Background: Health workers are vulnerable to experiencing psychological and physiological stress, including burnout syndrome (BOS). BOS can be measured using the Maslach Burnout Inventory (MBI) assessment. BOS can also affect heart rate variability (HRV). Music therapy is one of the BOS therapies in the recovery phase. This study aims to evaluate the effects of virtual music therapy on "Burnout Syndrome" in health workers in Tertiary Hospitals

Methods:  This research is a qualitative study and a randomized control trial using a pre-and post-test control group study design on healthcare workers at Dr. Kariadi Hospital and Dr. Cipto Mangunkusumo Hospital for three months. Subjects were divided into two groups, namely the intervention group and the control group, each consisting of 20 people. The instruments used were the MBI-HSS questionnaire and heart rate variability measuring devices for the pretest and posttest. Depending on the data distribution analysis performed using the Shapiro-Wilk test, data analysis was performed using either the Mann-Whitney test or the independent T-test. Data were analyzed using SPSS version 21.0 for Windows.

Results: This study shows significant differences in the MBI-HSS scores between the intervention and control groups (p<0.05). In the HRV-SDNN scores, there were only significant differences in the control group (p<0.05), although there was an increase in the mean values in the intervention group.

Conclusion: The use of music therapy according to culture and individual preferences can significantly affect the MBI-HSS score, which indicates burnout and increases the HRV value.

Introduction: Traumatic brain injury (TBI) is the disease that causes the most common disability globally. The cisternostomy as adjuvant management of TBI lacks documentation. We aim to prove the effectiveness and safety of cisternostomy and decompressive craniectomy in managing traumatic brain injury.

Methods: The search for published scientific articles using the Preferred Reporting, Items for Systematic Reviews, and Meta-Analysis (PRISMA) method. The search was conducted using the PubMed, Cochrane library, and Medline databases published in English for the last ten years until June 2022, evaluating the effectiveness and safety of cisternostomy and decompressive craniectomy in managing traumatic brain injury. The Oxford Center for Evidence-based medicine assessed the evidence levels of each study. Data analysis with RevMan version 5.3.

Results: Four studies were included in this meta-analysis, two RCTs, and two observational studies. We find a total of 1000 patients with; 596 cisternostomies and 404 decompressive craniectomies. These primary points show that mean GOS at six weeks is 0.93 (I2:52%; 95%CI: 0.70 to 1.17; p<0,01), decrease in intracranial pressure post-operation is -3.20 mmHg (I2:97%; 95%CI: -3.84 to -2.56; p<0,01), duration of ICU stay is -2.37 days (I2:37%; 95%CI: -4.54 to -0.21; p<0,03), and mortality is 0.51 (I2:21%; 95%CI: 0.42 to 0.63; p<0,01).

Conclusion: Cisternostomy is a beneficial procedure in TBI, leading to survival benefits and better clinical outcomes. Hopefully, more studies will examine its role in TBI patients critically in the future.

Background: Triple Negative Breast Cancer (TNBC) is one of the breast cancer subtypes with an aggressive clinical course and has a limited therapeutic strategy. Until now, conventional chemotherapy is still used as standard therapy, although it still has an inadequate therapeutic response. One of the chemoresistance mechanisms is likely due to the immunosuppressive effect of CD73-derived adenosine. This study aims to evaluate the high CD73 expression as a negative predictor of clinical neoadjuvant chemotherapy response in TNBC.

Methods: This study was a retrospective case-control study. A total of 46 TNBC patients who received neoadjuvant chemotherapy at Prof Dr. I.G.N.G Ngoerah's Hospital were enrolled. Twenty-three patients with positive neoadjuvant chemotherapy responded as the control group and 23 with negative neoadjuvant chemotherapy responded as the case group. Evaluation of CD73 expression was carried out by immunohistochemistry from a biopsy taken before the patient underwent neoadjuvant chemotherapy. CD73 expression was categorized into low and high based on staining intensity and percentage of the stained tumor cells. Data were analyzed using SPSS version 25.0 for Windows.

Results: Analysis showed a significant relationship between CD73 expression and clinical neoadjuvant chemotherapy response (OR=4.41; 95% CI=1.26-15.41; p=0.017). Multivariate analysis showed CD73 expression (AOR=4.88; 95%CI=1.08-21.99; p=0.039) and T stage (AOR=18.82; 95%CI=1.83-193.00; p=0.013) simultaneously affect clinical neoadjuvant chemotherapy response.

Conclusion: It can be concluded that high expression of CD73 and T stage is an independent predictor of negative clinical neoadjuvant chemotherapy response in TNBC patients.

Background: Low-grade chronic inflammation may contribute to the development of atherosclerosis as well as hypertension by inducing the production of pro-inflammatory cytokines. Several studies have revealed a relationship between the microbiota living in the gut and the incidence of hypertension. Two of several gut microbiota that contributed, in this case, are Escherichia coli (E. coli) and Roseburia intestinalis (R. intestinalis). Therefore this study aimed to identify and quantify gut microbes namely R. intestinalis and E.coli in hypertensive patients in Bali, especially in Denpasar City.

