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.

Background: Chronic viral hepatitis B causes chronic inflammatory process, hepatocyte damage, progressive fibrosis, and irreversible liver damage, leading to high morbidity. There are two methods of diagnosing liver fibrosis, invasive (biopsy) and non-invasive, including radiological examination using the elastography method and hematological examination. This study aims to determine the relationship between the elasticity of liver parenchyma using the Shear Wave Elastography (SWE) method and fibrosis index in chronic viral hepatitis B patients.

Methods: This research is a cross-sectional study using 68 samples that met the inclusion criteria. The 2D-SWE examination was blindly performed by two observers using a convex transducer probe with frequencies ranging from 1.2 to 6 MHz. Data were analyzed using SPSS version 20.0 for Windows.

Results: In our study, there was a significant moderate positive correlation between the elasticity of liver parenchyma and the fibrosis index performed by both observers (r=0.52; p < 0.001). After controlling confounding variables, a higher correction was obtained (r=0.61), suggesting a change from moderate to strong correlation (p<0.05).

Conclusion: There was a positive and significant correlation between the elasticity of liver parenchyma and fibrosis index.

Background: Colorectal cancer (CRC) is cancer of the colon or rectum and one of the leading causes of cancer-related deaths. The marker for CRC is Carcinoembryonic Antigen (CEA). Lymphocytes play a role in cytotoxic cell death, inhibition of tumor cell proliferation, and migration. Lymphocyte Monocyte Ratio (LMR) is an easy-to-use laboratory biomarker to predict clinical outcomes in patients with colon cancer. This study aims to evaluate the relationship between CEA and LMR levels with the severity of CRC.

Methods: The researcher cross-sectional analyzed 53 CRC patients by taking secondary data from medical records of colorectal cancer patients, CEA, and CBC data at Dr. Wahidin Sudirohusodo Hospital Makassar. The data were grouped and then analyzed statistically. Data analysis was performed using SPSS version 25.0 for Windows

Results: The number of patients with male sex was 38 people (71.7%) and 15 women (28.3%). The age group of the patients ranged from 32 to 84 years, with a mean of 58.1 ± 11.3 years. The most severe degree of CRC was moderate, 29 people (73.6%), followed by mild degree, 8 people (15.1%), and severe degree, 6 people (11.3%). There is a significant negative correlation between LMR and CEA (r=-0.357; p=0.009)

Conclusion: There is a significant negative correlation between LMR and CEA. A decrease in LMR can be associated with a poor prognosis in cancer patients, whereas an increase in LMR before treatment can provide a good prognosis

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: ABO and Rhesus blood groups are clinically important, especially in blood transfusion. Blood groups are determined by the antigens found on the erythrocyte membrane. In patients with hematologic malignancies, especially from the myeloid lineage, changes in blood group can occur in the ABO system mainly due to weakness or loss of some ABO antigens.

Case Description: A nine-year-old girl was admitted to the hospital with a chief complaint of high fever three days before admission. The patient had been diagnosed with acute non-lymphoblastic leukemia three months ago. From medical history, the patient had undergone chemotherapy and received 22 bags of PRC transfusion with blood group O (+) from February 27^th until May 28^th 2018. On July 21^st 2018, the transfusion procedure was repeated, and the blood group showed B (+). The procedure was repeated using a new sample but the result remained the same. The crossmatch was performed with five blood groups O (+) and two blood groups B (+) showed mayor: negative, minor:+weak, AC:+weak, mayor: negative, minor:+weak, AC:+weak, respectively.

Conclusion: Changes in blood group antigens in hematologic malignancies that experience ABO antigen alternation and return to the original blood group reflect the remission from the disease. The expression of H antigen in blood groups A and B may revert to normal with an improvement from the underlying disease.

Introduction: Inverted papilloma is a benign epithelial tumor of cavum nasi and paranasal sinuses that originates on the mucosal surface of the sinonasal tract. The etiology of this tumor remains unknown although chronic sinusitis, allergy, and viral infections are suspected. Although it is a benign tumor, it has a tendency toward malignancy. We aim to present the report as a case of sinonasal inverted papilloma with clinical manifestations, and radiological and histopathological features in a 61-year-old male patient.

Case Presentation: A 61-year-old man presented to the Department of Ear, Nose, and Throat (ENT), Bali Royal Hospital on 17 January 2023 with left nasal obstruction 5 years ago, and getting worse over 3 months. Due to the obstruction, he felt his sense of smell diminished. He also often sneezed had headaches and felt his left nose was bigger than his right. On examination, a grey-white mass with an irregular, slippery surface, and soft consistency were found. The mass did not bleed easily, was not painful when touched, and filled almost the entire cavum nasi sinistra. CT scan revealed rhinosinusitis of maxillary dextra et sinistra, ethmoidal dextra et sinistra, and frontalis sinistra with polyp shape and concha nasi sinistra protruding posteriorly. Functional Endoscopic Sinus Surgery (FESS) and extirpation under general anesthesia (GA) were planned. An excisional biopsy was sent for histopathological examination. Based on clinicohistopathologic, it suggests of final diagnosis of inverted papilloma.

Conclusion:  Due to the signs and symptoms of inverted papilloma are not specific, a CT scan and biopsy are needed to confirm the diagnosis. To reduce the recurrence of these tumors, complete tumor removal with an endoscopic approach is recommended. Long-term follow-up is also necessary to prevent the recurrence