bluuebunny/crossref_metadata_2025 huggingface dataset:
Aerobic walking exercise improves dynamic balance but not muscle mass in office workers with mechanical chronic low back pain
Authors: Hardiyanto Muhammad Devy , Andriana Meisy , Andriati Andriati , Tinduh Damayanti , Sugianto Paulus , Melaniani Soenarnatalina
Published: January 2025

Background: Low back pain (LBP) is a musculoskeletal disorder that commonly occurs in office workers, mainly due to sedentary lifestyles, especially during the COVID-19 pandemic. Chronic LBP causes musculoskeletal system deficiencies, such as lumbar proprioceptive and muscle mass changes that can cause balance deficiency. Aerobic Walking Exercise is expected to be one of the solutions to improve this condition due to its easy implementation and patient compliance.
Methods: 32 office workers were divided into control and treatment groups. Both groups received conventional low back pain rehabilitation exercises. The treatment group received additional walking aerobic exercise for thirty minutes three times a week for eight weeks. Dynamic Balance was assessed with the Five Time Sit to Stand (FTSTS) test. Muscle Mass was assessed using Bioimpedance Analysis. Measurement was taken before and after eight weeks of intervention. Exercise supervision is carried out using the telerehabilitation method.
Results: The results showed a significant increase in FTSTS in both groups and a non-significant increase in muscle mass in both groups. Comparison of FTSTS change values between post-treatment groups showed a significant increase (p = 0.00), while in muscle mass, there was an insignificant increase (p = 0.28). There were no side effects during treatment.
Conclusion: Adding walking aerobic exercise for eight weeks can improve the dynamic Balance of office workers with chronic low back pain.
Tinea unguium in a child caused by Trichophyton rubrum: a case report
Authors: Karmila I Gusti Ayu Agung Dwi , Praharsini I Gusti Ayu Agung , Karna Ni Luh Putu Ratih Vibriyanti , Ganeswari Putu Ayu Dewita , Dharmasamitha Indira , Permana Aditya , Sarasmita Luh Putu Rani
Published: January 2025

Background: Nails are susceptible to fungal infections because they do not have effective cellular immunity. Onychomycosis describes a fungal infection of the nails caused by dermatophytes. The incidence of onychomycosis is increasing among children and adolescents. This case report will describe a nail fungal infection in a child and aims to improve understanding regarding tinea unguium clinical findings and treatment, especially in the pediatric population.
Case: A 10-year-old Balinese girl complained of nail discoloration on her right index finger that initially appeared on the tip of the nail and gradually spread to the base of the nail, accompanied by swelling and pain in the surrounding area. Clinical and dermoscopy examination showed the distolateral subungual type of onychomycosis in a severe degree based on the onychomycosis severity index (OSI) score. Trichophyton rubrum was identified on culture examination, and she was diagnosed with tinea unguium. She was treated with oral fluconazole 150 mg once weekly and topical ketoconazole 2% twice daily. Clinical improvement was seen after 35 days of treatment.
Conclusion: In the case of pediatric onychomycosis, the nails are thinner and growing faster than adults. Combination therapy of oral antifungal can result in a higher cure rate. However, prognosis is dubius because many factors contribute to the disease course and recurrence. Risk factor management is highly expected.
Cadre-driven health education for enhanced tuberculosis treatment in North Minahasa Indonesia
Authors: Kandou Grace Debbie , Pinontoan Odi Roni , Doda Diana Vanda D , Kandou Priscilla Caroline
Published: January 2025

Introduction: Tuberculosis remains a global concern, with rising incidence and mortality rates, notably in Indonesia. Specifically, the Wori Health Center in North Minahasa Regency reports a treatment success rate of only 75%, indicative of ongoing challenges. Community cadres play a pivotal role in tuberculosis management by facilitating patient referral and care. This study aims to bolster cadre involvement through targeted health education, addressing the pressing need to improve TB treatment outcomes in Wori Subdistrict of North Minahasa, Indonesia.
Methods: Using a quasi-experimental design, this study assessed the impact of health education on cadre knowledge regarding TB prevention. Total sampling involved 100 community cadres within the Wori Health Center's jurisdiction.
Results: Pre- and post-intervention analysis revealed a significant increase in cadre knowledge concerning tuberculosis prevention (p-value = 0.000). This underscores the efficacy of health education in fostering informed and proactive community engagement, thereby enhancing tuberculosis treatment success rates.
Conclusion: The study emphasizes the pivotal role of health education in empowering community cadres, especially in remote regions. By equipping cadres with enhanced knowledge, this approach contributes substantially to the effectiveness of tuberculosis treatment efforts in underserved areas. Integrating health education strategies is thus imperative for optimizing cadre involvement and combating TB in challenging contexts.
Effect of Nanofat therapy on tendon strength in albino rabbits post-tendon repair: an experimental study
Authors: Wahdono Muhammad Ihsan , Saputro Iswinarno Doso , Budi Agus Santoso
Published: January 2025

