bluuebunny/crossref_metadata_2025 huggingface dataset:
Urticarial vasculitis associated with post-streptococcal disease in children: a case report
Authors: Sutawan Ida Bagus Ramajaya , Putera Azwin Mengindra , Hikmah Zahrah , Endaryanto Anang
Published: May 2024

Background: Urticarial vasculitis (UV) is a rare clinicopathologic, especially among children and infants. Most urticarial vasculitis is caused by unknown etiology. Rarely has it been linked to post-streptococcal disease as a non-suppurative complication of a streptococcus infection. Treatment of urticarial vasculitis can be challenging. It is based on the clinical phenotype, systemic symptoms, and/or underlying diseases.
Case Presentation: This study reports a case of a child with an itchy but more painful and burning sensations urticarial lesion which persisted for more than 24 hours, left a residual ecchymotic hyperpigmentation lesion when resolved, and was accompanied by systemic symptoms such as joint pain, fatigue, and gastrointestinal symptoms. The symptoms were preceded by signs of pharyngitis one week before the symptoms and supported by an increase in ASO titer that raised the suspicion of a previous recent streptococcal infection. Skin biopsy revealed a leukocytoclastic vasculitis, a specific finding supporting the diagnosis of urticarial vasculitis. The combination of antibiotics, antihistamines, and corticosteroids gave our case a good clinical response and outcome.
Conclusion: A high awareness of urticarial vasculitis linked to post-streptococcal diseases is needed to establish prompt treatment and prevent further complications.
Fibroblast growth factor 2 expression on lymph node metastasis in early-stage breast cancer
Authors: Kartini Diani , Panigoro Sonar Soni , Alam Islam Akbar , Dien Alban Willian , Soemarko Dewi Sumaryani , Hellyanti Tantri , Wardhana Jessica Dewati , Marcevianto Kevin Varian
Published: May 2024

Introduction: Axillary lymph node involvement is an important aspect of breast cancer diagnosis in determining treatment and predicting distant metastasis. Lymph node metastasis is associated with higher recurrence and survival rates. Lymph node status is a significant prognostic factor and is widely used. Several factors affect lymph node metastasis, including tumor size, grade, and invasive ductal histological type. FGF2, a lymphangiogenesis factor, influences the occurrence of lymph node metastasis. The present study aimed to determine the association between FGF2 expression and axillary lymph node metastasis in early-stage breast cancer and evaluate the association between FGF2 expression and clinicopathologic factors.
Methods: A cross-sectional design was used to evaluate the expression of FGF2 in 47 early-stage breast cancer patients who underwent either a mastectomy or breast-conserving surgery procedure at Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, from January 2014 to December 2018. FGF2 expression was examined by immunohistochemistry.
Results: FGF2 expression was significantly correlated with axillary lymph node metastasis incidence [p = 0.044, odds ratio 4.22 (95% CI 0.983-18.1)]. Higher FGF2 expression was significantly correlated with the grade, subtype, estrogen receptor (ER) status, and progesterone receptor (PR) status of the tumor (p = 0.017, p = 0.031, p = 0.002, p = 0.013, respectively).
Conclusions: Increased FGF2 expression and tumor size significantly correlated with axillary lymph node metastasis. The tumor's grade, intrinsic subtype, ER and PR status were significantly correlated with increased FGF2 expression. Our study indicated that FGF2 expression might aid in determining the presence of axillary lymph node metastasis.
Efficacy of transcutaneous electrical nerve stimulation on slow transit constipation in children with cerebral palsy
Authors: Soumena Rifah Zafarani , Darma Andy , Ranuh Reza Gunadi , Indra Gunawan Prastiya , Fardah Athiyyah Alpha , Rizky Sumitro Khadijah , Marto Sudarmo Subijanto
Published: May 2024

Introduction: Slow transit constipation ended up causing persistent symptoms that do not respond to medical treatment. Children have common soiling, irregular bowel movements, and colicky abdominal pain. Treatment-resistant slow-transit constipation in children has improved with transcutaneous electrical nerve stimulation (TENS). Several studies reported that TENS therapy was successful in prolonging colonic transit time in children with chronic constipation and reported no side effects. Thus in this study, we would like to investigate the effectiveness of TENS in conjunction with standard therapies for constipated children with cerebral palsy (CP).
Method: This was a cross-section study with a consecutive random sampling technique. This study was conducted from April 2022 – October 2022, in the faculty of medicine, Universitas Airlangga, Surabaya, Indonesia. Patients from 2 until 18 years with cerebral palsy suffering from constipation with slow transit time were recognized according to Rome-IV criteria of constipation and colonic transit colon (CTT) based on radio-opaque markers, Sitzmarks®. In two treatment groups, the intervention group was given laxatives with TENS, and the control group was given laxatives without TENS. Patient records the history of defecation frequency/week, type of stool, and colonic transit colon (CTT) based on radio-opaque markers. Analyses based on statistical parametric comparisons were performed before and after therapy (paired t-test).
Result: Defecation frequency was increased significantly in the intervention group (pre 1.33 ± 0.5 vs post 3.56 +2.0 defecation/week p=0.019) compared with the control group (pre 1.9 ± 01.9 vs post 3 ± 1.8 defecation/week p=0.117). Stools got wetter after stimulation significantly in the intervention group (p = 0.02). Colonic transit was a shorter duration in the children intervention group compared to their based line (p = 0.039).  
Conclusion: Transcutaneous electrical nerve stimulation can speed up colonic transit time to be considered for constipation in CP children.
Copeptin levels as a predictor of acute kidney injury (AKI) in ST-segment elevation myocardial infarction (STEMI)
Authors: Ariningrum Dian , Senaputra Mas Aditya , Sumardiyono  , Purwanto Adhi Pireno  , Suromo Lisyani B.
Published: May 2024

