bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of Balinese Purple Sweet Potato (Ipomoea batatas L.) tuber ethanolic extract on renal Nox4 level in mice with a high purine diet
Authors: Mahendra Agung Nova , Dewi Ni Wayan Sucindra
Published: June 2021

Background: TLR4-NADPH Oxidase-4 or TLR4-Nox4 signaling pathway uric acid (UA)-induced oxidative stress is involved in urate nephropathy pathogenesis, which can culminate into renal fibrosis, a common feature of chronic kidney disease (CKD). Based on the hyperuricemic and antioxidant effect of anthocyanin on the kidney, we assumed that Balinese purple sweet potato (Ipomoea batatas L.) tuber in its ethanolic extract form (PSPEE) could suppress the activation of renal TLR4-Nox4 signaling. This study was aimed to investigate the renoprotective effect of PSPEE via renal Nox4 downregulation, using a murine model induced with a high-purine diet.Methods: This study was an experimental laboratory study using a post-test only with a control group design among 38 male Swiss mice. The Male Swiss mice (20-30 g) were randomly allocated into 2 groups, namely, the control group (treated with a high-purine diet for 7 days) and the PSPEE group (treated with a high-purine diet for 7 days and PSPEE for 14 days). The serum uric acid (sUA) level was quantified using the UA phosphatase method. Meanwhile, the renal Nox4 level was quantified using ELISA. Data were analyzed using SPSS version 20 for Windows.Results: Our study found that the renal Nox4 levels were 18.65Â±1.67 ng/mL and 15.14Â±1.66 ng/mL for the control and PSPEE groups. Based on the statistical analysis, there was no statistically significant difference between control and PSPEE groups (p>0.05).Conclusion: Balinese PSPEE tends to decrease renal Nox4 level in high-purine diet-treated mice, but fails to show a significant effect.
Strategy within limitations during COVID-19 pandemic in Indonesia: Shortage of PPE, prevention, and neurosurgery practice
Authors: Lauren Christopher , Iskandar Angel , Argie Donny , Malelak Elric Brahm , Sebayang Samuel Edhi Surata , Mawardy Reza , Junaidy Vito Masagus , Firmansyah Yohanes
Published: June 2021

N/A
Mutilating surgery with free flap in oral and oropharyngeal cancer: A report of case series
Authors: Yahya Mohammad Nasyatmuddin , Khalid Ahmad Kusyairi , Yunus Mohd Razif Mohamad , Saad Arman Zaharil Mat
Published: June 2021

Introduction: Globally, oral cancer is the eighth most common malignancy with over 300,000 people are diagnosed in each year. It is also the third most common cancer in South East Asia. The tongue is the most common intraoral site for cancer. The aim of this study is to highlight the relevance of mutilating surgery of head and neck cancer in the current minimally invasive and robotic surgery era.Case description: We present four case series of tongue carcinoma who underwent combined mandibulectomy, neck dissection (COMMANDO), resection of tumours and reconstruction with anterolateral thigh flaps. All cases showed remarkable outcome in which the flap was viable and healthy, with good tongue mobility postoperatively. All patients were discharged from ward two weeks after operation with tracheostomy tube decannulated.Conclusion: COMMANDO operation with anterolateral thigh flap reconstruction is relevant in the current era, especially for the late and advanced stages of oropharyngeal carcinoma. Therefore, multidisciplinary trained surgeons are required to perform these cases, i.e. qualified head and neck surgeon with reconstructive teams.Â
The effect of ethyl acetate fraction of Moringa oleifera leaves on neutrophil and MDA levels in the improvement of liver dysfunction in male rats with sepsis model
Authors: Riswanto Riswanto , Sumandjar Tatar , Redhono Dhani , Kurniawan Robby , Rahman Arief
Published: June 2021

Purpose: Sepsis is life-threatening organ dysfunction caused by the dysregulation of the host response due to infection. Sepsis is caused by an imbalance between pro-inflammatory and anti-inflammatory cytokines. Moringa oleifera (Mo) leaves naturally contains antiinflammation and antioxidant. We aim to investigate Mo leaves in sepsis.Patients and methods: This is an experimental laboratory study with Post Test Only Control Group Design. 30 Winstar males rats were divided into four treatment groups; each consist of 6 rats. The negative group, the positive control group received an injection of LPS dose of 0.25 mg/kg BW, and the interventional group with Mo-EA dose of 10, 20, 40 mg/kg BW. The Annova and Kruskal-Wallis test was used in this study. The significant p-value<0.05. The measured outcome were neutrophil levels, malondialdehyde (MDA) levels, and Serum Glutamic Pyruvate Transaminase (SGPT) / Serum Glutamic Oxaloacetic Transaminase (SGOT).Results: The neutrophil, MDA, SGOT, and SGPT levels were decreased significantly within the treated group. MO Fraction can decrease the serum of MDA, Neutrophil, and SGOT/SGPT levels in days 3 and 7 (p<0.05).Conclusion: There was a decrease in the level of Neutrophil, MDA, SGOT, and SGPT improvement of Hepar organ dysfunction after administration of MO Extract, so it is useful to inhibit the progression of sepsis.
Tracheostomy in upper airway obstruction on a COVID-19 patient
Authors: Jaafar Rohaizam Japar , Yahaya Zakinah , Mohamad Yunus Mohd Razif , Mat Baki Marina
Published: June 2021

