Indonesia Journal of Biomedical Science Open Access Journal of Biology, Pharmacology, Medicine, Chemistry, Biochemistry en-US <p><a href="" rel="license"><img src="" alt="Creative Commons License" /></a><br /><span>This work is licensed under a </span><a href="" rel="license">Creative Commons Attribution 4.0 International License</a><span>.</span></p> (Putra Manuaba) (Dr. Arul Kandasamy) Mon, 16 Jan 2023 00:00:00 +0000 OJS 60 Association between shear wave liver elastography and fibrosis index in chronic viral hepatitis B patients <p><strong>Background: </strong>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.</p> <p><strong>Methods: </strong>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.</p> <p><strong>Results: </strong>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 &lt; 0.001). After controlling confounding variables, a higher correction was obtained (r=0.61), suggesting a change from moderate to strong correlation (p&lt;0.05).</p> <p><strong>Conclusion: </strong>There was a positive and significant correlation between the elasticity of liver parenchyma and fibrosis index.</p> Harley Septian, Nyoman Srie Laksminingsih, Made Widhi Asih, I Gde Raka Widiana, I Ketut Mariadi Copyright (c) 2023 Wed, 08 Mar 2023 00:00:00 +0000 Effects of virtual music therapy on Burnout Syndrome in health workers in Tertiary Hospitals <p><strong>Background: </strong>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</p> <p><strong>Methods: </strong>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.</p> <p><strong>Results:</strong> This study shows significant differences in the MBI-HSS scores between the intervention and control groups (p&lt;0.05). In the HRV-SDNN scores, there were only significant differences in the control group (p&lt;0.05), although there was an increase in the mean values in the intervention group.</p> <p><strong>Conclusion</strong>: 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.</p> Yanuar Ardani, Rudi Putranto, Em Yunir, Sukamto Koesnoe, Muhadi, Hamzah Shatri, Muchtaruddin Mansyur, Ivona Oliviera, Rendi Faris Anggono, Kezia Putri Copyright (c) 2023 Tue, 21 Feb 2023 00:00:00 +0000 Analysis of Carcinoembryonic Antigen (CEA) markers and Lymphocyte Monocyte Ratio (LMR) in patients with colorectal cancer <p><strong>Background: </strong>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.</p> <p><strong>Methods: </strong>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</p> <p><strong>Results: </strong>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)</p> <p><strong>Conclusion: </strong>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</p> Wihelmina Yuliana Beatrix Madjar, Agus Alim Abdullah, Uleng Bahrun Copyright (c) 2023 Mon, 03 Jul 2023 00:00:00 +0000 The effectivity and safety of cisternostomy and decompressive craniectomy as management of brain trauma: a systematic review and meta-analysis <p><strong>Introduction: </strong>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.</p> <p><strong>Methods:</strong> 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.</p> <p><strong>Results: </strong>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&lt;0,01), decrease in intracranial pressure post-operation is -3.20 mmHg (I2:97%; 95%CI: -3.84 to -2.56; p&lt;0,01), duration of ICU stay is -2.37 days (I2:37%; 95%CI: -4.54 to -0.21; p&lt;0,03), and mortality is 0.51 (I2:21%; 95%CI: 0.42 to 0.63; p&lt;0,01).</p> <p><strong>Conclusion: </strong>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.</p> Agung Bagus Sista Satyarsa, Dewa Putu Wisnu Wardhana, Ida Bagus Yorky Brahmantya, Rohadi Muhammad Rosyid, Sri Maliawan Copyright (c) 2023 Mon, 27 Mar 2023 00:00:00 +0000 Analysis of the ability of nano-mixture of Coriandrum sativum L. and Mimosa pudica L. leaves ethanol extract in lowering blood glucose and malondialdehyde (MDA) increased superoxide dismutase (SOD) in hyperglycaemic Wistar rats <p><strong>Introduction</strong>: Nano-mixture chitosan was used as a nano-extract framework, while tripolyphosphate was used as a stabilizer. <em>Coriandrum sativum L.</em> and <em>Mimosa pudica L.</em> nano extracts were created using the ionic gelatin technique. This study aimed to evaluate the effect of nano-mixture herbal extract of <em>Coriandrum sativum L.</em> and <em>Mimosa pudica L.</em> to lower free radicals and glucose levels in streptozotocin-induced hyperglycaemic rats.</p> <p><strong>Methods</strong>: Fourier transformation infrared (FTIR) characterized the resultant nano-mixture extract. The antihyperglycemic characteristics of a nano-mixture extract were investigated in streptozotocin-induced rats using a randomized post-test-only control group design. At the same time, blood glucose levels and oxidative stress markers MDA and SOD were monitored.</p> <p><strong>Results</strong>: <em>Coriandrum sativum L.</em> and <em>Mimosa pudica L.