Background: Tendons play a crucial role in joint movement by connecting muscles and bones. Nanofat therapy has been extensively studied for its ability to promote wound healing and prevent scar formation. The aim of this study is to analyze the effect of Nanofat induction on the tendon strength in post-repair tendon rabbit albino.
Methods: The study used a randomized posttest-only control group design from July to December 2023. The subject of this study was the Achilles tendons of New Zealand albino rabbits, which were divided into 2 groups (treatment and control groups). Subjects were used to compare the tensile strength post tendon repair with and without Nanofat therapy. The analysis used in this study includes the independent t-test and Wilcoxon test with p-value <0.05.
Result: The results of the subject measurements showed a tensile strength of 2.175 ± 0.987 MPa with treatment groups of 2.967 ± 0.732 MPa and control groups of 1.383 ± 0.353 MPa (z = -3.576; p <0.001). Meanwhile, the maximum load given to the Achilles tendon was 41.11 ± 18.66 N, with treatment groups of 56.08 ± 13.84 N and control groups of 26.14 ± 6.67 N (z = -3.576; p <0.001).
Conclusion: Nanofat therapy can improve tendon healing, increasing tensile strength.
Abdominal pain in children with systemic lupus erythematosus, what radiologists should know: A serial case
Authors: Margiani Nyoman , Pande Putu Yuli Anandasari  , Ketut Dewi Kumara Wati  , Gunawan Listyani
Published: January 2025

Background: Systemic lupus erythematosus (SLE), an autoimmune disorder, can affect various organs, including the gastrointestinal system, presenting with diverse clinical symptoms. As a radiologist, diagnosing SLE-related gastrointestinal involvement relies on patient history and abdominal CT scan with contrast, which reveals characteristic features like bowel wall thickening (target sign), mesenteric vessel engorgement (comb sign), or increased mesenteric fat attenuation, serving as the gold standard diagnostic method. This case report emphasize the importance of abdominal CT scan with contrast for detecting gastrointestinal involvement in SLE patients, highlighting characteristic imaging features like the target sign, comb sign, and hyper attenuation of mesenteric fat.
Case Reports: In the first case, a 17-year-old girl with SLE history presented abdominal pain. CT scan showed a target sign in the ileum, comb sign, hyper attenuation of mesenteric fat, and ascites. Symptoms improved with high-dose methylprednisolone. The second case involved a 14-year-old boy with SLE, severe protein malnutrition, and symptoms of abdominal pain, diarrhea, and fever. CT scan revealed similar findings along with hepatomegaly, bilateral pleural effusion, and pericardial effusion, responding to methylprednisolone. The third case, a 13-year-old girl with SLE, showed a target sign on the jejunum, comb sign, and hyper attenuation of mesenteric fat on CT scan angiography, without vascular thrombus evidence.
Conclusion: Abdomen CT scan with contrast, findings of target sign, comb sign, and hyper attenuation of mesenteric fat support the picture of SLE involvement in the gastrointestinal system. This must be considered, because the response to therapy is good, if not handled properly it can cause ischemia, perforation and bleeding.
Left Atrial Myxoma, which leads to obstructive shock and hematuria-is it a ticking time bomb? When do we need to act aggressively?: a case report
Authors: Oktavio Theovano , Hadi Dylan , Rooroh Victor Giovannie Xaverison , Homenta Rampengan Starry , Leonard Jim Edmond
Published: January 2025

Background: Cardiac tumors are the least seen type of all primary tumors, accounting for only less than 0.1% of total cardiac tumors. Atrial myxoma is the most common type of primary cardiac tumor, with more than 75% of myxomas originating in the left atrium, either at the mitral annulus or the fossa ovalis border of the interatrial septum. Atrial myxomas are associated with a triad of complications: obstruction, emboli, and constitutional symptoms (such as fever and weight loss).
Case Presentation: This is a case report of a 63-year-old woman presenting with shortness of breath and was found to have an atrial myxoma, which was found to be the cause of secondary severe mitral stenosis. On the 5th day of admission, the patient showed signs of acute kidney injury and congestion; after that, the patient was transferred to the intensive cardiac care unit. The patient then developed signs of obstructive shock with hypotension and cold extremities with desaturation; invasive ventilation was planned. However, the patient developed cardiac arrest, and cardiopulmonary resuscitation was then performed, but unfortunately, the patient did not respond.
Conclusion: The management of atrial myxoma involves immediate surgical removal of the tumor before the obstructive shock occurs, which usually signifies delayed management. If obstructive shock occurs, prompt fluid resuscitation is the most important thing to do, with the addition of an inotrope if necessary to save the patient.
Management of type 1 diabetes in a pregnant woman with preeclampsia and bad obstetric history
Authors: Rahma Safira Aulia , Zaimatuddunia Irma , Budhiwardoyo Najib , Dewi Herlina Kusuma
Published: January 2025

Introduction: Type 1 diabetes (T1D) during pregnancy poses significant risks to both maternal and fetal health. Intensive pre-conception counseling and ongoing pregnancy management can mitigate complications, requiring personalized approaches and regular follow-up.
Case Presentation: We report a case of a 36-year-old woman with T1D in her fourth pregnancy presented with leg swelling. Despite a history of three miscarriages, she diligently followed antenatal care. Diagnosis revealed T1D, preeclampsia, and bad obstetric history. An immediate cesarean section was performed, resulting in a healthy baby. Successful management involved multidisciplinary collaboration, including medications and interventions.
Conclusion: This case underscores the importance of meticulous glycemic control throughout pregnancy for women with T1D, minimizing adverse outcomes. Despite challenges, successful management was achieved through a comprehensive, multidisciplinary approach, emphasizing the need for ongoing care and collaboration.
Sepsis-induced purpura fulminans caused by acute cholangitis and choledocholithiasis: a case report
Authors: Pradana Aditya Dias , Maimunah Ummi
Published: January 2025