Background: Â Stridor due to upper airway obstruction in a COVID-19 positive patient is a big challenge to the medical team, especially anesthetists and otolaryngologists. In this condition, performing aerosol-generating procedures (AGP) is time-sensitive and increases virus transmission risk. The dilemma of treating a stridorous patient with laryngeal carcinoma and concurrent COVID-19 positive with pneumonia is possibly become a new normal in this era.Case Report: A 66-year-old male, chronic smoker, completed six days of in-patient treatment for community-acquired pneumonia when the RT-PCR for COVID-19 was found to be negative. He was seen in the otorhinolaryngology (ORL) clinic two weeks later due to hoarseness for two months associated with worsening shortness of breath and cough. He had soft stridor at rest and was mildly tachypnoeic. Flexible endoscopy revealed a mass on the right immobile vocal cord with a small glottic airway. A repeat nasopharyngeal swab for COVID-19 on the same day was positive. A detailed discussion involving a multidisciplinary team lead to the decision to secure the patient's airway by first intubating him with a small endotracheal tube and followed by tracheostomy in the same setting. Here, the experience in managing upper airway obstruction due to laryngeal carcinoma (at least T3) in a patient with stage 4 COVID-19 is presented and discussed. The challenges emerged due to the inevitable series of AGPs that need to be performed. Multidisciplinary team involvement comprises ORL surgeon, anesthetist, infectious disease, and respiratory physician is pertinent. Â Conclusion:Â  This is the first case in the literature on a stridorous COVID-19 positive patient with laryngeal carcinoma that requires emergency tracheostomy. The case highlights the challenges and decision-making in managing such cases that are supposed to be straightforward before the COVID-19 pandemic era. This shall be the new normal for otorhinolaryngologists, anesthetists, and maybe any other specialties who deal with AGPs.
Sinister Snoring in A Child
Authors: Te Boon Chin , Yeoh Zhi Xiang , Japar Jaafar Rohaizam , Goh Bee See
Published: June 2021

Introduction. Snoring in a child is not uncommon and is frequently caused by adenotonsillar hypertrophy, or rarely, by some sinister lesions. High clinical suspicion for head and neck malignancy is warranted in a child with atypical snoring presentation associated with neck swelling.Case. We present a case of parapharyngeal Lymphoma in a child who presented with progressively worsening snoring. Clinical examination revealed swelling on the left side of the neck, with medialization of the left lateral pharyngeal wall, suggesting a left parapharyngeal tumor. A subsequent biopsy confirmed the diagnosis of Lymphoma. Chemotherapy was initiated immediately.Conclusion. The presentation of head and neck Lymphoma in a child can be vague. Early recognition and treatment are crucial to improve the survival of a child.
Relationship of proteinuria severity with Xerosis Cutis in children with Nephrotic Syndrome at the Haji Adam Malik Hospital
Authors: Utamiati Ami , Purnama Sri Wahyuni , Roesyanto Irma D
Published: June 2021

Introduction: Proteinuria is a risk factor for the progression of Nephrotic Syndrome. Xerosis cutis is a disorder of the skin due to reduced fluid or oil content in the skin that moisture the surface of the skin layer. The three primary keys that play a role in the incidence of Xerosis Cutis are the lack of moisture-binding substances, lack of skin fat and ceramics and the latter lack of skin moisture wiring in the viable epidermis mediated by the aquaporin water channel. Reduced protein content and impaired collagen maturation, for example due to proteinuria, might influence the mechanism behind preservation skin moisture. This study aimed to determine the relationship between the severity of proteinuria and Xerosis Cutis in children with Nephrotic Syndrome.Method. This is a cross-sectional analytic study involving 50 patients with Xerosis Cutis with Nephrotic Syndrome. Kruskal Wallis test is used to determine the association of proteinuria severity with Xerosis Cutis in children with Nephrotic Syndrome.Result: The median value of age was 8 (3-16) years, with the most range at 6-10 years old (52%). It consists predominantly of male patients (68%). The duration of the Nephrotic Syndrome has a median value of 2 (1-7) years. Subject with +1 proteinuria (36%), +2 (32%), +3 (28%) and +4 (4%). Skin moisture level was dry (Xerosis Cutis) (36%), normal (56%), and moist (8%). Â There was a significant association between skin dryness and the severity of proteinuria (p = 0.002).Conclusion: There is a significant relationship between the severity of proteinuria and Xerosis Cutis. The higher the severity of proteinuria associated with having skin dryness and thus indirectly describing the more protein wasted through urine.
Hip fracture among elderly people: a single cohort study from Kurdistan of Iraq
Authors: Amin Asso , Ali Hersh Haider Hama , Faraji Saman Anwar , Ghafoor Sara Noori , Shareef Saman Hama , Sadeq Saman , Noori Soran , Ghareeb Khalid Anwar Hama , Gubari Mohammed Ibrahim Mohialdeen
Published: June 2021

