bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between serum TNF-α level with the incidence of metastases in women with breast cancer in Dr. Soetomo General Hospital, Indonesia
Authors: Efendi Rachman , Ghaib Husnul , Ali Iskandar
Published: December 2022

Abstract
Background: Breast cancer is the most common cancer in women. The occurrence of metastasis in breast cancer should be detected early. Tumor necrosis factor-α (TNF-α) is involved in every step of the carcinogenesis process. A rise in TNF-α level is linked to the advancement of breast cancer. We aimed to determine the association between TNF-α levels and breast cancer metastases.
Methods: An analytic cross-sectional study was conducted on women with breast cancer treated at the Oncology Surgery Center between November 2021 and April 2022. The patient's data were collected from the medical record, including age, menopausal status, tumor size and lymph node involvement, and tumor subtype. The serum TNF-α level was measured using ELISA. The optimal cut-off value was determined using the receiver operating characteristics analysis. The association between serum TNF-α and the incidence of breast cancer metastases was analyzed using SPSS version 26 for Windows.
Results: We analyzed a total of 50 patients. The mean age was 48.8 ± 8.3 years. The serum TNF-α level was divided into high-TNF-α and low-TNF-α using a cut-off value of 22.755 pg/mL. There were 27 patients (27/50; 54.0%) with high serum TNF-α levels and 23 patients (23/50; 46.0%) with low TNF-α levels. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 73.9%, 63.0%, 63,0%, 73,9%, and 68%, respectively. There was a statistically significant association between serum TNF-α levels and metastatic breast cancer (p=0.009).
Conclusion: There was a significant association between TNF-α levels and metastatic breast cancer. Serum TNF-α may be a potential biomarker to detect metastasis in breast cancer patients.
One health strategy in prevention and control of parasitic zoonosis globally and Indonesia- from theory to practice: a mini-review
Authors: Negara Khesara Sastrin Prasita , Yulia Sari  , Lilik Wijayanti  , Sri Haryati  , Azzahra Harmalia Anjani  , An’nurihza Zidhan Azhara  , Azzahra Fadhlila Aulia Nisa
Published: December 2022

Infections caused by parasites infect millions of people worldwide, especially in developing countries. Most parasites have a life cycle that lives in hosts (animals or humans) and the environment; thus, the One Health approach is an advanced strategy to overcome these challenges. Recently, One Health has become important as it considers several factors of the connection between humans, animals and the environment. This study aims to understand the One Health Approach as a strategy to prevent and control parasitic zoonosis globally and in Indonesia. We used a literature review using PubMed and Google Scholar based on PRISMA guidelines. Our review identified 22 recommendations and applications of the One Health strategy to handle zoonotic parasitic diseases globally and in Indonesia. There are theoretical and practical gaps in the implementation of this strategy. Further studies are needed to implement better One Health of combating parasitic zoonosis globally and in Indonesia.
A rare nasal myiasis in a patient with diabetes mellitus
Authors: Rahardjo Teguh , Jappi Yoseph , Wibisono Sony
Published: December 2022

Background: Nasal myiasis, a type of cavitary myiasis, is an infestation of parasitic insect larvae or eggs in the nasal cavity of the human body. The risk of nasal myiasis increases in individuals with immunocompromised such as diabetes mellitus (DM). The aim of this study was to report a rare case of nasal myiasis in a patient with DM.
Case Presentation: A 54-year-old female patient was referred to Dr. Soetomo General Hospital Surabaya with a chief complaint of spontaneous anterior epistaxis from the left nostril for three days. Anterior rhinoscopy revealed a narrowed left nasal cavity covered with excessive bloody discharge and>50 larvae coming out of the nasal passage. Nasoendoscopy showed ulcerated lesions on the left nasal cavity floor and nasal lateral wall, destructions of the osteomeatal complex and lateral wall, thick bloody discharge with excessive crust, as well as a larva around the osteomeatal complex entering the maxillary sinus. Paranasal sinus CT scan showed no further infection to surrounding organs. The patient had a history of type 2 DM for the past 2.5 years. The patient was diagnosed with nasal myiasis, unregulated type 2 DM, and diabetic neuropathy. Therapies included larval removal by endoscopy, wound irrigation using antiseptic solutions, maxillary sinus irrigation, administration of the topical antiparasitic ivermectin, and insulin therapy. After seven days of the treatment, the patient was discharged from the hospital with a resolved infection and controlled blood sugar levels.
Conclusion: Awareness of risk factors for myiasis along with proper therapy is prominent. Nasal endoscopy, together with nasal irrigation and antiparasitic drug administration was effective in the management of nasal myiasis.
Vertebral anomalies associated with anorectal malformations incidentally found on contrast studies: a case series
Authors: Nike Felicia , Anandasari Pande Putu Yuli
Published: December 2022

