bluuebunny/crossref_metadata_2025 huggingface dataset:
Massive subdural empyema secondary to infectious parotitis: a case report
Authors: Maliawan Sri , Awyono Steven , Eufrata Silvestris Junus  , Golden Nyoman
Published: December 2022

Background: Subdural empyema is an intracranial focal collection of purulent material between the dura and arachnoid mater. The most common causes are purulent meningitis in infants and sinusitis and otitis media in older children through a direct extension of the infection. Although it is very rare, parotitis may also cause subdural empyema. This report presents our case of subdural empyema due to infectious parotitis in a pediatric patient.
Case report: A 1-year-old boy was referred from other hospitals for multiple seizure episodes. He also had a complaint of vomit and fever 3 weeks ago. On the neurological examination, we found that he had a GCS of 8, no meningeal sign was found, and with dilated pupil on the right side. A contrast-enhanced head computed tomography (CT) scan revealed multiple hypodense masses with ring enhancement over the right hemisphere, and a severe midline shift suggested as subdural empyema. We then performed a craniotomy to evacuate the empyema. Two weeks after surgery, he was fully alert without any surgical morbidity.
Conclusion: Although parotitis is the less likely disease that can cause subdural empyema, we should also include the disease as the possible cause before we examine the patient more thoroughly and exclude them as the disease that can cause subdural empyema.
The serum acetylcholinesterase (AChE) levels as an alternative diagnostic tool in pre-operative Hirschsprung's disease
Authors: Wasito Dennis Chrissandy , Ali Iskandar , Kusumowidagdo Fransiska , Hariastawa I Gusti Bagus Adria
Published: December 2022

Background: The golden standard of Hirschsprung's disease diagnosis is through a histopathological examination of the aganglionic site. The significance of serum acetylcholinesterase (AChE) immunohistochemistry for diagnosing Hirschsprung's disease has been widely accepted. However, the study of serum AChE levels in Hirschsprung's disease patients is still scarce. We aimed to examine the serum levels of AChE in individuals with Hirschsprung's disease.
Methods: An analytical observational study with a cross sectional design was conducted on 29 patients with Hirschsprung's disease. We divided the patients into two groups: 14 in Hirschsprung's disease group and 15 in the control group. Serum AChE level was measured using the enzyme-linked immunosorbent assay (ELISA) method. The optimal cut-off value for detecting Hirschsprung’s disease was determined using the ROC analysis.
Results: The prevalence of Hirschsprung was higher in males than in females. The average AChE level in the Hirschsprung group was 95.89 ± 51.11 Units/mL, while the average level of AChE in the control group was 44.45 ± 33.40 Units/mL. The optimal cut-off value was 46.615 Units/mL. We found that this study's sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values ​​were 83.3%, 70.6%, 66.7%, 85.7%, and 75.9%, respectively. There was a significant relationship between serum AChE levels and Hirschsprung's disease (p=0.004).
Conclusion: The AChE levels in blood serum can be used as an alternative diagnostic parameter for Hirschsprung's disease. Patients with Hirschsprung's disease had higher serum AChE levels than patients without Hirschsprung's disease.
The use of Neutrophil – Lymphocyte Ratio (NLR) as a potential biomarker to predict the prognosis of Ludwig's angina patients
Authors: Sakarozi Ruli , Susilo Dwi Hari , Wibowo Marjono Dwi
Published: December 2022

Background: Ludwig's angina is an infection of the submandibular cavity in the form of cellulitis that is rapidly progressive and potentially life-threatening. Neutrophils and lymphocytes play an important role in this infection process. Neutrophil-lymphocyte Ratio (NLR) is a simple biomarker to evaluate systemic inflammation. We aimed to determine the association between NLR and various prognostic parameters in patients with Ludwig's Angina.
Methods: A retrospective cohort study was conducted using medical records of Ludwig's Angina patients treated at Dr. Soetomo General Hospital, Surabaya, Indonesia, between January 2018 – December 2021. The NLR cut-off value was calculated using the receiver operating characteristics (ROC) curve. The association between NLR with severity, length of stay (LoS), and mortality were analyzed using SPSS version 23 for Windows.
Results: We recruited a total of 96 patients. NLR values are divided categorically into low NLR and high NLR using a cut-off value of 16.86. There were 49 patients (51%) with low NLR and 47 (49%) with high NLR. There was a significant relationship between NLR with severity, LoS, and mortality in Ludwig’s angina patients (p=0.032, p=0.002, and p=0.026, respectively). According to a survival study, the high NLR group's survival rate was significantly lower than the low NLR group's (p=0.009).
Conclusion: There was a significant relationship between NLR severity grading, survival, and the length of stay in patients with Ludwig's Angina.
Restarting living donor kidney transplant during COVID-19: a single center experience
Authors: Mochammad Fairuz Zahran  , Tanaya Ghinorawa
Published: December 2022