Background: Acute myocardial infarction is a cardiac emergency with a high mortality rate. The ST-segment elevation myocardial infarction (STEMI) patients have complete coronary artery occlusion, so they usually present with severe symptoms and a higher risk of early mortality. The prevalence of type 1 cardiorenal syndrome (CRS), namely acute kidney injury (AKI) in acute heart failure, is 24%-45%. Copeptin is the C-terminus of pro-vasopressin's peptide, the arginine vasopressin's precursor. This study aimed to prove whether copeptin is a predictor of AKI in the STEMI patient population after adjusting for confounding variables.
Methods: This prospective cohort study was conducted between March and December 2020. Eighty-four subjects with STEMI who came to the emergency department at Dr. Moewardi Hospital and met the inclusion and exclusion criteria were enrolled. The data were analyzed to calculate relative risk and 95%CI for each variable, followed by multivariate analysis with logistic regression. Data were analyzed using SPSS version 23 for Windows.
Results: The prevalence of AKI in this study was 67%. The copeptin level at the cut-off of 273.6 pg/ml has an AUC of 0.774 (95%CI=0.676-0.873, p=0.000). Copeptin level, acute heart failure, and risk of renal ischemia associated with AKI in STEMI. Copeptin >273.6 pg/ml showed a statistically significant association with AKI in STEMI (adjusted RR 5.298; 95%CI=1.771-15.847; p=0.003).
Conclusion: Copeptin levels higher than 273.6 pg/ml is known to be an independent predictor of AKI in STEMI.
Validity and reliability of the Indonesian version of QOLIE-10
Authors: Mirawati Diah Kurnia , Subandi  , Handayani Lestari , Budianto Pepi , Prabaningtyas Hanindia Riani , Putra Stefanus Erdana , Hafizhan Muhammad , Febrianty Astrida Fesky , Fauzi Novia Isnaening Tyas
Published: May 2024

Background: Epilepsy could result in disability and lowered patient's quality of life. Quality of Life in Epilepsy Inventory 10 (QOLIE-10) is a questionnaire to assess epilepsy patients' quality of life, but it has not been translated into Indonesian yet. This study aims to translate QOLIE-10 into Indonesian and analyze its validity and reliability.
Methods: This was a cross sectional study conducted at Neurology Clinic, Universitas Sebelas Maret, Surakarta. The translation process consists of two steps, a forward and backward process; each is done by two independent translators. Participants recruited were then asked to complete the Indonesian version of QOLIE-10 twice, with an interval of approximately one month.
Results: From the data obtained, we observed an r-value ranging from 0.247 to 0.669 on the pretest and post-test, greater than the critical r-value of 0.235 (p<0.05). We also observed Cronbach's alpha coefficient of 0.938 and 0.909 (p<0.05) for the pretest and post-test, respectively, and the test-retest reliability with r=0.871 (p=0.000).
Conclusion: Indonesian version of QOLIE-10 is understandable to Indonesian native speakers, valid, and reliable.
Steroid impact on the efficacy and safety of SARS-CoV-2 vaccine: a systematic review
Authors: Pujo Prawiro Negoro  , Gatot Soegiarto  , Laksmi Wulandari
Published: May 2024

Background: The COVID-19 vaccine has become the utmost protection against the pandemic, with billions of doses has been used across the globe. Immunosuppression has been one of the leading issues in the vaccination program, one of which should not be handled lightly is the use of the steroid. Thus, this systematic review is aimed to explore the Impact of steroid use on the efficacy and safety of the COVID-19 vaccine.
Methods: The systematic review is conducted based on the PRISMA guideline by conducting a literature search and screening process through several databases (PubMed, ScienceDirect, Scopus, and EBSCOHost) based on the predetermined PICO criteria. Original articles (Controlled trial or cohort) on the use of steroids in healthy or non-immunocompromised or autoimmune patients were included. The included articles were then assessed for risk of bias using the ROBINS-I tool.
Results: 6,857 articles were screened, with two articles included for the final analysis. The results show a non-significant Impact of steroid use on the vaccine efficacy based on seropositivity and antibody count. However, steroid use is related to milder adverse effects and symptoms.
Conclusion: Steroid is not associated with lower response to the COVID-19 vaccine. Further research on the dose-dependent response to steroid use should be conducted.
A challenging triple valve surgery for long-standing pulmonary hypertension in rheumatic heart disease: a case report
Authors: Narenza Cut Dhora , Habibie Yopie Afriandi
Published: May 2024

