bluuebunny/crossref_metadata_2025 huggingface dataset:
The outcome of sternum healing among diabetic patients undergoing open heart surgery: a literature review
Authors: Nur Yahya Taufik , Sembiring Yan Efrata , Soelistijo Soebagijo Adi
Published: December 2022

Background: As part of the surgery, sternotomy is a common technique to expose the underlying organs, allowing surgeons to explore the targeted organ. Despite the benefits offered, it has several considerable complications; one of them is wound healing defect. The impairment of sternal wound healing after sternotomy could be superficial and/or deep. This condition is influenced by many factors, including diabetes mellitus, obesity, and other comorbidities. These anomalies will affect the normal healing process of the bone and other connective tissue, particularly after a major invasive event, such as in sternotomy. This study aimed to review the outcome of sternum healing among diabetics that underwent heart surgery with a sternotomy approach.
Methods: Works of literature reviewed in this study were obtained from Pubmed and Google Scholar databases starting from 1992 until April 2022. The keywords used were ‘sternal wound healing’, ‘cardiac surgery’, and ‘diabetes mellitus’. An advanced search based on the exact phrases was conducted on Google Scholar. Gathered kinds of literature were then selected based on relevancy.
Results: The majority of articles reviewed were observational, and most of them had CABG as a part of open heart surgery, followed by valvular and aortic surgeries and others. The incidence of impaired sternal healing and other complications (superficial and/or deep) was more commonly seen among patients with diabetes. Most studies also reported a significant correlation between DM and the incidence of impaired sternal healing, suggesting that DM was a significant predictor of it.
Conclusion: Diabetes mellitus is a medical condition that must be taken into account among the candidates for open heart surgery, particularly if it is poorly controlled. The Hyperglycaemic state experienced by the patients will lead to multiorgan damage and immunological dysfunction that could affect the healing process of the sternum.
Association of neutrophil-lymphocyte ratio (NLR) with the anthracycline-based neoadjuvant chemotherapy (NAC) clinical response in locally advanced breast cancer (LABC) in young women
Authors: Vania Idelia Winantyo  , Vidi Vianney Chrisana Magrit Tanggo  , Iskandar Ali
Published: December 2022

Background: Breast cancer in young women is one of the leading causes of cancer death in young women worldwide, including in Indonesia. Most patients come to the hospital at the advanced stage. Neoadjuvant chemotherapy (NAC) is the standard treatment for locally advanced breast cancer. However, half of breast cancer patients had a negative response to therapy.  

Methods: A retrospective cohort, analytic observational study to determine the association between NLR and anthracycline-based NAC clinical response in locally advanced young age breast cancer in Dr. Soetomo General Hospital, Surabaya.

Results: We analyze a total of 44 patients. 81.8% had stage IIIB, 93.2% >50 mm tumor size. Most of the cases had invasive ductal carcinoma type (86.4%), grade 3 (52.3%), and Luminal B HER2-negative type (34.1%). 52.3% of patients had a negative clinical response. The mean NLR was 3.07 ± 1.69, with a cut-off value of 2.805. There was no significant association between age, tumor size, histopathological type, grade, and subtype with neoadjuvant chemotherapy clinical response. There was a significant relationship between NLR with anthracycline-based NAC clinical response in locally advanced young age breast cancer (p < 0.001).

Conclusion: There was a significant relationship between NLR with the anthracycline-based neoadjuvant chemotherapy clinical response in young women with LABC.
The effect of boxing exergame on blood lactate and VO2max in non-athlete healthy young men
Authors: Fairuz Silvi  , Raden Ayu Meisy Andriana  , Indrayuni Lukitra Wardhani  , Yudith Dian Prawitri  , Inggar Narasinta  , Soenarnatalina Melaniani
Published: December 2022

Background: The lack of physical activity and high sedentary behavior is among the main causes of non-communicable diseases at a young age. Moreover, exergaming (EXG) is a type of exercise that integrates different modes of digital games into physical activities. Since several young men spend a significant amount of time on sedentary games, it is believed that replacement with exergames will improve physical activity levels. Therefore, this study was carried out to evaluate the effectiveness of exercise by measuring blood lactate (BLa) and VO2max in non-athlete healthy young men. This study aims to analyze the effect of exercise using NintendoTM switch "Fitness Boxing 2" on BLa and VO2max in non-athlete healthy young men.
Methods: Experimental series with repeated measures on healthy young men of 20-40 years by the health worker at Dr. Soetomo Hospital Surabaya. This research was based on the exercise using Nintendo SwitchTM "Fitness Boxing 2" with the hard or high-intensity mode at a duration of 38 minutes consisting of warm-up, core training which included variations of Straight, Hook, and Uppercut strokes, and cooling down three times a week for one month. The BLa examination was carried out 3 times before and after exercises I, VI, and XII during the exercise. VO2max was examined using the 6-minutes walking test based on the Nusdwinuringtyas formula one day before and after exercises I and XII, respectively.
Results: This study included 13 healthy young men, with an average age of 30.77± 3.632. The mean BLa before and after exercise was 2.03 and 3.02, respectively, with an increase of 0.99. The three p-values ​​were carried out by the Wilcoxon Signed Rank Test, where a p-value = 0.001 was obtained, indicating a significant increase in post-exercise BLa levels. The VO2max before and after treatment obtained an average of 23.39± 2.82 (mL/kg/minute) and 30.69 ± 4.95 (mL/kg/minute), respectively. Furthermore, the comparison of VO2max examination before and after treatment with an average of 7.30±4.04 (mL/kg/min) obtained a significant difference with a p-value = 0.000.
Conclusion: The effect of high-intensity exercise using Nintendo SwitchTM "Fitness Boxing 2" increases the BLa levels and VO2max in non-athlete healthy young men.
Development of a tinnitus sound generator that matches the sound of tinnitus patient
Authors: Made Lely Rahayu  , Gde Ngurah Indraguna Pinatih  , Eka Putra Setiawan  , I Wayan Lolik Lesmana  , Ketut Tadeus Max Nurcahya Pinatih  , I Made Nudi Arthana  , I Gusti Ayu Putu Wahyu Widiantari
Published: December 2022