Abstract: The decision that declared COVID-19 as a pandemic in March 2020 had become a medical emergency that also effects kidney transplantation program and care. Kidney transplantation has been a definitive treatment for end-stage renal disease (ESRD) patients since it improves patient’s quality of life. However great the beneficence is, kidney transplant procedure still carries high risk of COVID-19 infection especially for recipients who are obliged to take immunosuppression agents after transplantation.
Purpose: This study aimed to evaluate kidney transplant procedure in Dr. Sardjito General Hospital within before and during pandemic based on recipients’ and donors’ characteristics and laboratory findings such as creatinine and urine time.
Patients and methods: This study is designed as a cross-sectional analytic research to evaluate 30 patients that underwent kidney transplant in Dr. Sardjito General Hospital within before (April 2019-2020) and during (April 2020-2021) COVID-19 era. Data analyses were carried out using SPSS version 25.0 and were served with simple charts and tables.
Results: There is a decrement of kidney transplant procedure within before (n=16) and during (n=14) COVID-19. Age group of recipients that underwent the most of transplantation before pandemic are 20-29 years old while during pandemic are 40-49 years old. There is no significant difference in length-of-stay within before (12.0±4.17 days) and during (9.29±3.73 days) COVID-19 (p=0,077). Laboratory findings such as creatinine of pre-transplantation (9.47±4.05; 7.81±6.00) and 3 months’ post-transplantation (1,55±0,78; 1,15±0,67) also did not show significant changes (p=0,153) as well as urine time (245.60±225.55; 428.38±657.70; p=0.321).
Conclusion: There is a decrement of kidney transplant procedure in Dr. Sardjito General Hospital within before and during COVID-19 era. There are no significant differences found within length-of-stay, creatinine pre and 3 months’ post-transplantation and urine time. On the whole, transplant outcomes have remained similar within pre and during COVID-19 era.
Utilization of local culture "Bapalas Bidan" as a postpartum counseling media on contraception tools
Authors: Noordiati  , Sukriani Wahidah
Published: December 2022

Background: Postpartum contraception is a way to prevent recurrent pregnancies to ensure the health of both mother and baby. Many postpartum mothers think that there will be no pregnancy during amenorrhea in the postpartum period and will use the contraceptive method after the first menstruation. There are still some who do not use contraception. Contraceptive success will be achieved if the counseling and media are effective. Palangka Raya's city has a Bapalas Bidan culture, a ritual in which a newborn baby is declared a midwife's child until the midwife's blessing ceremony is carried out for the baby and the mother.
Methods: This research type is a quasi-experimental study with two group comparison pretest-posttest design with counseling intervention and booklets. The research subjects were postpartum mothers who gave birth or were treated at the Midwives Individual Service in Palangka Raya City, amounting to 30 each per treatment and control group.
Results: There was a difference in the mean and an increase in the group's knowledge score after receiving counseling through the Bapalas Bidan (p = 0.000). The increase in knowledge was higher in the group that received counseling than in those who did not get counseling. Postpartum mothers who have high knowledge of contraception use contraception more than mothers with low knowledge. The proportion of postpartum mothers who used contraception was more in the group who received counseling (p = 0.018), aged 20-35 years (p = 0.015), had parity ≥3 (p = 0.024), and higher education (p = 0.006).
Conclusion: Postpartum mothers who have high knowledge of contraception use contraception more than mothers with low knowledge.
Protective effect of lavender essential oils on depression and multi-organ stress
Authors: Algristian Hafid , Bintarti Tri Wahyuni , Baroroh Rani Nur Mukaromatim , Leila Qorieatul , Ulfa Reina , Amelia Krismawati  , Nurdiana Mifa , Sudjarwo Giftania Wardhani , Nurhidayat Adhi Wibowo , Irawan Satriotomo  , Handajani Retno
Published: December 2022

Introduction: Lavender essential oils (LEO) have been known to have relaxing effects, improve mood, and treat anxiety, but the effect on multiple organ stress concurrently is unknown. This multiorgan stress is related to depression can be caused by chronic psychological stress due to excessive cortisol levels and can lead to organ damage. This study analyzed LEO in preventing depression and multiorgan failure using intraperitoneal injection of corticosteroids in animal-model.
Methods: Rats (Rattus norvegicus) Wistar strain, male, aged 7-8 weeks were involved in this study. Depression in animal-model is defined by immobilization using tail suspension test and anhedonia using sucrose preference test. LEO 5% was diluted in virgin coconut oils as vehicle. Serum cortisol was analyzed using enzyme-linked immunosorbent assay (ELISA). Organs were extracted and processed using hematoxylin eosin staining.
Results: The results of this study indicate that LEO was able to prevent damage to the glial cells, myocardiac cells, and gastrointestinal mast cells infiltration, but not to the hepatocytes and renal cells damage. LEO also induced behavioral activation as improvement of depression, but anhedonia was still remained.
Conclusion: The effect of LEO is to prevent the increase in blood cortisol levels, thus reduce the reactivity of depressed individuals to stress, although the individual still has anhedonia as a residual symptoms
Antibacterial activity of Sentul fruit peel extract (Sandoricum koetjape) against Streptococcus mutans and Staphylococcus aureus
Authors: Wirata I Nyoman , Anak Agung Gede Agung  , Ni Wayan Arini  , Regina Tedja Sulaksana  , Mochammad Choirul Hadi  , I Gusti Ayu Raiyanti
Published: December 2022

