Background: Sensorineural hearing loss (SNHL) is a hearing loss that accounts for almost 90% of all hearing loss. Various factors can cause this disorder, one of which is diabetes mellitus (DM). However, few studies still discuss biomarkers to detect the incidence of SNHL in patients with DM as early as possible. The purpose of this paper is to determine the potential of biomarkers to detect SNHL in type 2 diabetes mellitus (T2DM) patients.

Methods: The author uses a database in the form of PubMed, Cochrane, and ScienceDirect used to search for articles using the Boolean operator "AND" or "OR" using the keywords "hearing loss," "diabetes," "biomarkers," "Prestin," "lipid profile," and "Nox2". A total of 276 studies were obtained, followed by the title and abstract screening and feasibility assessment (eligibility) to get inclusion studies included in the qualitative analysis (systematic study).

Result: A total of 10 inclusion studies consisted of 2 cross-sectional studies, 2 case controls, and six preclinical studies with 105 and 101 patients in the cross-sectional and case-control studies, respectively. A total of 5, 3, and 2 studies reported associations between hearing loss and Prestin, Nox2, and lipid profile values, respectively.

Conclusion: The biomarkers such as Prestin, Nox2 and lipid profile have a role in the early diagnosis of SNHL, but no related studies discuss T2DM. Therefore, basic and clinical studies are still needed to determine its effectiveness.

Introduction: Estrogen Receptor 1 (ESR1) expression has appeared to impact prostate cancer advancement significantly. This study aims to compare the expression of ESR-1 in BPH and prostate cancer.

Methods: The samples were collected from a single-center hospital from 2014 to 2020. We exclude samples in which RNA concentration is under the minimum standard allowance to proceed. Deparaffinize formalin-fixed paraffin-embedded and RNAs extraction by manufacturer’s protocol with slight modification was performed. The RNA expression was investigated by using quantitative real-time polymerase chain reaction. We categorized into Benign Prostate Hyperplasia (BPH), Non-Metastatic Prostate Cancer (Non-MPCa) and Metastatic Prostate Cancer (MPCa) groups. The One Way ANOVA was used to analyze the data.

Result: The 40 samples included 15 BPH, 6 non-metastatic prostate cancer, 19 metastatic prostate cancer. Expression of ESR1 in BPH (6.9 ± 3.8) compared to expression of ESR1 in MPCa (12.7 ± 9.5), and Non-MPCa (2.6 ± 1.0) shows a significant difference. Expression of ESR1 in Non-MPCa compared to MPCa also indicates a significant difference in which expression MPCa shows an increased level of ESR1 expression.

Conclusion: This study shows that ESR 1 has significant expression differences in Benign Prostatic Hyperplasia, non-Metastatic Prostate Cancer, and Metastatic Prostate Cancer. The highest ESR1 expression is found in Metastatic Prostate Cancer. In conclusion, higher ESR1 expression is related to metastatic prostate cancer.

Background: Packed Red Cells (PRC) is one of the blood component obtained from the whole blood through the removal of blood plasma. The storage of PRC aims to maintain the viability and function of erythrocytes by reducing cell metabolic activity. However, PRC's biochemistry changes could occur through storage lesion by releasing Stromal Cell-Derived Factor 1 (SDF-1) and Transforming Growth Factor-Beta 1 (TGF-?1) that affect the erythrocytes metabolism and viability prior to transfusion. This study aims to evaluate the increase of SDF-1 and TGF-?1 levels in PRC as the indicator of storage lesion at Sanglah Hospital-Blood Bank, Bali, Indonesia.

Methods: An observational cross-sectional study using randomized post-test only without control group design was conducted at Sanglah Hospital-Blood Bank, Bali. The consecutive random sampling technique was used in this study to the PRC, who met the inclusion criteria. Samples of the SDF-1 group (N=84) were divided into 3 such as Group 1 (1-7 days), Group 2 (8-14 days), and Group 3 (15-21 days). However, 53 PRC was divided into 2 groups as Group 1 (1-7 days) and Group 2 (8-14 days).  The SDF-1 and TGF-?1 levels were evaluated for each group using Human SDF-1/CXCL12 and TGF-?1 Kit from Elabcience® by ELISA method.  Data were analyzed using SPSS version 25 for Windows software.

