively breastfeed, came from families with income under minimum wage, inadequate daily protein consumption, and suspect deviation results in developmental pre-screening. Bivariate analysis showed significant results of stunting with consumption of growing-up milk (GUM), liver, and egg (p=<0.05). Further multivariate analysis revealed the strongest relation between the volume of consumed GUM (β=1.081, 95%CI=0.680-1.481, p=<0.01) and frequency of egg consumption (β=0.458, 95CI%=0.129-0.788, p=0.007) with stunting.
Conclusion: Stunting is related to animal protein consumption. Milk and egg consumption in substantial amounts every week can be considered as a a stunting preventive measure.
Impact of initial nutrition timing on the success weaning of mechanical ventilation in patients with sepsis
Authors: Setyarini Dian Ika , Kusuma Edward , Rehatta Nancy Margarita
Published: January 2025

Introduction: The prevalence of malnutrition in patients with sepsis in critical care can range from 40-60% due to hypermetabolism. Patients with sepsis treated for more than 48 hours in critical care may be at risk of malnutrition. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends starting nutrition within 24-48 hours after critical care or resuscitation. Unsuccessful weaning from mechanical ventilation can be caused by many factors, one of which is nutrition. This study aimed to analyze the impact of the timing of initial nutrition on the successful weaning of mechanical ventilation in patients with sepsis.
Methods: This single-center, prospective observational study enrolled 36 patients with sepsis in a critical care setting. The timing of initial nutrition was calculated from when patients began receiving nutritional support after admission to critical care and measured in hours. Nutrition was initiated via parenteral or enteral routes containing carbohydrates, proteins, and lipids according to trophic feeding guidelines (10-20 ml/hour or 10-20 kcal/hour, up to a maximum of 500 kcal/day). The patient can be weaned from mechanical ventilation after six hours of use, up until the 21st day, provided that there is no need for mechanical ventilation support for the following 48 hours. The study involved collecting demographic data, recording the timing of nutrition initiation, and analyzing these data using Multiple Logistic Regression.
Result: The findings revealed that the timing of the initial nutrition significantly affected the success of weaning of mechanical ventilation (p = 0.049, OR = 10.9). Specifically, initiating nutrition within 0-6 hours of admission to critical care or following resuscitation can increase the likelihood of successful weaning of mechanical ventilation by 10.9 times in patients with sepsis.
Conclusion: The study concluded that the timing of initial nutrition significantly influenced the success of weaning of mechanical ventilation in patients with sepsis. Early nutritional intervention may enhance the recovery of major organ function and reduce the inflammatory processes associated with hypermetabolic and hypercatabolic states.
The relationship between stone score and stone-free number in percutaneous nephrolithotomy procedure at Cirebon General Hospital
Authors: Bahagianto Aditya Fajar , Ferdian Vicky
Published: January 2025

Background: PCNL is considered a safe and effective technique for removing kidney stones. PCNL success was determined by the absence of clinically significant residual stone fragments on X-rays or CT scans. The S.T.O.N.E Score can predict the PCNL stone-free rate. High points indicate complexity and low stone-free number probability. This study aims to evaluate the stone-free PCNL procedures at Cirebon Hospital using the S.T.O.N.E Score.
Methods: This retrospective cohort study uses participants' medical records from October 2018 to November 2019. Before surgery, participants' STONE scores were evaluated. The procedure recorded operating time, tubeless technique, and transfusion needs. Stone-free status and the number of additional procedures determined the procedure's success. Analysis was done using descriptive study and analytically with Mann-Whitney and linear regression test.
Results: This study included 124 samples, of which 64 (51.61%) were female and 60 (48.39%) were male. The mean age of the participants was 49.52 ±11.78 years. Most surgical outcomes in patients were stone-free, precisely 78 samples (62.90%), while 46 samples (37.10%). The average stone size for the stone-free surgical outcome was 791.47 ± 555.51 mm2 compared to 1049.50 ± 666.64 mm2 for the residual. The S.T.O.N.E score had a statistically significant relationship with the operation outcome, with a significance value of 0.001 between the stone-free outcome and a lower STONE score of 7.55 ± 1.48 compared to those with a residue of 9.59 ± 1.86.
Conclusion: The success rate of percutaneous nephrolithotomy based on the S.T.O.N.E score was high at our center, reaching 62.90%. A moderate correlation exists between the S.T.O.N.E score and the success rate of percutaneous nephrolithotomy.
Papillary thyroid carcinoma: a case of extremely rare sternal metastasis with concurrent lung involvement
Authors: Siregar Kamal Basri , Wijaya Jesslyn
Published: January 2025