Introduction: Infectious mouth diseases are caused by microorganisms such as      Staphylococcus aureus and Streptococcus mutans. Sentul fruit peel extract contains several phytochemical compounds, flavonoid compounds, saponins and tannins are aromatic hydroxyl groups that act as antibacterial so that they can be used as a treatment for infections of the mouth. This study aimed to determine the inhibitory ability of Sentul fruit peel extract (Sandoricum koetjape) against Streptococcus mutans and Staphylococcus Aureus bacteria which can cause oral infections.
Method: Sentul fruit peel simplicia was extracted by maceration method with ethanol for 24 hours. The maceration method was chosen in this study because it is a method that is easy to do and uses simple tools, which is enough to soak the sample in a solvent. A filtering process followed this and the filtrate was then evaporated with a vacuum rotary evaporator at a temperature of 45oC, so that a thick extract was produced. The maceration process was repeated 2 times. After the extraction process, then proceed with liquid-liquid fractionation using distilled water. The thick extract was put into a separating funnel and distilled water was added. Then it was shaken and the aquadest fraction was taken, followed by evaporation with a vacuum rotary evaporator at 45oC, so that the aqua fraction of the ethanol extract was produced.
Result: The results showed that the Sentul fruit peel extract was able to inhibit the growth of      S. mutans and S. aureus bacteria as seen from the formation of a clear zone. Based on the ANOVA test, the extract concentration treatment had a significant effect (p<0.005) on the diameter of the clear zone on S. mutans and S. aureus bacteria. Positive control (streptomycin) showed significant differences in Duncan's test, because it produced the greatest antibacterial activity against test bacteria compared to negative control and various extract concentrations. The diameter of the clear zone in the positive control against S. mutans and S. aureus bacteria were 17.63±0.28 mm and 17.62±1.04 mm, respectively. Sentul peel ethanol extract of aqua fraction at a concentration of 100% gave the highest inhibition zone compared to concentrations of 75%, 50%, and 25%, although it was still smaller than the diameter of the clear zone in the positive control. In bacteria S. mutans, the ethanol extract of Sentul peel aqua fraction at a concentration of 100% gave a clear zone diameter of 14.31±1.06 mm and in S. aureus bacteria it gave a clear zone diameter of 15.34±1.81 mm.
Conclusion: Sentul fruit peel extract (Sandoricum koetjape) has the ability to inhibit Streptococcus mutans bacteria and Staphylococcus Aureus bacteria.
Low dose bupivacaine spinal anesthesia for emergency cesarean section in a patient with uncorrected tetralogy of fallot, presenting with placenta previa
Authors: Millizia Anna
Published: December 2022

Background: Pregnant women with congenital heart disease tetralogy of fallot who undergo cesarean section have their own challenges for the anesthesiologist, not to mention if they have pregnancy complications such as placenta previa. The choice of the safest anesthetic technique is still debated today. The anesthetic technique must be able to maintain systemic vascular resistance, avoid increasing pulmonary vascular resistance, and be aware of the threat of blood loss due to placenta previa.
Case Report: 29 years old pregnant woman, weighing 46 kg and height 155 cm, G1P0A0, Gravida 27-28 weeks, single alive fetus, fetal distress, comes with complaints of shortness of breath, vaginal bleeding due to placenta previa with tetralogy of fallot planned emergency cesarean section. The patient presented with functional class NYHA II-III. We used low-dose spinal anesthesia with 5 mg bupivacaine 0.5% and 25 ug fentanyl as an adjuvant. Colloading was done with gelofusin colloid fluid to replace the amount of bleeding. Hemodynamics prior to anesthesia were BP 120/80, Heart Rate 80 x/minure, SpO2 72% with a non-rebreathing mask 10 litre/minute. There was no severe hypotension during surgery, and was hemodynamically stable with limited use of vasopressors. After the cesarean section was completed, the patient was transferred to the ICU and treated for 2 days, and was only discharged after 5 days of treatment without additional complications.
Conclusion: The use of low-dose spinal anesthesia in combination with adjuvant fentanyl results in a relatively safe anesthetic technique with minimal hemodynamic changes and adequate analgesia for cesarean delivery.
Secondary syphilis mimicking mid-borderline leprosy in HIV-positive patient
Authors: Putra Rheza Rahmadika , Hadi Usman
Published: December 2022

Background: Syphilis increases the risk of HIV transmission. Coinfection of both infectious diseases potentially changes the presentation of mucocutaneous lesions and accelerates disease progression, complicating the diagnosis and treatment with standard regimens. In the case study, we present a case of secondary syphilis in an HIV-positive patient with clinical manifestations resembling mid-borderline leprosy.
Case presentation: A 23-year-old male patient was referred to the emergency care unit of Dr. Soetomo General Hospital with red spots on the palms of the hands and soles of the feet for the past four months. The skin manifestation first appeared as a single spot, grew over time with itch and pain. The patient had lost 15 kg of body weight in the last three months which was confirmed as HIV-positive. He was also treated for leprosy based on the skin manifestations ever since. There was no history of direct contact with leprosy patients. The patient admitted that he had sex with men in the last 3-4 years. The laboratory examination showed negative results for Mycobacterium leprae through skin biopsy and negative for IgM and IgG of anti-phenolic glycolipid-1 (PGL-1). The patient however was positive for syphilis due to high titers of venereal disease research laboratory/rapid plasma regain (VDRL/RPR) and treponema pallidum hemagglutination (TPHA), supported by histological findings. The patient’s condition improved after receiving penicillin benzathine G, the definitive treatment for syphilis.
Conclusion: Secondary syphilis is a great imitator to mid-borderline leprosy, especially in HIV patients. To avoid misdiagnosis and mistreatment, a careful physical and laboratory examination, including serology and histopathology, should be carried out.
Soft skills elements in structured clinical skill assessment: a qualitative study
Authors: Jamaludin Thandar Soe Sumaiyah , Mohd. Said Nurumal  , Norfadzilah Ahmad  , Siti Aesah Naznin Muhammad  , Chong Mei Chan
Published: December 2022