Background: Spinal congenital malformations are closely associated with other congenital anomalies, are usually asymptomatic and be found incidentally. Moreover, spine abnormalities such as hemivertebra may cause further complications if left untreated. Among patients with VACTERL anomalies, spine anomalies account for 60-95% of them. This report aimed to describe rare and interesting cases of spinal malformation in children to provide further information on the importance of a proper approach in such cases.
Case Presentation: We present three pediatric cases of vertebral anomalies associated with anorectal malformations incidentally found in contrast studies. All patients have a history of anorectal abnormalities at birth and are referred to the hospital for contrast studies. The first case found semi-segmented hemivertebra at T8-9 levels, cleft at T10 level and high-type anorectal malformations (ARMs). The second case showed unsegmented hemivertebra at the level of L1 and butterfly vertebra at T10, approximately at the same level as the skin lesion, with the possibility of occult spina bifida and high-type ARMs. The third case revealed bilateral vesicoureteral reflux (VUR), grade 1 right hydroureteronephrosis and left hydroureter, with semi-segmented hemivertebra at the level of L3, unsegmented hemivertebra at L4-5 and an extra lumbar vertebra, possibly a lumbosacral transitional vertebra (LSTV).
Conclusion: Thorough screening and other examinations such as contrast studies could reduce their morbidity as more sophisticated imaging may be done to better visualize the anatomical malformation.
Complex distal radius fracture (CDRF) with median nerve injury management using one-stage distraction bridge plate fixation (DBPF) without nerve exploration allows nerve function recovery: a case report
Authors: Satmoko Benedictus Anindita , Suroto Heri
Published: December 2022

Background: Complex distal radius fracture (CDRF) associated with median nerve injury is rarely reported due to low incidence or low recognition rate. Thus, we reported the outcome of using distraction bridge plate fixation (DBPF) in managing CDRF associated with median nerve injury without volar nerve exploration.
Case description: We reported a 67-years old male who sustained pain in the right wrist with dorsal angulated deformation following a fall on an outstretched hand two hours before being admitted to the emergency department. The patient also complained of numbness in all of the fingers except the little finger of the right hand. Posteroanterior (PA)/right lateral X-rays showed grossly dorsal displaced of the comminuted distal radius fracture associated with ulnar styloid avulsion. The diagnosis was a CDRF associated with median nerve injury. He underwent surgery in an emergency setting with DBPF on the dorsal side without opening the fracture site guided by an image intensifier. Early mobilization was started as the patient could tolerate the pain, and neuromuscular electrical stimulation was given twice a week after surgery. Plate removal was done six months after surgery and continued with a range of motion exercise of the right wrist.
Conclusion: It is important to consider the anatomical reduction without additional soft tissue trauma by opening the fracture site and the early emergency surgery decision based on physical examination in CDRF management. The stable fixation allows axonal regeneration after median nerve injury, proved by good nerve functional outcomes. DBPF is suitable for post-operative wound care and decreases costs compared to staged fixation surgery and volar nerve exploration. However, we still need to further investigate this procedure through higher comparison studies.
Lung damage reduction due to reperfusion injury of acute lower limb ischemia with and without pentoxifylline and vitamin c combination therapy: histopathological evaluation
Authors: Tappang Maikel Triyudi , Sembiring Yan Efrata , Sandhika Willy
Published: December 2022

Several studies report an incidence of acute limb ischemia of approximately 1.5 cases per 10,000 persons per year. The mortality rate from acute limb ischemia ranges from 15-to 20% and the morbidity rate from 25% by amputation and 5-to 25% to fasciotomy. Revascularization is the main goal in the management of acute limb ischemia. Reperfusion of ischemic limbs can save limbs from amputation, but Ischemia-reperfusion injury can also cause systemic damage in the form of damage to body organs (lung, liver, kidney, heart, and brain tissue) which increases morbidity and mortality rates. Lung tissue is an easily affected target organ, and damage from Ischemia-reperfusion injury can cause acute lung injury and acute respiratory distress syndrome. These conditions damage the endothelium and epithelium of the lung parenchyma resulting in edema and impaired gas diffusion with a very high mortality rate of around 25-40%. The combination therapy of Pentoxifylline and Vitamin C in reducing the effect of Ischemia-reperfusion injury on lung tissues and have shown a protective effect of lung tissue damage due to ischemia-reperfusion injury in lower limbs.
Tracing management and epidemiological characteristics of close contact COVID-19 in primary health care
Authors: Hanardi Dwi Yulianingsih Putri , Rochmawati Erna
Published: December 2022

Introduction: Several countries, including Indonesia, have made tracing efforts to control the spread of infectious diseases such as COVID-19. In carrying out this tracing, it is not only about tracing close contacts but also about digging up some information related to the epidemiological characteristics of COVID-19. So this information can be useful in analyzing the future incidence of disease or health problems. This paper aims to analyze the management of tracing and epidemiological characteristics of close contacts with COVID-19 in Primary Health Care (Puskesmas). Especially Primary Health Care in Pengasih I, Pengasih II, Sentolo I, and Sentolo II.
Methods: The design of this study is a type of descriptive epidemiological research with retrospective data. Retrospective data were analyzed descriptively regarding the epidemiological characteristics of close contact with COVID-19. They then tested the formulation of the hypothesis with univariate, bivariate, and multivariate data analysis. Total sampling was utilized for the study from February 1st to March 3rd, 2022.
Results: Contact tracing was carried out by following the guidelines for tracing implementation issued by the government. Close contact data is 1,450 and dominated by women aged 16-54. The frequency of asymptomatic is more than that of symptomatic. There are 535 close contacts whose status changed to confirmed cases.
Conclusion: Close contacts have the risk of undetected infection, so early control of close contact can control the spread of the COVID-19 outbreak. Therefore, tracing efforts by health workers aimed at early detection of close contacts and quarantine measures for close household contacts are appropriate to break the chain of transmission of COVID-19 so that this tracing can be achieved.
Acute Sarcopenia in Elderly with COVID-19: An Overlooked Problem
Authors: I Gusti Putu Suka Aryana  , Dian Daniella  , Raden Ayu Tuty Kuswardhani  , Siti Setiati
Published: December 2022

