bluuebunny/crossref_metadata_2025 huggingface dataset:
Comprehensive sanitation situation analysis based on complete components in community-based total sanitation
Authors: Fasya Abdul Hakim Zakkiy , Ibad Mursyidul , Handayani Dwi
Published: December 2022

Introduction: Although research to analyze the sanitation situation in Indonesia has been intensively carried out, the results of this research are not sufficient to show aspects of community behavior comprehensively based on the components in total community-based sanitation (STBM). A recent study based solely on the availability of sanitation facilities and community affordability found that weak financial support allocated to address sanitation problems was a key factor. Therefore, this study aimed to analyze the sanitation situation comprehensively based on the components in STBM.
Methods: This research was conducted in 34 provinces in Indonesia. All areas were selected so that a complete and comprehensive analysis could be carried out. The data used in this study is secondary data obtained from the Basic Health Research and the Indonesian Demographic and Health Survey (IDHS). Cluster analysis using Fuzzy C-Means (FCM) was performed to cluster sanitation conditions based on the parameters of healthy latrine use; handwashing behavior and facilities; safe drinking water and food management; management of household waste and its facilities; and safe household liquid waste management.
Results: It is found that the value for cluster 1 does not have priority problems in terms of environmental health. There is only one indicator, namely littering, which is above the national average. While in cluster 2, the complexity of the problem is more complex where almost all indicators are above the national average, only the indicators of carelessly throwing garbage and disposing of feces are below the national average. Cluster 3 has complex problems in no defecation, no defecation, no sewerage, and littering. These areas are included in the priority sanitation intervention program; Bangka Belitung, North Sulawesi, Southeast Sulawesi, Gorontalo, West Kalimantan, Central Kalimantan, West Nusa Tenggara, South Kalimantan, Maluku, Central Sulawesi and East Nusa Tenggara.
Conclusions: This study determines the classification of sanitation conditions to provide comprehensive information on which areas are included in the priority sanitation intervention program. The novelty and contribution of this research is a comprehensive analysis based on the components of STBM, which has never been done before.
Stress due to online learning during the COVID-19 pandemic affects the menstrual cycle in college students
Authors: Afiyah Raden Khairiyatul , Kamariyah Nurul , Wijayanti Lono , Hasina Siti Nur , Sari Nisa Wahyu Dika Mila , Sari Ratna Yunita , Rusdianingseh  , Rahman Firman Suryadi
Published: December 2022

Introduction: The demands of academic life and obstacles during online learning in the Covid-19 pandemic make female students physically and mentally exhausted which can trigger stress. Stress involves the neuroendocrinological system that can affect the menstrual cycle. This study aims to analyze the correlation between stress due to online learning during the Covid-19 pandemic with students' menstrual cycles.
Method: The data measured are the stress due to online learning during the pandemic and the student’s menstrual cycles through the DASS 42 questionnaire (Depression Anxiety Stress Scale 42) to measure stress levels and a questionnaire containing categories to measure students' menstrual cycles.
Results: This study found that stress levels are correlated with the menstrual cycle. Stress levels affect the condition of the menstrual cycle
Conclusion: This study proves that stress due to online learning during the Covid-19 pandemic is related to the menstrual cycle of students.
Parenting stress against symptoms of gadget addiction in elementary school age during the COVID-19 pandemic
Authors: Hidaayah Nur , Esti Yunitasari  , Hanik Endang Nihayati  , Imamatul Faizah  , Ratna Yunita Sari
Published: December 2022

Introduction: The COVID-19 pandemic creates parenting stress for parents. When parents experience parenting stress, the solution that can be done is to give the gadgets to make children calm at home so they don't interfere with their parents' daily activities. This study aims to analyze the effect of parenting stress on symptoms of gadget addiction in elementary school-aged children.
Methods: The research design used the quantitative correlation method. The research was carried out in July - August 2021. The subjects of this study were parents whose children were in elementary school in Surabaya involving 130 respondents who were taken by random sampling technique. Determination of the parenting stress scale and gadget addiction symptoms using the Parental Stress Scale (PSS) and Internet Addiction Test (IAT) questionnaires. Data analysis used a simple linear regression test with a significance value of p <0.05.
Result: The results of the analysis show that parental stress has an effect on symptoms of gadget addiction in elementary school-aged children (F=6,821, sig.=0,000, R2= 0,554) with the regression equation Y=-17,198 + 1,360 X.
Conclusion: The higher the stress level of parenting, the higher the symptoms of gadget addiction in elementary school-age children. The need to overcome the stress of parenting to prevent early symptoms of gadget addiction in children. Family and professional support is needed to overcome the stress of parenting and how to prevent gadget addiction in elementary school-aged children.
Clinical characteristics and mortality associated with COVID-19 in islamic hospital of Jemursari, Surabaya, Indonesia: A hospital-based retrospective cohort study
Authors: Evi Awwaliyah  , Hotimah  , Michio Shimabukuro
Published: December 2022