Background: Purpura fulminans rarely happens as the subsequent condition of disseminated intravascular coagulation, which is frequently caused by sepsis. Purpura fulminans was recognized from cutaneous manifestations resulting from the occlusion of dermal venules and capillaries by microthrombi causing hemorrhagic infarction, followed by ecchymosis in the subepidermal area. We reported a rare case of sepsis-induced purpura fulminans due to acute cholangitis and choledocholithiasis.
Case Presentation: A 38-year-old female patient was referred to the emergency unit of Dr. Soetomo General Hospital, Surabaya, with colicky pain in the right upper quadrant abdomen, fever, and conjunctival icterus. The laboratory examinations suggested anemia, acute kidney injury, and elevated leukocytes, prothrombin time, international normalized ratio (INR), C-reactive protein, procalcitonin, and D-dimer. In the next two days, petechiae and erythema appeared in the abdomen and right arm, respectively. The petechiae transformed into ecchymosis in the abdomen and all extremities on the sixth day. Abdominal ultrasound and magnetic resonance cholangiopancreatography revealed gallstones in common bile duct and dilated common hepatic duct, intrahepatic bile duct, and ductus cysticus. The patient was diagnosed with sepsis-induced purpura fulminans caused by acute cholangitis and choledocholithiasis. The treatments consisted of infusions of electrolyte and aminofluid, ceftriaxone, metronidazole, transfusion of packed red cell and fresh frozen plasma, paracetamol, potassium chloride, ursodeoxycholic acid, and lansoprazole. The patient was suggested for endoscopic retrograde cholangiopancreatography for the gallstone removal.
Conclusion: When a patient has choledocholithiasis, holistic examinations should be performed to predict potential sepsis complications, such as purpura fulminans. An early diagnosis may raise the patient's survival rate by using magnetic resonance cholangiopancreatography and thorough treatments, including appropriate antibiotics, fluid replacement, and endoscopic retrograde cholangiopancreatography.
Preoperative anxiety and plasma adrenaline levels changes in caesarean section with spinal anesthesia: a literature review
Authors: Widiartha Wahyudi  , Fitriati Mariza , Airlangga Prananda Surya , Semedi Bambang Pujo
Published: January 2025

Anxiety is a subjective condition of emotional unease, anguish, apprehension, or fearful concern accompanied by somatic and autonomic symptoms that impairs functioning or activity is called anxiety. Different epidemiological research showed that preoperative anxiety varied among patients undergoing surgery including caesarean section. Anxiety and fears such as anxiousness, worry of not waking up from anesthesia, worry of pain following surgery, and fear of dying can all affect patients who are scheduled for surgery. This literature review aims to comprehend preoperative anxiety and plasma adrenal level changes in caesarean section undergoing spinal anesthesia. Preoperative anxiety varies in severity among surgical patients based on the type and purpose of the procedure, the patient's gender, the way the patient interacts with the medical personnel, the patient's prior experience with the surgical procedure, and the patient's susceptibility to stressful situations. Elective caesarean section patients have anxiety levels higher than emergency patients in which these levels aligned to plasma adrenaline levels. Preoperative anxiety in caesarean section patients is influenced by a number of factors, such as age, gender, marital status, education level, and uncertainty about the precise day of surgery. Other factors that may contribute to preoperative anxiety include fear of anesthesia, fear of surgery, fear of complications, fear of death, fear of disability, worry about family, postoperative pain, difficulty recovering, and fear of unknown causes. Future measures include early screening and focused intervention to reduce preoperative anxiety in caesarean section patients. Furthermore, amore research should be done in analysis regarding patients undergoing surgery who have a significantly higher burden of preoperative anxiety.
Formula characteristics and physical stability test in glutathione cream
Authors: Amandita Tiara Amanna , Hariani Lynda , Nata’atmadja Beta Subakti
Published: January 2025

Introduction: Glutathione is an antioxidant that can minimize the effects of oxidative stress by increasing intracellular glutathione and accelerate wound healing by increasing the contraction capacity of fibroblasts. Research development with topical application, especially cream, allows concentration adjustments to improve wound healing more effectively.
Method: This research method is a true experimental research using pre-post test without control group design. The glutathione cream formula was replicated 3 times, then cycling test was carried out with duration of storage period for 12 days, then observed the organoleptic, pH test, spreadability, emulsion type and viscosity cream.
 Result: Organoleptical observations of Glutathione cream before and after the cycling test were the same. pH test results with p 0.004 <0.05, which means there is difference between the pH before and after the cycling test. The viscosity test with p 0.005 <0.05 shows an average difference between viscosity before and after the cycling test. There was no significant difference between the spreadability of Glutathione cream before and after the cycling test with p 0.423 > 0.05.
Conclusion: The conclusion of this study is the characteristics of Glutathione cream after the cycling test obtained a semi-solid texture, bone-white color, and a distinctive smell of cream and distributed homogeneous, the pH of the cream decreases, which becomes acidic 4.070 ± 0.070, and the results of the spreadability of the cream did not find significant differences before and after the cycling test, and after the centrifuge test obtained a stable cream formula, no phase separation. There was no difference between the emulsion type of Glutathione cream before and after the cycling test, with the emulsion type is o/w, from the test results it can be concluded that the cream is stable.
The relationship between age and gender and radiological features of Adult Spinal Deformity (ASD) based on modified SRS – Schwab Classification at Airlangga University Teaching Hospital
Authors: Wardana Gigih Aditya , Subagio Eko Agus , Utomo Sri Andreani , Utomo Budi , Parenrengi Muhammad Arifin , Al Fauzi Asra
Published: January 2025