The coronavirus Disease-19 (COVID-19) pandemic was announced in March 2020 by World Health Organization (WHO). Studies showed that the elderly had higher morbidity and mortality rates. Acute sarcopenia in the elderly with COVID-19 is an overlooked problem. Inflammation, malnutrition, immobilization, a side effect of COVID-19 treatment, depression, and hormonal dysregulation contributed to acute sarcopenia in COVID-19, especially in the elderly. Muscle quantity can be assessed with different techniques such as imaging or anthropometric measurements in diagnosing sarcopenia. Imaging such as CT scan was widely used in multiple studies. Still, anthropometric measurements are more fit in developing countries because they are widely available, safe, do not require special skills, and fit in low-resources facilities. Muscle strength can be assessed with grip strength. Acute sarcopenia was associated with immune dysregulation and cytokine storm, length of stay and readmission, and ICU admission and mechanical ventilation. These will contribute to high mortality in sarcopenic elderly with COVID-19.
Visual science mapping and future direction of pediatric acupuncture: a bibliometric analysis from Scopus database and VOSviewer
Authors: Handayani Selfi , Wiyono Nanang , Kartikasari M. Nur Dewi , Suparyanti Endang Listyaningsih , Moelyo Annang Giri , Balgis  , Muhammad Faizal , Iman Ahmad Fasichul
Published: December 2022

Introduction: Pediatric acupuncture is an interesting subject to study along with strengthening the current development of acupuncture therapy. Not only for adults, but acupuncture is also safe for children. There have been many studies on acupuncture, but publications related to acupuncture for children are still very few compared to adults. The purpose of this study is to visually map and guide future research on Pediatric acupuncture based on bibliometric analysis.
Method: We conducted this study from September 16 to 19, 2022. Publications regarding pediatric acupuncture were extracted from the Scopus database. The search strategy included two keywords: (ACUPUNCTURE)*(PEDIATRIC). The final result was acquired by searching those keywords without limitation because the number of articles was less than 1000. We used VOSviewer and bibliometric indicators to generate a maps-based data network from all keywords-related studies showing association among journals, countries, publication frequency, authors, and citations. Keywords were used to infer pediatric acupuncture. A total of 669 documents related to pediatric acupuncture were retrieved. This includes 432 articles, 176 reviews, and 16 conference papers.
Results: A total of 10,918 citations have been recorded for all publications with an h-index count of 52. The first relevant study is dated on 1966. Since then, there has been a steady increase in total publications each year whereas 2021 as the most productive year with 53 publications. The Medical Acupuncture Journal (25) was the most prolific journal. The United States of America (298) and China (54) are the most productive country and institutions. The article entitled Clinical Practice Guideline: Allergic rhinitis by Seidman et al. (386) is the most cited reference.  
Conclusion: The benefit and potential of acupuncture for several diseases in pediatric patients are promising and no adverse side effects have been reported.
Body image and the level of stress in cervical cancer patients
Authors: Rejeki Sri , Agustyaningrum Eka , Macmudah  , Khayati Nikmatul , Hartiti Tri , Safitri Dwi Nur Rahmantika Puji , Olina Yanuan Ben
Published: December 2022

Introduction: Chemotherapy is one of the management applied to cervical cancer patients. Chemotherapy is beneficial to kill cancer cells, but it affects normal body cells, such as hair roots, skin, and changes in physical appearance. These physical changes result in poor self-assessment and stress. This study was conducted to describe the correlation between body image and stress level of cervical cancer patients undergoing chemotherapy at the Gynecology Polyclinic, Dr. Kariadi General Hospital Medical Center Semarang.
Methods: This type of research is quantitative using a correlational research design. The research process was carried out in 2020 at Dr. Kariadi General Hospital Medical Center Semarang with the number of samples obtained was 87 respondents.
Results: It showed that there was a relationship between body image and stress levels in cervical cancer patients receiving chemotherapy (r = -0.313 and p-value = 0.003). With a change in physical appearance, patients would feel something different which affects psychological situations and further causes stress.
Conclusions: The level of stress has a significant correlation with the body image score of cervical cancer.
Excessive physical exercise caused a decrease in CD4+ and Hematopoietic Stem Cell (HSC) levels in Wistar rats
Authors: Putrawan Si Ngurah Oka , Jawi I Made , Yasa I Wayan Putu Sutirta , Subawa Anak Agung Ngurah , Manuaba Ida Bagus Putra
Published: December 2022