Background: Hip fracture is considered a major health problem worldwide. The current study aimed to investigate hip fracture characteristics among older people in Iraq and factors involving postoperative mortality.Method: A single cohort study was carried out in Sulaimani and Shar Teaching hospitals in Sulaimani from the 1st of July 2018 to 30th of June 2019.Â  Hip fracture was diagnosed by a specialist physician using an X-Ray. The data was collected by the researcher through direct interviews and filling a prepared uniform questionnaire. The data analyzed by SPSS and p-value<0.05 was significant.Results: From the total of 100 hip fracture patients included, the average age of patients was 74.45Â±8.18 years. Fifty-nine patients aged 60 to 75 years, while the rest were older than 75 years. Female consisted of 59.0% of the total samples. Non-mechanical falls accounted for (84%) of all falls. Most patients had intertrochanteric fractures (65%), while 35% had femoral neck fractures. The Proximal femoral nail (PFN) operation was the primary type of operation (77%) performed. Most patients (94%) were discharged after two days. There was a significant association between gender and postoperative mortality; female patients had worse prognosis and higher mortality, relative risk (95%CI) 0.18 (0.0424Â toÂ 0.7788). Older patients aged 75 and more had a remarkably poorer prognosis than younger patients, relative risk (95%CI) 0.30 (0.10Â toÂ 0.93). There was a strong relationship between poor cognitive function (moderate to severe depression) and postoperative mortality rate with relative risk (95%CI) 0.04 (0.006Â toÂ 0.36). Finally, patients on three or more medications also had an outstanding worse prognosis, relative risk (95%CI) 0.022 (0.001Â toÂ 0.37). Conclusion: Hip fracture was more common among women and people aged above 75 years. The prevalence of intertrochanteric fractures was nearly double the femoral neck fractures. Age, female, depression, and polypharmacy had a statistically significant association with three-month mortality in hip fracture patients.
Factors influence bullous keratopathy post cataract surgery at National Eye Center of Cicendo Eye Hospital (PMN RSMC), West Java, Indonesia
Authors: Siska Siska , Memed Feti Karfiati , Musa Ine Renata
Published: June 2021

Background: Bullous keratopathy is one of the leading causes of vision loss following cataract surgery. Several factors have been elucidated regarding the influence of bulosa keratopathy post cataract surgery. This study aims to evaluate pre-, intra-, and postoperative predisposition factors for bullous keratopathy following cataract surgery.Methods: A retrospective descriptive study was done using data extracted from medical records. Patients diagnosed with bullous keratopathy after cataract surgery who underwent further examination procedures for at least 3 months were included. Patients with a history of glaucoma, Fuch's dystrophy, or other intraocular procedures were excluded. Data were analyzed by SPSS version 20 for Windows.Results: Fourteen cases were included in this study. Most cases were female (78.57%) aged â‰¥60 years old (64.29%). There were postoperative changes in visual acuity and corneal status in most patients without any change in intraocular pressure. The majority of patients underwent manual small incision cataract surgery with posterior chamber intraocular lens implantation. Intraoperative complications were vitreous prolapse and Descemet membrane stripping, while postoperative complications were uveitis and lens adhesion.Conclusion: Bullous keratopathy after cataract surgery was more common in elderly females. There were notable changes in visual acuity and corneal status postoperatively. Further large-scale analytic study is warranted to confirm the predictive factors and causality.
Correlation between stress level and family support towards fasting and postprandial glucose level in type 2 diabetes mellitus
Authors: Trisnadewi Ni Wayan , Adiputra I Made Sudarma , Oktaviani Ni Putu Wiwik , Suapriyanti Putu Aris , Intan Saraswati Ni Luh Gede
Published: June 2021

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by increased blood glucose (hyperglycemia). Stress and familyâ€™s support in managing diabetic Mellitus are two critical external factors that influence blood glucose levels. This research aimed to analyze the relationship between stress level and familyâ€™s support with fasting blood glucose levels and 2 hours post prandial in T2DM patients.Method: Study design using cross sectional model. Eligible T2DM patients in Tabanan II primary health care center, between period September 2017- February 2018 were evaluated for fasting and post prandial blood glucose and stress level (Depression Anxiety Stres Scale-14) and family support. Spearman correlation test was used to determine correlation between family support and stress level toward fasting and post prandial glucose levels in T2DM patients.Result: The result suggested that 29 respondents (36.3%) get severe stress levels, 51 respondents (63.85%)Â  get high family support, fasting blood glucose level was 168.42Â±63.57 and post prandial glucose level was 229.18Â±88.593. There was a positive correlation between family support and stress level toward fasting glucose level (r=0.341; p<0,001) and post prandial glucose level (r=0.276; p<0,001).Conclusion: Stress level and family support in diabetic mellitus management can influence fasting and post prandial glucose level T2DM patients. Managing stress and family support can assist in stabilizing fasting and post prandial glucose level.
Effect of heparin administration on heparin-induced thrombocytopenia (HIT) in atherosclerotic New Zealand Rabbit (Oryctolagus cuniculus)
Authors: Nababan Victor Jesron , Prasmono Agung , Retnowati Endang , Legowo Djoko , Banjarnahor Sofna
Published: June 2021

Background: Platelets have been associated with the pathogenesis of atherosclerosis by excreting various chemokines (i.e. PF4), which systematically interact with multiple molecules. The formation of circulating heparin-platelet factor-4 (PF4) complexes have been observed in heparin-induced thrombocytopenia (HIT) cases, raising questions about the role of PF4-derived atherosclerosis in the predisposition of HIT.Â Â  Methods: An in vivo model of atherosclerosis was generated by feeding rabbits with a high-cholesterol diet for six weeks and a normal rabbit as a control group. HIT was induced by injecting heparin subcutaneously for ten days twice daily. Platelets count before and after heparinization was performed by hemocytometer, PF4 measurement was determined by ELISA assay. Histopathology examinations for artery thickness, foam cell, and endothelial denudation were conducted by Hematoxylin and Eosin (H&E) staining. Results: There was no significant difference in the IgG PF4/heparin complex between the atherosclerotic and the normal groups (43.84Â±2.07 ng/mL vs. 41.87Â±3.44 ng/mL), platelet count was significantly reduced only in the atherosclerotic group (p=0.01; mean differences 7162.00Â±57311.02/mm3), endothelial denudation and foam cell formation were observed in the atherosclerotic group. Also, a significant difference observed in endothelial thickness between the atherosclerotic group compared to the normal group (470.32 Â± 131.15 Âµm vs. 332.05Â±50.82 Âµm; p=0.032).Conclusion: Our results suggest that atherosclerosis was significantly associated with the development of heparin-induced thrombocytopenia. However, atherosclerosis is not a risk factor for the formation of PF4-heparin complex in HIT.
Antiplasmodial activity of chalcone derivatives compound through phagocytosis of kupffer cells in experimental malaria hosts
Authors: Wijayanti Lilik , Dirgahayu Paramasari , Sari Yulia , Hermawan Danus , Nurwati Ida
Published: June 2021

