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) Wed, 26 Jan 2022 00:00:00 +0000 OJS 60 Overexpression of Estrogen Receptor 1 (ESR-1) in metastatic prostate cancer <p><strong>Introduction: </strong>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.</p> <p><strong>Methods: </strong>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.</p> <p><strong>Result:</strong> 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.</p> <p><strong>Conclusion: </strong>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.</p> Lucky Frannata, Ery Kus Dwianingsih, Raden Danarto, Indrawarman Copyright (c) 2022 Thu, 23 Jun 2022 00:00:00 +0000 Correlation between serum IL-17 levels with Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels of new cases of pulmonary tuberculosis at Sanglah Central General Hospital, Bali, Indonesia <p><strong>Background: </strong>Tuberculosis (TB) is a mycobacterial infection that usually attacks the lungs and triggers lung damage and dysfunction related to the reléase of IL-17, Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP). This study aims to evaluate the correlation between serum IL-17 levels with ESR and CRP levels in new cases of pulmonary tuberculosis at Sanglah Central General Hospital, Bali, Indonesia.</p> <p><strong>Methods: </strong>A cross-sectional study was conducted among 56 TB patients treated as new pulmonary TB cases in Outpatient and Inpatient Internal Medicine at Sanglah Hospital, Bali, Indonesia. IL-17 levels in this study were the results of IL-17 examination from patient serum using the ELISA method from R&amp;Dsystems with units of pg/mL. The Erythrocyte Sedimentation Rate (ESR) in this study is the rate of blood deposition in mm/hour using a Westergreen tube. Meanwhile, the C-Reactive Protein (CRP) examination was carried out using a Roche 6000 analyzer in mg/dL. Data were analyzed with SPSS version 16 for Windows.</p> <p><strong>Results: </strong>Most respondents are female (75.0%) and the 30-34 years old group (26.8%). The mean value of ESR is 40.39±25.86 mm/hour, followed by CRP (9.95±10.01 mg/dL), and IL-17 (15.21±1.20 pg/mL). There is no significant correlation between ESR to CRP (r=0.069; p=0.613) and IL-17 (r=0.135; p=0.323). In addition, there is no significant correlation between CRP and IL-17 (r=0.168; p=0.215).</p> <p><strong>Conclusion: </strong>This study's results indicate no significant correlation between IL-17 levels with CRP and ESR or between CRP and ESR.</p> Ni Nyoman Mahartini, Jusak Nugraha, Suprapto Ma’at Copyright (c) 2022 Thu, 30 Jun 2022 00:00:00 +0000 Potential diagnostic biomarkers for early detection of idiopathic sensorineural hearing loss in type 2 diabetes mellitus patients <p><strong>Background:</strong> 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.</p> <p><strong>Methods:</strong> 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).</p> <p><strong>Result</strong>: 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.</p> <p><strong>Conclusion</strong>: 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.</p> Agus Santosa, Ketut Suastika, Made Ratna Saraswasti, Wayan Suardana, I Nengah Sujaya Copyright (c) 2022 Mon, 02 May 2022 00:00:00 +0000 Relationship between nutritional status and family support with quality of life elderly <p><strong>Background: </strong>The quality of life elderly in the physical domain will decrease which will lead to changes in nutritional status. Nutritional status can prevent or defend the body from various chronic and acute diseases, and it also plays a role in the healing process. Family support is needed to improve the quality of life elderly to improve health and reduce morbidity and mortality. This study analyzes the relationship between nutritional status and family support with the quality of life elderly.</p> <p><strong>Method: </strong>This type of research is analytical observational with a cross-sectional design. The sample was taken by purposive sampling, namely 145 people over 60 years old. The sampling technique used was cluster sampling which took samples from health centers, namely urban and rural areas. The instruments used were family support questionnaires, WHOQOL-BREF questionnaires, and weight and height measurements. This research analysis used Chi-Square.