Background Pulmonary hypertension is an increase in the mean pulmonary arterial pressure, greater than 25mmHg at rest, or greater than 30mmHg while exercising. In valvular heart disease its presence indicates a decompensated state of the disease. Surgical interventions are the ultimate treatment for the correction of valvular heart disease.
Case Report A 38-year-old female was admitted to the Emergency Department (ER) with complaints of shortness of breath, chest pain, palpitations, and history of fainting. The patient was initially scheduled for aortic and mitral valve replacement and tricuspid valve repair at the end of year 2020. However, due to covid-19 pandemic, the patient was re-scheduled for surgery. On the 15th of June 2022, the patient was admitted to the ER of Zainoel Abidin General Hospital, and was consulted to the CTVS division. On the 17th of June 2022, the patient underwent a successful mitral valve replacement using mechanical St. Jude 29 mm valve, mechanical St. Jude 17 mm for aortic valve position, and tricuspid valve repair commissurotomy and using MC3 Edward ring annuloplasty. The patient was hospitalized for seven days and underwent successful first phase cardiac rehabilitation before discharge. The patient has since made remarkable improvements, establishing better quality of life.
Conclusion Reduced pulmonary pressures postoperatively are often modest, and persistent pulmonary hypertension (PH) is known to be common and an indicator of poor prognosis. For patients with long-standing pulmonary hypertension due to rheumatic heart disease, valve replacement surgery effectively reduces pulmonary hypertension caused by damage to the left heart valve.
Achievement of Decision-to-Delivery Interval in Emergency Caesarean Section Category 1 During the Covid-19 Pandemic: a Scoping Review
Authors: Mardiawan Dimas , Prawitasari Shinta
Published: May 2024

Decision-to-delivery interval of emergency Caesarean Section (CS) Category 1 is a medical intervention that consists of many factors that influence it and should achieve within 30 minutes. In adaptation to the Covid-19 pandemic, health services in hospitals had changed. Thus, this literature review aims to identify factors affecting DDI in emergency CS category 1 during the Covid-19 pandemic. This study was conducted using a scoping review method that referred to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) protocol. The literature search uses electronic databases such as PubMed, ScienceDirect, and Google Scholar with keywords such as “The Covid-19 Pandemic”, “Emergency Caesarean Section”, and “Decision-to-delivery Interval”. Literature included were health reports, clinical practice guidelines or recommendations, and peer-reviewed journal articles without limiting published years. From 451 articles retrieved, 17 articles meet the eligible criteria. Eleven articles discussed factors that influenced DDI of CS emergencies before and during the Covid-19 pandemic and six articles discussed emergency surgery practices recommendations. New factors that had been affecting DDI during the Covid-19 Pandemic were the shortage of health workers number, limited medical supplies, installation of PPE, and infection protocol system due to virus transmission. Postponing elective surgery and new patient triage systems could help the hospitals to achieve decision-to-delivery intervals within the recommended time when medical supplies and shortage of health workers during the Covid-19 Pandemic.
Massage stimulation’s effect on melatonin levels in preterm infants via vagal activity
Authors: Diah Budiarti  , Suryawan Ahmad
Published: May 2024

Massage stimulation has been suggested to be used to promote the growth and development of preterm and low birth weight (LBW) infants. Some experts believe that infant massage can help develop the central nervous system, which increases vagal activity, improves hormone secretion, triggers the release of melatonin, and increases its production. Rhythmic endogenous melatonin secretion appears in term infants around 2-3 months of age, whereas preterm infants have delayed melatonin secretion, which persists after correction for 8 to 9 months of gestation. Massage stimulation increases vagal activity, which causes an increase in melatonin. Vagal activity then modulates pineal and extrapineal activity, resulting in melatonin production. Based on scientific evidence, current reviews suggest that massage stimulation can provide health benefits to newborns, particularly preterm infants. This article aims to review that massage stimulation can increase melatonin levels by activating vagal mechanisms.
Validity test of pre-screening developmental questionnaire (PDQ) and mother and child health (MCH) handbook for determining children's readiness to enter elementary school
Authors: Nurani Widianti  , Ahmad Suryawan  , Mira Irmawati
Published: May 2024

Introduction: Many experts have tried to invent appropriate measures for deciding children’s school readiness, one of which is the Nijmeegse Schoolbekwaamheids Test (NST). Unfortunately, it conveys several troubles such as being time-consuming, expensive, and uncomfortable for children. Meanwhile, the majority of parents have been accustomed to the pre-screening developmental questionnaire (PDQ) and mother and child health (MCH) handbook to monitor their children's development. The present study aimed to examine the PDQ and MCH handbook’s validity for determining children’s readiness to enter elementary school based on sensitivity, specificity, positive predictive value, and negative predictive value.
Methods: The study used a descriptive-observational research approach with a cross-sectional research design conducted from March to May 2022. Data were obtained from the completed PDQ, MCH handbook, and NST forms. The data were analyzed using the Chi-squared test to contrast the results of sensitivity, specificity, positive predictive value, and negative predictive value between variables to reveal whether the PDQ and MCH handbook were valid to be used besides the NST.
Results: There was a relationship between children’s readiness to enter elementary school based on PDQ and NST (p < .05) and the MCH handbook and NST (p < .05). The sensitivity of children’s readiness to enter elementary school based on PDQ was 96.2% with the specificity of 50%, the positive predictive value of 96.2%, and the negative predictive value of 50%. Moreover, the sensitivity of children’s readiness to enter elementary school based on the MCH handbook was 80% with a specificity of 75%, a positive predictive value of 97.7%, and a negative predictive value of 23.1%.
Conclusion: The PDQ and MCH handbook can help Indonesian parents define their children’s readiness to enter elementary school as it is more reachable and applicable.
The effect of exercise using incentive spirometry on heart rate variability in patients after COVID-19 infection
Authors: Harisuddin Hilman , Subadi Imam , Sulistiawati Nuniek Nugraheni , Andriati  , Melaniani Soenarnatalina
Published: May 2024