Introduction: Malaria is still one of the major health problems, specifically due to drug resistance in Plasmodium, which encourages extensive research to find effective alternatives. One of the new antimalarial compounds is chalcone-derivative compound (E)-1-(4-aminophenyl)-3-(2,3-dimethoxy phenyl)prop-2-en-1-one. However, its potency is still needed to be evaluated. Therefore, this study aimed to determine the efficacy and identify the pharmacological mechanism of this chalcone-derivative.Â Methods: An experiment using post-test only with control group design was conducted from May 2016 to July 2017 in the laboratory of Parasitology and Clinical Pathology Faculty of Medicine, Universitas Gadjah Mada. Swiss mice were used and infected with Plasmodium before being divided into nine groups with different concentrations of (E)-1-(4-aminophenyl)-3-(2,3-dimethoxy phenyl)prop-2-en-1-one. Histological examination was conducted to count the number of Kupffer cells and the proportion of Kupffer cells that had phagocytosed the Plasmodium. Results: Both doxycycline and (E)-1-(4-aminophenyl)-3-(2,3-dimethoxy phenyl)prop-2-en-1-one Â decreased the parasitemia in the tested mice with higher efficacy was observed in the doxycycline group. Likewise, both compounds also increase the number ofÂ  Kupffer cells which become phagocytes of erythrocytes containing Plasmodium was higher in the treatment group than in the control group (p 0.000 <0.05). Substance (E)-1-(4-aminophenyl)-3-(2,3-dimethoxy phenyl) prop-2-en-1-one may act as an antimalarial by phagocytes of erythrocytes containing Plasmodium. Conclusion In conclusion, the (E)-1-(4-aminophenyl)-3-(2,3-dimethoxy phenyl)prop-2-en-1-one exhibited potent antimalarial activity via the phagocytic activity of Kupffer cells. This compound may be developed into a new antimalarial drug.
Exercise and cardiomyocyte regeneration
Authors: Juhanna Indira Vidiari , Adiputra I Nyoman , Adiatmika I Putu Gede , Muliarta I Made , Linawati Ni Made , Griadhi I Putu Adiartha
Published: June 2021

Cardiovascular disease is the most common cause of death. Many researchers have evaluated the effect of exercise on heart function improvement, but studies about how exercise can affect heart regeneration are rare. Most of the previous studies only assess biomarkers that indicate heart damage. GATA-4 Transcription Factor is one of the transcription factors that form heart cells, showing the heart's ability to function properly under pressure. Cardiac-restricted zinc-finger TF GATA-4 is a survival factor that can break the vicious cycle of post-MI heart failure through increased myocardial angiogenesis, decreased apoptosis, and increased c-kit cell generation. Further research is needed because of its critical role in heart regeneration, whether GATA-4 can be used as an excellent cardiac biomarker in the future, and how the role of exercise or physical exercise on GATA-4 protein and its expression in cardiac regeneration.
Blood pressure and glomerular filtration rate in obese adolescents
Authors: Mahayani Gusti Ayu Putu Sri Satya , Arimbawa I Made , Subanada Ida Bagus , Artana I Wayan Dharma , Hartawan I Nyoman Budi , Suarta I Ketut
Published: June 2021

Background: Obesity in children has the potential to increase the risk of morbidity and even death in the future. One of the diseases that are at risk due to obesity is hypertension and also impaired kidney function. Glomerular filtration rate differences in obese and normal-weight children are somehow contradictory. This study aims to prove the difference in blood pressure and kidney function in adolescents with obese and non-obese.Methods: A cross-sectional study was conducted among high school children in Denpasar. Subjects were classified as obese and non-obese. The Mann-Whitney test was used to assess the mean difference of blood pressure, whereas the Independent t-test was used to determine the mean difference of GFR. Multivariate analysis was performed with logistic regression and ANCOVA. Data were analyzed using SPSS version 20 for Windows.Results: A total of 68 subjects with obese and 52 subjects with non-obese were included in this study. Systolic and diastolic blood pressure in the obese group was higher than in a non-obese group, with the mean difference in systolic and diastolic blood pressure was 29 mmHg (P<0.001) and 18 mmHg (P=0.002), respectively. Obesity increases the risk of hypertension 9.78 times (95% CI: 1.86-51.39; P=0.007), and obese adolescents have an average GFR of 11.51 lower than non-obese (95% CI: 17.32 â€“ (-5.69); P<0.001).Conclusion: Hypertension is higher in obese adolescents than non-obese, while glomerular filtration rate is lower than non-obese adolescents.
Ventral meatotomy as management of female urethral stricture: a case report
Authors: Oka Anak Agung Gde
Published: June 2021