Introduction: The intangible nature of soft skills makes it difficult for nursing academics to evaluate nursing students' attainment of these skills. Most of the time, academics focus more on assessing nursing students' knowledge and performance (hard skills) in clinical skill assessments. In focusing primarily on assessing nursing students' hard skill competencies, the nursing profession has given inadequate attention to developing their soft skill competencies. Thus, this study aimed to explore the nursing academic's view on soft skills elements in structured clinical skill assessment for the undergraduate nursing program.
Method: This study was conducted using a qualitative approach. A total of 10 nursing academics were involved, and they were recruited through a purposive sampling method. Data was collected through in-depth interviews using open-ended questions to gain insight into nursing academics' perception of soft skills elements in structured clinical skill assessment for the undergraduate nursing program. Data analysis was conducted by using an inductive content analysis method.
Results: Four themes emerge from this study. These are 1) awareness and involvement, 2) Factors influencing on implementation of soft skills in the structured clinical skills assessment, 3) academic responsibility, and 4) suggestions to overcome barriers.
Conclusion: Findings from this study provide new insights into the nursing academic perception of soft skills elements in structured clinical skill assessments of undergraduate nursing program needs improvement and proper structure on how/what are the soft skills elements that want to measure for nursing students. These findings would assist in developing a more strategic framework for soft skills elements in structured clinical skill assessments to produce quality nursing graduates.
Ameliorative effect of 50% ethanol extract of moringa leaves (Moringa oleifera Lam.) on lead-induced oxidative stress in the liver of male wistar rat model
Authors: Laksana Agung Saprasetya Dwi , Kusumasita Lily , Faniyah Falah
Published: December 2022

Purpose: This study aimed to examine the ameliorative effect of 50% ethanol extract of Moringa leaves on lead-induced oxidative stress in the liver of male Wistar rat model.
Experimental Animal and methods: In this study, adult male Wistar rats were divided into 4 groups, consists of one control group (Kn) and three experimental groups (P1, P2 and P3). All group received Pb-acetate 750 mg/kgBW/day for 7 days. After that, control groups received 1 ml aqua for 14 days, and 3 experimental groups received 1 ml volume of 250, 500 and 1.000 mg/kgBW/day of 50% ethanol extract of moringa leaves orally for 14 days, respectively. Methods measured liver level of GSH, GPx, SOD, CAT and MDA describes by Hernayanti and Simanjuntak (2018) and Ratnaningtyas et al (2022). GSH was measured by a method described by El Shater et al (2016). Data were analyzed with ANOVA and Tukey HSD post hoc test.
Results: Study results demonstrated that there was significant elevation of liver level of GSH, GPx, SOD, and CAT (p<0,05), and significant decreased of MDA levels (p<0,05) in all experimental groups. Significant amelioration of oxidative stress (p<0,05) were found in groups received 250, 500 and 1.000 mg/kgBW/day orally for 14 days.
Conclusion: In conclusion, 50% ethanol extract of moringa leaves doses 250, 500 and 1.000 mg/kgBW/day orally for 14 days ameliorates lead-induced oxidative stress in rat liver. The most effective dose was 1.000 mg/kgBB/day orally for 14 days.
Fatigue and excessive daytime sleepiness among nurses
Authors: Septian Mixrova Sebayang  , Made Suandika  , Ita Apriliyani  , Suci Khasanah  , Asmat Burhan  , Noor Yunida Triana  , Dwi Astuti
Published: December 2022

Background: Nurses are responsible for ensuring the safety of their patients. It has long been known that weariness and sleepiness can lead to mistakes that jeopardize patient safety. The researchers wanted to see if there was a link between exhaustion and excessive daytime sleepiness among nurses.
Methods: The study used a cross-sectional correlational design with 36 nurses from a Tertiary Eye Care Hospital as participants. Convenience sampling was used to collect data. The Epworth Sleepiness Scale (ESS) and the Three-Dimensional Work Fatigue Inventory (3D-WFI) were used to collect data. Pearson's correlation coefficient was used to calculate the correlation between WFI and ESS.
Results: The statistical analysis with ratio data between exhaustion and Excessive Daytime Sleepiness, we obtained that p 0.000 with Pearson correlation and suggests that there is a strong link between fatigue and excessive daytime sleepiness (EDS) among hospital nurses.
Conclusions: Fatigue and daytime sleepiness are significant occupational health concerns for hospital nurses. According to this study, nurses should optimize their work hours to avoid daytime sleepiness and maintain circumstances to avoid excessive sleepiness, which can lead to adverse outcomes.
Gut microbiome analysis in human living close to livestock at Mlati district, Sleman, Yogyakarta
Authors: Sari Yulia , Suryawati Betty , Probandari Ari Natalia , Hartono  , Wayan Tunas Artama  , Purwanto Bambang , Soetrisno
Published: December 2022