Background: COVID-19 infection causes various sequelae and complications after recovery. Changes in heart rate variability (HRV) were found in patients with COVID-19 infection, suggesting a disturbance in the autonomic system. Breathing exercises with diaphragmatic breathing and incentive spirometry have been shown to increase HRV by increasing lung capacity, respiratory muscle strength, and pulmonary O2 pressure, which can affect baroreflex signals. Incentive spirometry is one of the easy-to-use, safe, inexpensive pulmonary rehabilitation exercises that can be done at home without supervision and are accompanied by a visual display as a guide to the patient. The purpose of the study was to determine the effect of giving breathing exercises using Incentive Spirometry for four weeks on Heart Rate Variability in patients post COVID-19 infection
Method: This research is an experimental study with a pre-post-test control group design. The treatment group was given breathing exercises using Incentive Spirometry, while the control group used diaphragmatic breathing five times a day, seven times per week, for four weeks in each group. HRV measurement was performed before and after four weeks of intervention, using the parameter Root Mean Square of Successive Differences between normal heartbeats (RMSSD), Standard Deviation of N-N intervals (SDNN), and LF/HF ratio of Heart Rate Variability (HRV).
Result: There subject of this study was 20 post-COVID-19 patients divided into a treatment group (n=10) and a control group (n=10). There was no significant increase in RMSSD, SDNN, and LF/HF ratio pre and post-intervention in both groups, suggesting no significant increase in HRV.
Conclusion: Exercise with Incentive Spirometry and Diaphragmatic Breathing for four weeks did not increase the Heart Rate Variability value in post-COVID-19 patients.
Successful treatment for retinopathy of prematurity in a very preterm baby: a case report
Authors: Yulia Dian Estu , Casey Anthea
Published: May 2024

Background: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide, including in Indonesia. ROP screening and intervention are essential to establish the diagnosis, stop disease progression, and prevent retinal detachment that causes blindness. ROP treatments such as vitrectomy and laser are beneficial. This case aims to report the anatomical and functional outcomes after surgery for ROP.
Case description: A very preterm baby with 29 weeks of gestational age and birthweight of 1300 grams was referred to the pediatric ophthalmology clinic at Cipto Mangunkusumo Hospital for ROP screening. Retinal camera (RetCam®) examination revealed stage 3 ROP in the right eye (RE) and stage 4A ROP in the left eye (LE). The LE underwent a vitrectomy, while the RE underwent laser photocoagulation under general anesthesia. Upon examination under sedation (EUS) after surgery, the retina was examined using RetCam® and was found attached to the LE and regressed on the RE. The baby is able to fixate on and follow objects. However, the refraction examination showed myopia in both eyes. Glasses were prescribed due to the myopia outcome in this case. 
Conclusion: Vitrectomy for stage 4A ROP and laser photocoagulation for stage 3 ROP are effective in anatomical and functional outcomes in a very preterm baby.
Factors related to mortality in geriatric patients after elective surgery: a retrospective cohort study
Authors: Mupangati Yudo Murti , Mustain  , Setyawan Henry , Riwanto Ignatius , Soejono Czeresna Heriawan , Gasem Muhammad Hussein
Published: May 2024

Introduction: The increased number of surgery on the elderly is often followed by an increased risk of mortality rate. Identifying the risk factors of surgical death in elderly patients will be mandatory before making a decision.  This study aimed to determine mortality-associated factors in older people who underwent inpatient elective surgery.  
Methods: This cohort retrospective study analyzed secondary data from the medical records of geriatric patients hospitalized at Dr. Kariadi Hospital Semarang in 2020.  Patients aged ≥ 60 years and who have undergone elective surgery were included. Patients with incomplete medical records, who had undergone outpatient surgery, more than one surgery, and emergency surgery, Covid-19, were excluded. A total of 382 patients met the criteria.  In this study, independent variables analyzed were age, sex, nutritional status based on body mass index, functional status by Barthel, marital status, residence status, number of comorbidities according to Charlson Comorbidity Index, albumin levels, electrocardiogram (ECG) abnormalities, surgery type, and American Society of Anesthesiologists (ASA) status. The dependent variable was in-hospital mortality. In the logistic regression analysis, we identified the five most significant variables to allow for the prediction of in-hospital mortality.
Results:  Residence status (p= 0.003), ECG (p= 0.001), comorbidity (p <0.0001), albumin status (p< 0.0001), and ASA status (p< 0.0001) were identified as factors that affect postoperative mortality after multivariate analysis.
Conclusion: In this study, mortality-associated factors were living alone, ECG abnormality, comorbidity > 2, hypoalbumin, and ASA > 2.
High ratio of neutrophils to lymphocytes and high triglyceride levels in serum as risk factors for pre-eclampsia
Authors: Anak Agung Ngurah Jaya Kusuma  , Endang Sri Widiyanti  , Anak Agung Gde Marvy Khrisna Pranamartha  , Adytia Theopani Bineredo Damanik
Published: May 2024