</p> <p><strong>Result: </strong>There was no significant relationship between nutritional status and quality of life elderly (p = 0.597 ), and there was no significant relationship between family support and quality of life elderly (p = 0.153).</p> <p><strong>Conclusion: </strong>there is no relationship between nutritional status and family support with quality of life for the elderly</p> Astri Dyah Kustiar, Eti Poncorini Pamungkasari, Selfi Handayani Copyright (c) 2022 Thu, 19 May 2022 00:00:00 +0000 The role of Stromal Cell-Derived Factor 1 (SDF-1) and Transforming Growth-Factor-Beta 1 (TGF-?1) levels in Packed Red Cells (PRC) as the indicator of storage lesion at Sanglah Hospital-Blood Bank, Bali, Indonesia <p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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&lt;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).</p><p><strong>Conclusion: </strong>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.</p> Anak Agung Wiradewi Lestari, Ni Kadek Mulyantari, I Putu Yuda Prabawa Copyright (c) 2022 Thu, 27 Jan 2022 00:00:00 +0000 Characteristics of follicular adenoma patients at H. Adam Malik General Hospital, Medan, during the 2017-2020 period <p><strong>Background: </strong>Follicular adenoma is a benign tumor enclosed by a capsule with follicular differentiation, more common in women and usually occurs in adulthood, and is more common in iodine deficiency. The average tumor size is 1-3 cm. Follicular neoplasms do not have features of papillary thyroid carcinoma and no capsule and/or vascular invasion were found. This study aims to evaluate the characteristics of follicular adenoma patients at H. Adam Malik General Hospital, Medan, during the 2017-2020 period</p><p><strong>Methods: </strong>This study is a descriptive study with a cross-sectional approach on 31 samples based on medical record data diagnosed as follicular adenoma. After reviewing the slides, 23 samples were obtained that met the inclusion and exclusion criteria. Samples were assessed according to age, sex, tumor size, number of nodules, growth patterns, and histopathological variants. Data were analyzed using SPSS version 26 for Windows.</p><p><strong>Results: </strong>Cases of follicular adenoma at H. Adam Malik Hospital Medan during 2017-2020 with an average age of 46.7 years. The youngest age was 20 years and the oldest age was 71 years, with the highest age group being 50-59 years (26.1%). Most gender was female (87.0%) than male (13.0%). The most common tumor size was above 4 cm (69.6%). The highest number of nodules was found in 1 nodule (solitary or unilateral) (52.2%). The most common growth pattern in microscopic preparations was macrofollicular adenoma (65.2%), with the most histopathological variant being conventional follicular (91.3%).</p><p><strong>Conclusion: </strong>Benign lesions such as adenomas are often misdiagnosed due to the lack of further studies on the histopathological criteria. Follicular adenomas can be treated with lobectomy and have a good prognosis if diagnosed early and with proper treatment.</p> Lidya Imelda Laksmi, Betty Betty, Sylvia Hilda Copyright (c) 2022 Fri, 04 Feb 2022 00:00:00 +0000 High Bioscore predicts metastasis in breast cancer patients in Sanglah General Hospital, Denpasar, Bali, Indonesia <p><strong>Background:</strong> 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.</p><p><strong>Objective:</strong> To determine the bioscore scoring system as a risk determination for metastases in breast cancer at Sanglah Hospital, Denpasar.</p><p><strong>Methods</strong><strong>:</strong> 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.</p><p><strong>Results</strong><strong>:</strong> 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).</p><p><strong>Conclusion</strong><strong>: </strong>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.</p> Ika Ariandana, Ida Bagus Made Suryawisesa, I Ketut Widiana Copyright (c) 2022 Fri, 18 Feb 2022 00:00:00 +0000 Hypercoagulation state in infant with COVID-19: a case report <p><strong>Background: </strong>COVID-19 pandemic is not over yet, and the clinical manifestations of this newly emerged disease vary due to the rapid mutation of SARS-CoV-2 as its causative agent. The SARS-CoV-2 infection will stimulate the release of proinflammatory cytokines in large amounts, which further leads to hypercoagulation. The aim of this study is to describe a case of COVID-19 with hypercoagulation and what can be done to prevent serious complications.