Background: Tinnitus is the perception of sound heard by a person in the absence of an external stimulus. About 10-14.5% of the world's population experience tinnitus, with the most common age group being 40-60 years. As many as 10-12 million people in the United States suffer from severe tinnitus and feel disturbed enough to seek treatment. The management of tinnitus is still a challenge for researchers. Existing therapies include counseling, cognitive therapy, hearing aids, and tinnitus retraining, but until now, there has been no significant therapy. The last therapy that is available is to make artificial sounds that imitate the sound of tinnitus so that it can mask the actual tinnitus sound. In addition, therapy using music is expected to reduce the stress level of tinnitus patients.

Methods: This research is action research, a follow-up study from previous research, with consecutive sampling and in accordance with the inclusion and exclusion criteria. After getting the frequency and amplitude of tinnitus, a sound stimulus is made in the form of combining tone variations and sound generators obtained from audiometric masking. Tone variations are made using a basic tone that matches the patient's tinnitus frequency. After that, the patient will assess the results of the merger.

Results: The results showed the frequency and amplitude of tinnitus, suitability with masking, type of tinnitus, degree of deafness, and all participants were comfortable when listening to sound therapy from a sound generator.

Discussion: The patient will use a tinnitus sound generator for 2 hours for 2 days, so the amplitude is safely limited to less than 91 dB. In this study, we set the tinnitus sound as closely as possible with the frequency, amplitude, tinnitus pulsating or not, appropriate music and paying attention to the hearing threshold.
Spinal Cord Injury in Tuberculous Spinal Epidural Abscess Patient with Deficiency of Vitamin D : A Case Report with Literature Review
Authors: I Nyoman Semita  , Ni Njoman Juliasih  , Azham Purwandhono  , Setyawardani Astuti , Muhammad Yuda Nugraha
Published: December 2022

Background: Spinal cord injury is not only caused by trauma but also by non-trauma, such as spinal epidural abscess (SEA). Tuberculous SEA is a rare infectious disorder, a delayed diagnosis associated with morbidity and mortality. The problems of tuberculous SEA is not only infection but also neurological deficit, axial back pain, pathological fracture, deformity, and socioeconomic and psychogenic problem. There are a few cases of SEA caused by Mycobacterium tuberculosis, mostly caused by Staphylococcus aureus with decreasing body’s defense mechanism caused by a deficiency of vitamin D. This study aimed to evaluate the neurological recovery of non-traumatic spinal cord injury caused by spinal tuberculosis with spinal epidural abscess and vitamin D deficiency that treated with vitamin D as an adjuvant.
Case Report: A 31-year-old female came to the orthopedic clinic with paraparesis ASIA grade C, axial back pain, and spinal deformity for three months, with vitamin D levels of 15.5 ng/ml. MRI showed epidural abscess at the level of the 10th-11th thoracic vertebrae, spondylodiscitis of the 10th-11th thoracic vertebrae accompanied by paraspinal abscess of the 8th thoracic vertebrae to the 1st lumbar vertebra. The diagnosis was confirmed by cultured and histopathological examination. The treatment was surgery, followed by anti-TB drugs and daily vitamin D 5000 IU for one year. After one year of follow-up, the patient returned to work without a neurological deficit and axial back pain.
Conclusion: This report describes the importance of early diagnosis and proper treatment of spinal cord injury in tuberculous SEA with a deficiency of vitamin D.
Effects of probiotics and high fructose diet on De Ritis ratio, TGF-B levels, and liver histopathology of Sprague Dawley rats
Authors: Kusumawati Ninung Rose Diana , Panunggal Damianus Galih , Mexitelia Maria , Sidhartani Magdalena , Utari Agustini
Published: December 2022

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. Histopathological diagnosis has been the gold standard for diagnosing and determining the severity of non-alcoholic steatohepatitis (NASH). However, this method is invasive, especially for diagnosing NASH in children. This research aimed to study the effect of probiotics on the De Ritis ratio, TGF-β levels, and histopathological changes in rats given High Fat, High Fructose (HFHFr) diet to look at the correlation between the De Ritis ratio and liver histopathology in diagnosing NAFLD.
Method: Twenty-one male Sprague Dawley rats were included and divided into three groups. In the first group, as control only received a normal chow diet for eight weeks. The second group received an HFHFr diet for eight weeks, and the last group received HFHFr for eight weeks and a combination of HFHFr and probiotics for another eight weeks. After decapitation, we took 3 ml of serum from each rat to measure AST, ALT, and TGF-β. A 4 μm thick liver tissue slide was taken and stained with Hematoxylin – Eosin Stain for histopathological analysis. We used the Non-Alcoholic Steatohepatitis (NAS) Score for measuring liver damage progression.
Results: De Ritis ratio and TGF-β level did not significantly differ between probiotic and non-probiotic groups (p = 0.064 and 0.383), but there was a significant NAS score difference (p = 0.001) in probiotic and non-probiotic groups. This was followed by a significant correlation between the De Ritis ratio and the NAS score (r = 0.613, p = 0.003).
Conclusion: Probiotic supplementation alleviated liver damage caused by the HFHFr diet but did not successfully reduce the De Ritis ratio or improve TGF-β.
Knowledge and parity prevention of anemia in pregnancy
Authors: Ekasari Tutik , Natalia Mega Silvian , Zakiyyah Muthmainnah
Published: December 2022