Methods: This research is a cross-sectional study located at South Denpasar Health Center I, Bali, and the Integrated Biomedical Laboratory, Faculty of Medicine, Universitas Udayana. The sample in this study were hypertensive patients who had been registered at South Denpasar Health Center I and who met the inclusion criteria and did not meet the exclusion criteria. The E. coli and R. intestinalis concentrations were assessed by conducting DNA isolation and RT-qPCR. Statistical analysis using univariate analysis, bivariate analysis using the Independent T-Test; Mann-Whitney Test; Chi-Square, and ROC analysis

Results: There were 70 subjects included in this study. Thirty-one subjects were hypertensive patients and the other 39 patients were not hypertensive. The age of the subjects between the two groups was found statistically significant (p=0.007). We also found that comorbid were found mostly in hypertensive patients (p=0.009). Most of the comorbid experienced among them were cardiovascular diseases and diabetes mellitus. Hypertensive subjects had more E. coli concentration in their gut compared with non-hypertensive subjects (p=0.048), while R. intestinalis concentrations were similar in both groups (p>0.05). From the multivariate analysis, it was found that hypertensive patients tended to have a higher concentration of E. coli than non-hypertensive patients (p=0.012; 95% CI:0.055–0.417).

Conclusion: E. coli concentration in the gut is independently associated with the incidence of hypertension, while R. intestinalis concentration is not.

Background: Acute lymphoblastic leukemia (ALL) is a malignancy of blood cells in many children. Predicting the severity of ALL is important for treatment. An easy and cheap marker is eosinophil count. This study aims to analyze eosinophil count as a predictor of ALL severity.

Methods: Retrospective study using medical record data of 76 ALL patients from January 2020 to September 2021 was conducted at RSUP Dr. Wahidin Sudirohusodo Hospital. Patients are classified as ALL remission and relapses. Eosinophil Count based on routine blood test results using Sysmex XN-1000. Statistical Test using Kolmogorov-Smirnov test to assess data normality, Mann-Whitney test, eosinophil count diagnostic values analyzed with ROC curve to assess AUC and determination of cut-off value. The test results are significant if p<0.05.

Results: The sample consisted of 59 ALL remissions and 17 ALL relapses. The mean eosinophil was found to be significantly lower in the relapse patient (0.19) than in the Remission patient (0.47) (p<0.05). Based on the ROC curve, the value AUC = 0.660 and significant (p<0.05). This shows that the cut-off value of eosinophil count can be used as a prognostic value for the status of ALL patients. ROC curve shows the sensitivity and specificity of the eosinophil count is 70.6% and 54.2% at a cut-off of 0.15.

Conclusion: Eosinophil Count can be used as a prognostic value for the status of ALL patients with a cut-off value of 0.15. The eosinophil count was lower in the relapse patients than in the remission patients.

Introduction: Abdominal mass is one of the common pediatric tumors that can manifest as abdominal pain or a distended abdomen, and it requires immediate management. Some of them can often be incidentally discovered by parents, during routine pediatric examination in an outpatient clinic, or detected on imaging multimodalities. This study is aimed to evaluate the prevalence of pediatric abdominal mass and to demonstrate tumor characteristics by radiology imaging findings in Prof. I G. N. G. Ngoerah Hospital Denpasar.

Methods: We conducted a descriptive, cross-sectional study of patients with abdominal masses

discovered by Abdominal CT scan in the Radiology Department of Prof. I G. N. G. Ngoerah Hospital from January 2018 to December 2020. Medical record review and data analysis were done retrospectively.

Results: We identified 143 pediatric patients diagnosed with abdominal masses discovered by a CT scan in the Radiology Department of Prof. I G. N. G. Ngoerah Hospital from January 2018 to December 2020. Female patients were found more than male patients (77 vs. 66 patients). Out of all patients, the majority of age were 1 to 9 years old (65 patients, 45%), while the second were 10 to 18 years old (52 patients, 35%), and the rest were one month – 11 months (17 patients, 12%) and <1 month (5 patients, 4%) respectively. The average age was 7.44 years old.

Conclusion: The abdominal imaging and histopathological findings help evaluate abdominal mass in children. An accurate diagnosis is essential for proper management.

Introduction: Dyslipidemia is an abnormal condition of blood lipid levels with a global prevalence of 31.2% which can cause various complications including atherosclerosis that can develop into stroke. Therefore, it is necessary to develop therapeutic modalities. One of them is Antisense Oligonucleotides (ASO) which target Apo C-III, a protein that controls body fat metabolism.