Results: The median levels of SDF-1 in Group 1 group was 0.385 (0.050-1.020) ng/mL, followed by 0.455 (0.330-0.750) ng/ml in Group 2, and 0.490 (0.380-0.920) ng/ml in Group 3 (p<0.05). The mean of TGF-?1 levels was slightly higher in Group 1 (2,365.21±715.96 pg/ml) compared with Group 2 (2,210.39±994.68 pg/ml) (p=0.523). There was a significant difference in SDF-1 levels in Group 1-Group 2 (P=0.041) and Group 1-Group 3 (P=0.000) groups; however, no significant difference was found in Group 2-Group 3 (P=0.133) using the Mann-Whitney test. The Spearman's rho test found a moderate positive correlation between SDF-1 levels and storage time by day (r=0.546; P=0.000). In addition, based on the Pearson correlation test, there was a weak positive correlation between TGF-?1 levels and storage time by day (r=0.461; p=0.001).

Conclusion: The increase of SDF-1 and TGF-?1 levels in PRC by days of storage time could be used as the indicator for storage lesion at Sanglah General Hospital-Blood Bank, Bali, Indonesia.

Background: Risk determination of breast cancer metastases is important for clinicians to be able to estimate the adequate therapy for the patients provide the basis for clinical reasoning and explanation of the possibility of metastasis to breast cancer patients who are in treatment. However, current prediction models have low accuracy and molecular determinants tend to have a high evaluation cost. Bioscore had emerged as a new reliable option in determining the risk of metastases in breast cancer, but it is not widely applied yet. Therefore, it is necessary to study its capability in determining risk of metastasis in the clinical setting in order to validate its future application.

Objective: To determine the bioscore scoring system as a risk determination for metastases in breast cancer at Sanglah Hospital, Denpasar.

Methods: This research was a nested case control study involving 32 subjects in two groups, namely metastatic and non-metastatic breast cancer groups. All patients are registered in the Cancer Registry Data at Sanglah Central General Hospital. The parameters in this study were age, stage, grading, hormonal status, HER2 status, menopausal status, metastatic status and bioscore values. Data were tabulated and statistically analyzed using SPSS 25.

Results: From all subjects, the average patient age of 51.50 (±8.491) years, ranging from 31 - 72 years old. The bioscore was significantly associated with all research variables. Risk analysis showed that breast cancer patients with a high bioscore (5-7) has a significantly higher risk of metastasis (OR: 21.00; 95% CI: 5.620 – 78.475) compared to those with low bioscore (1-4).

Conclusion: The bioscore scoring system may have a significant value in predicting metastasis in breast cancer patients. However, its application still needs further and more comprehensive studies to validate its application in breast cancer management.

Introduction: The rising prevalence of obesity forces the orthopedist to consider it in fracture risk assessment. Multiple studies have consistently demonstrated that people with obesity have increased bone mineral density (BMD). Although it appears other factors in bone strength may influence the fracture risk, including bone microarchitecture, which recently can be measured by trabecular bone score (TBS). The complex associations between TBS and BMI remain unclear, and some studies show inconsistent findings. This systematic review and meta-analysis aimed to understand whether increased BMI is associated with lower TBS by indirectly pooling all the available evidence from the published literature.

Methods: A literature search was carried out using PubMed, Cochrane Library, Google Scholar and other popular journal databases using the terms "trabecular bone score", "body mass index" and the possible synonyms. We extracted the total sample, mean and standard deviation of TBS for patients within each BMI category from the selected literature. A meta-analysis was conducted using a random-effects model and inverse variant methods to synthesize the pooled effect size (mean difference) for each gender subgroup.