Introduction: The largest public health issue in the globe, particularly for women who are close to childbearing age, is anemia. Anemia during pregnancy is said to be “dangerous to mother and child”. In 2015, Indonesia's maternal mortality rate (MMR) was 305 per 100,000 KH. Pregnancy who experienced anemia in the world are still very high. The prevalence of anemia in pregnancy is 41.8%. In Indonesia, the increasing in the incidence of anemia in pregnancy from 37.1% in 2013 to 48.9% in 2018. One of the causes of anemia in pregnant women is the knowledge and parity. This study aimed to analyze the knowledge and parity of the incidence of anemia in pregnant women.
Methods: The research design is cross-sectional with the independent variables which are knowledge and parity. The dependent variable is the incidence of anemia in pregnant women. The population used by all pregnant women is 48. The sampling technique uses total sampling and collecting data using questionnaires and interviews. Data analysis used univariate and bivariate.
Results: The results of research informed that most pregnant women had anemia, around 56.2%. The results of the statistical analyses revealed a p value of 0.007, indicating a relation between parity and the prevalence of anemia. Besides that, there was a relation between knowledge and the prevalence of anemia.
Conclusion: There is an influence between knowledge and parity on the incidence of anemia in pregnant women. Countermeasures that can be done by providing information communication and education on pre-wedding preparation.
Blockchain integration for hospital information system management
Authors: Naufal Adi Satrio  , Sritrusta Sukaridhoto  , M. Udin Harun Al Rasyid  , Rizqi Putri Nourma Budiarti  , Ilham Achmad Al-Hafidz  , Evianita Dewi Fajrianti
Published: December 2022

Introduction: A lot of hospital management systems, especially open-source ones, still lack interoperability which is holding back the effectiveness of administration. This happens due to different regulations from hospital organizations. Therefore, there must be a system that facilitates interoperability. Blockchain is a decentralized ledger system, to insert the data from the blockchain all parties must agree that the data is valid thus the data can be inserted so, all the data are immutable thus every change can be audited.
Methods: We integrate the Hyperledger fabric network, an open-source modular blockchain platform, into an open-source hospital management system, openEMR. We take the changed data using debezium connect and Kafka and inserted it into the blockchain.
Results: Based on our test, we managed to get average read latency at 27ms, average read throughput at 36 Read per Second, average transaction latency at 45ms, average transaction throughput at 22 Transaction per Second, and average integrated system data transfer at 111.36ms.
Conclusions: All services deployed successfully at the Kubernetes without any error. All services work as they should be. One service can integrate through the internal network of the Kubernetes and from the outside cluster using ingress. OpenEMR can be used normally as indicated in the official documentation and the data change is stored in the blockchain.
Frequency of Interleukin-6 rs 1800796 (-572G/C) and 2069837 (intron 2A/G), TNF-α rs1800750 (-376G/A), and 1800629 (-308G/A) polymorphism in COVID-19 patients with clinical degrees in Central Java
Authors: Reviono  , Hendrastutik  , Yulia Sari  , Betty Suryawati  , Darmawan ismail  , Ketut Putu Yasa
Published: December 2022

Background: Coronavirus Disease 2019 (COVID-19) is an easily contagious disease, and not much is known about the characteristics of COVID-19, both in terms of susceptibility, severity, and spreadability of various SARS-CoV-2 strains. Patient genomic factors, especially related to genomic polymorphisms that affect the body's immune system, can influence the course of infectious diseases. The aim of this study is to get an adequate picture regarding gene polymorphisms, both susceptibility and related to the clinical degree in COVID-19 patients.
Methods: The PCR preparations were carried out in the Biomedical laboratory of the Faculty of Medicine, Universitas Sebelas Maret. The qualitative PCR (qPCR) examination was sent to the Genetica Science laboratory, Tangerang, West Java. The research subjects were divided into 3 groups, namely COVID-19 patients with no symptoms, COVID-19 patients with mild-moderate symptoms, COVID-19 patients with severe-critical symptoms. The research subjects were taken 6 cc of venous blood (3 cc for examination of serum IL-6 and TNFα levels and 3 cc for DNA examination).
Results: Serum levels of IL-6 and TNF-α in the clinical grade group were almost all above normal values. The frequency of TNF- α polymorphisms (-376G/A) all showed homozygote GG. TNF-α (-308G/A) also showed homozygote GG was dominant for SARS CoV2. IL-6 (-572G/C) polymorphism for cases requiring medium and severe clinical degree hospitalization was found to have more C allele than G allele. IL-6 polymorphism (intron A/G) the G allele is less common in cases requiring hospitalization.
Conclusion: TNF-α(−308A) allele has an influence on the development of clinical symptoms of SARS CoV2 infection. The rs1800796GG genotype in the IL-6 promoter contributes to milder symptoms in SARS CoV2 infection. Allelic variants of the gene under study may show different effects in other races depending on their interactions with other risk factors.
A rare case of isolated post-traumatic subscapularis abscess in a paediatric patient
Authors: Faris Indra Prahasta Bin Didi Indra  , Syed Ibrahim bin Wan Mohamad Akbar  , Mohd Anuar Ramdhan Bin Ibrahim  , Ong Lik Han
Published: December 2022