Introduction: According to WHO, the COVID-19 epidemic a public health emergency came to international attention in March 2020, and the pandemic quickly spread around the world. This disease is caused by the novel coronavirus SARS-CoV-2, which may enter human target cells via angiotensin-converting enzyme 2 (ACE2). This study aimed to assess the risk factors associated with poor prognosis among COVID-19 patients in the Islamic Hospital of Jemursari, Surabaya, Indonesia.
Methods: This study was a retrospective cohort study that used patients hospitalized with COVID-19 at the Islamic Hospital of Jemursari, Surabaya as a study subject. Patients of all ages who enter the hospital and were confirmed with a positive real-time polymerase chain reaction (RT-PCR) result for SARS-CoV-2 were inclusion criteria of this study.
Results: We included 554 COVID-19-positive patients with the highest age at 26-35 years old as much as 26.72%, followed by the second highest at 36-45 years old at 20.86%. In addition, from all the patients in this study, it was found that the most patients were 281 male and 273 female. Characteristics of comorbidities in COVID-19 patients, where type 2 diabetes mellitus is the most comorbid factor 88.89% in recovered COVID-19 patients and 11.11% in patients who have died. In addition, hypertension is also the second most comorbid 96.55% of Covid-19 patients.
Conclusion: Based on this study, the independent risk factors related to critical outcomes among COVID-19 cases include old age, males, diabetes mellitus, cardiac-related disease history, and the presence of two or more comorbidities. In future research, we suggest designing a unique multi-item scale system to prognosticate COVID-19 patients.
Distribution of blood-added tablets in adolescent girls in the COVID-19 pandemic
Authors: Pratiwi Hariyani Putri  , Dini Setiarsih  , Rizki Amalia
Published: December 2022

Introduction: The prevalence of anemia among adolescent girls is still quite high. Whereas anemia will have a negative impact on health and productivity. The government implements a program of providing blood-added tablets, one of which is through school institutions. However, during the Covid-19 pandemic, this condition becomes an obstacle for the implementation of the iron injection distribution through schools. This study aims to analyze the distribution of TTD in adolescent girls during the Covid-19 pandemic.
Methods: Descriptive study with a case study approach and is located in 6 districts/cities in East Java Province from September-November 2021. This study used purposive sampling by taking 6 respondents, namely 1 person from each district/city health office. Data collection was carried out using a questionnaire instrument.
Results: The results of the study show that 4 of the 6 regencies/cities in this study have special policies in the form of appeals and circulars so that the TTD program for adolescent girls can continue during the pandemic. However, 2 districts that did not issue specific policies continued to run the TTD program. The distribution of TTD is still carried out through schools and also directly to homes. The control of TTD consumption is not only carried out by teachers but is also assisted by parents and cadres. Adolescent girls who received TTD in the 1st and 2nd quarters have not yet reached their target. Data for adolescent girls who consume TTD is also difficult to obtain.
Conclusion: Four of the 6 districts/cities have nutrition education programs that are implemented with a special time allocation or combined with other lessons at school. So adolescent girls have a high awareness to obediently consume iron tablets even without the supervision of other parties.
Acceptance of the covid-19 vaccine based on health belief model
Authors: Eppy Setiyowati  , Rahayu Anggraeni  , Priyo Mukti Winoto  , Domingas da Silva Soares Pereira  , Paulo Lopes  , Aquino Tinos Martins
Published: December 2022

Introduction: Cases of coronavirus that causes Covid-19 disease in the world have reached 1.8 million people. Cases of coronavirus that causes Covid-19 disease in the world have reached 1.8 million people. The purpose of the study analyzed predictions of covid-19 vaccine acceptance based on sufferers and health belief models in Indonesia and Timor Leste. 
Method: Analytical research method with cross-sectional survey approach, the population is taken from community living at Surabaya Indonesia and Timor Leste as many as 250 respondents. Sampling was conducted in a consequent sampling in two regions at Surabaya Indonesia and Timor Leste.  Data collection using google form, share through were respondents. Statistical analysis with rank spearmen.
Result: the relationship of vulnerability perception with acceptance vaccine covid-19 and correlation coefficient showing a figure of 0.29. It refers to the value of 0.20- 0.40 is considered weak. Similarly, the relationship of severity perception with acceptance vaccine covid-19 obtained coefficient correlation 0.41 expressed strong. on the perception of cues doing actions with acceptance vaccine covid-19, there is a strong relationship, because value correlation coefficient 0.41. For the relationship of benefit perception with acceptance vaccine covid-19 get a weak result because the correlation coefficient of 0.23 in the category below 0.40 is considered weak.
Conclusion: there are four components of Health Belief Model associated with Acceptance vaccine covid-19
The impact of COVID-19 on personal hygiene behavior of female students in islamic boarding school
Authors: Agustina Widayati  , Umi Narsih  , Homsiatur Rohmatin
Published: December 2022

Introduction: Corona Virus Infection 2019 (Covid-19) is still a problem faced by all countries in the world, including Indonesia. Islamic boarding schools are a vulnerable place to be cluster spread of COVID-19 because there is much interactivity in a limited environment. This study aims to study the impact of Covid-19 on the personal hygiene behavior of female students in Islamic Boarding School.
Methods: The research design is cross-sectional. The sample in this study was 117.  Data collection using questionnaires and interviews by applying strict health protocols. Data analysis used univariate and bivariate.
Results: The results of the study informed that before covid-19 there were many female students who did not practice personal hygiene properly. Meanwhile, during the COVID-19 pandemic, most of the female students had practiced personal hygiene with sufficient category. Conclusion: There was a significant change in the personal hygiene behavior of female students in Islamic boarding schools before and during the COVID-19 pandemic.
Brachial artery and cephalic vein diameter as maturation predictors of brachiocephalic arteriovenous fistula in end-stage renal diseases with type 2 diabetes mellitus
Authors: Pratama Dedy , Daenuri Ahmad , Kekalih Aria , Darwis Patrianef , Ferian Muhammad Farel , Amin Bany Faris
Published: December 2022