Background: Excessive physical exercise can cause injury and disrupt the body's homeostasis. Excessive physical exercise also causes increasing oxygen demand and reactive oxygen species production (ROS) that induce damage in various cells and body tissue, including HSC and CD4+ cells. This study aims to prove that excessive physical exercise decreases the CD4+ and HSC levels in Wistar rats and evaluates the correlation between HSC and CD4+ cell levels.
Methods: An experimental study with a randomized post-test-only control group design was conducted among 44 male Wistar rats in Clinical Pathology Laboratory, Mangusada General Hospital, Bali, from June to September 2022. The samples were divided into two groups; 22 rats received excessive physical exercise (treatment group) and 22 rats as the control group. The CD4+ cells and HSC were examined after 14 days of intervention. Data regarding the means of CD4+ and HSC levels between the two groups were assessed, and the correlation between HSC and CD4+ cell levels was analyzed using SPSS version 21 for Windows.   
Results: We used 22 rats for each treatment and control group. The mean level of CD4+ and HSC were significantly lower in the treatment group compared to the control group (356.41 vs. 661.41x106 cell/µl; p<0.001) and (359.14 vs. 551.09 x106 cell/µl). We found a statistically significant difference in CD4+ and HSC levels between the two groups, p<0.001). We also found a positive correlation between HSC and CD4+ level with r=0.636; p<0.001. Excessive physical exercise affected the immune function by decreasing CD4+ ad HSC levels in Wistar rats.
Conclusions: The impact of excessive physical exercise on immune function showed by decreasing the level of CD4+ and HSC level in Wistar rats. The HSC number also has a positive correlation with CD4+ cell level.
Application of DNA Barcoding for authentication of Balinese traditional medicinal plant Purnajiwa (Kopsia arborea Blume. and Euchresta horsfieldii) (Lesch.) Benn
Authors: Putu Eka Pasmidi Ariati  , Sasadara Maria Malida Vernandes , I Gede Putu Wirawan  , Made Sritamin  , I Ketut Suada  , I Nyoman Wijaya  , Rindang Dwiyani  , I Putu Sudiarta  , Ida Ayu Putri Darmawati
Published: December 2022

Background: Purnajiwa is one of the medicinal plants in Bali. Species information regarding this plant is still unconfirmed. Currently, this plant is considered rare and endangered. Molecular identification supports authentication at the species level, which will also support conservation efforts.
Method: Molecular identification using DNA Barcoding was carried out on purnajiwa from three sampling locations in Bali (Jimbaran, Mambal, and Bedugul) using rbcL primers (rbcLaF and rbcLaR). Data analysis was performed using BLAST with species on GenBank. Pairwise and similarity values ​​were used to measure the three samples' proximity to the Gen Bank species.
Result: The phylogenetic tree was constructed with the Maximum Likelihood and Tamura-3-parameter model. The analysis results show a close relationship between the purnajiwa from Jimbaran and Mambal with the species Kopsia arborea (KP095079). Meanwhile, the Purnajiwa from Bedugul showed a difference from the other two purnajiwa and was closely related to Euchresta horsfieldii (U74225).
Conclusion: It can be concluded that the Purnajiwa from Jimbaran and Mambal is a species of Kopsia arborea while the Purnajiwa from Bedugul is a species of Euchresta horsfieldii.
Association between patient with muscle-invasive bladder cancer with the incidence of urinary tract infection in Karawang Regional Hospital: a single center study
Authors: Muhamad Iqbal Tafwid  , Achmad Rizky Herda Pratama
Published: December 2022

Background: Several studies link urinary tract infection (UTI) and bladder cancer. However, the association between bladder cancer muscle invasiveness and the incidence of UTI is not known
Objective: This study aimed to study the association between the occurrence of UTI in bladder cancer and the severity of the bladder cancer, specifically in a patient admitted to Karawang regional hospital, Indonesia.
Material and Methods: This is a single-center retrospective case control. Data were obtained through medical records of the patient admitted with bladder cancer in Karawang Regional Hospital from 2019-2021. Diagnosis of Non-muscle invasive Bladder cancer (NMIBC)/Muscle-invasive Bladder Cancer (MIBC) and UTI were all obtained through medical records. Binary logistic regression analysis was used to determine the odds ratio between these variables and the incidence of UTI
Result: A total of 59 samples were obtained. 57.7% were males, and 42.3% were females, with a mean age of 59 years and distributed into two groups, NMIBC/MIBC. There are also no significant gender and age difference between groups. Our data showed no significant association between bladder cancer muscle invasiveness and the incidence of UTI (OR=1.67; 95%CI 0.218-12.7; p=0.622). Subgroup analysis with different gender also yields no significant result.
Conclusion: UTI incidence increased in MIBC patients compared to NMIBC, but it is not statistically significant.
Association between the levels of muscle-specific creatinine kinase (CK-MM) and the incidence of persistent myalgia in COVID-19 survivors
Authors: Adhiatma Aria , Waloejo Christrijogo Sumartono , Semedi Bambang Pujo , Hamzah  , Kriswidyatomo Prihatma , Lestari Pudji
Published: December 2022

Introduction: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, may result in musculoskeletal tissue injury and is assumingly regulated through central and peripheral pathways. Muscle-specific creatinine kinase (CK-MM) is a specific biomarker used to indicate the presence of musculoskeletal tissue damage. This study aimed to investigate the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.
Methods: A cross-sectional study was conducted among COVID-19 survivors at the Faculty of Medicine and Clinical Pathology Laboratory, Universitas Airlangga, Surabaya from June - August 2022. The degree of pain of the myalgia was assessed using a visual analog scale (VAS), while CK-MM level was measured using a sandwich enzyme-linked immunosorbent assay (ELISA). Pearson correlation test at α=0.05 was used to identify the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.
Results: A total of 84 participants were enrolled in the study and half (50%) of them reported persistent myalgia post-COVID-19 recovery. Fatigue was the patients' most common persistent symptom (63%). Of the total 42 patients with persistent myalgia, more than half (56%) had mild pain intensity (VAS score: 1–3), and almost all of them (41 patients) experienced myalgia during the COVID-19 diagnosis. All the patients with post-COVID-19 myalgia had normal levels of CK-MM (mean: 32.7 ng/mL; range: 12–93 ng/mL), suggesting no musculoskeletal tissue damage. Anova test suggested no significant different of CK-MM levels between those with and without myalgia in patients with post-COVID-19 syndromes p=0.054).
Conclusion: There was no significant association between CK-MM levels and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.
Role of neutrophil gelatinase-associated lipocalin (NGAL) as a acute prerenal kidney injury marker: Exploring factors associated with its postoperative levels in hypotension-controlled otorhinolaryngology surgery
Authors: Saputra Andy Nauman , Airlangga Prananda Surya , Rahman Boby Abdul , Kusuma Edward , Kriswidyatomo Prihatma , Sumartomo Christrijogo
Published: December 2022