Introduction:  Subscapular abscess is an extremely rare condition. To our knowledge there were nine reports on subscapular abscess in the literature, four of them happened paediatric patients. The signs and symptoms could be very subtle making the diagnosis is difficult and often delayed.
Case description: We share a rare case of isolated subscapularis abscess with no glenohumeral involvement of a healthy 9-year-old boy following blunt trauma to the shoulder treated with antibiotics and percutaneous drainage with good outcome.
Conclusion: Subscapular abscess should be suspected in a child present with fever and shoulder pain. Magnetic resonance imaging is the best modality for diagnosis as plain radiograph would not give any diagnostic help. Surgical drainage combined with antibiotics are the mainstay of treatment. However, percutaneous drainage is one of treatment options especially in paediatric patient as demonstrated in our report.
Histopathology of colorectal cancer in Cut Meutia Hospital, Aceh-Indonesia from 2017-2020
Authors: Sayuti Muhammad , Syahriza Muhammad , Ami Ghisca Chairiyah
Published: December 2022

Introduction: Colorectal cancer still causes high morbidity and death rates worldwide. This study aims to determine the histopathology of colorectal cancer at Cut Meutia Hospital, North Aceh Regency in 2017-2020.
Methods: This research is descriptive with a cross-sectional approach. The total sample of 64 CRC patients was taken by total sampling that met the inclusion and exclusion criteria.
Results: Univariate data analysis showed that the most histopathological type of research was found in Adenocarcinoma, amounting to 55 people (88.7%). The anatomical location of cancer was found mostly in the rectum, amounting to 26 people (41.9%). Description of the characteristics according to age and gender was mostly at the age of 45-54 years, amounting to 21 people (33.9%) and male gender which amounted to 36 people (58.1%).
Conclusion: The study showed the distribution of age in CRC patients at Cut Meutia Hospital, North Aceh Regency in 2017-2020, the most were at the age of 45-54 years. The description of characteristics according to gender in CRC patients, most of them were male. This study showed the anatomical location of cancer in CRC patients was more commonly found in the rectum. The histopathology type of CRC was mostly found in Adenocarcinoma.
The sensitivity pattern of ciprofloxacin and amoxicillin in chronic suppurative otitis media
Authors: Suryani Lilis , Widuri Asti , Kurniawan Muhammad , Nurpagino Bombong
Published: December 2022

Introduction: In both poor and developed countries, chronic suppurative otitis media affects 1-46 percent of the population. The incidence of chronic suppurative otitis media is much higher in Indonesia due to various of factors, including poor sanitation, low socio-economic and nutritional status, and high population density. To reduce the occurrence of chronic suppurative otitis media, an adequate treatment is required.
Purpose: the study was to identify the bacteria that cause chronic suppurative otitis media and ciprofloxacin and amoxicillin antibiotic sensitivity pattern in Asri Medical Centre and PKU Muhammadiyah Gamping hospital, Yogyakarta.
Patients and methods: This is a prospective descriptive study with 27 patients with chronic suppurative otitis media whom met the inclusion criteria. Bacteria were isolated from ear secretions and cultured on TSA and McConkey agar medium. The antibiotics ciprofloxacin and amoxicillin were tested for susceptibility, and Gram staining, catalase test, and biochemical test were used to identify bacteria.  
Results: 63 bacteria were isolated from 27 chronic suppurative otitis media patients, among of them positive-gram bacteria (52%) and negative-gram bacteria (48%). The sensitivity of positive-gram bacteria and negative-gram bacteria causing chronic suppurative otitis media to ciprofloxacin was 84% and 79%, respectively. The resistance of positive-gram bacteria and negative-gram bacteria to amoxicillin by 100%.
Conclusion: Staphylococcus sp and Pseudomonas aeruginosa were the most caused chronic suppurative otitis media at the Asri Medical Centre and PKU Muhammadiyah Gamping hospital in Yogyakarta. The antibiotic ciprofloxacin is the most effective treatment for bacteria that cause chronic suppurative otitis media.
Correlation of S100B level and postoperative cognitive dysfunction (POCD) events among patients with ear, nose and throat (ENT) surgeries with controlled hypotension
Authors: Rahman Boby Abdul , Airlangga Prananda Surya , Saputra Andy Nauman , Kriswidyatomo Prihatma , Salinding Agustina , Hamzah  , Maulidya  , Yusuf Muhtarum
Published: December 2022

Introduction: Controlled hypotension is one of the techniques applied to several microscopic ear, nose, and throat (ENT) surgeries. However, this technique has risks and complications, which result in impaired perfusion and oxygenation of organs including the brain that could trigger the postoperative cognitive dysfunction (POCD). Damage that occurs in brain cells can trigger the secretion of biomarker proteins in the blood, one of which is S100B which can indicate nerve damage in the intra and postoperative period. This study aimed to analyze the correlation between S100B protein level and the incidence of POCD in patients who received ENT surgeries with controlled hypotension.
Methods: A cross-sectional study was conducted among patients that underwent elective ENT surgeries at Dr. Soetomo General Academic Hospital, Surabaya, from July to August 2022. Cognitive function was assessed using Mini-mental State Examination (MMSE) at 12 hours before and 2 and 24 hours after surgery. The level of S100B was measured using enzyme-linked immunosorbent assay (ELISA) 12 hours prior surgery and 30 minutes post-surgery.
Results: A total of 31 patients were recruited in the study, including a mean age of 31.7 years. The mean S100B levels in POCD patients pre- and postoperative were 311.97 ng/L, and 415.34 ng/L, respectively. In non-POCD patients, the mean levels of S100B pre and postoperative were 436.90 ng/L, and 444.29 ng/L, respectively. There were 3 (9.7%) patients experienced POCD. Our data suggested there was a significant difference between preoperative and postoperative S100B levels in the groups of patients with POCD (103.37ng/L) and non-POCD (7.38 ng/L) (p<0.001). Patients that experienced POCD had significantly increased S100B compared to those who did not.
Conclusion: There is a correlation between changes of S100B levels and the incidence of POCD in patients undergoing ENT surgeries with controlled hypotension.
Detection of myelin oligodendrocyte glycoprotein antibody in pediatric patient with acute disseminated encephalomyelitis: a case report
Authors: Nicolas Valentina , Prastiya Indra Gunawan  , Riza Noviandi  , Samosir Sunny Mariana
Published: December 2022