Introduction: Arteriovenous fistula (AVF) is the gold standard for vascular access for hemodialysis in end-stage renal disease (ESRD) patients. There is a high rate of AVF maturation failure, especially in DM patients, and it takes longer for maturation in diabetes mellitus (DM) patients. This study aimed to obtain the recommendations for the minimum diameter of the brachial artery and cephalic vein as a predictor of brachiocephalic AVF maturation in ESRD patients with type 2 diabetes mellitus after six weeks to eight weeks of AVF creation.
Methods: This study is a retrospective cohort study using secondary data from patients with brachiocephalic arteriovenous fistula. The examined variables were brachial artery diameter, cephalic vein diameter, and brachiocephalic arteriovenous fistula maturation. Comparative analysis and ROC curve analysis were performed.
Results: A total of 72 patients met the inclusion and exclusion criteria. Forty-four (61,11%) patients were mature at six weeks, while 47 (65,28%) were mature at eight weeks postoperatively. At week six, the mature group had a significantly larger cephalic vein diameter (3,20±0,94 vs. 2,65±1,02, p=0,002). At week eight there was a significantly larger brachial artery (4,22±0,70 vs 3,78±0,60, p=0,012), and cephalic vein diameter (3,28±0,98 vs 2,43±0,82, p=0,000) in the mature group.
Conclusion: The best threshold value for preoperative brachial artery diameter predicting AVF maturation eighth week was 3.85 mm. The best threshold value for preoperative cephalic vein diameter predicting AVF maturation at the sixth week was 2.45 mm, and at the eighth week, it was 2.45 mm.
Implementation of the blood donation preservation strategy at Indonesian red cross (IRC) blood donor unit (BDU) Banda Aceh during the COVID-19 pandemic
Authors: Surya Akbar Teuku Ilhami , Ikhsan Maulana , Dewi Ratna Sari
Published: December 2022

Background: The ongoing COVID-19 impacts the world of health, including IRC BDU. There is a need for a rapid response and countermeasures to meet the enormous challenge of balancing blood supply and demand. IRC BDU Banda Aceh in collaboration with the Aceh Government has carried out the civil servant (CS) movement for blood donation. This movement has been carried out since June 2020 until now. The CS donation movement is one of the IRC BDU strategies for the City of Banda Aceh in preserving donors during the COVID-19 pandemic. The study aims to see the impact of the COVID-19 pandemic and the implementation of strategies at IRC BDU Banda Aceh City on the number of blood donors at IRC BDU Banda Aceh City.
Methods: This type of research is a descriptive study with a cross sectional survey design. The first quarter of the analysis was carried out to compare the initial period of the 2020 pandemic with the non-pandemic year 2019 to see the impact of the pandemic on the number of blood donors. The second quarter analyzed the impact of the 2020 pandemic with the implementation of the strategy carried out in 2021 on the number of blood donors at IRC BDU Banda Aceh.
Results: There was a 12.8% decrease in the number of blood donors in the 2020 period compared to the 2019 period (Mann Whitney test, p-value = 0.038). This shows the impact of the COVID-19 pandemic on the decline in the number of blood donors at IRC BDU Banda Aceh in 2020. In the second quarter, the government's strategy to deal with the shortage of blood supply with the CS donor movement succeeded in increasing the number of blood donors by 12.7% (Mann Whitney test, p-value = 0.242) in 2021 (compared to 2020). This shows that the implementation of the COVID-19 handling strategy from the local government plays an important role in increasing the number of blood donors at IRC BDU Banda Aceh. but there was no significant difference in the average number of donors each month.
Conclusion: Management and government participation in mobilizing blood donors and proper utilization are the keys to blood availability during the covid-19 pandemic era.
The relationship between inflammatory markers and vitamin D levels with the severity of coronary artery disease in elderly patients
Authors: Limantoro Charles , Santoso Fandy , Suharti Catharina , Nugroho Trilaksana
Published: December 2022

Introduction: Coronary artery disease (CAD) is the accumulation of atherosclerotic plaques in the coronary arteries. CAD is the most common cause of death worldwide, and its prevalence continues to increase, especially in the elderly population. Atherosclerosis is a chronic inflammatory condition that involves various inflammatory markers, including tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). In the inflammatory process, vitamin D plays an essential role in developing atherosclerotic plaques affecting the severity of CAD. The elderly are susceptible to vitamin D deficiency and an increase in the inflammatory process related to the severity of CAD. Therefore, this study aims to prove the relationship between inflammatory markers and vitamin D levels with the severity of CAD in elderly patients.
Methods: This study used a cross-sectional design in stable CAD patients aged 60 - 75 years who had passed through coronary arteriography. The severity was assessed from the angiography results using the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, which 3 cardiovascular consultants evaluated and the average outcome was calculated. TNF-α, IL-6, and vitamin D were taken during angiography and examined using high sensitivity enzyme-linked immunoabsorbent assay (ELISA). The correlation test was analyzed using Spearman's Rank correlation test.
Results: A total of 38 subjects were included in this study, where 30 (78.9%) patients were male. The mean age of the patients was 64.79 years, and the prevalence of vitamin D deficiency was 57.9%. There was a moderately significant positive correlation between markers of inflammation TNF-α (r=0.499, p=0.001) and IL-6 (r=0.518, p=0.001) and the SYNTAX score. A weak negative correlation was also discovered between vitamin D and the SYNTAX score (r=-0.335, p=0.040).
Conclusion: The levels of inflammatory markers (TNF-α and IL-6) and vitamin D correlated with the severity of CAD in elderly patients.
Management options for primary umbilical endometriosis: a case report
Authors: Nora Hilwah , Indirayani Ima , Rusnaidi  , Maulana Razi
Published: December 2022