Introduction: Female urethral stricture is considered a rare condition. This condition may lead to recurrent lower urinary tract symptoms and urinary retention. Several techniques have been reported to overcome this disease with some advantages and disadvantages. This case report shows the author's experience in treating female urethral stricture using the ventral meatotomy technique.Case description. A 63-year-old female suffered from poor urinary flow, recurrent urinary tract infection and lower urinary tract symptoms. Physical examination and urethrocystoscopy showed narrow urethral opening and severe trabeculation, respectively, which indicated bladder outlet obstruction due to urethral stricture. A ventral meatotomy was performed, followed by an indwelling catheter for a week. The patient showed improvement of the symptoms postoperatively.Conclusion. Urethral reconstruction in female urethral stricture should be decided as definitive therapy, and an individualized approach must be applied based on patient factors and surgeon experience.
The effect of Myrmecodia pendans extract toward gastric histology in white rats treated with toxic dose of gentamicin: a preliminary report
Authors: Putra I Made Bagus Januar Bahari , Budiasa Ketut , Merdana I Made , Adi Anak Agung Ayu Mirah
Published: June 2021

Introduction: Myrmecodia pendans, or traditionally known as ant nest fruit, is one of popular traditional medicines in Indonesia with a wide range of effects such as antidiabetic, anticancer, and free-radical scavenging agents. Despite of the extensive research, reports regarding its toxicity are scarce. Gentamicin is also one of popular and widely used anti-biotic but it is associated with a wide range of toxicity, especially if administered at high dose. Therefore, this study aimed to evaluate the effect of Myrmecodia pendans extract in the mice what received toxic dose of gentamicin.Method: 24 male white rats were used and randomly divided into 4 groups: P0 (negative control), P1 (100 mg/kgBW intraperitoneal gentamicin), P2 (gentamicyn + 250 mg/kgBW myrmercodia extract), P3 (250 mg/kgBW myrmercodia extract which administered for 7 days and followed by gentamicin). The treatment was given for 10 days and all mice were sacrificed at the end of the study. The stomach was taken from each mouse and examined pathologically using Hematoxylin-Eosin (HE) staining.Results: The necrosis was found in all groups that received gentamicin (P1-P3) with P2 had the most severe necrosis. Hemorrhage was only found in group that received Myrmecodia extract (P2 and P3) and, again, P2 had higher score of hemorrhage compared to P3.Conclusion: The administration of Myrmecodia extract at 250 mg/kgBW together with toxic dose of gentamicin exacerbate the gastric tissue damage in Wistar rats.
The potential of sunscreen preparation containing ethanol extract of Moringa oliefera leaves in nanoemulgel formulation
Authors: Indrayani Agung Wiwiek , Artini I Gusti Ayu , Widhiarthini Ida Ayu Alit , Tianing Ni Wayan , Jawi I Made
Published: June 2021

Introduction: Quercetin (3, 3'4', 5.7-pentahydroxyflavone) within Moringa oliefera leaves is known to prevent cellular damage and dermal inflammation due to ultraviolet light exposure. However, its administration in Nanoemulgel form, which gives the cosmetics a good stability and compound release, is not yet evaluated. Therefore, this study aimed to characterize and develop a nanoemulgel sunscreen preparation containing Moringa oliefera leaves.Methods: Design and optimization using simplex lattice design were performed. The optimum formulation for three independent variables involved propylene glycol- (X3), tween 20- (X2), and oleic acid oil- (X1) with a percentage ratio at 11.31; 77.50 and 11.19, respectively.Results: The results showed that the optimum nanoemulgel formulation yielded an SPF value at 33.35, with a percentage of transmittance at 88.03. The emulsification time was recorded at 19.19s with droplet diameter at 138.0-nm with zeta potential at -37.1mV and polydispersity index at 0.537.Conclusion: This study concluded that the moringa leaf nanoemulgel sunscreen was successfully formulated with a high SPF value.
Prevalence of and risk factors associated with anal HPV infection among men who have sex with men in Bali, Indonesia
Authors: Somia I Ketut Agus , Merati Tuti Parwati , Sukmawati Dewi Dian , Indira I Gusti Ayu Agung Elis , Dwija Ida Bagus Nyoman Putra , Prasetia Made Yogi Oktavian , Phanuphak Nittaya , Nonenoy Siriporn
Published: June 2021

Background: Anal human papillomavirus (HPV) is one of the most common sexually transmitted infection. Men who have sex with men (MSM) are commonly affected by anal HPV infection. Until now, there is no data available on the prevalence of HPV genotype in the MSM in IndonesiaPurpose: This study aimed to determine the prevalence and risk factors of anal HPV infection among MSM in Bali, Indonesia.Patients and methods: A cross-sectional study was conducted among MSM in Sanglah Hospital, Bali, Indonesia. Blood samples were collected for HIV serological testing and syphilis serological screening, and anal swabs were collected for HPV genotyping. Risk factors associated with anal HPV infection were assessed by univariate and multivariate logistic regression. Anal HPV infections were also being categorized into any anal HPV types, HR HPV types, LR HPV types, and multiple HPV types.Results: Mean age of participants was 31.4 years. The prevalence of HPV infection was 89.3% and 61.3% for coinfection between LR and HR types. Almost half of our participants had at least two HR anal HPV and they were co-infected with HPV 16, 39, and 51. Participants with HIV infection were associated with anal HPV, LR HPV, and multiple HPV types of infections.Conclusion: HIV status were associated with anal HPV infection among MSM in Bali, Indonesia. Since all of the participants with at least two anal HPV genotypes were co-infected with HPV 16, 39, and 51, it is to be hoped that HPV vaccination can be introduced into MSM communities in Bali, Indonesia.
Hypertensive emergency: an overview of heart as target organ damage
Authors: Rampengan Starry Homenta , Sunarto H J
Published: June 2021

