Introduction: Retinopathy of prematurity (ROP) is one of the important causes of blindness in children. ROP is characterized by abnormal retinal neovascularization of premature infants.

Purpose: This study aimed to estimate the prevalence of ROP in preterm infants at Sanglah Hospital Bali from 2015-2017 and identify the risk factors predisposing them to ROP.

Methods: This was a retrospective study, observational analysis on premature infants diagnosed as ROP at Sanglah Hospital Bali from January 2015 to December 2017, with a gestational age of 30 weeks or less at birth and a birth weight of 1500 grams or less. Infants whose gestational age was >30 weeks or whose birth weight was >1500 grams were also included. The ophthalmological examinations were initiated between the fourth and sixth weeks of chronological age or 34 weeks of corrected age, whichever was earlier, and were repeated weekly or biweekly as per Indonesian guidelines for ROP screening, until full vascularization of the retina reached zone 3.

Results: Out of 31 infants diagnosed as ROP, 3 (9.7%) cases developed ROP in one eye, and 28 (90,3%) cases in both eyes. They were classified as 23 (74.2%) cases stage 1, and 8 (25,8%) cases stage 2. None of the studied infants presented ROP at stage 3, 4, or 5. The risk for ROP was not significantly associated with birth weight (OR 0.375; 95% CI 0.030 – 4.635), gestational age (OR 0.897; 95% CI 0.792 – 1.015), sepsis (OR 1.111; 95% CI 0.089 – 13.835), blood transfusion (OR 1.111; 95% CI 0.089 – 13.835), and HMD (OR 1.118; 95% CI 0.977 – 1.443).

Conclusions: The data of this study showed that low gestational age, low birth weight, sepsis, oxygen therapy, and blood transfusion may be contribute to the development of ROP, but not significant statistically. Clinicians should be aware of the presence of the additional risk factors when monitoring preterm infants,especially when giving supplemental oxygen therapy.

Background: Tinnitus is the perception of sound heard by a person without an external stimulus. About 10-14.5% of the world's population experience tinnitus, with the most common age group being 40-60. The management of tinnitus is still a challenge for researchers. Until now, there has been no effective management of tinnitus. The last therapy available is to make artificial sounds that imitate the tinnitus sound so that it can mask the actual tinnitus sound. In addition, music therapy is expected to reduce the stress level of tinnitus patients.

Methods: This research is a follow-up study from previous research with 26 subjects. After getting the frequency and amplitude of tinnitus, a sound stimulus is made by combining tone variations and good 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. Then all the participants will listen to dan evaluate the mixing song.

Results: Of all subjective tinnitus sound generators, 3-5% have frequencies below 20 Hz and above 20,000 Hz. Songs made by recording in a soundproof room also have a frequency of 20 Hz and above 20,000 Hz, about 5 – 7%, where the song has an unnecessary frequency. The subjective tinnitus sound generator with the created song has an amplitude of < 85dB so that it can be adjusted with the volume control on the speaker.

Conclusion: Tinnitus songs were made with the addition of Piano and Violin and Flute music, and Guitar, Bass and Balinese gamelan had a frequency of 20 – 20,000 Hz with an amplitude of < 85 dB, which can be adjusted with the volume so that it is safe and comfortable for tinnitus sufferers.

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.

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: Research related to the implementation of the referral system still needs to be conducted in more depth because there are still problems and obstacles in the implementation of the referral system along with the development of the health service system in recent years. This study aims to determine the development of research on referral system implementation in health services from 2013 to 2022.

Methods: This research category is qualitative with a literature study. This research uses the Scopus search engine to search for journals related to the implementation of the referral system from 2013 to 2022, with keywords "implementation" AND "referral system" with subject area restrictions related to referral system in health care, the document type is an article and English language. This research also uses VOSviewer and R-Studio for data mapping and analysis.

Results: From this research, 222 English-language articles were selected. Research publications are increasing in 2020, 2021, and 2022. Fondazione IRCSS Istituto Nazionale Dei Tumori Sn and Tabriz University of Medical Sciences contributed the most publications in this study. The journal BMC Health Services Research published the most articles on referral system implementation; Petersen, I. Rashidian, A., and Putoto, G. were the top authors on this research topic. The word human was found 196 times, the female was found 177 times, and the patient referral was found 139 times. From the VOSviewer visualization analysis, topics such as disease case groups (neoplasms, Human Immunodeficiency Virus), digitalization of health services (electronic health records, telemedicine, telehealth), and related developing countries such as Ethiopia and India, and underdeveloped countries such as Tanzania still have excellent opportunities for future research.

Conclusion: This research is dominated by developed countries, so research in developing countries needs to be reproduced and developed. Data sources from the Web of Science are recommended for future research.

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.