Background: The common location of Endometriosis is in genitalia organs, for instance, the ovary, uterus, fallopian tube, and sometimes even in the intestine, bladder, and in rare locations such as the navel, lungs, or brain. Umbilical Endometriosis is the most irregular form of Endometriosis and the most common cutaneous form of Endometriosis. Primary umbilical endometriosis diagnosis is often biased and delayed; the exact etiopathology remains unclear. Our case report discusses the diagnosis and management options for this rare disease.
Case presentation: We reported a Primary Umbilical Endometriosis case, confirmed by a history of the nodule with pain, swelling, and bleeding at the umbilicus, which occurs during menstruation. The nodule was surgically removed, and histopathological analysis shows fibromycsoid tissue with multiple forms of subepithelial endometrial glands and surrounding stroma, confirmed as Endometriosis.
Conclusion: The definitive treatment for umbilical Endometriosis is surgical excision with total removal of the umbilicus. The prognosis is good, and the recurrence rate is meager if complete excision is successfully performed.
Aloe vera and its potency as antituberculosis against strains of Mycobacterium tuberculosis that is resistant to some tuberculosis drugs
Authors: Mawarti Herin , Rajin Mukhamad , Khusniyah Zulfa , Asumta Zulfikar , Khotimah  , Christina Destri Wiwis Wijayanti
Published: December 2022

Introduction: Aloe vera has anti-bacterial ability against Gram-positive and Gram-negative bacteria; however, anti-bacterial study, especially in multidrug resistant strain of Mycobacterium tuberculosis, has not been evaluated yet. This study aims to determine the potential of Aloe vera as an antituberculosis against drug-resistant strains of tuberculosis.
Method: Stages of research include the production of ethanol extract of Aloe vera, then testing the phytochemicals (identification of alkaloids, steroids/triterpenoids, anthraquinone, flavonoids, saponins, tannins) and chemical content testing by thin layer chromatography (TLC). The anti-bacterial test for Mycobacterium tuberculosis was performed on the Lowenstein Jensen media.
Results: Test results showed the qualitative identification, and TLC contains alkaloids, steroids/triterpenoids, anthraquinone, flavonoids, saponins, and tannins. Antioxidant activity against DPPH radical shows an IC50 value of 6927.133 ppm. Test of anti-bacterial activity to Mycobacterium Tuberculosis H37Rv and MDR TB strains HE (resistant to INH and Ethambutol), and SR (resistant to streptomycin and Rifampicin) showed inhibition ranging concentration of 50 mg/mL in all extracts as well as to test the sensitivity, a sensitive start to a concentration of 50 mg/mL in all extracts.
Conclusions: Aloe vera contains alkaloids, steroids/triterpenoids, anthraquinone, flavonoids, saponins, and tannins that act as antioxidants and antituberculosis against strains of Mycobacterium tuberculosis that are not resistant and resistant to anti-tuberculosis drugs.
Recurrent seizures as manifestation of hypoparathyroidism-related hypocalcemia in a patient with post-subtotal thyroidectomy
Authors: Setiawan Febrian Daru , Novida Hermina
Published: December 2022

Background: Hypocalcemia, a condition where the serum calcium concentration or total serum calcium is below normal, could be associated with various manifestations including severe symptoms requiring immediate hospitalization. The condition can cause by several causes including iatrogenic thyroidectomy. Here, we report a patient of hypocalcemia associated with hypoparathyroidism due to post-thyroidectomy.
Case presentation: A 32-year-old woman admitted to the hospital complained of stiffness and tingling in the extremities accompanied by recurrent seizures. The serum calcium level was low and this hypocalcemia condition was associated with low parathyroid hormone levels after subtotal thyroidectomy surgery. Laboratory examination indicated calcium 4.8 mg/dL and parathyroid hormone 2.21 pg/ml. The patient had bradycardia with prolonged QT on electrocardiography (ECG) and developed cataracts in both eyes which could be associated with chronic hypocalcemia. The patient's condition improved after correction of hypocalcemia. After discharge, the patient was given calcium and levothyroxine supplementation due to hypothyroid conditions.
Conclusion: The hypocalcemia condition in the patient was associated with low parathyroid hormone level post-subtotal thyroidectomy surgery. This case highlights the impotence of detailed analyses of hormonal, radiological and histological investigations of patients with thyroid gland diseases to diagnose such conditions early and to ensure timely management.
Comparison of sperm parameters and fertility rate in subclinical varicocele patients treated with varicocelectomy versus no varicocelectomy: a systematic review
Authors: Afdal  , Fakhri Zuhdian Nasher
Published: December 2022