Background: Preeclampsia is still a concerning health problem in pregnancy which can get worse if it is supported by low patient compliance. Appropriate screening method modalities can help in predicting the possibility of worsening. Neutrophil to Lymphocyte Ratio (NLR) and serum triglycerides could be used as blood parameters in preeclampsia conditions. This study determined the high Neutrophil to Lymphocyte Ratio (NLR) and high triglyceride levels as risk factors for preeclampsia in pregnant women.
Methods: A case-control study was conducted from January to June 2022 at the Obstetrics and Gynecology Polyclinic, Prof. dr. I.G.N.G Ngoerah Hospital. This study involved pregnant women over 18 years of age with a gestational age of more than 20 weeks by consecutive purposive sampling. Neutrophil to Lymphocyte Ratio (NLR) and serum triglycerides were obtained by tracing complete blood laboratory results in the medical record. Chi-square analysis was conducted and continued by logistic regression analysis with the p-value <0.05 categorized as a significant result.
Results: High NLR levels were at risk of experiencing preeclampsia 32.2 times higher than those with low NLR (95%CI 6.8 – 151; p=0.000). Patients with high triglyceride levels had a risk of experiencing preeclampsia 23.1 times higher than those with low triglycerides (95%CI 5.45 – 97.26; p=0.000). NLR, serum triglycerides, and maternal age were independent risk factors for preeclampsia after controlling for parity variables (p<0.05).
Conclusion: Neutrophil to Lymphocyte Ratio (NLR) and high triglyceride levels are risk factors for preeclampsia.
The presence of stem cells in ovarian cancer: a review
Authors: Anggraeni Tricia Dewi , Thiono Jenivia , Pratiwi Intan Winta , Hariadi Ariananda , Kispa Tera Dria , Kekalih Aria , Askandar Brahmana , Lisnawati  , Prijanti Ani Retno , Mohamad Farid Aziz  , Winarto Hariyono , Tan Marselina Irasonia , Andrijono
Published: May 2024

Ovarian cancer is one of the deadly gynecological malignancies. The disease has usually difficult to detect at the early stage as there are only a few specific symptoms and not many screening methods, thus patients usually come in an advanced and metastatic stage of the disease. Initial therapy for the disease includes surgery to remove the tumor, then followed by chemotherapy. This therapy shows a promising result at first until some sign of reoccurrence starts to show. One of the main reasons is thought to be the presence of a small subset of cells called cancer stem cells (CSCs). These cells may escape from the initial therapy, and due to the CSCs' ability to self-renew, grow into various lineages, and multiply widely. There are multiple efforts done to isolate and identify this subset cell, such as identifying the specific antigen in the cell surface, using Side Population, the ability of CSCs to form floating spheres in serum-free media, and the level of ALDH expression. Such methods have been performed together to identify purely cancer stem cells from the malignancy. The ability of the cell to produce new tumors in immuno-deficient animals, however, is the gold standard for identifying CSC, according to the current study. This review will discuss several methods that have been used to isolate cancer stem cells and prove the stemness of these cells by injecting them into immuno-deficient mice. Cancer stem cells also can avoid the effect of chemotherapy. Several things contribute to this ability. This review there will discuss methods that have been several things that make it possible to be able to escape chemotherapy drugs. By understanding these mechanisms, hopefully, new therapy modalities will be developed and specifically targeted, so that can be used to treat malignancies more effectively.
A novel preoperative scoring system to predict postoperative mortality after pancreaticoduodenectomy in pancreatic cancer patients at Dr. Soetomo General Hospital: a retrospective cohort study
Authors: Arland Chandra  , Lesmana Tomy
Published: May 2024

Introduction: Knowing the risk of surgery before performing one is essential for informed consent and decisions making for the doctors, patients, and their families. Complexities of surgery and pancreatic cancer aggressiveness are two factors that contribute to high mortality rate in pancreaticoduodenectomy. There has been a few scoring systems developed to predict mortality after pancreaticoduodenectomy. However, external validation of these scoring systems failed to achieve good predictive value consistently. This could happen due to differences in patient demographics, variables and their cut-off, patient samples, and hospital or health care standard where these scoring systems were constructed. This study aims to develop a novel scoring system to predict postoperative mortality and to compare its performance with the existing scoring systems.
Methods: Data were collected retrospectively from all patients who underwent pancreaticoduodenectomy in Dr. Soetomo General Hospital, starting from January 2012 to October 2022. 75 patients were included based on the inclusion criteria. Multivariate logistic regression analysis was performed to select multiple risk factors correlated with in-house mortality. A novel scoring system was formed using these risk factors. We also assessed and compared the predictive value of the existing scores (Parikh, Nugroho, and WHipple-ABACUS) using the ROC curve. Chi square test with odds ratio calculation and logistic regression were used in this study.
 Results: Post pancreaticoduodenectomy mortality rate was 28% (21 out of 75 patients) with 4 statistically significant risk factors. Those factors are age > 52 years. (OR 7.435; 95% CI 1.113-49.677, p = 0.038), comorbidities (OR 5.793; 95% CI 1.116-30.067, p = 0.037), American Society of Anaesthesiology (ASA) 3 (OR 8.932; 95% CI 1.329-60.022, p = 0.024), and total bilirubin > 16.6 mg/dL (OR 8.329; 95% CI 1.577-43.983, p = 0,013). These factors were used to form a novel scoring system. The predictive performance of the newly created scoring system was 0.911 (95% CI 0.823-0.965). While external validation of the existing scoring systems was as follows: Parikh 0.684 (95% CI 0.567-9.787), Nugroho 0.829 (95% CI 0.724-0.906), and WHipple-ABACUS 0.736 (95% CI 0.62-0.832).
Conclusion: The newly created scoring system uses 4 relatively easy and accessible preoperative variables to predict post-pancreaticoduodenectomy mortality. However, it still requires external validation in multicenter hospitals with large numbers of patients.
Effect of Spiramycin and Moringa leaf feeding in improving placenta, heart, histopathological neurons and glia in fetal models with toxoplasmosis
Authors: Nurinasari Hafi , Sajidan  , Bambang Purwanto  , Dono Indarto  , Didik T Subekti  , Hendrastuti Apriningsih  , Ariva Syiva’a  , Soetrisno
Published: May 2024