Background: Adult spinal deformity (ASD) includes spectrum heterogeneous abnormalities, which involve the lumbar or thoracolumbar segment during adulthood. In this research, age, and gender are used to describe radiological Adult Spinal Deformity based on the modified SRS-Schwab classification.
Methods: This research is an observational analytical study using a cross-sectional design from AP/Lateral lumbar/lumbosacral radiological images in 2021. Patients with adult spinal deformity (ASD) were assessed based on AP/Lateral lumbar/lumbosacral X-ray radiology at Dr. Soetomo and Airlangga University Hospital; age, gender, and radiological parameters in the sagittal and coronal planes were analyzed.
Results: This research's data comprised 228 samples (95 men and 133 women). The characteristics of the coronal plane with respect to age were tested for correlation with Cobb angle, lateral listhesis, and intercrest line with correlation coefficients (r) of 0.154, 0.221, and 0.020 (p = 0.020, 0.001, and 0.760). In the sagittal plane, the correlation test between age and lumbar lordosis, osteoporotic bone obtained r values of 0.113 and 0.462 (p = 0.08 and 0.001). Correlation tests between gender and the characteristics of the coronal plane Cobb angle, lateral listhesis, and intercrest line obtained correlation coefficient values of 0.123, 0.198, and 0.185 (p 0.063, 0.003, and 0.005). For the sagittal plane parameters, the correlation coefficient (r) values for the lumbar lordosis and osteoporotic bone parameters were 0.089 and 0.016 (p 0.181 and 0.812).
Conclusion: There is a correlation between age and Cobb angle, lateral listhesis, and osteoporotic bone. Also, gender correlates with lateral listhesis and intercrest line.
Microbiological characteristics and outcomes of neonatal ventilator-associated pneumonia in Dr. Soetomo Hospital Surabaya
Authors: Ratna Deni Widya , Mertaniasih Ni Made , Etika Risa , Endraswari Pepy Dwi , Setiabudi Rebekah Juniati
Published: January 2025

Background: Blood stream infection (BSI) and ventilator associated pneumonia (VAP) are the two most common acquired infections in ventilated neonates. There were not many studies correlating microbiological findings in blood culture and endotracheal aspirate culture (EAC) with the occurrence of VAP and its outcome. This study aims to analyze correlation between BSI and EAC findings with occurrence of VAP and its outcome.
Methods: Case control study was conducted to neonate that mechanically ventilated more than 2 days, in which blood culture and EAC were available, from January 2020 to December 2021, in Dr. Soetomo Hospital Surabaya. Analysis was conducted between pathogen type, polymicrobial, previous BSI with the occurrence of VAP and its clinical outcomes such as duration of neonatal intensive care unit (NICU) treatment, duration of hospital stay, total ventilation duration and mortality. Univariate analysis conducted by Chi Square and the correlation was significant if p value<0.05.
Results: Study subjects were 88 neonates, consisting of 44 VAP cases and 44 non-VAP controls. Most common pathogen in blood culture and EAC was Gram-negative, dominated by Klebsiella pneumoniae.  Pathogen type, polymicrobial, BSI were not correlated with VAP and its outcomes. Polymicrobial only correlated with duration of hospital stay (p=0.009).  Duration of NICU treatment was correlated with VAP (p=0.011). There was no correlation between total ventilation duration, duration of hospital stays with VAP and mortality.
Conclusion: There was no correlation between pathogen type, BSI with incidence of VAP and its outcome. Longer duration of hospital stay was correlated with polymicrobial finding.  Ventilator associated pneumonia caused a longer duration of NICU treatment.
Histopathological correlation of ABO blood type antigen expression in colorectal cancer patients
Authors: Jalil Muhammad Rusdan , Kusuma Ihwan , Cangara Muhammad Husni , Hendarto Joko
Published: January 2025

Background: Early detection of colorectal cancer is crucial to diminish its mortality rate. The ABO blood group antigen is identified as a factor that has a positive association with the onset of colorectal cancer. Despite recognizing the ABO antigen as a potential oncogene related to cancer, its use as a diagnostic marker for colorectal cancer has not been extensively researched in Indonesia. This research aims to examine the association between the presence of ABO blood type group antigens and patients with colorectal conditions.
Methods: The study was conducted with a cross-sectional study of eligible colorectal cancer patients in Wahidin Sudirohusodo Hospital in Makassar. The ABO blood type group antigens in colorectal cancer patients were assessed using the immunohistochemical technique that utilizes the streptavidin-biotin-peroxidase method. The results, represented by stained cells, were evaluated under a light microscope within the observed field. For comparison, regular colon tissue served as a control. The statistical analysis used the Gamma & Somers' D correlation and the Wilcoxon test for comparison.
Results:  Out of the 50 participants, the majority were female (54%), aged between 56 and 65 years (40%), diagnosed at clinical stage II (40%), had a moderate histopathological grade (62%), and belonged to blood type A (50%). In both the control and tumor groups, a significant statistical correlation was not observed between factors such as gender, age, colorectal cancer stage, histopathological grading, and the levels of ABO blood group antigens expression in colorectal tissue (all p > 0.05). However, a significant disparity in ABO blood type antigen expression was observed between normal and colorectal tumor tissues (p-value < 0.001).
Conclusion: The manifestation of ABO blood type group antigens in colorectal tissue may serve as an indicator of a malignancy.
Low expression of Human Leukocyte Antigen-G (HLAG) in the placenta is a risk factor for preeclampsia
Authors: Putra I Wayan Artana , Harrista Daniel Victor , Mulyana Ryan Saktika , Suardika Anom , Surya I Gede Ngurah Harry Wijaya , Wiradnyana Anak Agung Gede Putra , Budiana I Nyoman Gede
Published: January 2025