Introduction: Subclinical varicocele is defined as non-palpable varicocele which diagnosed solely through imaging examination, namely ultrasonography. Despite the current high prevalence of subclinical varicocele as one of the most common cause of men infertility, there is still lack of evidence regarding the need to perform varicocelectomy among these patients. This systematic review aims to evaluate and compare the sperm parameters and fertility rate of subclinical varicocele patients treated with varicocelectomy versus no treatment. 
Methods: A systematic literature search was conducted on the international databases PubMed, Scopus, Cochrane, EMBASE, EBSCOHost, and Google Scholar published in the last ten years up to August 21st, 2022. Risk of bias assessment was performed using the Newcastle-Ottawa Scale tools for cohort study and converted regarding the AHRQ standards.
Results: Three cohort studies were conducted in three different countries with 363 patients. The risk of bias assessment revealed that all of the three studies included in this review have good quality and low risk of bias. Varicocelectomy significantly improves sperm parameters in terms of sperm concentration (p<0.05) and sperm motility (p<0.05) while its effects on sperm morphology are not significant (p>0.05). The effects of varicocelectomy on fertility rate are reported by one study by Cantoro et al. as significant (p=0.011).
Conclusion: Varicocelectomy correction has been proved to significantly improve sperm parameters in terms of sperm concentration and motility, while its effect on fertility rate remains unclear and no conclusion can be drawn yet. Therefore, this study recommends further randomized controlled studies with larger sample size in the future to prove the effectiveness of varicocelectomy in subclinical varicocele patients before its implementation in clinical settings.
The use of Kepok Banana Stem (Musa paradisiaca) in diabetes rats does not reduce Malondialdehyde (MDA) levels
Authors: Indriawati Ratna , Rahmawati Martina Dyah , Hidayati Titiek
Published: December 2022

Introduction: The prevalence of diabetes mellitus (DM) is still high and is expected to continue to increase. An increase follows this increase in the number of side events, so innovation is needed in DM therapy. DM induces oxidative stress so antioxidants can be an alternative therapy for DM. One source of antioxidants whose use is still limited is the banana plant, especially the banana stem. This study aimed to determine the effectiveness of kepok banana stem extract (Musa paradisiaca Var. Balbisiana colla) on MDA levels in diabetic rats.
Methodology/Approach: The study used a post-test-only control group design on 24 male rats (Rattus novergicus) Sprague Dawley strain with a bodyweight of 150-250 grams and ± eight weeks old. Rats were divided into four groups, namely the metformin treatment for positive control, distilled water for the negative control, and stem banana extract dose of 200 mg/kg BW and 250 mg/kg BW as treatment group of mice induced diabetes using STZ-NA and given treatment according to the group for 14 days. MDA level measurement using the TBARS method on rat liver. Data were analyzed using the One Way ANOVA comparison test.
Results: MDA levels in the positive control group, negative control, treatment 1 (200 mg), and treatment 2 (250 mg) were 0.9790 + 0.52 mg/dl, 0.7533 + 0.58 mg/dl, 1.2510 + 0.52 mg/dl, 1.5175 + 0.53 mg /dl. There was no statistically significant difference in MDA levels between groups (p=0.182), but there was a decrease in blood glucose levels in the group treatment. The highest decrease in blood glucose levels was in the dose treatment group, 250 mg/kg BW.
Conclusion:The treatment of kepok banana stem extract (Musa paradisiaca Var. Balbisinia colla) for 14 days at 200mg/kg BW and 250mg/kg BW increased malondialdehyde (MDA) levels, although not statistically significant.
Clostridium difficile virulence factors as the cause of antibiotic-associated diarrhea (AAD): a literature review
Authors: Wedari Ni Luh Putu Harta , Budayanti Ni Nyoman Sri , Darwinata Agus Eka
Published: December 2022

Clostridium difficile is an anaerobic gram-positive bacillus, capable of forming spores and toxins, transmitted to humans by the faecal-oral route C. difficile infection (CDI) is recognized as a typical cause of healthcare-associated infections (HAIs) and contributes to a significant proportion of morbidity and mortality of hospitalized patients. C. difficile culture and toxin examinations are still minimal in many hospitals in various Asian countries. As a result, reports of C. difficile in Asia are still rare, while reports of cases of CDI in Indonesia are still rare. Several risk factors including advanced age, antibiotic exposure, and hospitalization are strongly associated with CDI. C. difficile has the ability to colonize the large intestine, then release exotoxin proteins (TcdA, TcdB) causing colitis in people with risk factors. A diagnosis of suspected C. difficile infection in a patient with diarrhea without a clear alternative explanation, with relevant risk factors (including long antibiotic consumption, hospitalization events, and elderly age), was then performed microbiological examination to carry out proper management and control of infection. This study aims to review C. difficile virulence factors as the cause of antibiotic-associated diarrhea.
Understanding the purchasing behaviors of halal cosmetics of teenagers in Indonesia using the theory of planned behavior and theory of consumption value
Authors: Huriah Titih , Permana Iman , Octavia Mega , Hamid Siti Hazariah Binti Abdul
Published: December 2022