Background: Toxoplasmosis is a protozoan disease caused by Toxoplasma gondii that can cause fetal abortion, stillbirth, death, or fetal and neonatal abnormalities. Spiramycin prophylactic purpose is to prevent fetal infection in toxoplasmosis. While Moringa oleifera contains bioactive compounds that benefit from treating oxidative stress and infections. This study aims to evaluate the effect of Spiramycin and Moringa leaf extract in improving the placenta, heart, histopathological neurons and glia in fetal rat models with toxoplasmosis.
Methods: An experimental study with a post-test-only control group design was done using  24 pregnant female rats divided into the control group receiving spiramycin therapy (P1) and two intervention groups that were given spiramycin and ethanol extract from Moringa leaves at a dose of 240 mg/kg body weight (P2) and combination of spiramycin and ethanol extract from moringa leaves at a dose of 420 mg/kgBW (P3). A histopathological examination was then performed.
Results: Administration of spiramycin and ethanol extract of Moringa leaves at 420 mg/kg body weight had the same histopathological examination results as spiramycin administration. In a histopathological examination of toxoplasmosis pregnant rat placenta and toxoplasmosis fetal rat heart was effective in repairing gliosis in neurons and neuroglia of toxoplasmosis rat fetuses.
Conclusion: Administration of spiramycin and ethanol extract from Moringa leaves was effective in repairing gliosis in neurons and neuroglia of toxoplasmosis rat fetuses.
Perception and readiness of medical students and teaching staff to implement interprofessional education
Authors: Darmayani I Gusti Ayu Sri , Manuaba Ida Bagus Amertha Putra , Yani Made Violin Weda , Wiguna I Gede Wikania Wira , Kusuma I Komang Wira Ananta , Supadmanaba I Gede Putu
Published: May 2024

Introduction: Interprofessional education is a learning method that involves two or more professions learning from each other to create effective collaboration. Meanwhile, the education program at the medical faculty still adheres to each study program's curriculum, which creates obstacles in implementing IPE courses. This study aimed to assess the readiness and perceptions of students and teaching staff at the Faculty of Medicine, Universitas Udayana, regarding implementing IPE.
Methods: This study used a cross sectional design. Research subjects were collected using the total sampling method, and data were collected using IEPS and RIPLS questionnaires and distributed online. Data were analyzed using the SPSS ver.25.0 programs using the chi-square test, with a p <0.05, considered statistically significant.
Results: Based on the research results, the total number of research respondents was 37 supervisors and 416 students with an average age of 40.6±6.15 years and 19.05±1.04 years, respectively. Based on the results of research on supervisor respondents, it was found that the average IEPS and RIPLS scores were 85.41±9.15 and 76.86±5.35, respectively, with a distribution of readiness levels dominated by good IPE readiness (>75) of 22 people (59.5%). While the student respondents found an average score of IEPS and RIPLS, respectively 86.42±10.64 and 75.58±5.94, with a distribution of readiness levels dominated by good IPE readiness (>75) of 229 people (55.0%).
Conclusion: Based on the study results, it can be concluded that supervisors and students of the Faculty of Medicine, Universitas Udayana, have a good level of perception and readiness for IPE.
A naive human immunodeficiency virus (HIV) patient with extrapulmonary tuberculosis manifestation: diagnosis and management challenges
Authors: Hadiatma Faradika Nopta , Triyono Erwin Astha
Published: May 2024

Background: Co-infection of human immunodeficiency virus (HIV) and extrapulmonary tuberculosis (TB) is common tropical countries and could manifest with diverse clinical manifestations and mimic other diseases. This case report highlights the diagnosis and management challenges of a patient with HIV naive who had pleural and pericardial effusion manifestation due to extrapulmonary TB.
Case presentation: A male 48 years old was referred with shortness of breath, cough with phlegm, fever with night sweats. The patient complained of chest tightness and pain, decreased appetite, and weight loss approximately 10 kg in the last six months. The patient had several times having sexual intercourse with prostitutes. White patches were presented on the tongue. The patient was tested twice with three methods for HIV test and yielded inconclusive results. The chest X-ray examination suggested left pleural effusion and echocardiography with the results of pericardial effusion. The patient had thoracentesis with the adenosine deaminase (ADA) test 52 U/L and the culture resulted a positive for Mycobacterium tuberculosis sensitive to rifampicin, isoniazid, ethambutol, and pyrazinamide. The patient was treated with anti-TB. Later, the viral load yielded a value of 1.43x106 IU/mL and the patient was treated with antiretroviral therapy.
Conclusion: Due to challenges of diagnose and manage of such co-infection with unusual clinical manifestations, multi-disciplinary approaches are required together with adequate healthcare facilities to support the diagnostics.
Adjusted enhanced recovery after surgery (ERAS) protocol in colorectal surgery at dr. Cipto Mangunkusumo General Hospital, Jakarta
Authors: Suryadi Andre Setiawan , Vania Myralda Giamour Marbun  , Arnetta Naomi Louise Lalisang  , Jeo Wifanto Saditya , Mazni Yarman , Lalisang Toar Jean Maurice
Published: May 2024