</p> <p><strong>Case:</strong> 1.5-month-old baby boy presented with a complaint of coughing for 10 days. It was accompanied by persistent fever, diarrhea, and vomiting, but no shortness of breath or rhinorrhea was reported. It was known that his parents, whom he was living with, were self–isolating due to COVID – 19. On physical examinations, his vital signs were within normal limits except for axillary temperature, which was tested at 38.3°C. Laboratory results showed a prolongation of coagulation time (PT: 8,3 seconds, APTT: 23,2 seconds), elevated D-Dimer (&gt;10.000 ng/mL), and a positive COVID-19 PCR test. He was diagnosed with a hypercoagulation state in severe COVID-19 and received both supportive and anticoagulant therapy. His condition improved, and he was discharged in good condition after 12 days of hospitalization.</p> <p><strong>Conclusion:</strong> In order to get good outcomes, thorough examinations and comprehensive management have to be ensured in patients with a hypercoagulation state due to severe COVID-19.</p> Teo Wijaya, Peter Prayogo Hsieh, Fitriana Melinda, I Kadek Suarca Copyright (c) 2022 Sun, 31 Jul 2022 00:00:00 +0000 Recurrent shoulder dislocation treated with Bristow Latarjet procedure: a case report <p><strong>Introduction:</strong> The shoulder's glenohumeral joint is the most frequently dislocated joint because of its unstable structure. The recurrence rate of shoulder dislocation is high with most of them were anterior dislocations. Bristow-Latarjet (BL) procedure had been reported to provide good outcomes in restoring the joint's stability. The aim of this report is to describe a case of recurrent anterior shoulder dislocation treated with an open BL procedure.</p> <p><strong>Case description:</strong> A 36-year-old patient came to our center with complaints of left shoulder pain after falling from a bicycle. Anterior apprehension and sulcus sign was positive on the physical examination and MRI showed anteroinferior labral detachment suggesting a Bankart lesion. This was a second episode of left anterior shoulder dislocation of this patient. An open BL procedure was conducted to this patient and good functionality and stability of the shoulder were obtained. The patient’s history, physical, and radiological examinations were in accordance with the diagnosis of recurrent anterior shoulder dislocation due to a Bankart lesion. Open BL procedure was done and its reported outcomes were also supported in several previous studies.</p> <p><strong>Conclusion:</strong> Recurrent anterior shoulder dislocation is still a significant problem, especially in young individuals and athletes. The BL procedure is a good treatment choice in this patient whose instability was due to a Bankart lesion.</p> Safrizal Rahman, Gabriel Klemens Wienanda, Fikri Akbar Copyright (c) 2022 Tue, 31 May 2022 00:00:00 +0000 Severe diabetic ketoacidosis with cerebral edema and acute kidney failure: a case report <p><strong>Background:</strong> 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.</p> <p><strong>Case:</strong> 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.</p> <p><strong>Conclusions:</strong> 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.</p> Peter Prayogo Hsieh, Teo Wijaya, Fitriana Melinda, I Wayan Bikin Suryawan Copyright (c) 2022 Sun, 31 Jul 2022 00:00:00 +0000 Multiple Antimicrobial-Resistant Bacteremia and Fungal Infection Pneumonia in Elderly Patient: A Case Study <p><strong>Introduction: </strong>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.</p><p><strong>Case:</strong> 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.</p><p><strong>Conclusion:</strong> 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. </p> I Gusti Agung Ayu Indrayuni, I Gusti Ayu Agung Istri Anteja, I Gusti Putu Suka Aryana Copyright (c) 2022 Thu, 24 Mar 2022 00:00:00 +0000 Pathogenesis of tuberculous meningitis (TBM): a mini-review <p><strong>Background: </strong>Tuberculosis (TB) is the leading cause of death from a single infectious agent (<em>Mycobacterium tuberculosis</em>) and killed nearly 1.5 million people in 2018. TB mostly manifests as a pulmonary disease but can also affect other parts of the body, causing extrapulmonary TB. Approximately 5% of all cases of extrapulmonary TB are tuberculous meningitis (TBM), which is caused by the spread of <em>M. tuberculosis</em> to the meninges and cerebrospinal fluid (CSF).