</em> extracts included polyphenols, flavonoids, alkaloids, and terpenoids, according to the results of the phytochemical test. Nano extract was well supported by PSA characterization as a delivery vehicle for bioactive chemicals, with a zeta potential of -23.98 mV and a particle size of 422.20 nm. The oral administration of the nano-mixture extract at a dose of 50 mg/Kg BW/day had the greatest results for lowering glucose blood MDA and raising SOD levels in hyperglycaemic rats, according to the antihyperglycemic test on streptozotocin-treated rats.</p> <p><strong>Conclusion</strong>: In hyperglycaemic rats, a nano-mixture of <em>Coriandrum sativum L.</em> and <em>Mimosa pudica L.</em> nano extract may lower MDA and blood glucose while raising SOD levels.</p> Sri Wahjuni, Ni Made Puspawati, Mustika Lahaya, I.B. Putra Manuaba Copyright (c) 2023 Tue, 20 Jun 2023 00:00:00 +0000 High expression of CD73 as a negative predictor of clinical neoadjuvant chemotherapy response in triple-negative breast cancer <p style="text-align: justify;"><strong>Background: </strong>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.</p> <p style="text-align: justify;"><strong>Methods:</strong> 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.</p> <p style="text-align: justify;"><strong>Results:</strong> 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.</p> <p style="text-align: justify;"><strong>Conclusion:</strong> 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.</p> Silvia Khosasi, Ni Putu Sriwidyani, I Wayan Juli Sumadi, Ni Wayan Winarti, Ni Putu Ekawati, I Made Muliarta Copyright (c) 2023 Thu, 08 Jun 2023 00:00:00 +0000 Factors Associated with the incidence of perinatal asphyxia at Sanjiwani Regional General Hospital, Gianyar, Bali, Indonesia <p><strong>Background</strong>: perinatal asphyxia is the second-highest cause of neonatal death in Indonesia. According to the World Health Organization (WHO), perinatal asphyxia is when a baby experiences spontaneous and regular breathing failure immediately after birth. Various risk factors may cause perinatal asphyxia, including maternal, fetal, and placental factors. This study aims to identify the risk factors associated with the incidence of perinatal asphyxia at the Sanjiwani Regional General Hospital, Gianyar.</p> <p><strong>Methods</strong>: This research was an observational analytic study with a case-control design involving 114 samples of newborns from January 1 to December 31, 2022, at the Sanjiwani Gianyar Hospital. The case group was selected using a total sampling technique, and the control group using a simple random sampling technique. Data were extracted from the medical records and analyzed using univariate, bivariate, and multivariate methods. Bivariate analysis used Chi-square or Fisher's exact tests, while multivariate analysis used logistic regression. The P-value of &lt;0.05 is considered significant.</p> <p><strong>Results</strong>: A total of 57 cases and 57 controls were included in this study. The bivariate analysis found the factors associated with perinatal asphyxia were meconium-stained amniotic fluid (p=0.021; OR=2.742; 95%CI=1.150-6.539), mode of delivery (p=0.003; OR=3.203; 95%CI=1.484-6.913), low birth weight (p=0.002; OR=4.595; 95%CI=1.681-12.561), and prematurity (p=0.006; OR=4.732; 95%CI=1.462-15.322). In multivariate analysis, it was found that meconium-stained amniotic fluid has the strongest association with perinatal asphyxia.</p> <p><strong>Conclusion</strong>: There is a significant relationship between meconium-stained amniotic fluid, method of delivery, low birth weight, and prematurity with the incidence of perinatal asphyxia.</p> Kadek Enny Pradnyaswari, Romy Windiyanto Copyright (c) 2023 Fri, 03 Mar 2023 00:00:00 +0000 Identification and quantification of Roseburia intestinalis and Escherichia coli in hypertensive patients in Denpasar <p><strong>Background</strong>: 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 <em>Escherichia coli</em> (<em>E. coli</em>) and <em>Roseburia intestinalis </em>(<em>R. intestinalis</em>). Therefore this study aimed to identify and quantify gut microbes namely <em>R. intestinalis</em> and <em>E.coli</em> in hypertensive patients in Bali, especially in Denpasar City.</p> <p><strong>Methods</strong>: 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 <em>E. coli</em> and <em>R. intestinalis</em> 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</p> <p><strong>Results</strong>: 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 <em>E. coli</em> concentration in their gut compared with non-hypertensive subjects (p=0.048), while <em>R. intestinalis</em> concentrations were similar in both groups (p&gt;0.05). From the multivariate analysis, it was found that hypertensive patients tended to have a higher concentration of <em>E. coli</em> than non-hypertensive patients (p=0.012; 95% CI:0.055–0.417).</p> <p><strong>Conclusion</strong>: <em>E. coli</em> concentration in the gut is independently associated with the incidence of hypertension, while <em>R. intestinalis</em> concentration is not.