Background: The Enhanced Recovery After Surgery (ERAS) strategy has been proven to be successful in lowering hospital perioperative problem rates and postoperative length of stay (LOS) in colorectal surgery. The inability of dr. Cipto Mangunkusumo General Hospital's to implement all of the components of the ERAS protocol was attributed to three major factors: patient-related (compliance), physician-related (silo mentality), and hospital-related (long waiting lists and inability to provide required facilities). This study aims to determine how well the ERAS procedure can be partially implemented to achieve the ERAS objective.
Methods: This study is a cross-sectional study involving sixty-three colorectal patients who underwent surgical procedures between 2015 and 2017 were evaluated retrospectively for complete ERAS protocol implementation. The complete implementation is the ability to accomplish all 15 ERAS components. Demographic, clinical, and total LOS data were also collected from medical records. These samples were analyzed using univariate analysis and Pearson correlation tests to determine the relationship between the number of ERAS components that accomplish per subject and the LOS of the patient.
Results: Eleven out of 15 ERAS components were implemented on 63 patients. The majority of the cohort were female (male-to-female ratio of 1:1.2) with an average age of 53 years, 0% mortality, 7.9% morbidity (1.6%, 1.6%, and 4.8% due to surgical site infection, pneumonia, and urinary retention, respectively), and underwent conventional rather than laparoscopic surgery (84.1% vs. 15.9%). The most common location of tumors and procedures were sigmoid (47.6%) and colostomy closure (25.4%). None of the patients was able to comply with all components of the ERAS protocol; however, the results from 6 patients who implemented ten or more components of the ERAS protocol showed a higher reduction rate of the total LOS from 8−12 days to only five days (a reduction rate of 62.5%) compared to patients who completed less than 10 components (p<0.01, r=−0.568).
Conclusion: Implementing at least 10 ERAS components may have a similar impact to fully implementing the ERAS protocol regarding how patients who have colorectal surgery are managed. These ten components are subsequently called the adjusted ERAS protocol for colorectal surgery.
The relationship between nutritional status before chemotherapy with nutritional status after chemotherapy in locoregionally advanced nasopharyngeal carcinoma patients
Authors: Rini Felita Surya , Murbawani Etisa Adi , Fasitasari Minidian , Puruhita Niken , Khairuddin
Published: May 2024

Background: Malnutrition in nasopharyngeal carcinoma (NPC) patients is caused by various factors such as tumor localization, metabolic derangement, and side effects of therapy. Poor nutritional status in cancer patients is associated with serious clinical consequences such as poor quality of life, higher treatment toxicity, and poor prognosis. The purpose of this study was to determine the effect of nutritional status before chemotherapy on the nutritional status after chemotherapy in non-metastatic advance-stage NPC patients.
Methods: This study was an observational study with a cross sectional design using secondary data involving non-metastatic advanced-stage NPC patients undergoing chemotherapy at dr. Kariadi Hospital Semarang in January 2020 – June 2022. The sampling technique used was consecutive sampling. Nutritional status was measured by malnutrition criteria according to the American Society for Parenteral and Enteral Nutrition (ASPEN). Statistical analysis was performed with Chi-Square and McNemar analysis test.
Results: Total sample of this study was 55 subjects. The results of this study were there was a relationship between nutritional status before chemotherapy and nutritional status after chemotherapy in non-metastatic advanced-stage NPC patients (P<0.05). All subjects were malnourished before chemotherapy, with 12.7% moderately malnourished and 87.3% severely malnourished. All subjects were malnourished after chemotherapy, with 41.8% moderately malnourished and 58.2% severely malnourished, decreased nutritional status of post-chemotherapy non-metastatic advanced NPC patients was related to the length of chemotherapy (p<0.05), but not related to comorbidities, age, and stage of chemotherapy (p>0.05).
Conclusion: There is a relationship between nutritional status before chemotherapy and nutritional status after chemotherapy in non-metastatic advanced-stage NPC patients.
Preoperative alpha-blockers to facilitate ureteral access sheath (UAS) insertion: a systematic review and meta-analysis
Authors: Yusuf Muhlis , Yogiswara Niwanda , Setiawan Muhammad Rifki , Salsabila Sirin , Soebadi Mohammad Ayodhia , Wirjopranoto Soetojo
Published: May 2024

Background: Recent studies have proposed the use of preoperative alpha-blockers to facilitate urethral access sheath (UAS) placement, but the definite role of this practice is still unclear. We aimed to evaluate the efficacy and safety of alpha-blocker use for UAS placement in intrarenal endoscopic procedures.
Methods: The course of this study followed the preferred reporting items for systematic review and meta-analyses guidelines. Articles investigating the use of preoperative alpha-blockers for patients who underwent intrarenal endoscopic procedures were systematically reviewed from PubMed, EMBASE, and Scopus databases. Odds ratio (OR) with 95% confidence intervals (CIs) were applied for the outcome estimates. Analyses were performed with RevMan 5.4 software. The protocol of this study is enlisted in the registry of PROSPERO (CRD42022342811).
Results: Six articles comprising 462 study populations were included in the review. Meta-analysis on the success rate of UAS placement showed a significant advantage of the alpha-blocker group compared to the control group (OR: 3.83; 1.83-8.00; 95% CI; p = 0.0004). Ureteral wall trauma was higher in the control group (OR: 0.38; 0.17-0.84; 95% CI; p = 0.02). Furthermore, there was no clear association between the UAS size and the success rate of UAS insertion.
Conclusion: Preoperative alpha-blockers may increase the success rate of UAS insertion while decreasing the risk of ureteral wall injury in intrarenal endoscopic procedures.
The relationship between metabolic acidosis as a predictive factor of mortality in Ludwig's Angina patients at Dr. Soetomo General Hospital, Surabaya, Indonesia
Authors: Adi Alif Rakhman Prima , Wibowo Marjono Dwi , Susilo Dwi Hari
Published: May 2024

