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: Dementia is a syndrome of decreased cognitive ability that hinders daily life. Dementia is associated with mortality, especially in patients with major depression, so health services are needed to identify cognitive disorders through pre-elderly and elderly screening. AD8-INA is one of the cognitive screening methods where the questions are directed to patient caregivers that are most practical, concise, and suitable for patients who cannot use their dominant hand, so researchers are interested in studying the sensitivity and specificity of AD8-INA to MoCA-INA and CDT.

Methods: A cross-sectional study design was used to observe and analyze cognitive function variables. This study used primary data sources with interviews based on questionnaires on 114 subjects, consisting of pre-elderly and elderly groups who met the eligibility criteria to be included in the study. The MoCA-INA scores were divided into 26 normal and 26 cognitive impairments, the CDT scores 4 normal and 4 cognitive impairments, and the AD8-INA scores 0–1 normal and 2 cognitive impairments. An analysis was carried out to determine the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and confidence interval.

Results: It was found that the sensitivity of AD8-INA to MoCA-INA was 87.14%, AD8-INA to CDT was 82.14%. In addition, the specificity of AD8-INA to MoCA-INA was 50% and AD8-INA to CDT was 61.11%.

Conclusion: AD8-INA has high sensitivity but low specificity. AD8-INA can still be used as an initial screening tool for cognitive function at the Uabau Health Center, but all examination results must be evaluated further.

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.

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.

Heart failure remain as major health problem worldwide, causing severe morbidity and high mortality. Strong relationship between cardiac disorders and kidney disorders that affect the patient's prognosis. Cardiorenal syndrome (CRS) is a group of symptoms due to acute or chronic damage to one of the organs, including the heart or kidneys, which will affect the function of other organs. The heart and kidney each play a role as a regulator of the body's hemodynamic balance. The kidneys produce urine based on that produced by glomerular filtration which depends on the level of renal perfusion and arteriolar blood pressure. CRS classified into five. The classification is based on the primary and secondary damage from CRS occurs in the heart, kidney or outside the heart and/or kidney. Understanding the pathophysiology of CRS benefit to comprehensively manage patients with such condition.

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