Background: Transmission of pathogenic and non-pathogenic microorganisms from animals to humans can affect the composition of gut bacteria (gut microbiome) in humans and can also be a potential source of transmission of zoonotic diseases. Therefore, this study aimed to analyze the gut microbiome interactions between the human and the livestock.
Method: This study was a cross-sectional study conducted in Mlati District, Slemanm Yogyakarta. The fecal sample was used to identify parasites by using trichrome staining. Then NGS selected samples were used to analyze the gut microbiome using Illumina high throughput 16S rRNA region V3-V4 sequencing.
Result: The analysis showed that Bacteroidetes was prevalent in the HCA group (57%), while Firmicutes (70%) were commonly found in HNC. Regarding the potential parasitic infection, direct microscopic examination and trichrome staining showed that Blastocystis sp and Entamoeba coli cyst was found in several subjects in HCA groups, with prevalence rate at 7.69% and 2.5%. Meanwhile, no parasite was found in HNC feces.
Conclusion: There was a significant difference in the gut microbiome and parasitic infections between the HCA and HNC groups, with Blastocystis sp and Entamoeba coli as the most prevalent parasites.
Spine vascular lesions from embryology to imaging findings review article with serial cases
Authors: Utomo Sri Andreani , Bajamal Abdul Hafid , Yuyun Yueniwati P.W.
Published: December 2022

Spine vascular lesions like brain vascular lesions include spinal cord stroke, vascular malformation such as venous malformation or venous angioma, cavernous malformation, arteriovenous malformation or arteriovenous fistula. Embryogenesis of spinal vascular is the basic principle to understand the vascular malformation of the spine. This study aims to report serial cases with review of spinal vascular lesions. MR angiography techniques with contrast injection may reflect the direction of flow epidural veins to describe the site of arterial feeders. Serpiginous veins are commonly visible through the dorsal cord surface in MR myelography. The gold standard for diagnosing vascular malformation is Digital Subtraction Angiography (DSA). MRA helps to guide the location for DSA. Several cases are reported using MRA modalities and show the special location site of the spinal disorder.
The effect of intravenous remifentanil and fentanyl postoperative delirium incidence in patients receiving elective orthopedic surgeries
Authors: Aryana Hanung , Susila Dedi , Wirabuana Belindo
Published: December 2022

Background: The use of certain opioids associated differently with the incidence of postoperative delirium (POD). Remifentanil and fentanyl are short-acting opioids widely used in surgery; however, studies assessing their relationship with POD incidence are still limited. This study aimed to determine the association of remifentanil and fentanyl uses with the incidence of POD in elective orthopedic surgery patients.
Methods: A cross-sectional study was conducted in Surgical Unit at Dr Soetomo General Academic Hospital in Surabaya, Indonesia from August to September 2022. Patients who underwent elective orthopedic surgery and used remifentanil (n=16) and fentanyl (n=14) as postoperative analgesia were enrolled in the study. Delirium was assessed using Confusion Assessment Method-ICU tool (CAM-ICU). The associations of remifentanil and fentanyl use as well as patients’ characteristics with POD incidence were assessed statistically.
Results: Our data found that there was no significant difference between the incidence of POD with the use of remifentanil (p=0.125) in orthopedic surgery patients. The total doses of fentanyl and morphine equivalent (of remifentanil or fentanyl) were associated significantly with the POD incidence (p=0.010 and p=0.002, respectively). Other factors associated with POD incidence were the use of bone cement during the surgery (p=0.034), duration of surgery (p<0.001), and bleeding volume during the surgery (p=0.024).
Conclusions: Our study showed high dose of fentanyl, use of bone cement, longer duration of surgery, and high bleeding volume have greater risk of developing POD in orthopedic surgery patients.
The impact of age, gender, family history of allergy, clinical symptoms, and duration of illness on flare diameter of skin prick test
Authors: Wardana Uuk Riuh Kusuma , Endaryanto Anang , Prakoeswa Cita Rosita Sigit
Published: December 2022

Introduction: Skin prick test (SPT) is a method for diagnosing IgE-mediated allergen sensitization. Although the sensitivity and specificity are quite good, false positive and false negative results are possible. The diameter of the wheal and flare of each allergen can affect the skin prick test measurement, especially if the results of the examination overlap. Because of the usage of the SPT and the emphasis on quality control of health services recently, several variables that can affect the results of SPT must be considered. This study aims to analyze the effect of age, gender, family history of allergy, clinical symptoms, and illness duration on SPT's flare diameter.
Method: This is a cross-sectional study conducted from 2015 to 2020 in Surabaya, Indonesia. Children with possible allergies were tested with a skin prick test at the allergy immunology outpatient clinic of the Dr. Soetomo General Academic Hospital. Inclusion criteria were ≤ 18 years old children, possibly diagnosed with allergies, who had skin prick test. Children with incomplete medical record data were excluded.  The Chi-square test or Fisher exact test to determine the relationship between the independent and dependent variables for nominal data. The p-value was declared significant if P<0.05 to determine the effect between variables on flare diameter on skin prick test. We use SmartPLS to analyse the relationships simultaneously to compare relationships with the regression analysis.
Result: Age, gender, clinical symptoms, and duration of illness did not show a significant effect. In contrast, the flare diameter determined by SPT and the presence of an allergic family had a significant correlation (p = 0.017). Therefore, the appropriate distance between allergens must be specified to prevent overlap of SPT flare diameters.
Conclusion: Member of family allergy affects the diameter of the flare on skin prick test.
Regenerative alveolar bone in dental sockets of diabetic wistar rats post tooth extraction
Authors: Nanik Zubaidah  , Muhammad Luthfi  , Wisnu Setyari  , Retno Palupi  , Nur Imamatul Ummah  , Ardyta Lintang Maheswari  , Arif Rahman Nurdianto  , Fathillah Abdul Razak
Published: December 2022