Background: Mortality in a patient with Ludwig's Angina is usually due to prolonged sepsis. When sepsis is present, acidosis and lactate independently predict mortality in critically ill patients. Patients who develop acidosis after 6 hours are at high risk of death and should be treated more aggressively than septic patients.  
Methods: A retrospective cohort study to determine the association between metabolic acidosis and mortality in Ludwig's Angina patient at Dr. Soetomo General Hospital Surabaya at Dr. Soetomo between January 2019 - December 2020. We retrospectively reviewed 42 medical records of patients with Ludwig's Angina. We collected patient data such as age, history, physical examination, blood gas analysis, surgical intervention, comorbidities, complications before surgery, and patient outcomes.
Results: We analyze a total of 42 patients. 71.40% were male, and 38.60% were in the group of 51-60 years, with a mean age of 45.73 years. 59.50% had metabolic acidosis, and 83.30% died. Based on the comorbidities, there were 28.60% with diabetes mellitus, 21.40% with dental caries and 16.70% with hypertension. A complication of hypoalbuminemia was found in 42.90%, 23.80% with sepsis, and 21.40% with acute kidney injury. Metabolic acidosis and mortality had a significant relationship with a p-value of 0.047, OR 5.00 (95% CI, 0.933-26.785). No comorbidity or complication variables impacted patient outcomes (p > 0.05 for all).
Conclusion: There was a significant relationship between metabolic acidosis and mortality of Ludwig's angina patients.
The percentage of positive biopsy cores in predicting biochemical recurrence and adverse pathology in prostate cancer patients after radical prostatectomy: a systematic review and meta-analysis
Authors: Fitra Ahmad Fathira , Yogiswara Niwanda , Djatisoesanto Wahjoe , Chung Eric , Hakim Lukman
Published: May 2024

Background: Biochemical recurrence (BCR) occurs in more than one-third of prostate cancer (PCa) patients 10 years after radical prostatectomy. The percentage of positive biopsy cores (PPBC) obtained from prostate needle biopsy is suggested as one of the predictors of BCR. We aim to investigate the role of PPBC in predicting BCR and adverse pathology in PCa patients after RP.
Methods: A systematic search was conducted based on PRISMA guidelines from Pubmed, Scopus, and Cochrane Library databases up to July 2022. We screened studies that met our inclusion criteria and NOS (Newcastle-Ottawa Scale) was utilized as the quality assessment tool. The primary outcome was BCR measured as Hazard Ratios (HRs). The secondary outcome was adverse pathology, including positive surgical margin (PSM), Extra-prostatic disease (EPD), and seminal vesicle invasion (SVI). Review Manager®5.4 was used as the statistical analysis tool.
Results: A total of 5971 patients were included from eleven eligible studies with overall good quality scores. Eleven studies were included in the qualitative synthesis and five of them were analyzed in the meta-analysis. The pooled analysis demonstrated that higher PPBC has a 2.77 times risk of BCR (OR 2.77 (95% CI: 1.97, 3.9; p<0.00001) after RP. Similarly, it has significant results in SVI (OR 2.61 (95% CI: 1.19, 5.73; p=0.02). However, there were insignificant results in terms of EPD (p=0.17) and PSM (p=0.33).
Conclusion: This systematic review and meta-analysis (SRMA) indicate that a high PPBC is strongly correlated with a greater risk of BCR and SVI, but not EPD and PSM in patients following RP.
Postoperative supplementation effect of zinc and vitamin C in primary colonic anastomosis on peritonitis condition: A study on New Zealand rabbit
Authors: Luh Putu Neolita Pradnya Wineni  , Adria Hariastawa  , Ariandi Setiawan
Published: May 2024

Background: Colon has the highest risk of anastomotic leakage and increases 2.5-fold in peritonitis. To prevent leakage of colonic anastomosis, there are some modalities to upgrade the quality of wound healing. The mineral zinc is good for healing intestinal anastomotic wounds and vitamin C, whose function is related to wound healing and maintaining vascular integrity. This study investigated the effect of daily zinc and vitamin C supplementing on rabbits with peritonitis who underwent colonic anastomosis.
Material and methods: Thirty-six New Zealand rabbits underwent peritonitis 5 hours after they continued with a laparotomy to wash the abdominal cavity and colonic anastomosis. The rabbits were then divided into 2 groups. First group was given zinc and vitamin C syrup, while the second group was given normal saline without zinc and vitamin C. On the 6-day postoperative, the rabbits were terminated, and tissue was collected at the colonic anastomosis to examine the histological score of anastomotic wound healing.
Results: Significant differences in anastomotic healing in terms of histological scores (collagen density α=0.00, p<0.05; Neovascularisation α=0.00, p<0.05; Fibroblasts, α=0.00, p<0.05). This study generally explains the relationship between zinc and vitamin C administration and colonic anastomosis wound healing in peritonitis.
Conclusion: There were significant differences in histological wound healing scores (collagen density, neovascularization, fibroblasts) in the treatment group compared to the control group.