Introduction: Acute kidney injury (AKI) is a sudden decrease in kidney function due to damage within seven days or less, thus inducing an early stress response that can be promptly detected by biomarkers, such as Neutrophil Gelatinase-Associated Lipocalin (NGAL). The aim of this study was to analyse the role of NGAL level as a biomarker of postoperative prerenal AKI in patients who underwent otorhinolaryngology surgery with controlled hypotension.
Methods: A prospective study was conducted among patients that underwent otorhinolaryngology surgery with controlled hypotension. Patients were selected with purposive sampling. NGAL level was measured using enzyme-linked immunosorbent assay (ELISA) from venous blood collected 1-hour pre- and 2-hour post-surgery. NGAL levels were compared between preoperative and postoperative states. Wilcoxon and Spearman test were used to determine the correlation between NGAL levels and parameters of AKI.
Results: A total of 30 patients underwent a varies of otorhinolaryngology surgeries were recruited in this study. Our data suggested no significant different between the level of NGAL during preoperative and postoperative (184.73±120.09 ng/mL vs 175.80±129.97 ng/mL). Pre-operative laboratory parameters of AKI such as blood urea nitrogen (BUN), serum creatine (SCr), BUN/SCr ratio, and GFR had no correlation with postoperative NGAL level. In addition, systolic blood pressure, diastolic blood pressure, MAP, heart rate, EtCO2, duration of surgery and the duration of controlled hypotension had no correlation with postoperative NGAL.
Conclusion: NGAL levels have nonsignificant role as biomarker of incidence of postoperative prerenal AKI in patients who receiving otorhinolaryngology surgery with controlled hypotension. However, further study with the bigger sample size is warrant to confirm the findings of this study.
Association between insulin, glucagon, high sensitive c-reactive protein, insulin resistance with visceral adipose tissue-derived serine protease inhibitor (VASPIN) in obese population
Authors: I Made Pande Dwipayana  , Wira Gotera  , Ketut Suastika  , I Wayan Putu Sutirta Yasa  , Anak Agung Gede Budhiarta  , Made Ratna Saraswati  , I Made Siswadi Semadi  , Ida Bagus Aditya Nugraha
Published: December 2022

Background: Obesity is an inflammatory condition that results in an increase in high sensitive C-Reactive Protein (hs-CRP), a risk for insulin resistance (IR). Vaspin has the effect of increasing insulin receptor sensitivity and on the other hand is a compensatory response to insulin resistance, one of which is measured by homeostasis models assessment-insulin resistance (HOMA-IR). This study was an analytical cross-sectional observational design, to determine the association between insulin, glucagon, CRP, and HOMA-IR levels with serum vaspin in obesity.
Method: This study is an analytical study with a cross-sectional design.  Criteria of inclusion were subjects in the range 18-60 years Denpasar citizen with BMI above 25 kg/m2 and willing to be involved in this study, while exclusion criteria were with either chronic conditions or acute inflammation such as infection, cancer, tumor, or chronic disease which is altered and threatening life. Correlation tests using spearman analysis.
Results: From 131 obese subjects in this study, there were 72 (55%) men and 59 (45%) women. Median age: 33 (22-57) years, fasting insulin: 8.90 (2.20-74.50) ìIU/mL, glucagon: 48.10 (7.58-293.90) pq/mL, hs-CRP: 1.90 (0.20-9.50) mg/L, HOMA-IR: 2 (0.50-23.15), and vaspin levels: 0.16 (0.04-1.46) ng/mL. There was a significant positive correlation between HOMA-IR, insulin and glucagon with vaspin (r = 0.20, p = 0.020; r = 0.20, p = 0.022; and r = 0.28, p = 0.001), and a significant negative correlation between hs-CRP and vaspin (r = -0.24, p = 0.005) in obesity. In the path analysis, there was a direct and total negative effect of hs-CRP on vaspin (coefficient = -0.19; p = 0.027 and coefficient = -0.02; p = 0.038).
Conclusion: This study shows a positive association between insulin, glucagon, and HOMA-IR with serum vaspin, while CRP is negatively associated with serum vaspin in obesity.
A pilot study of new scoring system severity of striae distensae
Authors: Putra Imam Budi , Jusuf Nelva Karmila , Amal Alviera Yuliandra
Published: December 2022