</p> Komang Januartha Putra Pinatih, Desak Made Wihandani, Agus Eka Darwinata, Gede Setula Narayana, I Putu Gede Septiawan Saputra, I Gede Putu Supadmanaba Copyright (c) 2023 Mon, 17 Apr 2023 00:00:00 +0000 Characteristic and risk factors of retinopathy of prematurity in Sanglah Hospital Denpasar: 3-years retrospective study <p><strong>Introduction:</strong> Retinopathy of prematurity (ROP) is one of the important causes of blindness in children. ROP is characterized by abnormal retinal neovascularization of premature infants.</p> <p><strong>Purpose:</strong> 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.</p> <p><strong>Methods:</strong> 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 &gt;30 weeks or whose birth weight was &gt;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.</p> <p><strong>Results:</strong> Out of 31 infants diagnosed as ROP, 3 (9.7%) cases developed ROP in one eye, and 28 (90,3%) cases in both eyes<strong>. </strong>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).</p> <p><strong>Conclusions</strong>: 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.</p> I Wayan Eka Sutyawan, Maria Vinsensia Lie , Intan Ade Indraputri , Made Ayu Surasmiati , Ari Andayani, Ni Made Ari Suryati Copyright (c) 2023 Tue, 28 Feb 2023 00:00:00 +0000 Analysis of eosinophil count as a predictor of Acute Lymphoblastic Leukemia (ALL) <p style="text-align: justify;"><strong>Background:</strong> Acute lymphoblastic leukemia (ALL) is a malignancy of blood cells in many children<strong>. </strong>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.</p> <p style="text-align: justify;"><strong>Methods</strong>: 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&lt;0.05.</p> <p style="text-align: justify;"><strong>Results: </strong>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&lt;0.05). Based on the ROC curve, the value AUC = 0.660 and significant (p&lt;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.</p> <p style="text-align: justify;"><strong>Conclusion</strong>: 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.</p> Nefie Ilona Nurue, Darwati Muhadi, Mansyur Arif Copyright (c) 2023 Thu, 08 Jun 2023 00:00:00 +0000 Making tinnitus songs according to the frequency and amplitude of the sound of tinnitus sufferers that are safe and comfortable for sufferers <p><strong>Background: </strong>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.</p> <p><strong>Methods:</strong> 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.</p> <p><strong>Results:</strong> 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 &lt; 85dB so that it can be adjusted with the volume control on the speaker.</p> <p><strong>Conclusion:</strong> 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 &lt; 85 dB, which can be adjusted with the volume so that it is safe and comfortable for tinnitus sufferers.</p> Made Lely Rahayu, Eka Putra Setiawan, I Ketut Sumerjana, Ida Bagus Made Suryatika, I Wayan Gede Artawan Eka Putra, Ketut Tadeus Max Nurcahya Pinatih, Idola Pratiwi, I Made Nudi Arthana, I Gusti Ayu Putu Wahyu Widiantari Copyright (c) 2023 Tue, 07 Mar 2023 00:00:00 +0000 Prevalence and Characteristics of Pediatric Abdominal Mass in Radiology Department Prof. Ngoerah General Hospital Bali, From January 2018 to December 2020 <p><strong>Introduction:</strong> 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.</p> <p><strong>Methods</strong>: We conducted a descriptive, cross-sectional study of patients with abdominal masses</p> <p>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.</p> <p><strong>Results:</strong> 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 &lt;1 month (5 patients, 4%) respectively. The average age was 7.44 years old.</p> <p><strong>Conclusion:</strong> The abdominal imaging and histopathological findings help evaluate abdominal mass in children. An accurate diagnosis is essential for proper management.</p> Ni Nyoman Margiani Copyright (c) 2023 Wed, 08 Mar 2023 00:00:00 +0000 Comparison of cognitive function tests AD8-INA against MoCA-INA and CDT in the elderly age group at the Uabau Health Center <p><strong>Background: </strong>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.</p> <p><strong>Methods:</strong> 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.</p> <p><strong>Results:</strong> 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%.</p> <p><strong>Conclusion: </strong>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.</p> Ni Putu Inna Ariani, Anak Agung Ayu Agung Pramaswari Copyright (c) 2023 Thu, 08 Jun 2023 00:00:00 +0000 Apoliprotein C-III (Apo C-III) inhibitors effect of antisense oligonucleotides in the management of dyslipidemia <p><strong>Introduction: </strong>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.