Introduction: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer which arises from thyroid follicular cells. PTC is typically characterized by its slow growth and propensity for lymphatic spread to regional cervical lymph nodes. While distant metastasis, particularly to the lungs and bones, is uncommon, rare presentations such as sternal metastasis pose diagnostic and therapeutic challenges.
Case description: We are reporting A 49-year-old male with dyspnea and a progressively enlarging mass in the neck and chest. Imaging studies including chest X-ray and CT scan confirmed lung and sternal metastasis along with lymph node enlargement. Fine-needle aspiration biopsy indicated a follicular neoplasm. Following total thyroidectomy with radical neck dissection, sternal and clavicle bone resection with titanium sternum reconstruction, histopathological analysis revealed PTC with lymphovascular invasion. Postoperative recovery was uncomplicated, leading to discharge on day 10, and planned radioiodine therapy.
Conclusion: A multidisciplinary approach is crucial for managing sternal metastasis in papillary thyroid carcinoma due to its atypical presentation.
The effect of exercise using incentive spirometry on maximum oxygen consumption (VO2 max) in patients after COVID-19 infection
Authors: Harisuddin Hilman , Subadi Imam , Narasinta Inggar , Andriati  , Al-Hayyan Abdul Jabbar , Maranatha Daniel , Melaniani Soenarnatalina
Published: January 2025

Background: The COVID-19 infection causes various sequelae and complications felt by post-recovery patients, including functional capacity declines. The decrease in maximum oxygen consumption in post-COVID-19 patients was caused by decreased lung function, prolonged bed rest during treatment, and self-isolation. Breathing exercises with diaphragmatic breathing and incentive spirometry are proven to increase maximal oxygen consumption by increasing lung capacity and respiratory muscle strength, which can increase O2 levels in the blood. Breathing exercises with incentive spirometry are one of the easy-to-use, safe, and inexpensive pulmonary rehabilitation techniques that can be done at home without supervision and accompanied by a visual display as a guide to the patient. This study aims to determine the effect of giving breathing exercises using Incentive Spirometry for four weeks on maximum oxygen consumption (VO2 max) in patients after COVID-19 infection.
Method: This study was conducted from October 2021 to October 2022. The research subjects comprised 20 post-COVID-19 infection patients, divided into a treatment group and a control group (each consisting of 10 subjects). The treatment group was given breathing exercises using Incentive Spirometry five times a day, seven times per week, for four weeks. In comparison, the breathing control group used diaphragmatic breathing five times a day, seven times per week, for four weeks. The parameter evaluated in this study was VO2 max. Measurements were taken twice: before and after four weeks of intervention.
Result: There was a significant increase in the value of VO2 max in the control group (p = 0.000) and treatment group (p = 0.000). There was no significant difference (delta) in VO2 max values between the two groups (p = 0.560).
Conclusion: Exercise using Incentive Spirometry and Diaphragmatic Breathing for four weeks increases VO2 max in patients after COVID-19 infection.
The use of single-dose CO2 laser for vaginal laxity and sexual function improvement
Authors: Yudhistya Ngudi Insan Ksyatria  , Paksi Suryo Bawono  , Darto  , Anggraeni Asih
Published: January 2025

Introduction: To analyze the use of single-dose CO2 laser for improving vaginal laxity and sexual function in women.
Methods: This study was conducted at Dr. Moewardi Regional General Hospital, Surakarta, in the Urogynecology Outpatient Clinic from November to December 2023. Using an analytical cross-sectional observational method, the study evaluated the effects of single-dose CO2 laser using the IDS Kaiser Fractional CO2 Laser + ALVR (Automatic Laser Vaginal Rejuvenation) brand on vaginal laxity and sexual function based on VLQ and FSFI scoring, as well as the frequency of sexual intercourse before and after treatment. The population involved patients with symptoms of vaginal laxity. Subjects were selected through consecutive sampling based on specific inclusion and exclusion criteria, with a sample size of 17. Data analysis was performed using SPSS software.
Results: Normality test results showed an abnormal distribution for VLQ scoring, so the data were analyzed using the Mann-Whitney test. In contrast, FSFI scoring results were analyzed using the T-test. There was a significant difference between pretest and posttest VLQ scores (p=0.002), pretest and posttest FSFI scores (p=0.000), and pretest and posttest frequency of sexual intercourse (p=0.000).
Conclusion: Single-dose CO2 laser treatment is significant for improving vaginal laxity and sexual function in women in the short term. Long-term evaluation and further research are needed.