Hypertension is currently still a global problem in the cardiology and vascular fields with an increasing trend. One of the emergency conditions related to an increase in blood pressure is emergency hypertension. Emergency hypertension is a condition where blood pressure rises rapidly and severely, resulting in new or progressive organ damage. Symptoms can range from chest pain, shortness of breath to delirium. The heart is one of the organs that can be damaged by hypertensive emergencies. The availability and demand for oxygen from the coronary blood vessels to the heart muscle cells will experience an imbalance due to a sudden increase in blood pressure. Lack of oxygen that occurs can cause heart muscle cells' death affected heart structure and its function. The symptoms that appear can be in the form of acute coronary syndrome or acute heart failure. Some modalities can detect heart structure changes, like electrocardiography for general and echocardiography for specific examination. Hypertensive emergencies can be treated by several rapid-acting antihypertensive agents, which can be selected based on the clinical manifestations. As the symptoms related to heart damage are acute coronary syndrome and acute heart failure, so the treatment will be specific, respectively. Good knowledge related to emergency hypertension management and early treatment will reduce patient morbidity.
Ethical and medicolegal consideration in case of pregnancy due to sexual abuse in the schizophrenic patient
Authors: Suryadi Taufik , Rizia Fitra , Kulsum Kulsum
Published: June 2021

Background: Pregnancy due to sexual abuse in schizophrenic patients always become a clinical problem in the obstetrics and gynaecology that can arise ethical dilemmas and medicolegal issues. Doctors must be able to balance between the obligation to protect patients from morbidity (nonmaleficence) and also respect the rights and decisions regarding patient reproduction (respect for autonomy). Ethical and medicolegal dilemmas can be resolved with consideration of clinical ethics namely indications of medical, preferential from the patient, life qualities and features of the contextual.Case description: It is a case a 35-year-old patient diagnosed with Schizophrenia 4 years ago. Currently, the third pregnant patient due to sexual abuse (rape). In these conditions, there are two dilemmatic conditions, namely whether the patient continues the pregnancy with the risk that the baby will be born stranded or termination of pregnancy and carried out steady contraception?.Conclusion: The decision was taken to terminate and Pomeroy tubectomy as a contraceptive choice for patients with various considerations such as age, adequate children and especially chronic mental illness. Patients with problems like this are at risk of having a poor quality of life. Decision making for solid contraception is supported by the representative of the social ministry of the Republic of Indonesia and the patient's family.
The Intracytoplasmic Sperm Injection (ICSI) technique in an infertile man with Hepatitis-B Virus (HBV) infection: a case report
Authors: Pramesemara I Gusti Ngurah , Faizah Zakiyatul , Darsini Ninik
Published: June 2021

Background:Â Several studies have suggested a relationship between chronic infection of the Human Hepatitis-B Virus (HBV) and infertility in men. HBV infection causes instability of spermatozoa chromosomes, interferes the parameters of semen analysis, and have risks to infecting fetus or embryo. In order to prevent the HBV infection, the Intracytoplasmic Sperm Injection (ICSI) procedure has been established. This case study aims to evaluate the ICSI technique conducted to an infertile man with HBV infection.Case Description:Â We reported a case of a 42-year-old infertile male who had primary infertility for 11 years with positive HBsAg. Patients were given Tribulus terrestris and an antioxidant also referred to an internist colleague for the definitive treatment of Hepatitis-B. Then the patient and his wife were prepared to undergo an In-Vitro Fertilization (IVF) procedure by washing spermatozoa and ICSI. Routine evaluation for 15 days post-ICSI for the first time did not show biochemical signs of pregnancy in wives with negative Î²-hCG.Â Conclusion:Â It was concluded that the ICSI procedure could be considered in the action of IVF in infertile man with HBV due to no adverse effect recorded.
Correlation between radiograph imaging and degree of chondrosarcoma histopathology
Authors: Wijayaningrum Sherly Eva , Martadiani Elysanti Dwi , Asih Made Widhi , Widiana I Gde Raka , Sitanggang Firman Parulian , Anandasari Pande Putu Yuli
Published: June 2021

Background: Chondrosarcoma is the second most common primary bone tumor in adults after osteosarcoma. It is difficult to distinguish between low and high-grade chondrosarcoma radiographically, due to its various imaging appearances. Therefore, an imaging analysis method is needed to increase grading accuracy preoperatively. This study aim was to evaluate the correlation between imaging characteristics and degree of chondrosarcoma from histopathology.Material and methods: This study was approved by the ethical clearance and ethics committee in our centre. A cross sectional study was conducted of 22 subjects with histopathology proven diagnosis of chondrosarcoma and had met both inclusion and exclusion criteria. Bone destruction, endosteal scalloping, transitional zone, chondroid matrix calcification, and periosteal reaction were the imaging characteristic that was re-evaluated by two radiologists with hidden identification.Result: Mean age of all subjects was 43.22 Â± 14.28 years old, with slight female predominance (54.5%). 21 out of 22 chondrosarcomas (95.55%) were found in appendicular skeleton and the most frequent site was found in iliac bone (31.82%), followed by femur, humerus, and pubic ramus. Bone destruction and soft tissue mass were the characteristics found on high-grade chondrosarcoma as many as 94% and 100% respectively, in the other hand all low-grade chondrosarcoma none has a picture of endosteal scalloping and periosteal reaction. Still, all low-grade chondrosarcoma has a chondroid matrix. Transitional zone margin 1B and 1C were discovered more on high-grade chondrosarcoma, whereas 1A, 1B, and no 1C were detected on low-grade chondrosarcoma. A radiographic abnormality score â‰¥3 has 4.7 times more chance to become a high degree greater than <3 score, with ROC curve 0.96 (p<0.05). The intraobserver and interobserver scores were r = 0.630.Conclusion: Each abnormality in this plain photo cannot stand alone, but must be combined and produce a total score of radiograph abnormality. A radiograph abnormality score with cut off value 3 can help to determine chondrosarcomaâ€™s histopathology degree. Further research with a larger sample and better image quality can be done to increase statistical analysis accuracy.
Extravesical diverticulectomy: a case report
Authors: Tirtayasa Pande Made Wisnu , Supit Wempy , Saleh Firdaus
Published: June 2021