Background: Striae distensae (SD) is a common skin disorder in the form of linear atrophy, which arises due to stretching and is one of the most common cosmetic problems. There is no scoring system to assess the severity of striae distensae that is easy to use, non-invasive, and consistent and can be used to evaluate SD treatment. This study formulated and validated a scoring system to assess the severity of striae distensae.
Methods: This study was a descriptive observational study with a cross sectional approach involving 30 female health workers at the Universitas Sumatra Utara Hospital. Assessment of SD severity in six regions using four parameters.
Results: A scoring system for the severity of striae distensae has been formulated, named the INA score, to assess the severity of SD in six regions; mammae, axilla, abdomen, femur, gluteus and poplitea using four parameters; the number of lines, the size of the longest striae distensae line, color, and itchy. The results of the validation test are statistically valid (r-value>0.361), and the reliability test is found to be reliable (Cronbach's Alpha>0.361).
Conclusion: The formulation of a valid and reliable scoring system, named the INA score, has been obtained to assess the severity of striae distensae measured at six locations and four parameters.
Management of bilateral nubbin testis, past and present controversies: a case report
Authors: Syahputra Dian Adi , Indriasari Vita , Kusumowidagdo Fransiska
Published: December 2022

Introduction: Testicular nubbin is the most common case of impalpable testis found by pediatric urologists. Diagnostic and surgical management, including long-term follow-up, is still a debate, especially in cases of bilateral testicular nubbin.
Case presentation: A 5-year-old boy with bilateral impalpable testis was brought to a hospital. A diagnostic laparoscopy was performed, and both internal inguinal rings were closed with testicular blood vessels, and the vas deferens had entered the inguinal canal. We found bilateral testicular nubbin on inguinal exploration and subsequently performed only right orchidopexy because it was larger than the left testis.
Conclusion: Evidence-based medicine, comprehensive management, and consultation between doctor and patient are needed in bilateral management of testicular nubbin for a good patient outcome.
Subacute thyroiditis associated with COVID-19 affecting health professionals, a case series in high-risk population
Authors: Zufry Hendra , Firdausa Sarah , Ekadamayanti Agustia Sukri , Sucipto Krishna Wardana
Published: December 2022

Background: Healthcare professionals are more vulnerable to infectious infections, especially ones that are easily transferred, such as COVID-19. Subacute thyroiditis is a self-limiting thyroid gland infection caused by a virus. SARS-CoV-2 infection increases the prevalence of subacute thyroiditis.
Objective: This case series addresses the emergence of subacute thyroiditis cases linked to SARS-CoV-2 infection, which is more common in healthcare personnel.
Methods: This study analyzed nine COVID-19 cases with neck pain symptoms. The clinical presentation, thyroid markers, ultrasound features of the thyroid gland, and its management were described in this study.
Result: There were nine cases included, and seven out of nine were experienced by healthcare professional workers. All of them were patients in the Clinic of Endocrinology Metabolism and Diabetes - Thyroid Center, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, from January to June 2021. Most of them presented with mild to moderate neck pain. All patients had clinical improvement within two weeks to two months after receiving treatments.
Conclusion: Subacute thyroiditis is a painful thyroid gland disease characterized by acute inflammation of the thyroid gland, which can arise during or after a viral infection such as COVID-19. This case series emphasizes the importance of physicians awareness that subacute thyroiditis could be one of many clinical spectra of SARS-CoV-2 infection that should not be missed.
Analysis of Serum Vitamin D Level in Leprosy Patients
Authors: Darus Nadia Inasya Mozart , Lubis Ramona Dumasari , Jusuf Nelva Karmila
Published: December 2022

Introduction: Leprosy is a chronic granulomatous infection with a variety of clinical spectrum caused by Mycobacterium leprae (M. leprae) that is highly influenced by host immune response. In leprosy, vitamin D acts as an immunomodulator through a VDR-mediated antimicrobial pathway that affects the innate immune system to bacterial killing. M. leprae inhibits VDR activity through the down-regulation of CYP27B1. Elevated 1.25(OH)2D levels are required to modulate cathelicidin antimicrobial peptide (CAMP) production, which leads to reduced 25(OH)D level. This study aimed to analyze the difference in serum vitamin D level between leprosy patients and healthy people.Methods: This research was an analytical observational study with a cross-sectional design involving 20 patients with new cases of leprosy and 20 controls. The diagnosis of leprosy was confirmed through physical examination and laboratory examination. We conducted blood sampling and measurement of serum vitamin D (25(OH)D) level in both groups using the chemiluminescence immunoassay (CLIA) method. The collected data were then processed and analyzed statistically using the Mann-Whitney test.Result: In this study, we found that the mean serum vitamin D level in leprosy patients (22.27 Â± 5.418 ng/mL) was lower than controls (33.00 Â± 1.913 ng/mL), and the difference was statistically significant (p < 0.05). The mean serum vitamin D level in male leprosy patients (23.69 Â± 4.034 ng/mL) was higher than females (16.55 Â± 7.081 ng/mL), and was highest in patients aged 36 â€“ 45 years (25.314 Â± 2.2945 ng/mL).Conclusion: Serum vitamin D level was significantly lower in leprosy patients than in controls. Serum vitamin D level in leprosy patients was higher in the male group and was highest in patients aged 36 â€“ 45 years.
Hypercoagulation state in infant with COVID-19: a case report
Authors: Wijaya Teo , Hsieh Peter Prayogo , Melinda Fitriana , Suarca I Kadek
Published: December 2022

