Background: Anorectal malformation is a congenital abnormality that shows imperfect anus or absence of anus. The most common complication in patients with anorectal malformations after posterior sagittal anorectoplasty (PSARP) are disorders in defecation, especially constipation.

Method: The purpose of this study was to determine the correlation of quality of defecation measured with the presence of constipation with the type of PSARP surgery in Arifin Achmad Hospital of Riau Province. This study used an analytical retrospective method from November 2018 to March 2019. Total sampling was the sampling method used in this study, which accounted for a total of 28 subjects. The population of this study was all patients with anorectal malformation and fistula in the Pediatric Surgery Division of Arifin Achmad General Hospital.

Result: This study showed that among 28 cases found, there were 19 female patients (68%) and 9 male patients (32%). Based on the lesion level, there were 17 cases (60,7%) of intermediate lesions and 11 cases (39,3%) of high lesions. In this study, rectovestibular fistula had the highest incidence among other types of fistula (53,6%). Constipation were found in 53.6% patients with p-value of 0.025 (OR 6.40, 95% CI 1.183-34.613).

Conclusion: There was a significant correlation between the PSARP method and constipation in patients who underwent anorectal malformation surgery, which constipation was a sign of the quality of defecation.

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: 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.

Method: 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.

Result: 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).

Conclusion: there is no relationship between nutritional status and family support with quality of life for the elderly

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.

Background: Tuberculosis (TB) is the leading cause of death from a single infectious agent (Mycobacterium tuberculosis) 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 M. tuberculosis to the meninges and cerebrospinal fluid (CSF).

Result: 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.

Conclusion: 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.

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.

Introduction: 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.

Case description: 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.

Conclusion: 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.

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.