Introduction: Acute Disseminated Encephalomyelitis (ADEM) is an immunity-mediated central nervous system demyelinating disorder. Myelin Oligodendrocyte Glycoprotein (MOG) examination provides information about a patient's ADEM development status. A positive MOG antibody can signify a first episode or incomplete recovery. This review aims to report a case of a pediatric patient with acute disseminated encephalomyelitis with positive MOG antibody.
Case Presentation: We present a 5-year-old girl with symptoms of low-grade fever, encephalopathy, blurred vision, numb and tingling sensations on hands and feet, weakness, unable to walk. Head MRI (Magnetic Resonance Imaging) examination reveals lesions in the bilateral thalamus and white matter of the left parietal lobe. There was also a bilateral thickening of the optic nerves. Blood laboratory examination was relatively normal, and the MOG antibody test was positive. The patient was then treated with corticosteroids for 1 year and had 2 recurrent episodes of attacks. MOG test evaluation was still also positive 6 months after the first attack. After Intravenous immunoglobulin (IVIG) treatment was given, resulting in excellent clinical response and no recurrent attack since then.
Conclusions: ADEM cases have a good prognosis and good recovery. IVIG administration, with the help of other supportive therapy, improves recovery in treating pediatric ADEM.
Dynamic balance in obese subjects: before and after telerehabilitation weight-bearing exercise for better balance
Authors: Noviana Astika Cahya , Andriana Meisy , Pawana I Putu Alit , Tinduh Damayanti , Novida Hermina , Melaniani Soenarnatalina
Published: December 2022

Background: People with obesity tend to have balance disturbance and a higher fall risk than those with normal BMI. The Weight-bearing Exercise for Better Balance (WEBB) is an exercise program that could improve balance in the elderly population, but no study implementing the WEBB program on obese subjects. This study aims to analyze the effects of the telerehabilitation WEBB program on dynamic balance in obese subjects, measured by Maximized Reach Distance (%MAXD) and a composite score of the Modified Star Excursion Balance Test (mSEBT).
Methods: Ten male participants aged 18-30 were recruited. Participants underwent the WEBB program 3 times a week for 8 weeks in their own homes under the supervision of the researchers. The intensity of the exercise was increased every 2 weeks. For the analysis, %MAXD and composite score mSEBT were used to assess the dynamic balance before and after the WEBB program.
Results: There was a significant increase (p < 0.05) in %MAXD of both sides and all directions. The mSEBT composite score of both sides also significantly increased (p < 0.05). All the statistical results showed large effect sizes.
Conclusion: The WEBB program through telerehabilitation is proven to significantly improve dynamic balance, as indicated by an increase in %MAXD and mSEBT composite scores in obese subjects.
Spine injury: how to recognize and stabilize patient in golden hours periods
Authors: Azharuddin Azharuddin
Published: December 2022

An acute spinal cord injury (SCI) early management is one of the most challenging tasks in trauma cases. The outcome of its cases depends upon the accuracy, adequacy, and speed of first aid management, diagnosis, and treatment within the â€œGolden Hours Periods.â€ Rapid and safe transport of the spinal injury patient allows for early medical stabilization designed to preserve and potentially improve the neurological outcome. The complications that arise from spinal instability or neurological must be prevented immediately and involves all members of the multidisciplinary team. Specialized assessment of people with new spinal cord injuries must take place immediately after an injury. The diagnosis of SCI should include the level and severity of the damage of the spinal cord, type of fracture or/and dislocation of the injured vertebrae, and the stability of the spinal column. Imaging begins from plain radiograph and should include a multi-slice CT protocol of the entire spine to delineate the known injury and to exclude non-contiguous damages. The outcome SCI treatment depends on the number of axons that survived â€“ the higher the number of surviving axons, the restoration of neurological functions might be higher. The management of SCI begins before the patient admitted to the hospital. The principles of treatments include early reduction and fixation, combined extramedullary and intramedullary decompression, cell transplantation, early rehabilitation treatment, and complication prevention. The surgical treatment sometimes needed to evaluate, stabilize the spine, decompress the area that injured, and managed any other injuries that may have been associated with the accident. Once a patient was stabilized, care, and treatment focus on supportive care and rehabilitation.
Platelet-rich fibrin (PRF) as modalities therapy of venous ulcer
Authors: Rusyati Luh Made Mas , Suryawati Ni Nyoman , Karmila I Gusti Agung Ayu Dwi
Published: December 2022