Background: COVID-19 pandemic is not over yet, and the clinical manifestations of this newly emerged disease vary due to the rapid mutation of SARS-CoV-2 as its causative agent. The SARS-CoV-2 infection will stimulate the release of proinflammatory cytokines in large amounts, which further leads to hypercoagulation. The aim of this study is to describe a case of COVID-19 with hypercoagulation and what can be done to prevent serious complications.
Case: 1.5-month-old baby boy presented with a complaint of coughing for 10 days. It was accompanied by persistent fever, diarrhea, and vomiting, but no shortness of breath or rhinorrhea was reported. It was known that his parents, whom he was living with, were self–isolating due to COVID – 19. On physical examinations, his vital signs were within normal limits except for axillary temperature, which was tested at 38.3°C. Laboratory results showed a prolongation of coagulation time (PT: 8,3 seconds, APTT: 23,2 seconds), elevated D-Dimer (>10.000 ng/mL), and a positive COVID-19 PCR test. He was diagnosed with a hypercoagulation state in severe COVID-19 and received both supportive and anticoagulant therapy. His condition improved, and he was discharged in good condition after 12 days of hospitalization.
Conclusion: In order to get good outcomes, thorough examinations and comprehensive management have to be ensured in patients with a hypercoagulation state due to severe COVID-19.
Pathogenesis of tuberculous meningitis (TBM): a mini-review
Authors: Haiga Yuri
Published: December 2022

Background: Tuberculosis (TB) is the leading cause of death from a single infectious agent (Mycobacterium tuberculosis) and killed nearly 1.5 million people in 2018. TB mostly manifests as a pulmonary disease but can also affect other parts of the body, causing extrapulmonary TB. Approximately 5% of all cases of extrapulmonary TB are tuberculous meningitis (TBM), which is caused by the spread of M. tuberculosis to the meninges and cerebrospinal fluid (CSF).
Result: TBM is the most devastating form of TB and causes high rates of morbidity and mortality, with an estimated 50% of patients dying or suffering from neurological sequelae and complications. Meningitis is categorized as a medical emergency because it can cause death due to inflammation that occurs in the brain and spinal cord. Most meningitis patients present with fever, and signs and symptoms of meningeal inflammation include headache, neck stiffness and altered mental status. Disease management has limitations due to the limited availability of available diagnostic approaches. Until now, knowledge about the pathogenesis of TBM has been limited.
Conclusion: Further research is urgently needed to improve understanding of disease pathogenesis and diagnostic approaches based on biomarkers of disease. Current knowledge on the pathogenesis of TBM summarize the literature on diagnostic approaches based on biomarkers, which may be useful in the management of TBM.
Relationship between nutritional status and family support with quality of life elderly
Authors: Kustiar Astri Dyah , Pamungkasari Eti Poncorini , Handayani Selfi
Published: December 2022

Background: The quality of life elderly in the physical domain will decrease which will lead to changes in nutritional status. Nutritional status can prevent or defend the body from various chronic and acute diseases, and it also plays a role in the healing process. Family support is needed to improve the quality of life elderly to improve health and reduce morbidity and mortality. This study analyzes the relationship between nutritional status and family support with the quality of life elderly.
Method: This type of research is analytical observational with a cross-sectional design. The sample was taken by purposive sampling, namely 145 people over 60 years old. The sampling technique used was cluster sampling which took samples from health centers, namely urban and rural areas. The instruments used were family support questionnaires, WHOQOL-BREF questionnaires, and weight and height measurements. This research analysis used Chi-Square.
Result: There was no significant relationship between nutritional status and quality of life elderly (p = 0.597 ), and there was no significant relationship between family support and quality of life elderly (p = 0.153).
Conclusion: there is no relationship between nutritional status and family support with quality of life for the elderly
Prevalence and prognosis from the disability related to spinal tuberculosis: a systematic review
Authors: Setiajaya Juanda
Published: December 2022

Objective: To review the disabilities caused by Spinal TB in relation to the prevalence and prognosis of the disabilities caused by the disease.
Method: We conducted systematic search of the literatures based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PICO criteria. Our inclusion criteria were: 1) Patients with spinal TB; 2) full original articles; 3) articles written in English; 4) the period of publication of articles from 2012 to 2022. Evaluation of each article was done by checklist Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).
Results: From all articles in the publication year of 2012 to 2022, we reviewed five retrospective cohort studies, all studies coming from Asian countries. The five articles observed the prevalence of disabilities caused by spinal TB reflected through some important outcome variables pre-treatment, where they continued to compare with the post-treatment outcome variables. All of the studies reviewed had agreed that immediate or delayed treatment would give significant benefits to the patients of spinal TB, even better with combined treatments of conventional pre-operative anti-TB drugs and surgical intervention. It was found that poor prognosis associated with preoperative neurological status of the patients.
Conclusion: Conventional anti-TB drugs and surgical intervention can be of great help and benefit for patients with spinal TB, reducing their disabilities severity and improving their prognosis.
Correlation between serum IL-17 levels with Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels of new cases of pulmonary tuberculosis at Sanglah Central General Hospital, Bali, Indonesia
Authors: Mahartini Ni Nyoman , Nugraha Jusak , Ma’at Suprapto
Published: December 2022