Introduction: Public awareness of halal lifestyles is increasing. This understanding concerns food and beverage and other halal aspects such as halal tourism, household needs and halal cosmetics. Indonesia is the country with the largest Muslim population in the world. However, the general public, especially teenagers, does not understand the concept of halal cosmetics, which currently prefers other cosmetic products whose halal identity is not yet clear. The willingness and intention to use halal cosmetics remain low. This research aims to determine the factors affecting the use of halal cosmetics in Indonesian students.
Methods: The study design was a descriptive study with a cross-sectional approach. This study combined the Theory of Planned Behavior and the Theory of Consumption Value (TCV) to identify factors affecting halal cosmetics in Indonesian students. This research employed a structured online survey, and 934 Muslim students aged 17 to 30 years old. The analysis process used Partial Least Square-Structural Equation Modelling (PLS-SEM).
Results: The results showed that three of the 11 hypotheses were not proved. There was a significant relationship between intention, conditional value, epistemic value, emotional value, and halal cosmetics, with an R square value of 0.762.
Conclusion: Four factors affect the use of halal cosmetics, 76.2%, while other factors outside the model cause the additional 23.8%.
Fibrin glue: an anti-fibrotic agent for contracted socket
Authors: Saputro Ivon Bremmy Wydha , Primitasari Yulia , Fatmariyanti Susy , Fauziah Dyah , Utomo Budi
Published: December 2022

Background: The contracted socket is caused by fibrosis leading to the shortening of the orbital tissue. Vascular endothelial growth factor (VEGF) is a profibrotic factor in postoperative wound healing. The novel option to prevent fibrosis is the use of fibrin glue. This study aims to evaluate the role of fibrin glue in reducing the VEGF expression in cells that cause post-socket surgery scar.
Methods: An in vivo experimental study using an animal model was conducted. We used twenty eyes of white rabbit species as the study sample. The evisceration was carried out and distributed to the animals in four experimental groups consisting of the control group, the MMC group (0.1 ml of mitomycin-C (MMC) 0.4 mg/ml), the triamcinolone acetonide (TCA) group (0.1 ml of TCA 40 mg/ml), and the fibrin glue group (0,1 ml of fibrin glue). The treatment was performed through injection of the subconjunctival. After 14 days, rabbits were euthanized, and conjunctiva samples were cut. Immunoreactivity scores (IRS) were used to analyze the expression of VEGF in epithelia conjunctiva with a significant level of p <0.05. Data were analyzed using SPSS version 26 for Windows.
Results: All groups showed a statistically significant difference in VEGF expression with a p-value 0,000 (p<0,05). The VEGF level was significantly lower in the three treatment groups compared with the control group. The VEGF expression was highest for the control group, followed by fibrin glue, TCA and MMC group. We found significant differences between the control group and the three treatment groups; the MMC group (p=0.001), the TCA group (p=0.002), and the fibrin glue group (p=0.005). While differences in VEGF expression between the three treatment groups could not be proven statistically.
Conclusion: Fibrin glue is proven to reduce VEGF expression as a marker of fibrosis; thus, fibrin glue can be an alternative anti-fibrotic agent.
The effect of fibrin glue on suppressing Transforming Growth Factor-β (TGF-β) expression compared to Mitomycin-C (MMC) and Triamcinolone Acetonide (TCA) as antifibrotic agents in contracted socket prevention
Authors: Aswati Nike , Indriaswati Luki , Sutjipto  , Fauziah Dyah , Utomo Budi
Published: December 2022

Background: Post-evisceration fibrosis remains the leading cause of contracted socket. The application of fibrin glue is considered an alternative adjuvant therapy in suppressing profibrotic factor (TGF-β) expression following evisceration surgery to prevent contracted socket. This study aimed to know the role of fibrin glue in suppressing the TGF-β expression following evisceration surgery.
Methods: An in vivo experimental study with a randomized post-test-only control group using twenty New Zealand rabbits were conducted. The sample was divided into four groups, each consisting of five rabbits, and one healthy eye was selected randomly for evisceration. Each rabbit in the study group was given a subconjunctival injection of agents corresponding to each study group, namely: Group I (control [no injection]), Group II (0.1 ml MMC 0.4 mg/ml), Group III (0.1 ml TCA 40 mg/ml), and Group 4 (0.1 ml fibrin glue) at the inferior fornix. Following a 14-day observation period, the animals were euthanized, and tenon conjunctiva in inferior fornix samples was collected for immunohistochemistry (IHC) staining examination. The pathologist calculates the immunoreactive scores (IRS) for each specimen. The differences in TGF-β expression were statistically analyzed with a significant p<0.05. Data were analyzed using SPSS version 26 for Windows.
Result: The highest TGF-β expression was found in the control group (I), and the lowest was in the mitomycin-C group (III), followed by the triamcinolone group (IV) and fibrin glue group (II). There were significant differences in TGF-β expression among the four groups (p=0.004). The difference between fibrin glue, MMC, and triamcinolone acetonide groups was insignificant (p>0.05).
Conclusion: As an alternative to mitomycin-C and triamcinolone acetonide, fibrin glue can be used as adjuvant therapy to prevent constricted sockets after evisceration.
Stromal Tumor Infiltrating Lymphocytes (TIL) as a potential prognostic biomarker for recurrence in Locally Advanced Breast Cancer (LABC) patients
Authors: Novriandhika Dannu , Susilo Dwi Hari , Fauziah Dyah , Wiratama Priangga Adi , Suprabawati Desak Gede Agung
Published: December 2022