Background: Preeclampsia (PE) is an incident of hypertension in pregnancy that has a negative impact on the mother or the fetus. PE is one of the causes of death in pregnant women throughout the world and is a significant cause of fetal mortality and morbidity. The etiopathogenesis of preeclampsia is currently unknown. HLAG is a product of the major histocompatibility complex (MHC) genetic locus located on chromosome 6, which protects trophoblast from maternal immune influences or maternal cytotoxic attacks. It is hoped that this research can explain the impact of low HLAG on the occurrence of preeclampsia.
Methods: This study used a cross-sectional analytical design to include a total of 44 women, 22 pregnant women with preeclampsia and 22 pregnant women without preeclampsia who were treated at Prof IGNG Ngoerah Hospital, Denpasar. The Chi-Square test is used to determine the prevalence ratio or risk estimate of HLAG levels on the occurrence of preeclampsia.
Results: Based on the mean comparison test, with the independent t test the mean maternal age in the preeclampsia group (31.09 ± 5.31) was not significantly different from the group without preeclampsia (27.86 ± 5.89) with a p-value = 0.060. The mean value of gestational age obtained by the preeclampsia group (35.45 ± 2.00) was not significantly different from the group without preeclampsia (2.82 ± 1.26) with a value of p = 0.068. The mean parity value between the preeclampsia group (3.27 ± 1.20) and the group without preeclampsia (2.82 ± 1.26) was not significantly different (p = 0.230). This study found that low HLAG expression in the placenta was a risk factor for PE with prevalence ratio (PR) of 15.96 (95% CI=2.35-108.36).
Conclusions: HLAG expression was significantly different in PE and without PE cases. Low HLAG expression in the placenta is a risk factor for PE with prevalence ratio (PR) of 15.96.
Bilateral horizontal gaze palsy in young patient: a case report
Authors: Sari Rusti Hanindya , Nauli Rahma Rizki , Setiohadji Bambang , Indriati Antonia Kartika , Ginting Dianita Veulina , Yollamanda Prettyla
Published: January 2025

Background: A rare condition known as bilateral horizontal gaze palsy has been linked to pontine lesions brought on by infarction, hemorrhage, or metastases. Bilateral horizontal gaze palsy may also be caused by demyelinating lesions resulting from multiple sclerosis. Multiple sclerosis (MS) is an inflammatory disease that damages the myelin sheath of the central nervous system, leading to a variety of neurologic abnormalities. Eye movement abnormalities might appear at the beginning of the disease or later on; however, they are frequently misdiagnosed. The purpose of this study was to describe a case of bilateral gaze palsy in a young male patient who had MS for the first time.
Case Presentation: In this article, we describe a 19-year-old guy who, one week before admission, had abrupt horizontal binocular diplopia. The patient previously experienced seizures a year ago. After an ophthalmic examination, both eyes' visual acuity was 1.0. His primary eye position is esotropia 7 degrees, and both eyes were limited in adduction and abduction. Direct and consensual light responses were reduced in both eyes in the anterior section. Segments in the posterior were within normal bounds. Humphrey had mild homonymous hemianopia sinistra on his visual field test. The patient was diagnosed with homonymous hemianopia sinistra and bilateral horizontal gaze palsy as a result of a pontine lesion. A high-dose oral corticosteroid was administered to him. Multiple hyperintense lesions were found in the cerebral periventricular, corpus callosum, cerebral juxtacortical, and brachium pontis on both sides during an MRI evaluation.
Conclusion: Demyelinating lesions can cause abnormalities in eye movement. A precise neuroanatomic localization diagnosis is frequently obtained when visual symptoms are combined with a thorough neuro-ophthalmic examination. Evaluations, in turn, may improve the capacity to track the advancement of the disease and recommend focused symptomatic treatments.
WNT/β-Catenin signaling pathway and clinicopathological factors in advanced stage non-small cell lung cancer: a multicenter study
Authors: Kristiani Erna , Syahruddin Elisna , Asmarinah  , Rachmadi Lisnawati , Ham Maria Fransisca , Zaini Jamal , Kekalih Aria , Heriyanto Didik Setyo , Hidajat Heriawaty , Gultom Fajar Lamhot
Published: January 2025