</p> <p><strong>Result: </strong>TBM is the most devastating form of TB and causes high rates of morbidity and mortality, with an estimated 50% of patients dying or suffering from neurological sequelae and complications. Meningitis is categorized as a medical emergency because it can cause death due to inflammation that occurs in the brain and spinal cord. Most meningitis patients present with fever, and signs and symptoms of meningeal inflammation include headache, neck stiffness and altered mental status. Disease management has limitations due to the limited availability of available diagnostic approaches. Until now, knowledge about the pathogenesis of TBM has been limited.</p> <p><strong>Conclusion:</strong> Further research is urgently needed to improve understanding of disease pathogenesis and diagnostic approaches based on biomarkers of disease. Current knowledge on the pathogenesis of TBM summarize the literature on diagnostic approaches based on biomarkers, which may be useful in the management of TBM.</p> Yuri Haiga Copyright (c) 2022 Sat, 25 Jun 2022 00:00:00 +0000 Prevalence and prognosis from the disability related to spinal tuberculosis: a systematic review <p><strong>Objective: </strong>To review the disabilities caused by Spinal TB in relation to the prevalence and prognosis of the disabilities caused by the disease.</p> <p><strong>Method: </strong>We conducted systematic search of the literatures based on PRISMA (<em>Preferred Reporting Items for Systematic Reviews and Meta-Analyses) </em>and PICO criteria. Our inclusion criteria were: 1) Patients with spinal TB; 2) full original articles; 3) articles written in English; 4) the period of publication of articles from 2012 to 2022. Evaluation of each article was done by checklist <em>Strengthening the Reporting of Observational Studies in Epidemiology</em> (STROBE).</p> <p><strong>Results: </strong>From all articles in the publication year of 2012 to 2022, we reviewed five retrospective cohort studies, all studies coming from Asian countries. The five articles observed the prevalence of disabilities caused by spinal TB reflected through some important outcome variables pre-treatment, where they continued to compare with the post-treatment outcome variables. All of the studies reviewed had agreed that immediate or delayed treatment would give significant benefits to the patients of spinal TB, even better with combined treatments of conventional pre-operative anti-TB drugs and surgical intervention. It was found that poor prognosis associated with preoperative neurological status of the patients.</p> <p><strong>Conclusion: </strong>Conventional anti-TB drugs and surgical intervention can be of great help and benefit for patients with spinal TB, reducing their disabilities severity and improving their prognosis.</p> Juanda Setiajaya Copyright (c) 2022 Sat, 25 Jun 2022 00:00:00 +0000 Body mass index inversely associated with bone microarchitecture quality: a systematic review and meta-analysis <p><strong>Introduction:</strong> 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.</p> <p><strong>Methods: </strong>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.</p> <p><strong>Results:</strong> 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 I<sup>2</sup> 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.</p> <p><strong>Conclusion:</strong> 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.</p> Kevin Kusuman, Kadek Adit Wiryadana, I Made Buddy Setiawan, Su Djie To Rante Copyright (c) 2022 Fri, 01 Apr 2022 00:00:00 +0000 Maintaining the quality of problem-based learning in developing countries during the pandemic era <p>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.</p> Ida Bagus Amertha Putra Manuaba, Gede Putu Supadmanaba, I Gusti Ayu Sri Darmayani, Made Violin Weda Yani, Ni Putu Sri Indrani Remitha, I Gede Aswin Parisya Sasmana, I Gusti Ayu Harry Sundariyati, Dwijo Anargha Sindhughosa Copyright (c) 2022 Tue, 25 Jan 2022 00:00:00 +0000