Background: Tumor-infiltrating lymphocytes (TIL) serves as the host adaptive immune response in breast cancer. TIL has the potential to be an independent prognostic factor in breast cancer patients. In this study, we aimed to examine the association between stromal TIL and recurrence in locally advanced breast cancer patients.
Methods: A cohort retrospective study was conducted using medical records of female breast cancer patients with locally advanced breast cancer. We collected patients' data, including demographic data from the medical record. Stromal TIL was examined following the recommendations of the International TIL Working Group 2014.
Results: 75 samples were included with an average age of 49.5±8.4. Ductal carcinoma was the most common type histologically (88.0%). Luminal B Her2-negative was the predominant breast cancer subtype (32.0%). There was a significant association between the breast cancer subtype and disease-free survival (P – 0.014). The optimal cut-off to determine the recurrence of breast cancer was 15%. The sensitivity, specificity, PPV, NPV, and accuracy of TIL to predict the 24-month disease-free survival (DFS) were 80.5%, 82.4%, 84.6%, 77.8%, and 81.3%, respectively. Every 10% increase in TIL percentage could raise the DFS by 5.45 months (p=0.001). Patients with high TIL values had higher survival than those with low TIL values.
Conclusion: There was a significant correlation between the stromal TIL and the recurrence rate. The pre-therapy stromal TIL percentage can be employed as a potential biomarker to predict breast cancer recurrence, particularly in the first two years.
Comparison of outcomes between a ruptured and unruptured intracranial aneurysm: results from an Indonesian cohort study
Authors: Julius July  , Lukito Patrick Putra , Angelica Vanessa , Wijaya Jeremiah Hilkiah , Hamdoyo Audrey , Sindunata Nyoman Aditya , Rusli Muljadi
Published: December 2022

Purpose: A ruptured intracranial aneurysm has a high mortality rate. Moreover, many of its surviving patients have to live with severe disabilities. Therefore, surgical or endovascular treatment is recommended in some patients with a known aneurysm and a high risk of rupture. However, many patients are reluctant to undergo treatment, fearing its complications. This study aimed to evaluate the treatment outcomes and safety in patients with a ruptured and unruptured intracranial aneurysm.
Methods: We retrospectively reviewed the records of patients treated for intracranial aneurysms in our hospital between 2017 to 2021. Our primary outcome was discharge functional outcome. We also evaluated cerebral infarction, stay duration, and mortality. We used bivariate and multivariate analysis.
Results: 85 patients were included in this study. 69 (77.5%) patients were treated after rupture. Most patients were treated with clipping (78.8%). Patients with a ruptured aneurysm significantly had a higher risk of poor discharge functional outcome (OR 5.708 [1.061 – 30.712]; p 0.042). Six patients with a ruptured aneurysm died. Patients with a ruptured aneurysm also spent more time at the hospital. There was no mortality or complication in patients with an unruptured aneurysm.
Conclusion: Patients treated before their aneurysms ruptured had better outcomes with no complications. Therefore, treatment should be considered for high-risk patients.
Expression of Superoxide Dismutase-1 (SOD-1) and changes of corneal endothelial morphology after phacoemulsification with hypothermic perfusion
Authors: Fadhlina Afia Nuzila , Indriaswati Luki , Nurwasis  , Fauziah Dyah , Mahmudah
Published: December 2022

Background: Hypothermic perfusion can be used as adjunctive therapy to reduce corneal endothelial cell damage during phacoemulsification procedures. This study aims to evaluate the effect of hypothermic perfusion on the expression of Superoxide Dismutase-1 (SOD1) and morphological changes in the corneal endothelium after ultrasound energy of phacoemulsification exposure.
Methods: Sixteen New Zealand white rabbits (n=16 eyes) were randomly divided into two groups and exposed to ultrasound energy of phacoemulsification. The control group was administered room temperature (RT) (24°C) Balanced Salt Solution (BSS) intraocular perfusion, and the treatment group was administered hypothermic (4°C) BSS intraocular perfusion. Coefficient of Variation (CV) and hexagonality were measured before and one day after surgery with specular microscopy. The expression of SOD1 was examined by immunohistochemistry staining. Data were analyzed using SPSS version 26 for Windows.
Results: The result showed that the SOD1 expression was significantly lower in the hypothermic perfusion group compared with the control group (p=0.024, p<0.05). There were no significant differences between the two groups in CV changes (p=0.494, p>0.05) and hexagonality changes (p=0.916, p>0.05). There was no correlation between the expression of SOD1 and change in CV (p=0.188, p>0.05) or the expression of SOD1 and change in hexagonality (p=0.763, p>0.05).
Conclusion: Hypothermic perfusion suppresses all metabolic processes, including the expression of SOD1 and ROS production. The coefficient of variation and hexagonality as a representative of corneal endothelial morphology changes also decrease with hypothermic perfusion after ultrasound exposure but are not statistically significant. There is no correlation between the expression of SOD1 and changes in CV and hexagonality.
Strengthening community roles to reduce stunting in COVID-19 pandemic in indonesia rural areas: capacity building program for cadres and local government
Authors: Wenang Supriyatiningsih , Rismawati Ima , Lidia Febrianti  , Susyanto Bambang Edi , Puspita Gina , Wahyuni Alfaina , Dewi Arlina , Sugiyo Dianita , Sutantri  , Nahdiyati Diyah , Nirwansyah Anang Widhi
Published: December 2022