Introduction: Stasis/venous ulcers are defined as ulcers which do not completely heal within 3 months and generally occurred over the age of 40 years or younger. Conventional treatment requires a long period of time. New therapy using platelet-rich fibrin (PRF) can accelerate healing. Case: A serial cases of venous ulcers. The first case, a 17-year-old woman, was diagnosed with the right leg venous ulcer for 6 months, was treated with PRF every week and wound closure occurred at the 4th week. The second case was an 85-year-old man, diagnosed with venous ulcer at right pedis since 7 years ago, and was treated with PRF. The wound healed within seven weeks. Discussion: Stasis ulcers are chronic ulcers that sometimes require long hospitalization and prolonged treatment, and it affects the socio-economic and quality of life of the patients. Platelet-rich fibrin (PRF) is autologous blood that is rich in fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), platelet-derived growth factors (PDGFs), transforming growth factor-beta (TGF-Î²), epidermal growth factor (VEGF), and insulin-like growth factor-1 (IGF-1) which can help accelerate wound healing without hospitalization. This method has been carried out in several countries, with wound healing occurred at week 15th. Conclusion: There have been 2 reported cases of venous ulcers treated with PRF and achieved wound healing after 4 weeks (first case) and 7 weeks (second case) of therapy.
High Bioscore predicts metastasis in breast cancer patients in Sanglah General Hospital, Denpasar, Bali, Indonesia
Authors: Ariandana Ika , Suryawisesa Ida Bagus Made , Widiana I Ketut
Published: December 2022

Background: Risk determination of breast cancer metastases is important for clinicians to be able to estimate the adequate therapy for the patients provide the basis for clinical reasoning and explanation of the possibility of metastasis to breast cancer patients who are in treatment. However, current prediction models have low accuracy and molecular determinants tend to have a high evaluation cost. Bioscore had emerged as a new reliable option in determining the risk of metastases in breast cancer, but it is not widely applied yet. Therefore, it is necessary to study its capability in determining risk of metastasis in the clinical setting in order to validate its future application.Objective: To determine the bioscore scoring system as a risk determination for metastases in breast cancer at Sanglah Hospital, Denpasar.Methods: This research was a nested case control study involving 32 subjects in two groups, namely metastatic and non-metastatic breast cancer groups. All patients are registered in the Cancer Registry Data at Sanglah Central General Hospital. The parameters in this study were age, stage, grading, hormonal status, HER2 status, menopausal status, metastatic status and bioscore values. Data were tabulated and statistically analyzed using SPSS 25.Results: From all subjects, the average patient age of 51.50 (±8.491) years, ranging from 31 - 72 years old. The bioscore was significantly associated with all research variables. Risk analysis showed that breast cancer patients with a high bioscore (5-7) has a significantly higher risk of metastasis (OR: 21.00; 95% CI: 5.620 – 78.475) compared to those with low bioscore (1-4).Conclusion: The bioscore scoring system may have a significant value in predicting metastasis in breast cancer patients. However, its application still needs further and more comprehensive studies to validate its application in breast cancer management.
Severe diabetic ketoacidosis with cerebral edema and acute kidney failure: a case report
Authors: Hsieh Peter Prayogo , Wijaya Teo , Melinda Fitriana , Suryawan I Wayan Bikin
Published: December 2022

Background: In 2018, the Indonesian Pediatric Society stated that there were 1,220 children suffering from Type 1 Diabetes Mellitus. This might be an iceberg phenomenon due to a large number of children and adolescents in Indonesia. Diabetic ketoacidosis is one of the Type 1  Diabetes Mellitus acute complications that could be fatal. The problem is that our society isn't familiar with this condition, and it leads to delayed diagnosis and treatment.
Case: A 16 – year – old girl was hospitalized due to right lower abdominal pain, nausea, vomiting, decreased appetite, and fever for 3 days. The next morning, she became unconscious with a Glasgow Coma Scale of E1V1M6. Her blood tests showed blood glucose levels of 551 mg/dL, C – Peptide of 0,65 ng/mL, pH of 6,81, and cHCO3 of 3 mmol/L. Her urine tests showed ketonuria of +4. She was diagnosed with Severe Diabetic Ketoacidosis and Cerebral Edema. She received 8 litre/minute of O2 NRM, 10 ml/kg of 0,9% NaCl in 1 hour continued with 1,5 times maintenance need + 5 mmol/kg/day of KCl, 0,1 IU/kg/hour of insulin, and 1 g/kg of mannitol. Renal function monitoring showed daily increases in serum creatinine to 9,2 mg/dL on the day – 7. This pre-renal acute kidney injury was thought to be due to dehydration. She was then referred to a higher-level hospital for hemodialysis.
Conclusions: Diabetic Ketoacidosis in children shows a wide range of clinical manifestations. Therefore, awareness of this condition is of utmost importance in reducing patients' morbidity and mortality.
The role of Stromal Cell-Derived Factor 1 (SDF-1) and Transforming Growth-Factor-Beta 1 (TGF-?1) levels in Packed Red Cells (PRC) as the indicator of storage lesion at Sanglah Hospital-Blood Bank, Bali, Indonesia
Authors: Lestari Anak Agung Wiradewi , Mulyantari Ni Kadek , Prabawa I Putu Yuda
Published: December 2022