Background: The bone healing of the alveolar socket post-dental extraction is critical in dental services. Delayed healing is a common problem in diabetes mellitus (DM) patients. It is due to the impaired angiogenic response and microvascular complications. Okra fruit extract can control diabetes mellitus (DM) in several ways, delaying glucose absorption and regenerating pancreatic cells. It can impact an increase in insulin secretion and glycogenesis to control hyperglycemia in DM. This study analyzed the regenerative alveolar bone through the expression of TGF-β2 in the tooth socket of Wistar rats with diabetes mellitus post-extraction after administration of okra fruit extract.
Patients and methods: Extraction of the rat mandibular left incisor was performed using a pair of modified forceps. The tooth sockets were then rinsed using a saline solution. Two groups (control & treatment) of four rats were sacrificed on days 3, 5, and 7. The socket tissues from the rats were then immunohistochemically analyzed
Results: The average level of TGF‐β1 expression in the treatment (T) groups was higher compared to the control (C) group: day 3 (10.50±2.67 versus 4.83±1.17), day 5 (12.33±1.63 versus 5.17±2.32), and day 7 (13.00±2.83 versus 4.50±1.05), with P = 0.000
Conclusion: The administration of okra fruit extract can increase regenerative alveolar bone healing through increased expression of TGF-β2 in the dental socket after tooth extraction of diabetic Wistar rats.
The 1st Airlangga International Endodontic Symposium 2022
Authors: Dian Agustin Wahjuningrum
Published: December 2022

Airlangga International Endodontic Symposium is aimed as a platform for scientific communication for Endodontists as well as those who work this topic. The symposium upheld “The Roles of Endodontist to Achieve Sustainable Development Goals (SDGs)” as the theme to highlight the importance of Endodontists and Endodontist science in achieving SDGs in national level. This symposium hosted several notable experts in endodontists who have acknowledge as legend in endodontist and restorative expertise. Nevertheless, this symposium was hoped to enhance scientific interaction, scientific and expert networks, as well as to update the practical and scientific knowledge in endodontic area.
Distribution pattern and spatial analysis of factors for tuberculosis (TB) cases in Bandar Lampung City in 2022
Authors: Tuntun Maria , Aminah Siti , Yusrizal CH
Published: December 2022

Background: Indonesia will be free of TB (Tuberculosis) in 2050, and elimination will begin in 2030. TB cases are still high in Bandar Lampung City, so efforts are needed to solve the problem. Mapping of TB cases using a Geographic Information Spatial (GIS) approach was performed in this study to evaluate the spreading patterns of TB patients so that policies can be taken to deal with TB cases in an epidemiological manner.
Methods: The research was conducted in 31 public health centers in Bandar Lampung City. The number of TB patients in this study was 879 people. Making maps for visualizing the spread of TB patients using Archgis software, data were analyzed with Geoda and Moran's Index to see the spatial relationship between variables.
Results: The spatial analysis using Geoda found a spatial relationship between TB patients and population density (p=0.00079) and the distance between the TB patient's house and the health center (p=0.00000). However, there was a significant relationship between the underprivileged group (p=0.21682) and topography (p= 0.29139). The Z score for the 4 variables is quite large and >Z0.95, so the distribution pattern of TB patients is stated to be clustered (cluster).
Conclusion: Based on the TB patients mapping and the spatial analysis, it is known that the distribution pattern of TB patients in Bandar Lampung City forms a clusters pattern, and there is an autocorrelation relationship between population density, underprivileged groups, height and distance from the TB patient's house to the health center.
Trial of labor in women with two previous caesarian sections: a challenge
Authors: Indirayani Ima , Nora Hilwah , Rusnaidi  , Yenni Cut Meurah , Zahara Fatimah , Febrina Dara Meutia Ayu
Published: December 2022