Introduction: The COVID-19 pandemic has impacted the community's disruption of nutrition and health services, including the closure of an integrated healthcare center (posyandu) in many areas in Indonesia. Posyandu plays an important role in nutrition services, particularly in detecting and managing growth and development disorders, such as stunting. This study aims to identify the improvement of knowledge in health cadres and community leaders in areas with high cases of severe acute malnutrition (SAM), namely, Temon, Kalibawang, and Dekso subdistricts in Kulon Progo, DIY, which followed a capacity-building program about strengthening the role of the community in the delivery of nutrition programs.
Methods: The program was conducted through interactive online seminars to ensure the continuity of essential nutrition care services during this pandemic. This study used a one-group pre-test and post-test design. Knowledge measurement was conducted in three consecutive online seminars with 180 participants: health cadres/volunteers, village heads, community leaders, nursery/early years teachers, and academicians. The pre-test and post-test questionnaires were spread through Google Forms before and after online seminars and assessed using the Wilcoxon Signed Ranks Test.
Results: The results showed that the participants improved their knowledge in webinars I and III (p-value 0.001). However, there was no significant improvement in the participants’ knowledge in webinar II (p-value 0.251).
Conclusions: Multi-sectoral collaboration among the government, community leaders, health cadres, health professionals, non-government organizations, institutions, and nursery/early years teachers are needed to reduce stunting, particularly in pandemic situations.
Health literacy in patients undergoing hemodialysis: literature review
Authors: Rahmawati Berlian Ayu , Rochmawati Erna
Published: December 2022

Patients with end-stage chronic kidney disease require hemodialysis treatment to maintain kidney function. The patients should be prepared to manage symptoms that may arise and cope with physical, psychological and financial changes. In addition, the patients are expected to be able to make their own decisions on how to manage the disease and adhere to treatment. This situation requires good health literacy skills. Little is known about the synthesis of health literacy among patients with chronic kidney disease.
Goal: To summarize the available evidence on benefits and factors that affect health literacy in patients undergoing hemodialysis from the available literature.
Method: The study reviewed health literacy among patients undergoing hemodialysis.   A literature search using a database was conducted in  Ebsco, PubMed, Science Direct, Scopus, and Emerald in December 2021 using the terms health literacy, hemodialysis, dialysis, CKD, and ESRD. We included studies from 2010-2021 that involved adult patients. Screening title, abstract, and full text were conducted to check each study's eligibility.
Results: A total number of eight of 1223 articles were included, with 2,036 respondents. Most included studies found that patients had a low level or inadequate health literacy (n = 5). In contrast, one study shows moderate health literacy (n = 2), and one article found a good level of health literacy. Higher health literacy was shown can improve patients' quality of life. The review summarizes several factors influencing health literacy, such as education, health care providers, life experiences, happiness and anxiety.
Conclusion: The review shows that most studies found lower health literacy levels. It is expected that nurses and healthcare professionals can improve health literacy which could positively impact patients' quality of life.
Indonesian community knowledge, attitude and behavior towards COVID-19 vaccination
Authors: Hadning Ingenida , Putri Fanny Rohimatul Azizah , Ardhana Sherinda Syafa
Published: December 2022

Introduction: Coronavirus Disease 2019 (COVID-19) has spread throughout the world, including Indonesia, so it is designated as a pandemic. To prevent the wider spread of COVID-19 transmission, the Indonesian government has implemented a COVID-19 vaccination program. The community knowledge, attitudes, and behavior towards COVID-19 vaccination are needed to support the success of this program. Therefore, this research aims to determine the Indonesian community knowledge, attitudes, and behavior towards COVID-19 vaccination.
Methods: This research was conducted by non-experimental observation with a cross sectional approach. Sampling using accidental sampling technique with the duration of the distribution of the e-questionnaire for 30 days. The sample of this research is the Indonesian community. The data were processed using descriptive statistical tests.
Results: The results of the univariate analysis with a total of 662 respondents showed that the majority of respondents were female, aged 18 to 25 years, educated in Senior High School/Equivalent, Muslim, domiciled in Riau, student, and received information from social media and other online media. The majority of respondents have a good level of knowledge with a score of 80.1%, have a positive attitude and behavior with a score of 53.5% and 51.8%.
Conclusion: The Indonesian community have a good level of knowledge, as well as positive attitudes and behaviors towards COVID-19 vaccination.
COVID-19 emergency response in Southeast Asian region: A bibliographic analysis using VOSviewer software
Authors: Rahman Ferry Fadzlul , Haris Fahni
Published: December 2022

Introduction: A Public Health Emergency of International Concern, the WHO designated the outbreak in China and surrounding countries in 2019. The Global board proclaimed public health emergency after research. The WHO encouraged states to step up their efforts before the instances grow. Six ASEAN members have confirmed early instances. WHO reports that the pandemic has reached all ten ASEAN countries. Unclear and inconsistent information and actions show Asia's delayed response to epidemics.
Methods: This study uses VOSviewer to investigate ASEAN policy responses to the COVID-19 outbreak. A bibliographic data model can handle several data types. Categories, topics, density, and publication date are common article metadata.
Results: Early decisions were taken without a plan to halt COVID-19 from spreading across Asia. Upon confirmation of the first case, national prevention and control measures were launched. Encouraging frequent hand washing, adequate mask usage, and other personal hygiene and sanitation habits were also addressed. Its nature leaves many data and information gaps. Major issues included preventing, detecting, and responding to disease outbreaks in public and medical contexts.
Conclusion: The regional health systems came into action to help national health programs. The ASEAN countries have all responded to the COVID-19 outbreak. In order to prepare for and manage the COVID-19 outbreak, a thorough investigation is required.