Background: Tuberculosis (TB) is a mycobacterial infection that usually attacks the lungs and triggers lung damage and dysfunction related to the reléase of IL-17, Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP). This study aims to evaluate the correlation between serum IL-17 levels with ESR and CRP levels in new cases of pulmonary tuberculosis at Sanglah Central General Hospital, Bali, Indonesia.
Methods: A cross-sectional study was conducted among 56 TB patients treated as new pulmonary TB cases in Outpatient and Inpatient Internal Medicine at Sanglah Hospital, Bali, Indonesia. IL-17 levels in this study were the results of IL-17 examination from patient serum using the ELISA method from R&Dsystems with units of pg/mL. The Erythrocyte Sedimentation Rate (ESR) in this study is the rate of blood deposition in mm/hour using a Westergreen tube. Meanwhile, the C-Reactive Protein (CRP) examination was carried out using a Roche 6000 analyzer in mg/dL. Data were analyzed with SPSS version 16 for Windows.
Results: Most respondents are female (75.0%) and the 30-34 years old group (26.8%). The mean value of ESR is 40.39±25.86 mm/hour, followed by CRP (9.95±10.01 mg/dL), and IL-17 (15.21±1.20 pg/mL). There is no significant correlation between ESR to CRP (r=0.069; p=0.613) and IL-17 (r=0.135; p=0.323). In addition, there is no significant correlation between CRP and IL-17 (r=0.168; p=0.215).
Conclusion: This study's results indicate no significant correlation between IL-17 levels with CRP and ESR or between CRP and ESR.
The comparison of mitral annular plane systolic excursion (MAPSE) and mitral annular systolic velocity (Sm) in determining subclinical left ventricular systolic dysfunction in patients with type 2 diabetes mellitus
Authors: Saputra Bagus Made Indrata , Wibhuti Ida Bagus Rangga , Suastika Luh Oliva Saraswati , Sari Ni Made Ayu Wulan
Published: December 2022

Background: Type 2 diabetes mellitus (T2DM) is an independent factor in increasing the risk of heart failure in the absence of coronary heart disease and hypertension. Global longitudinal strain (GLS) as the gold standard in determining subclinical left ventricular (LV) systolic dysfunction is not available on all echocardiographic tools and requires good-quality images. Mitral annular plane systolic excursion (MAPSE) and mitral annular peak systolic velocity (Sm) are simpler, faster, and widely available method that can determine left ventricular systolic dysfunction regardless of image quality.
Methods: This study involved 72 asymptomatic T2DM patients, divided into two groups, patients with subclinical left ventricular systolic dysfunction (GLS >-18%) and normal systolic function (GLS ≤-18%). GLS was obtained from the mean of 18 left ventricular segments on the apical 4-chamber, 3-chamber and 2-chamber images. MAPSE was obtained on the septal and lateral sides of the mitral annulus using M-mode on apical 4-chamber view, while Sm was obtained using tissue doppler imaging (TDI).
Results: The study included 72 asymptomatic T2DM patients, 34 samples (47.2%) were found with subclinical LV systolic dysfunction. According to receiver operating characteristic (ROC) curve analysis, lateral TDI Sm had the highest area under the curve (AUC), it was 0.85, followed by average TDI Sm was 0.83 and average MAPSE was 0.81. The cut-off value of average TDI Sm <7.425 cm/s had the best sensitivity and specificity, 82.4% and 81.6%, while cut-off value of average MAPSE <13.4 mm had sensitivity of 76.5% and specificity of 73.7%.
Conclusion: TDI Sm had better accuracy than MAPSE in determining subclinical LV systolic dysfunction in T2DM patients. However, both of them can be used as alternative diagnostic methods of GLS.
Identification of active chemical compounds and potential antibacterial snail mucus (Achatina fulica) on bacteria Enterococcus foecalis causes of periodontitis
Authors: Swastini I Gusti Agung Ayu Putu , Sumerti Ni Nengah , Ramini Ni Ketut , Juniarsana Wayan , Suardana I Ketut , Arjani Ida Ayu Made Sri , Ratih Ida Ayu Dewi Kumala , Tedjasulaksana Regina
Published: December 2022

Background: A chemical compound is a chemical compound present in a natural source that gives it the special properties and characteristics of the plant or animal source. Snail slime is one of the traditional medicines from animals that is used by the community as a traditional medicine for healing minor wounds and toothaches. The aim of this study was to identify the active chemical compounds and antibacterial potential of snail mucus against the bacteria E. foecalis that causes periodontitis.
Method: True experiment laboratory research method which is carried out by laboratory analysis of snail mucus to obtain chemical elements, the content of compounds contained in a test sample. The content of active compounds based on the Gas Chromatography-Mass Spectrometry (GCMS) test.
Results: The average content of heparan sulfate with four repetitions was 16.45 mg/100g, Acharan sulfate 21.33 mg/100g, protein achasin 102.22 mg/100g, Glycoconyugat 88.6 mg/100g, Ion Ca2+ 86.2 mg/100g, Beta agglutinins 85.22 mg/100g. Toxicity test was carried out with four repetitions with concentrations of 100%, 50%, 25%, and 12.5%. And the lowest results of the toxicity test were at a concentration of 100% with a value of 0.171, while at a concentration of 50% 0.302, 25% 0.453, and 12.5% 0.768, for bacteria E. Foecalis with an inhibitory power of 23.15 mm, the category was very strong.
Conclusion: The active chemical content in snail mucus is Acharan sulfate, achasin protein, Glycoconyugat, Ca2+ ion, Beta agglutinin, and the antibacterial potential of snail mucus against E. foecalis bacteria is very strong.