Introduction: A trial of labor after a cesarean (TOLAC) section is an option for mothers who have had a previous caesarian section. However, for those with two previous scars, there are pros and cons to allowing the patient to have a vaginal birth after a caesarian section (VBAC) because of increasing complications. The incidence of CS in Indonesia has been growing over the past year. In addition, several studies have shown an increased risk of problems in subsequent pregnancies in mothers with a history of cesarean section. Thus, VBAC in two previous scars becomes an alternative choice for a certain patient.
Case Illustration: We reported three cases of TOLAC; Three of which had been planned for vaginal birth after caesarian section (VBAC) since the prenatal period Case 1: A 30-year-old woman, G3P2, is 39 weeks pregnant and has had two previous cesarean sections. Cardiotocography was normal. The patient was closely monitoring the signs of uterine rupture during labor, and after 7 hours, she had a successful VBAC without complication. A female baby weighting 4000g was born, both mother and child were in good health condition. Case 2: A 38-year-old woman, G6P4A1, is 41 weeks pregnant has had two previous vaginal deliveries, and has had two previous caesarian section prior to this pregnancy. The patient was closely monitored for vital signs and signs of uterine rupture. Cardiotocography is normal. She had a successful VBAC without complications after eight hours and delivered a male baby with a body weight of 3500g and good APGAR CSore. Case 3: A 35-year-old woman, G3P2A0, had two previous CS admitted at 39 in the latent phase of labor with a cervical dilatation of 2 cm. The labor progressed to the second stage after nine hours. After an hour attempted to conduct delivery, the fetus was still not delivered. Catheterization was performed, which revealed hematuria and proceeded with emergency caesarian section due to suspect a uterine rupture. Intraoperatively, the uterine rupture was noted at the lower anterior of the uterine corpus, measuring 2x1 cm and a repair was performed.
Conclusion: VBAC can be considered in patients two previous c-sections with after proper selection, close monitoring and adequate counseling. Prenatal care is a concern for pregnant women to prevent complications and reduce maternal and fetal morbidity and mortality. The VBAC decision returned to personalization and adequate assessment and counseling are mandatory.
Comparison of Protein-C levels in diabetes melitus type 2 patients with and without ulcers at Haji Adam Malik Hospital Medan Indonesia May-July 2017
Authors: Zulfa Zulfahmi , Mardia Andri I , Handayani Savita , Syafril Santi , Gatot Dairion
Published: December 2022

Introduction People with diabetes mellitus (DM) have an increased risk for thrombosis compared with non-diabetic patients. Several studies showed contradicting in data on levels of protein C in people with type 2 DM and diabetic ulcers.Methods This is a descriptive and analytical cross-sectional study on protein C concentration of patients with type 2 DM with and without foot ulcers. The control group was the type 2 DM patients without foot ulcers, whereas the case group was the type 2 DM patients with a rigid diabetic foot ulcer based on the Wagner criteria. Blood samples are then taken after 8 to 10 hours of fasting to check for protein C concentration and hemostasis examination including platelet count, prothrombin time (PT),Â  activated partial thromboplastin time (aPTT), thrombin time (TT), fibrinogen levels, and D-dimers.Results Of a total of 20 samples, there was no statistically significant difference in protein C levels of diabetic foot ulcers with hypercoagulation compared with no diabetic foot ulcers with hypocoagulation and no significant correlation between grade diabetic foot ulcers and protein C concentration.
High-sensitivity C-reactive protein as a 6-month predictor of mortality and rehospitalization in patients with heart failure
Authors: Tarigan Memorison , Safri Zainal , Hasan Refli
Published: December 2022

Background: C-reactive protein (CRP) is an acute phase protein that reacts as a non-specific systemic inflammatory marker. Recent studies indicate that high-sensitivity CRP (hs-CRP) is a strong risk factor for predicting ensuing cardiovascular events.Objective: To investigate whether hs-CRP could serve as a parameter in predicting 6-month mortality and the likelihood of rehospitalization of patients with HF.Method: A prospective cohort study observed a total of 44 patients admitted to RSUP Haji Adam Malik Medan diagnosed with primary heart failure (HF) from November 2016 to February 2017. Level of hs-CRP was analyzed at their initial assessment and subjects were followed up for 6 months for mortality and rehospitalization.Result: Fourteen (31.8%) patients died and nineteen (42.3%) patients were rehospitalized during the 6 months follow up period. The mean value of hs-CRP was higher in the mortality group (4 group (4.386Â±1.75) than the survivor group (2.227Â±1.80), P=0.001. There was no significant difference in the mean value of hs-CRP between rehospitalized patients group (2.858Â±1.99) compared to the group that was not rehospitalized (2.759Â±2.15), P=0.880. The analysis using the receiving operating characteristic (ROC) curve obtained area under curve (AUC) of 81% (95% confidence interval [CI]: 0.68-0.94), P=0.001. Based on the ROC curve, an hs-CRP value of 4.25 result in a sensitivity value of 63% and a high specificity value of 90%, P=0.000.Conclusion: Among HF patients, increasing level of hs-CRP with cut-off value of 4.25 can be used as a 6-month mortality predictor and have a sensitivity of 64% and specificity of 90%. There were no significant differences in hs-CRP level between patients with HF who experienced rehospitalization within 6 months and who did not, hence hs-CRP could not be used as a predictor of rehospitalization within 6 months in patients with HF.
HER2/neu and Ki-67 as prognostic factors in serous type ovarian carcinoma
Authors: Dewi I Gusti Ayu Sri Mahendra , Susraini Anak Agung Ayu Ngurah , Ekawati Ni Putu
Published: December 2022