</p> <p><strong>Purpose: </strong>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</p> <p><strong>Methods: </strong>This paper is a literature review that collects and selects data from credible sources using the keywords apoliprotein C-III, antisense oligonucleotides, and dyslipidemia</p> <p>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</p> <p><strong>Conclusion: </strong>Antisense oligonucleotides have great potential to inhibit Apo C-III as a treatment for dyslipidemia.</p> I Gede Aswin Parisya Sasmana, Putu Nindya Krisnadewi Rahadi, Anggi Amanda Triana Devy, Putu Ari Shanti Dewi, I Gede Putu Supadmanaba, Desak Made Wihandani Copyright (c) 2023 Thu, 12 Jan 2023 00:00:00 +0000 Cardiorenal Syndrome: revisiting its pathophysiology and classification <p>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.</p> I Made Fermi Wikananda, I Gde Raka Widiana, Dwijo Anargha Sindhughosa Copyright (c) 2023 Fri, 07 Apr 2023 00:00:00 +0000 The impact of the COVID-19 pandemic on the readiness of last year's medical students for clinical rotation <p>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.</p> Ida Bagus Amertha Putra Manuaba, Made Violin Weda Yani, I Gusti Ayu Sri Darmayani, I Gusti Ayu Harry Sundariyati, I Gede Putu Supadmanaba, Putri Ayu Wulandari, I Gede Krisna Arim Sadeva, Anak Agung Bagus Putra Indrakusuma Copyright (c) 2023 Mon, 16 Jan 2023 00:00:00 +0000 The impact of formula-fed feeding in comparison with breastfeeding to the infant’s intestinal microbiota: a literature review <p>Child health outcomes are related to the mother's nutrition during pregnancy and the baby's diet throughout infancy. The child's intestinal microbiome is the main source of postnatal immunological activation, which is linked to both health and disease in children. Nursing exclusively is advised for the first six months of a baby's life; otherwise, dairy-based infant formula is a supplement to breastfeeding. Numerous studies have shown that breastfed newborns have a different makeup of gut flora compared to infants fed formula. To highlight the important differences between human milk and infant formula in the development of the early intestinal microbiota and immune system, this study attempts to ignore any plausible explanations for some of the risks and benefits associated with human milk and infant formula. The approach was a literature review. A comprehensive search was done on the Pubmed Central® search engine. Using the Boolean operators "AND" and "OR," the search terms used are "breastfeeding," "formula," "microbiota," "intestinal," "human milk," and "infant." Among all the publications purchased, articles comprising various types of studies relevant to the literature review topic were picked. Breastfeeding is the preferred baby-feeding strategy. If exclusive breastfeeding is not preferred, infant formula prepared from cow's milk should be altered to promote the development of the infant's gut flora. Formulations could be modified by adding probiotic or prebiotic oligosaccharide agents.</p> Adrianus Andri Copyright (c) 2023 Wed, 30 Aug 2023 00:00:00 +0000 Immune regulation in obesity: a narrative review <p>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.</p> Ida Bagus Amertha Putra Manuaba, Dwijo Anargha Sindhughosa Copyright (c) 2023 Tue, 18 Apr 2023 00:00:00 +0000 Change of ABO blood group in a patient with Acute Myelocytic Leukemia (AML): a case report <p><strong>Background: </strong>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.</p> <p><strong>Case Description: </strong>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<sup>th</sup> until May 28<sup>th</sup> 2018. On July 21<sup>st</sup> 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.</p> <p><strong>Conclusion:</strong> 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.</p> Ni Ketut Puspa Sari, Ni Kadek Mulyantari, Sianny Herawati, Anak Agung Wiradewi Lestari, Ni Nyoman Mahartini, I Nyoman Wande Copyright (c) 2023 Fri, 14 Apr 2023 00:00:00 +0000 Post-return of spontaneous circulation (ROSC) management in STEMI patient with COVID-19: a case report <p><strong>Background:</strong> 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.</p> <p><strong>Case Presentation:</strong> A 43-year-old man came with a complaint of typical chest pain 3 days before admission, accompanied by symptoms of <em>orthopnea and dyspnea on exercise</em>, 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.</p> <p><strong>Conclusion:</strong> 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.</p> Richard Copyright (c) 2023 Wed, 14 Jun 2023 00:00:00 +0000 Inverted Papilloma in a 61-year-old Man: A Case Report <p><strong>Introduction</strong>: 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.</p> <p><strong>Case Presentation</strong>: 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.</p> <p><strong>Conclusion: </strong>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</p> Agus Santosa, Dian Permatasari, Putu Pradnyasanti Laksmi, Made Ratih Santi Devinta, Made Ratna Saraswati Copyright (c) 2023 Thu, 08 Jun 2023 00:00:00 +0000