Background: Several factors cause bladder diverticula. In adult males, the incidence tends to be due to infravesical obstruction. Various techniques have already been introduced to remove the bladder diverticula, which the most hazardous method is the extravesical diverticulectomy technique. This case study aims to report our successful experience in treating a patient with bladder diverticula with extravesical diverticulectomy technique.Case Description: A 69-year-old man was admitted to the urology clinic with recurrent urinary tract infection. Ultrasonography examination revealed bladder diverticula, mild bilateral hydronephrosis without prostate enlargement. Preoperative urethroscopy confirmed the presence of urethral stricture. Internal urethrotomy was performed, followed by extravesical diverticulectomy. The postoperative patient healed remarkably and no complaints were reported.Conclusion: The extravesical diverticulectomy approach seems to be a safe, simple, effective method and can be performed for many sizes of bladder diverticula when performed by an experienced surgeon.
Relationship between C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) with gall bladder adhesion on cholecystectomy at Abdul Wahab Sjahranie Hospital, Samarinda
Authors: Marcellis Nicholas David , Sampetoding Samuel , Suprapto Bambang , Seweng Arifin
Published: June 2021

Background: The conversion from laparoscopic cholecystectomy to open cholecystectomy often results from pericholecystic Adhesion. Pericholecystic Adhesion is a result of cholecystitis in the case of cholelithiasis. C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) can be increased in cholecystitis and used as a predictive factor for the degree of difficulty in laparoscopic cholecystectomy. This study aims to determine the relationship between CRP and ESR with gall bladder adhesion on cholecystectomy at Abdul Wahab Sjahranie Hospital, Samarinda.Method: A cross-sectional study was conducted among 61 respondents who underwent a cholecystectomy surgery at Abdul Wahab Sjahranie Hospital Samarinda during July-September 2019. Parameters assessed in this study were Gender, diagnosis, CRP, ESR, age, hemoglobin, leukocytes count, platelet count, and the relationship between CRP and ESR value with the pericholecystic adhesions. Data were analyzed by SPSS version 22 for Windows. Results: Most of respondents were female (70.5%), followed by cholelithiasis (73.8%) as primary diagnosis, no Pericholecystic Adhesions found (68.9%), CRP level < 23 mg/dl (77.0%), and ESR level â‰¥ 11 mm/hour (78.7%). In addition, the average age of respondents was 48.44Â±10.85 years old, followed by the hemoglobin level (12.43Â±1.77 g/dL), leukocytes counts (9,439.67Â±3,719.37/Âµl), and platelet counts (319,295.08 Â± 90,587.59/ Âµl). CRP level had a significant relationship to the occurrence of pericholecystic Adhesion (OR: 75.400; 95%CI: 7.991-711.441; p=0.000).Conclusion: It can be concluded that there was a relationship between CRP and ESR with the occurrence of pericholecystic Adhesion. However, based on multivariate analysis, CRP was more significant compared to ESR on the occurrence of pericholecystic Adhesion.
Effication of amniotic membrane topical stem cell-conditioned medium combined with YAG erbium fractional laser 2940 nm in photoaging skin
Authors: Praharsini I Gusti Ayu Agung , Indira I Gusti Ayu Agung Elis , Prakoeswa Cita Rosita Sigit , Adiguna Made Swastika , Rusyati Luh Mas , Umborowati Menul Ayu , Citrashanty Irmadita , Sari Maylita
Published: June 2021

Background: Skin ageing is a natural process in humans that is influenced by endogenous and exogenous factors. Nowadays, many people have the concept of health and skin beauty considered as one of the main factors that represent the perception of health in human wellness. Therefore, various anti-ageing therapy strategies that have been developed over the past few years include stem cell therapy. Amniotic Membrane Stem Cells (AMSC) are stem cell products taken from amniotic membranes that contain various proteins and have low immunogenicity. Objective: Proving that Amniotic Membrane Stem Cell (AMSC) metabolite products can improve the clinical picture of photoaging.Method: Study design using one group pre and post-test design model. Samples were obtained by consecutive sampling and the number of samples was 33 people. Clinical examination of patients with the Glogou scale followed by an one smart skin analyzer. Application of AMSC products 3 times daily at intervals of 2 weeks after the Erbium YAG Fractional 2940 nm laser and evaluation were carried out at weeks 0, 4, and 8.Results: Pore diameter showed significant improvement (p<0.001) from first to fifth visit (6.52 Â± 0.57 vs 5.79 Â± 0.7), wrinkles showed significant improvement (p<0.001) from baseline copared to fifth visit (4.28 Â± 0.38 vs 4.09 Â± 0.20), pigment, moisture, and skin elasticity showed significant improvement (p<0.001) from the (baseline) compared to fifth consecutive visits (4.35 Â± 1.41 vs 3.09 Â± 0.68), (42.2 Â± 7.64 vs 59.1 Â± 7.94), (48.2 Â± 14.1 vs 61.7 Â± 13.1) respectively. Sebum T Zone and U zone showed significant improvement (p<0.001) from (baseline) and compared to fifth consecutive visit (12325 Â± 10616.8 vs 2047.5 Â± 1887.9) and (8529.8 Â± 9026.8 vs 1560.6 Â± 895.7). Side effects of urticaria were found in 1 person.Conclusion: AMSC product therapy can be used as a potential for anti-ageing therapy.
Aloe vera gel application for faster healing of split-thickness skin graft donor site on Wistar rats
Authors: Suyata Astrinita Lestari , Hamid Agus Roy Rusly Hariantana , Mahadewa Tjokorda Gde Bagus , Sanjaya I Gusti Putu Hendra , Asmarajaya Anak Agung Gde Ngurah , Adnyana I Made Suka
Published: June 2021