Background: This study aimed to assess the association of GSK-3β, β-catenin, and CD44 expressions, which are the molecules involved in the WNT/β-catenin signaling pathway, with clinicopathological profiles and their correlation with the response to platinum-based chemotherapy using Response Evaluation Criteria in Solid Tumors (RECIST) criteria in advanced-stage Non-Small Cell Lung Cancer (NSCLC).
Methods: This research is a case-control study where we retrospectively collected data on every patient diagnosed with stage III-IV, adenocarcinoma EGFR-wild type and squamous cell carcinoma (SCC) who underwent three cycles of platinum-based chemotherapy and had their first RECIST evaluation. Immunohistochemical (IHC) staining for GSK-3β, β-catenin, and CD44 was performed on lung biopsy or surgical samples. RECIST statuses were classified as follows: complete response, partial response, and stable disease were considered favorable outcomes, while progressive disease was considered unfavorable.
Results: We analyzed 62 samples, including 37 patients with favorable outcomes and 25 patients with unfavorable outcomes. GSK-3β expression was higher in subjects who were male (p = 0,033), had stage III disease (p = 0,031), and had the SCC subtype (p = 0,015). While GSK-3β expression tended to be higher in subjects with unfavorable responses, while β-catenin and CD44 expression tended to be higher in subjects with favorable responses, these differences were not statistically significant. Correlation analysis among GSK-3β, β-catenin, and CD44 revealed no significant linear associations.
Conclusion: The WNT/β-catenin signaling pathway has a specific role in advanced-stage NSCLC. These findings emphasize the complex interplay between clinicopathological features and biological marker expression in NSCLC, warranting further investigation to elucidate underlying regulatory mechanisms and potential therapeutic targets.
Association of skin hydration and pruritus severity in type 2 diabetes mellitus patients
Authors: Susanto Claudia , Yosi Ariyati , Roesyanto-Mahadi Irma D.
Published: January 2025

Introduction: Pruritus is a non-infectious skin manifestation that often occurs in type 2 diabetes mellitus (DM) patients. Skin hydration presents water content in the stratum corneum. Normal skin hydration is necessary to maintain the integrity of the skin barrier. Disruption of the skin barrier causes the release of pruritic mediators resulting in pruritic sensation. The aim of this study is to evaluate the association of skin hydration and pruritus severity in type 2 DM patients.
Methods: This study was an observational study with a cross-sectional design of 97 type 2 DM patients with pruritus. All study subjects underwent skin hydration measurement with CM 825 corneometer® and pruritus severity assessment with Numerical Rating Scale. The relationship between skin hydration and pruritus severity was analyzed using the Chi-Square test and was significant if the p-value <0.05.
Result: Pruritus in type 2 DM patients was more common in female subjects (61.9%), with age 54±5.2 years, disease duration 7.3±6.2 years, and oral antidiabetic treatment (47.4%). Most patients had dry skin hydration (67%) and moderate pruritus severity (46.4%). The results of this study showed that there was no association between skin hydration and pruritus severity in patients with type 2 DM (p=0.816).
Conclusions: There was no association between skin hydration and pruritus severity in patients with type 2 DM.
Risk factors for mortality in pediatric cancer patients with febrile neutropenia
Authors: Mia Ratwita Andarsini  , Maria Christina Shanty Larasati  , Rasio Putra Hutama  , Almeir Pradhipta Andras Asmara
Published: January 2025

Introduction: Febrile neutropenia is the most common complication in pediatric patients with malignancy. Mortality of children with febrile neutropenia remains high, particularly in Indonesia. A high morbidity rate and high treatment costs accompany this. Identified mortality risk variables are essential for the early management of neutropenia fever hospitalization. This study aims to analyze mortality risk factors in children with cancer who have neutropenic fever.
Methods: This study was a retrospective cohort study of medical records from cancer children who had febrile neutropenia from January 2017 to December 2021. Patients who met the inclusion criteria were included in this study. Patients with incomplete data were excluded. Risk factors such as sex, nutritional status, pneumonia, thrombocytopenia, profound neutropenia, impaired liver function, impaired renal function, bacteremia, and elevated CRP levels were identified using bivariate and multivariate analysis.
Result: There were 188 pediatric cancer patients with neutropenia fever who met the inclusion criteria. Forty-three children (22.9%) died. Multivariate analysis found that significant mortality risks were pneumonia (p <0.001; OR 15.923; 95% CI 3.762-67.389), thrombocytopenia (p <0.001; OR 4.939; 95% CI 1.993-12.242), profound neutropenia (p <0,001 OR 5.075; 95% CI 2.066-12.466) and bacteremia (p <0.004; OR 3.656; 95% CI 1.517-8.672). Other variables were not significant risk factors for mortality in children with febrile neutropenia cancer.
Conclusion: Pneumonia, thrombocytopenia, profound neutropenia, and bacteremia are risk factors for mortality in childhood cancer with neutropenia fever.
Comparison between early and late surgical decompression in subaxial cervical spinal cord injury: a systematic review and meta-analysis
Authors: Mardhika Putu Eka , Mahadewa Tjokorda Gde Bagus , Senapathi Tjokorda Gde Agung , Golden Nyoman , Niryana Wayan , Suarjaya I Putu Pramana
Published: January 2025