Background: Packed Red Cells (PRC) is one of the blood component obtained from the whole blood through the removal of blood plasma. The storage of PRC aims to maintain the viability and function of erythrocytes by reducing cell metabolic activity. However, PRC's biochemistry changes could occur through storage lesion by releasing Stromal Cell-Derived Factor 1 (SDF-1) and Transforming Growth Factor-Beta 1 (TGF-?1) that affect the erythrocytes metabolism and viability prior to transfusion. This study aims to evaluate the increase of SDF-1 and TGF-?1 levels in PRC as the indicator of storage lesion at Sanglah Hospital-Blood Bank, Bali, Indonesia.Methods: An observational cross-sectional study using randomized post-test only without control group design was conducted at Sanglah Hospital-Blood Bank, Bali. The consecutive random sampling technique was used in this study to the PRC, who met the inclusion criteria. Samples of the SDF-1 group (N=84) were divided into 3 such as Group 1 (1-7 days), Group 2 (8-14 days), and Group 3 (15-21 days). However, 53 PRC was divided into 2 groups as Group 1 (1-7 days) and Group 2 (8-14 days).  The SDF-1 and TGF-?1 levels were evaluated for each group using Human SDF-1/CXCL12 and TGF-?1 Kit from Elabcience® by ELISA method.  Data were analyzed using SPSS version 25 for Windows software.Results: The median levels of SDF-1 in Group 1 group was 0.385 (0.050-1.020) ng/mL, followed by 0.455 (0.330-0.750) ng/ml in Group 2, and 0.490 (0.380-0.920) ng/ml in Group 3 (p<0.05). The mean of TGF-?1 levels was slightly higher in Group 1 (2,365.21±715.96 pg/ml) compared with Group 2 (2,210.39±994.68 pg/ml) (p=0.523). There was a significant difference in SDF-1 levels in Group 1-Group 2 (P=0.041) and Group 1-Group 3 (P=0.000) groups; however, no significant difference was found in Group 2-Group 3 (P=0.133) using the Mann-Whitney test. The Spearman's rho test found a moderate positive correlation between SDF-1 levels and storage time by day (r=0.546; P=0.000). In addition, based on the Pearson correlation test, there was a weak positive correlation between TGF-?1 levels and storage time by day (r=0.461; p=0.001).Conclusion: The increase of SDF-1 and TGF-?1 levels in PRC by days of storage time could be used as the indicator for storage lesion at Sanglah General Hospital-Blood Bank, Bali, Indonesia.
Characteristics of follicular adenoma patients at H. Adam Malik General Hospital, Medan, during the 2017-2020 period
Authors: Laksmi Lidya Imelda , Betty Betty , Hilda Sylvia
Published: December 2022

Background: Follicular adenoma is a benign tumor enclosed by a capsule with follicular differentiation, more common in women and usually occurs in adulthood, and is more common in iodine deficiency. The average tumor size is 1-3 cm. Follicular neoplasms do not have features of papillary thyroid carcinoma and no capsule and/or vascular invasion were found. This study aims to evaluate the characteristics of follicular adenoma patients at H. Adam Malik General Hospital, Medan, during the 2017-2020 periodMethods: This study is a descriptive study with a cross-sectional approach on 31 samples based on medical record data diagnosed as follicular adenoma. After reviewing the slides, 23 samples were obtained that met the inclusion and exclusion criteria. Samples were assessed according to age, sex, tumor size, number of nodules, growth patterns, and histopathological variants. Data were analyzed using SPSS version 26 for Windows.Results:  Cases of follicular adenoma at H. Adam Malik Hospital Medan during 2017-2020 with an average age of 46.7 years. The youngest age was 20 years and the oldest age was 71 years, with the highest age group being 50-59 years (26.1%). Most gender was female (87.0%) than male (13.0%). The most common tumor size was above 4 cm (69.6%). The highest number of nodules was found in 1 nodule (solitary or unilateral) (52.2%). The most common growth pattern in microscopic preparations was macrofollicular adenoma (65.2%), with the most histopathological variant being conventional follicular (91.3%).Conclusion: Benign lesions such as adenomas are often misdiagnosed due to the lack of further studies on the histopathological criteria. Follicular adenomas can be treated with lobectomy and have a good prognosis if diagnosed early and with proper treatment.
Maintaining the quality of problem-based learning in developing countries during the pandemic era
Authors: Manuaba Ida Bagus Amertha Putra , Supadmanaba Gede Putu , Darmayani I Gusti Ayu Sri , Yani Made Violin Weda , Remitha Ni Putu Sri Indrani , Sasmana I Gede Aswin Parisya , Sundariyati I Gusti Ayu Harry , Sindhughosa Dwijo Anargha
Published: December 2022

The COVID-19 pandemic is referred to as an unpredictable phenomenon and a challenge that stimulates change, one of which is in the field of medical education. Online learning as the main solution in the field of education certainly offers positive and negative impacts for medical students. Therefore, learning design is a strategy that continues to be developed in improving the quality of teaching that is more effective and innovative. The purpose of writing this review is to find out more about the quality of problem-based learning in developing countries during the pandemic era. This type of study is a literature review that uses the literature study method. The sources used in this review consist of relevant journals from search engines such as Pubmed, Google Scholar, ScienceDirect, and Cochrane Library. The results of the literature search show that pandemic conditions encourage learning to be carried out using virtual methods. To implement online learning during this pandemic, various technologies have been developed, ranging from digital problem-based learning (PBL) which has been implemented at the National Taiwan University College of Medicine, web video conferencing learning (WVC) at King Abdulaziz University in Saudi Arabia which is effectively used in the case-based discussion (CBD) process, as well as various platforms that support online learning, such as Tencent Meeting, DingTalk, and Edmodo. EdTech Start-ups and SWAYAM portal in India also aims to maintain equitable distribution, access, and quality in times of pandemic. Some applications that can support live streaming based on video conferencing are Microsoft Teams, Google Meet, Lark, Zoom. Seeing the various advantages and problems faced in implementing online lectures during the pandemic, various improvement strategies need to be carried out in maintaining the quality and learning outcomes, starting from infrastructure, personnel, methods in delivering lectures, learning outcomes, institutional responses, and support from the government.
Multiple Antimicrobial-Resistant Bacteremia and Fungal Infection Pneumonia in Elderly Patient: A Case Study
Authors: Indrayuni I Gusti Agung Ayu , Anteja I Gusti Ayu Agung Istri , Aryana I Gusti Putu Suka
Published: December 2022