Background: Split Thickness Skin Graft (STSG) donor site healing still becomes concerned since it caused massive pain, discomfort, irritation, soaked, and thick dressing. None of the dressing can be said as the ideal and universal way to treat donor site. Aloe vera has been used as wound treatment, but the mechanism is not well understood yet. This study aims to determine the application of aloe vera gel to heal split-thickness skin graft donor sites on Wistar rats.Methods: An experimental study was conducted among 32 male Wistar rats, 8-12 weeks age with STSG donor area divided into 4 control groups that treated with paraffin gauze and 4 groups that treated with Aloe vera gel. All wounds are closed by transparent dressing and being changed every 2 days. Healing time was count when all wound areas had epithelialization. In the microscopic evaluation, fibroblast, angiogenesis, and collagen deposition were counted on Day 5, 14, and 21. Data were analyzed using SPSS version 17 for Windows.Results: Topical Aloe vera gel for STSG donor site treatment proved initiating significant faster epithelialization time (p=0.018), increasing the amount of fibroblast (p=0.006), and collagen deposition (p=0.001) on Day 5. However, topical aloe vera did not significantly affect the amount of angiogenesis in the early phase (Day 5) of wound healing (p=0.114) but proved to increase significantly in Day 21 (p=0.027). Conclusion: Topical Aloe vera gel proved to heal the STSG donor site faster than paraffin gauze. Aloe vera can be used as one of STSG donor site treatment as it induces faster wound healing.
PTEN and PARP1 expression as predictors of neoadjuvant chemotherapy response in breast cancer: A case-control study
Authors: Sriwidyani Ni Putu , Saputra Herman
Published: June 2021

Background: Most breast cancer patients in developing countries present at an advanced stage and require neoadjuvant chemotherapy (NACT) before mastectomy. Chemotherapy in breast cancer generally kills cancer cells via apoptotic mechanisms, and chemotherapy response could be predicted by assessing biological markers associated with apoptosis, including phosphatase and tensin homolog deleted on chromosome ten (PTEN) and Poly-ADP-ribose polymerase 1 (PARP1). Objective: This study investigated the correlation between PTEN and PARP1 expression and NACT response in breast carcinomaMethods: Breast carcinoma patients who received NACT in 2017-2018 were consecutively selected, consist of 22 patients with positive NACT response and 22 patients with negative NACT response. Immunohistochemical examination of PTEN and PARP1 was carried out, and their expression was categorized with high and low PTEN expression and high and low PARP1 expression. Statistical analysis using chi-square test was performed to assess the relationship between clinicopathological characteristics, PTEN expression, PARP1 expression, and response to NACT. The significance test was determined at p <0.05.Results: There was a significant relationship between tumor size (p=0.030) and PTEN expression (p=0.035) with the response to NACT in breast carcinoma. Low PTEN expression had a risk of negative clinical response to NACT by 3.754 times compared to breast cancer with high PTEN expression. Meanwhile, there was no significant relationship between PARP1 expression and response to NACT in breast carcinoma.
Simulation-based learning compared with conventional methods in procedural skill
Authors: Putra Manuaba Ida Bagus Amertha , Dewi Ni Gusti Ayu Putu Lestari Santika , Prabawa I Putu Yuda , Bhargah Agha , Darmayani Sri , Wu Chien-Chih
Published: June 2021

Background: Recently in the development of the technology, the handling, and management taken for patients are increasingly complex and diverse, especially in the field of cardiology intervention. There are various interventions that residents need to know and cleanse in the field of cardiology in fulfilling their competencies before becoming cardiologists. If the intervention is not done properly, it can affect the patient safety risk or other undesirable complications of the patient. Conventional learning as one of the learning methods always seems to be used in several learning topics. In the middle of resident's hectic schedule and the competencies that must be mastered by them, it triggered the emergence of new learning methods in cardiology, especially in the field of intervention. Simulation-based learning (SBL) has a role in cardiology medicine. Thus, the present review aims to describe the conventional learning, SBL and develop a more effective method in the learning process of cardiology resident procedural skill.Method: We searched for all articles using the term "SBL in interventional cardiology, the effectiveness of SBL for cardiology resident skill, conventional learning method in cardiology medicine, SBL vs. conventional method in cardiology medicine, SBL vs. conventional method in interventional cardiology" in the title or research abstract. We did search on Google Scholar, Medical Education Journals, and Cochrane from 2004 until 2019. We also take a similar topic from the citation of the journal that included in this review.Conclusion: The effectiveness of SBL compared with conventional learning method is better in improving procedural cardiology resident skills. Given the increasing demand for procedural capability competencies that must be possessed by resident cardiology, some benefit of that learning method can be achieved from SBL especially in terms of procedural skills and patient safety.