Introduction: Serous type ovarian carcinoma occurs in about 59% of all ovaryâ€™s malignant tumors. The high incidence of advanced ovarian carcinoma at the time of diagnosis causes 5-year survival rate of only about 20%. Thus deep science in predictive biomarkers of prognosis is needed, which later could use in therapeutic considerations. Human epidermal growth factor receptor-2 (HER2/neu) is a proto-oncogene that is involved in cell proliferation, differentiation, and apoptosis. Ki-67 is a marker of proliferative activity that plays an essential role in tumor aggressiveness. This study aimed to prove that HER2/neu and Ki-67 have a role as a prognostic factor in serous type ovarian carcinoma.Methods: The study design was an analytic cross-sectional study, with total sample were 36 samples from the patientâ€™s surgery specimen of serous type ovarian carcinoma, examined at Anatomical Pathology Laboratory Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Denpasar. Histopathological diagnosis for the type of malignancy, grade, and pathological stage according to tumor size was determined on H & E stain. The expression of HER2/neu and Ki-67 was examined with immunohistochemical stain. The correlation between HER2/neu and Ki-67 expression with the degree of differentiation and tumor size was analyzed by the chi-square test, with p<0.05 was significant.Result: The mean of the age was 49.6 Â± 11.28, with range was between 26-64 years. Â The most were in the age group 51-60 years (38.9%). No significant correlation was found between HER2/neu expression with the degree of differentiation (Î± =0.178) and tumor size (Î± =0.264). A significant correlation was found between Ki-67 expression with the degree of differentiation (Î± =0.019) and tumor size (Î± =0.039).Conclusion: In this study, Ki-67 can be considered for its role as a prognostic factor, whereas HER2/neu requires further research, with a larger sample and followed by an examination of gene amplification.
IDH1 mutation in Balinese glioma patients and its relationship with clinicopatological parameters
Authors: Sriwidyani Ni Putu , Wahyuniari Ida Ayu Ika , Saputra Herman , Arijana I Gusti Kamasan Nyoman
Published: December 2022

Purpose: Isocitrate dehydrogenase 1 (IDH1) mutation plays an important role in the carcinogenesis of gliomas. The most recent WHO classification of central nervous system tumors has added molecular genetic in addition to the histological features of the tumor, including status of IDH mutation in glial tumors. The purpose of this study was to determine the prevalence of IDH1 mutations in Balinese glioma patients and its association with clinicopathological features.Patients and methods: This study was conducted from 30 glioma patients at Sanglah General Hospital during January 2018 until June 2019. DNA extractions were carried out from the FFPE of tumor tissue, followed by amplification of codon 132 in exon 4 of the IDH1 gene by allele specific PCR. Relationship between IDH1 mutation status and clinicopathological features was tested with X2 with 0.05 significance.Results: The age range of patients is 14-81 years with an average age of 43.4 years (SDÂ±17.9 years). Most patients with astrocytic tumors (25/30; 83.3%), others were oligodendroglial tumor (2/30; 6.7%) and oligoastrocytic tumor (3/30; 10%). Most patients were found with grade IV glioblastoma (18/30; 60%).Â  Genotyping analysis showed IDH1 mutations in the majority of glioma patients (90%). Most cases (92.6%) of mutant IDH1 showed heterozygous mutations (GA genotype) while the rest showed homozygous mutations (AA genotype). There were no significant relationship between IDH1 status and age (p=0.09), sex (p=0.63) and histologic type (0.14), but there was significant relationship between IDH1 mutation status and tumor grade (p=0.01). All of IDH1 mutation were found in diffuse glioma (grade II and III gliomas and grade IV glioblastoma).Conclusion: Most of diffuse glioma (grade II-IV glioma) patients in Bali had IDH1 mutation and IDH1 mutation status has significant relationship with tumor grade. Further research about genetic abnormalities in order to improve therapeutic efficacy against IDH-mutated gliomas is needed.
HIV-related toxoplasma encephalitis: a tertiary care experience
Authors: Prabowo Kurniawan Adi , Gayatri Anak Agung Ayu Yuli , Sukmawati Ni Made Dewi Dian , Utama Made Susila , Somia Ketut Agus , Merati Ketut Tuti Parwati
Published: December 2022

Introduction: Toxoplasma encephalitis (TE) is the most commonly found in HIV patients who have no cotrimoxazole prophylaxis, especially when the CD count is <100 / µL. Therapy is often based on a presumptive diagnosis because definitive diagnosis is difficult, and TE can be life threatening. Aim of this study is to provide a characteristic description of TE in HIV patients who admitted at Sanglah Hospital.
Methods: This is a retrospective descriptive study of 43 adult patients admitted with diagnosis TE at the Sanglah Hospital, Indonesia between January 1st 2018 to December 31th 2018. 
Results: Most patients were male (69.8%), with the predominant age ranged 31-40 years old (39.5%).  Among all patients; 14% on cotrimoxazole prophylaxis, and 23.3% on antiretroviral therapy. The most common clinical manifestation was headache (58.1%). Oral candidiasis was found in 67.4% of patients. CD4 levels <100 cells / µL were found in 62.8% of patients, absolute lymphocytes <500 / µL in 32.6% of patients. Anemia was found in 37.2% of patients. Multiple ring enhancement was the most common feature found on head CT scan, with the profound location was parietal lobe (46.5%). Pyrimethamine + clindamycin is used in 72.1% of cases. The TE mortality rate in HIV patients in this study was 11.6%.
Conclusion: TE in HIV patients was more common on male, younger age and who are not receiving appropriate prophylaxis and/or without antiretroviral therapy. Laboratory study predominantly showed severe immunodeficiency. The most patients making a full recovery with pyrimethamine and clindamycin treatment.