Introduction: The spread of multidrug-resistant bacterial pathogens has become alarming globally. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) have been recognized as a major multidrug-resistant bacteria implicated in hospital and community-acquired infections worldwide.Case: We present the case of an elderly male, 74-year-old, with multiple comorbidities, who came to the hospital with main symptoms of cough. Three months previously, he was diagnosed with pneumonia. Nevertheless, he was treated as an outpatient, with Cefixime prescribed as an oral antibiotic. His non-contrast chest CT Scan showed opacities at the upper zone, middle zone and lower zone of the left lung and the lower zone of the right lung. The patient’s symptoms and imaging expertise strongly suggest a pulmonary infection. Sputum culture and sensitivity test result eventually confirmed positive E. coli isolates demonstrated resistance to Augmentin, Ceftazidime, Gentamicin, Ampicillin sulbactam, Aztreonam, Cefotaxime, Cefepime. Fungal culture by sputum specimen revealed growth of Candida, non-Candida albicans. Concurrently, history of hospitalization and antibiotic treatment exposure are considered risk factors for the acquisition of multidrug resistance in this patient. Furthermore, corticosteroids in elderly patients are alleged as a risk factor of fungal infection.Conclusion: The increasing case of antimicrobial resistance in elderly patients is challenging for the clinician. Culture and sensitivity tests performed before starting antimicrobial treatment in hospitalized geriatric patients can reduce unnecessary and inappropriate antimicrobial use. Fungal test is considered to be done in a susceptible case of the elderly patients. The rapid diagnosis followed with prompt initiation of appropriate antibiotic and antifungal therapy is urgently required.
Overexpression of Estrogen Receptor 1 (ESR-1) in metastatic prostate cancer
Authors: Lucky Frannata  , Ery Kus Dwianingsih  , Raden Danarto  , Indrawarman
Published: December 2022

Introduction: Estrogen Receptor 1 (ESR1) expression has appeared to impact prostate cancer advancement significantly. This study aims to compare the expression of ESR-1 in BPH and prostate cancer.
Methods: The samples were collected from a single-center hospital from 2014 to 2020. We exclude samples in which RNA concentration is under the minimum standard allowance to proceed. Deparaffinize formalin-fixed paraffin-embedded and RNAs extraction by manufacturer’s protocol with slight modification was performed. The RNA expression was investigated by using quantitative real-time polymerase chain reaction. We categorized into Benign Prostate Hyperplasia (BPH), Non-Metastatic Prostate Cancer (Non-MPCa) and Metastatic Prostate Cancer (MPCa) groups. The One Way ANOVA was used to analyze the data.
Result: The 40 samples included 15 BPH, 6 non-metastatic prostate cancer, 19 metastatic prostate cancer. Expression of ESR1 in BPH (6.9 ± 3.8) compared to expression of ESR1 in MPCa (12.7 ± 9.5), and Non-MPCa (2.6 ± 1.0) shows a significant difference. Expression of ESR1 in Non-MPCa compared to MPCa also indicates a significant difference in which expression MPCa shows an increased level of ESR1 expression.
Conclusion: This study shows that ESR 1 has significant expression differences in Benign Prostatic Hyperplasia, non-Metastatic Prostate Cancer, and Metastatic Prostate Cancer. The highest ESR1 expression is found in Metastatic Prostate Cancer. In conclusion, higher ESR1 expression is related to metastatic prostate cancer.
Airway involvement and mechanical ventilation in Steven Johnson Syndrome and Toxic Epidermal Necrolysis management
Authors: Supono Benny , Leonardo  , Veronica Sieny
Published: December 2022

Steven-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe drug allergic reactions characterized by skin and mucosal membrane detachments. Most of the literature focuses only on the skin and ocular mucosal damage, but more severe and life-threatening mucosal damage may actually occur in the respiratory tract. This airway involvement may cause an acute complication, e.g. acute respiratory failure, and chronic complications, e.g. bronchiolitis organizing pneumonia, bronchiectasis, and restrictive bronchiolitis. The presence of airway involvement in SJS/TEN requires a more detailed examination, ranging from examination of the ear, nose, and throat (ENT), to fiberoptic bronchoscopy done by a skilled clinician to determine the presence of bronchial epithelial detachment. A higher percentage of skin and mucosal detachment is associated with a greater need for mechanical ventilation. Male sex, age, low serum bicarbonate, high serum urea, and higher amount of infiltrate on chest X-rays are also associated with a higher risk for mechanical ventilation in patients with SJS/TEN. The general indications for intubation and mechanical ventilation in patients with SJS/TEN are respiratory failures, inability to clear the airway, shock, neurologic disorder, and uncontrollable pain. More specific indications for intubation and mechanical ventilation are oral involvement with an initial total body surface area (TBSA) during hospital admission was ≥70%, or progression of TBSA ≥15% in the first 3 days of hospitalization, or neurological disorders, or documented airway involvement based on direct laryngoscopy examination.