Background: The most typical site of spinal cord damage is in the subaxial cervical region. Cervical stabilization and cord decompression are the surgical treatments. There is debate regarding when decompression should occur. The purpose of this study was to compare individuals with subaxial cervical spinal cord damage to gradual and early decompression.
Methods: A systematic literature search was done on the online databases of MEDLINE, CENTRAL, and E.M.B.A.S.E. This review included articles comparing early and late decompression in subaxial cervical spinal cord injury with a 24-hour cut-off point. Meta-analysis was performed using the software Review Manager 5.4.
Results: Systematic searching yielded 11 cohort articles and one randomized clinical trial. Postoperative neurological clinical improvement was higher in subjects who underwent early decompression (R.R. = 1.17; 95%CI = 1.03 – 1.34; p = 0.02). In central cord syndromes, incomplete and complete neurologic deficits, clinical neurologic improvement tended to be higher in subjects who underwent early decompression but not statistically significant. Length of stay in hospital was shorter in subjects who underwent early decompression (MD = 2.39; 95%CI = (-3.46) - (1.32); p < 0.0001). There was no complication difference between early and late decompression (R.R. = 0.98; 95%CI = 0.69–1.38; p = 0.89). Mortality tended to be lower in subjects in the late decompression group but not statistically significant (R.R. = 1.31; 95%CI = 0.87–1.98; p = 0.20).
Conclusion: When decompression occurred within a day, patients with subaxial cervical spinal cord injuries experienced improved neurological recovery and shorter hospital stays.
Correlation between grading of fat infiltration in multifidus muscle and degree of facet joint arthropathy in degenerative spondylolisthesis patients based on lumbosacral MRI: a cross-sectional study
Authors: Chandra Chin Edward , Nelwan Dario Agustino , Ilyas Muhammad , Qanitha Andriany , Biakto Karya Triko , Asriyani Sri
Published: January 2025

Background: Degenerative spondylolisthesis is a disorder caused by displacement of one vertebral body by one above or below it due to degenerative changes. Possible contributing causes of degenerative spondylolisthesis are facet joint osteoarthritis and inadequate muscle stabilization. The facet joint and multifidus muscle are innervated by the medial branch of the dorsal ramus of the segmental nerve. This study aims to investigate the relationship between grading of multifidus muscle fat infiltration and degree of facet joint arthropathy in patients with degenerative spondylolisthesis based on lumbosacral MRI.
Methods: This research employs a cross-sectional observational design, utilizing secondary data from the Picture Archiving and Communication System (PACS) and medical records. The aim is to investigate the relationship between the grading of multifidus muscle fat infiltration and the severity of facet joint arthropathy in patients with degenerative spondylolisthesis, based on non- weight-bearing lumbosacral MRI. The study includes all data stored in the PACS at our center from January 2022 until the required sample size was reached.
Results: This study analyzed 100 non-weight-bearing lumbosacral MRI samples of patients with degenerative spondylolisthesis. The distribution of samples based on lumbar multifidus muscle fat infiltration revealed that grade 2 had the highest prevalence at 33%. Similarly, the distribution based on facet joint arthropathy showed the highest occurrence at grade 2, or moderate, at 45%. Significant relationships were found between gender and age with lumbar multifidus muscle fat infiltration (p<0.05), and between gender and spinal level with facet joint arthropathy (p<0.05). Additionally, there is a strong positive correlation (r=0.64; p<0.05) between the grading of the multifidus muscle and the degree of facet joint arthropathy in these patients.
Conclusion: There is a strong positive and significant correlation between grading multifidus muscle and degree of facet joint arthropathy in patients with degenerative spondylolisthesis.
Operative management of breast cancer patients according to the clinicopathological characteristics at Dr. Kariadi General Hospital, Semarang 2020-2022
Authors: Hartanto Michael Mawi , Budijitno Selamat
Published: January 2025

Background: Breast cancer is a malignancy that attacks breast tissue, both the ductal epithelium and breast lobules. Treatment that can be given to breast cancer patients is surgery (surgery), chemotherapy, radiation therapy, and hormonal therapy. This study aims to evaluate the operative management of breast cancer patients according to the clinicopathological characteristics at Dr. Kariadi General Hospital, Semarang 2020-2022.
Methods: A descriptive study with a cross-sectional approach among 45 patients was conducted at Dr. Kariadi General Hospital from February to March 2024 with a total sampling technique. Variables assessed in this study include age, gender, Body Mass Index (BMI), histopathology characteristics, grade of differentiation, stage, immunohistochemistry subtype, and operative management. Data were analysed using SPSS version 25.0 for Windows.
Results: Most of the respondents 41-50 years age group (37.8%), followed by females (100.0%), obesity type II (51.1%), invasive ductal carcinoma (60.0%), grade 2 differentiation (82.2%), Stage II (A and B) (68.9%), Luminal B-type breast cancer (42.2%), and modified radical mastectomy (60.0%) as operative management. Modified radical mastectomy was the predominant operative management in the invasive ductal carcinoma (40.0%), grade 2 (42.2%), stage III (A, B, and C) (31.1%), and Luminal B subtypes (26.6%) of cancer.
Conclusion: Modified radical mastectomy was the predominant operative management based on the histopathology of invasive ductal carcinoma, grade 2, stage III (A, B, and C), and Luminal B subtypes of cancer.
Peyronie disease: a case series and review of the literature
Authors: Zahrina Tengku Tania , Mustafa Akhmad
Published: January 2025