Results: After an initial search and screening of 2399 studies, seven reports published between 2016-2019 were included (five cross-sectional, one cohort, and one randomized clinical trial). These include 2872 samples which were mostly women (2286). One thousand thirty-one samples were with normal BMI, 1124 samples were with overweight BMI, and 717 samples were with obesity. The included studies varied by age group and gender. The between-study heterogeneity with I² index ranging 0%-76% studies in man showed higher heterogeneity. Compared with normal individuals, those with overweight and obesity had lower TBS with a mean difference of -0.02 (95% CI -0.03 to -0.01) and -0.07 (95% CI, -0.09 to -0.05), respectively. The differences were consistent across gender, although larger differences were found in men.

Conclusion: Individuals with higher BMI have a lower TBS than individuals with normal BMI in a stepwise manner. It suggests that the inclusion of TBS can improve the assessment of fracture risk in obese individuals.

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

Background: In 2018, the Indonesian Pediatric Society stated that there were 1,220 children suffering from Type 1 Diabetes Mellitus. This might be an iceberg phenomenon due to a large number of children and adolescents in Indonesia. Diabetic ketoacidosis is one of the Type 1  Diabetes Mellitus acute complications that could be fatal. The problem is that our society isn't familiar with this condition, and it leads to delayed diagnosis and treatment.

Case: A 16 – year – old girl was hospitalized due to right lower abdominal pain, nausea, vomiting, decreased appetite, and fever for 3 days. The next morning, she became unconscious with a Glasgow Coma Scale of E1V1M6. Her blood tests showed blood glucose levels of 551 mg/dL, C – Peptide of 0,65 ng/mL, pH of 6,81, and cHCO3 of 3 mmol/L. Her urine tests showed ketonuria of +4. She was diagnosed with Severe Diabetic Ketoacidosis and Cerebral Edema. She received 8 litre/minute of O2 NRM, 10 ml/kg of 0,9% NaCl in 1 hour continued with 1,5 times maintenance need + 5 mmol/kg/day of KCl, 0,1 IU/kg/hour of insulin, and 1 g/kg of mannitol. Renal function monitoring showed daily increases in serum creatinine to 9,2 mg/dL on the day – 7. This pre-renal acute kidney injury was thought to be due to dehydration. She was then referred to a higher-level hospital for hemodialysis.

Conclusions: Diabetic Ketoacidosis in children shows a wide range of clinical manifestations. Therefore, awareness of this condition is of utmost importance in reducing patients' morbidity and mortality.

Introduction: The spread of multidrug-resistant bacterial pathogens has become alarming globally. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) have been recognized as a major multidrug-resistant bacteria implicated in hospital and community-acquired infections worldwide.

Case: We present the case of an elderly male, 74-year-old, with multiple comorbidities, who came to the hospital with main symptoms of cough. Three months previously, he was diagnosed with pneumonia. Nevertheless, he was treated as an outpatient, with Cefixime prescribed as an oral antibiotic. His non-contrast chest CT Scan showed opacities at the upper zone, middle zone and lower zone of the left lung and the lower zone of the right lung. The patient’s symptoms and imaging expertise strongly suggest a pulmonary infection. Sputum culture and sensitivity test result eventually confirmed positive E. coli isolates demonstrated resistance to Augmentin, Ceftazidime, Gentamicin, Ampicillin sulbactam, Aztreonam, Cefotaxime, Cefepime. Fungal culture by sputum specimen revealed growth of Candida, non-Candida albicans. Concurrently, history of hospitalization and antibiotic treatment exposure are considered risk factors for the acquisition of multidrug resistance in this patient. Furthermore, corticosteroids in elderly patients are alleged as a risk factor of fungal infection.

Conclusion: The increasing case of antimicrobial resistance in elderly patients is challenging for the clinician. Culture and sensitivity tests performed before starting antimicrobial treatment in hospitalized geriatric patients can reduce unnecessary and inappropriate antimicrobial use. Fungal test is considered to be done in a susceptible case of the elderly patients. The rapid diagnosis followed with prompt initiation of appropriate antibiotic and antifungal therapy is urgently required.