Purpose: This study aims to summarize the current progress, challenges, and potency of the apoliprotein C-III (Apo C-III) inhibitors effect of antisense oligonucleotides in the management of dyslipidemia

Methods: This paper is a literature review that collects and selects data from credible sources using the keywords apoliprotein C-III, antisense oligonucleotides, and dyslipidemia

Results: Antisense Oligonucleotides have high specificity and efficiency in inhibiting Apo C-III. Administration of ASO significantly reduced Apo C-III mRNA up to 98% and Apo C-III plasma protein up to 65% in experimental animals and reduced triglycerides up to 70.9% in clinical trials. A decrease in very low density lipoprotein (VLDL) of up to 69.2% was identified in the administration of ISIS 304801, spesific ASO in humans. The administration of ISIS 304801 also reduced the number of chylomicron particles as a source of cholesterol up to 61.1% and significantly increased the number of high-density lipoprotein (HDL) up to 45.7%, which represented the role of the modality as atheroprotection. Over time, an increase in the endosomal release, distribution, and half-life of ASO was achieved by modification of phosphorothioate linkages and lipid conjugation which represented an increase in ASO concentration. It also facilitates the interaction between ASO and intracellular spesific Apo C-III coding mRNA

Conclusion: Antisense oligonucleotides have great potential to inhibit Apo C-III as a treatment for dyslipidemia.

The coronavirus disease (COVID-19) pandemic affects various aspects of human life. To minimize the impact of lockdown, medical schools used online learning systems. However, online education also impacts student readiness, especially last year's medical students who will soon undergo clinical rotation. Therefore, this article aims to discuss the impact of the COVID-19 pandemic on the readiness of last year's medical students for clinical rotation. This study was a literature review that used several databases and online sources: Google Scholar, ScienceDirect, Pubmed (MEDLINE), and Cochrane Library, to search relevant journals related to the topic. Based on the literature search, the transition from student to doctor has been severely impacted by the COVID-19 pandemic, which had a substantial impact on medical student education, especially on interruptions of student assistantship that disturb students’ preparation, self-assurance and professional identity. The online education system in the last year of pre-clinical medical students involves changing the medical curriculum, duration of lectures, lecture schedules, and academic material loads, which are carried out through the implementation of online material sources or meeting platforms. However, the online education system also has several barriers that cause learning effectiveness that is not comparable to traditional face-to-face education systems, including the level of ability of both teachers and students to adapt online, time management, supporting infrastructure, integrated communication systems, and student engagement. This also had an impact on both students' theoretical and practical skills. Several factors also affect the student's readiness, including student assistantship interruption, OSCEs, written exams, competence, clerkship orientation, learning style, classroom environment, and mental health.

Obesity is a condition triggered by many risk factors, but the main one is due to high calorie intake and low physical activity. Various studies have explored the relationship between obesity and metabolic complications, namely chronic degenerative disorders. In the condition of obesity, there are biochemical changes including chronic inflammation. This condition mainly occurs due to the load on the metabolic tissue due to weight gain and fat tissue dysfunction. These changes result in changes in the distribution of leukocytes, lymphocyte activity, and in general the immune defense system. The changes that occur include the occurrence of a chronic inflammatory process. Among the various inflammatory mediators, there are three mediators that play an important role in the regulation of the immune system due to obesity, namely TNF-α, IL-6, and adiponectin. In addition, the accumulation of free fatty acids in obesity can activate a cascade of a series of pro-inflammatory kinases, such as IkB kinase and c-Jun N-terminal kinase, which triggers fatty tissue to release IL-6. Other effects include activation of the inflammasome, and hyperleptinemia. Leptin is then associated with cell survival, cytokine release, and chemotaxis. In addition, leptin can also be related to the proliferation of T cells.

Background: The COVID-19 pandemic is still a global emergency that causes higher mortality in patients with comorbidities. Current data shows the mortality rate of STEMI patients with COVID-19 is higher than that of STEMI patients without COVID-19. This study aims to improve the knowledge and skills in managing cardiac arrest in COVID-19 patients and post-ROSC management in STEMI patients with COVID-19.

Case Presentation: A 43-year-old man came with a complaint of typical chest pain 3 days before admission, accompanied by symptoms of orthopnea and dyspnea on exercise, and had experienced syncope 3 days prior. History of diabetes mellitus and previous heart attack. The examination results showed tachycardia, tachypnea and oxygen desaturase. The supporting examinations were ESR 89, CRP 48.72, D-dimer: 2.04, and HbA1C 10.1%. Swab Polymerase Chain Reaction (PCR) SARS Cov-2 showed a positive result, with pulmonary edema that may be accompanied by pneumonia (CORADS-3), bilateral pleural effusions, calcification of the descending aorta and coronary arteries LAD, LCX, RCA on computed tomography (CT) imaging. ) Thorax. On bedside echocardiography, EF 28%, LA-LV dilatation, anterior akinetic RWMA, and mild-moderate MR due to functional, mild TR were found. Patients diagnosed with STEMI anterior late onset Killip III, CCS IV, Grace 129, TIMI 9/14; ADHF on ACS; DM, Confirmed Covid-19, Hypoalbuminemia, Hypercoagulation state and had a heart attack and cardiac-respiratory arrest on the 14th day of treatment, performed cardiopulmonary resuscitation (CPR) and entered a state of return of spontaneous circulation (ROSC). The patient continued the treatment until day 23 and was referred to another hospital for further care.

Conclusion: In order to obtain good results in reducing mortality in STEMI patients with COVID-19, it is necessary to have the knowledge and skills of management of cardiac arrest in COVID-19 patients and post ROSC management in STEMI patients with COVID-19, as well as pay attention to and maintaining the safety of the rescuers.