Background: Peyronie's disease (PD) is a non-malignant, progressive condition causing abnormal penile curvature due to scar tissue formation within the erectile tissue. Affecting over 10% of men in the United States, PD often results in physical deformity and erectile dysfunction, significantly impacting quality of life. Surgical intervention, indicated for severe cases unresponsive to non-surgical treatment, includes options such as penile plication, plaque excision with grafting, and penile prosthesis placement. This case study aims to evaluate Peyronie's disease particularly in the surgical intervention.
Case Presentation: This study presents two cases of PD treated surgically: a 36-year-old male with a ventral plaque, treated with plaque excision and a tunica vaginalis graft, and a 40-year-old male with a left-side plaque, treated with plaque excision and a buccal mucosa graft. Both patients experienced significant improvements post-surgery, with resolved curvature and maintained erectile function.
Conclusion: Recent comparative studies indicate that tunica vaginalis and buccal mucosa grafts provide comparable technical success rates, erectile function improvements, and low adverse event incidence. Although buccal mucosa grafting may offer slightly better penile length outcomes, the choice of graft material should consider individual patient factors, surgeon experience, and cost-effectiveness. Further randomized controlled trials are necessary to optimize graft selection for PD surgery.
The relationship between sebum levels and the microbiome on facial skin
Authors: Siahaan Ade Gustina , Jusuf Nelva Karmila , Putra Imam Budi
Published: January 2025

Link of Video Abstract: https://youtu.be/FN5enZ3VrZQ
 
Introduction: Sebum is a mixture of nonpolar lipids largely synthesized de novo by the sebaceous glands. Sebum plays a crucial role in maintaining skin moisture and providing nutrients for microorganisms residing on the skin. The skin microbiome is a collection of microorganisms that help prevent the invasion of pathogens. The interaction between the host and the microbiome on the skin is a dynamic relationship. Understanding the composition and characteristics of the microbiome on facial skin is an important factor in comprehending facial skin health and developing care plans. Research to determine the relationship between sebum levels and the microbiome on facial skin has never been conducted in Indonesia, particularly in North Sumatra. This study aimed to investigate the relationship between sebum levels and the microbiome on facial skin.
Methods: This study was an observational analytic study with a cross-sectional approach involving 50 research subjects. Sebum levels were measured using a sebumeter in 5 facial areas. Microbiome identification was performed by aerobic and anaerobic bacterial culture on growth media, followed by identification using the Vitek® 2 system. The data were analyzed using the Independent T-test.
Results: This study found that the average age of the subjects was 34.62 years. There were more female subjects (72%) than male subjects (28%). The average sebum level was 90.46±18.38%. The most abundant aerobic bacteria are Staphylococcus sp. and Micrococcus sp. The most abundant anaerobic bacteria are Actinomyces naeslundii and C. acnes. There is a significant difference in sebum levels between aerobic and anaerobic bacteria (p=0.004).
Conclusion: There is a relationship between sebum levels and the microbiome on facial skin.
Correlation between Hypoxia Inducible Factor-1 Alpha (HIF-1α) levels with hydration of skin aging
Authors: Hutagalung Patricia S.U.Br , Jusuf Nelva Karmila , Paramita Deryne Anggia
Published: January 2025

Link of Video Abstract: https://youtu.be/GuWu8RHE6EMIntroduction: Skin aging involves a decline in skin physiological functions influenced by intrinsic and extrinsic factors. One crucial aspect is skin hydration, which affects the skin barrier and water content in the stratum corneum. Hypoxia triggers the activation of hypoxia-inducible factor (HIF-1α), essential for keratinocyte differentiation and maintaining skin barrier function. Reduced HIF-1α expression in the epidermis is associated with decreased skin hydration. This study aimed to determine the correlation between HIF-1α levels and hydration of skin aging.
Methods: An observational, cross-sectional study was conducted with 40 participants meeting the inclusion and exclusion criteria. Each subject underwent a detailed history, corneometer examination for hydration assessment, and blood sampling for HIF-1α level measurement via ELISA. Statistical analysis was performed using the Chi-square test, with significance set at p < 0.05.
Results: Based on age, the 40-45 years and 46-50 years groups had the most dry skin hydration values at 35% and 25% respectively, while the 50-55 years age group had the most very dry skin hydration at 12.5%. Among females, 7.5% had good hydration, 50% had dry skin, and 22.5% had very dry skin. HIF-1α levels were low in 90% of subjects and high in 10%, with a mean of 2.76 ng/ml. Statistical analysis revealed a significant correlation between low HIF-1α levels and decreased skin hydration (p = 0.01).
Conclusion: There is a correlation between HIF-1α levels and hydration of skin aging.
Case series of small bowel obstruction
Authors: Wayan Rismayanti  , Adnyani Anak Agung Dewi
Published: January 2025

Introduction: Small Bowel Obstruction remains a significant cause of morbidity and mortality, accounting for 12%-16% of hospital admissions for acute abdominal pain in the United States. Imaging typically provides insights into the degree of obstruction, its cause, and whether the case is severe or complicated. This study aimed to examine cases of small bowel obstruction, encompassing patient complaints, radiological findings, and prognosis.
Case description: The first case involves a 51-year-old male patient presenting with complaints of abdominal bloating for the past week. Physical examination and additional diagnostic tests indicated the patient was experiencing either partial ileus obstruction or total ileus obstruction, with total bowel obstruction suspected to be of malignant origin. The patient was treated in the ICU for two days, and then transferred to a general ward for five days before passing away. The second case involves a 57-year-old female patient presenting with complaints of epigastric pain for the past three days. Physical examination and additional diagnostic tests revealed either partial ileus obstruction or total ileus obstruction, with total bowel obstruction suspected to be of malignant origin. The patient was treated in the ICU for three days, followed by six days in a general ward. The patient showed significant improvement and was discharged with a recommendation for outpatient follow-up care at the polyclinic.
Conclusion: Both cases presented here demonstrated the presence of obstruction through clinical history, physical examination, laboratory findings, and radiology. Initial management was conservative, followed by laparotomy as the surgical approach.