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AIM: To compare intraluminal stenting and external ligation of Ahmed glaucoma valves (AGV) for refractory glaucoma management and postoperative hypotony prevention. METHODS: This randomized prospective blind study included 30 eyes of 25 patients (age range: 44-56y) with refractory glaucoma. This study was conducted from September 2018 to January 2020. The study included two groups, AGV with intraluminal stenting group (n=15 eyes) and AGV with external ligation group (n=15 eyes). Follow-up period was one year postoperatively. The primary outcome was intraocular pressure (IOP) and its association with the number of postoperative glaucoma medications. IOP?≤?21 mm Hg without medications indicated complete success while IOP?≤?21 mm Hg with medications indicated qualified success; and IOP

Background: Congenital Glaucoma(CG) is a multiple disease features that can lead to loss of vision. Unfortunately, studies involved in the detection of PCG in Egypt are not enough. Delayed diagnosis and management in those patients consequently lead to burdens on patients and their families. Objectives: To assess the frequency of CG among children aged 0 to 4years and to describe its associated risk factors and the used surgical modalities.Methods: A retrospective study was conducted on children aged 0-4years and presented to out-patient clinics at ophthalmology and pediatrics departments in Menoufia University hospitals during the period from 2017 to 2020. Results: Incidence of congenital glaucoma was 65.8 per100,000 patients during the studied 4years. Bilateral PCG comprised 84% of the total patients. Incidence of conjunctivitis, Nasolacrimal Duct Obstruction(NLDO), and corneal abrasion represented 526.3,394.7,and78.95 per100,000, respectively. Eighty-two percent of the patients had positive consanguineous marriage. Positive family history of PCG was detected in 20% of the patients. A highly significant difference was detected regarding pre to post-surgical management of PCG. Axenfeld-Rieger syndrome was presented only in 1patient. Visual acuity was mostly managed either by fix and follow or poor fixation in 42%and56%of the patients, respectively. Seven patients only experienced post-operative complications such as hypotony, choroidal hypotony, or uncontrolled IOP. Visual acuity problems were reported in32%of the patients.Conclusion: There was a high incidence of primary congenital glaucoma among children aged0-4years old declaring a public health concern. All children should be routinely investigated and assessed at birth for early detection and proper management.

BACKGROUND: Traumatic brain injury (TBI) is a major health problem. Surgery in patients with TBI is associated with a high rate of complications and mortality. The surgical Apgar score (SAS) is a simple quantitative and objective intraoperative tool for predicting major post-operative complications including mortality. AIM: Our study aimed to analyze the use of SAS as a predictor of post-operative complications in patients with TBI. METHODS: This was a prospective cohort study at our center in RSHS, Bandung, Indonesia, throughout 2017 by assessing SAS based on calculating intraoperative estimated blood loss, lowest mean arterial pressure, and lowest heart rate for each patient with TBI, as well as the incident complications within 30 days post-operative were recorded. RESULTS: One hundred fifty-six patients with TBI underwent surgery in 2017 with 123 patients met the inclusion criteria. Among those, 63 patients (51.2%) developed major complications with 8 patients (12.7%) experienced death. The mean SAS for patients without complication was 8.20, whereas for patients with complication was 6.11. SAS has an inverse correlation (r = –0.754) and an association (p < 0.005) with post-operative complication (s) within 30 days. CONCLUSIONS: The SAS has an inverse correlation and an association with incidence of complications thus potentially useful as an intraoperative predictor for incident complications within 30 days post-operative care in patients with TBI.

BACKGROUND: Traumatic brain injury (TBI) stills the leading cause of public health problem and disabilities in many countries, especially in lower-middle-income countries. Motor vehicle crashes, especially motorized two-wheeler riders, are the major cause of TBI, followed by fall and assault. During 2013–2014, a total of 2108 TBI cases (65.4% of them being caused by motor vehicle crashes) were documented in the Emergency Unit of Dr. Hasan Sadikin Hospital (RSHS) Bandung. Among these, 30.7% of cases were categorized as moderate and severe TBI, with a mortality rate of 29.2%. Half of the cases arrived at RSHS within 6 h and 14.0% of these cases were alcohol-intoxicated. Individuals with low activity of alcohol-metabolizing enzymes have low tolerance to alcohol and are therefore rapidly intoxicated, making them more susceptible to more serious injuries from motor vehicle crashes. METHODS: A prospective study was designed by consecutive sampling from January to August 2017 to review 30 intoxicated patients with TBI on hospital admission by measuring their serum alcohol dehydrogenase (ADH) concentration using an ELISA and then correlated it with the severity, type of TBI lesions, and the outcome. RESULTS: Demonstrated an ADH level of l d0.24 ng/ml in patients with TBI with a history of alcohol intoxication, which statistically correlated with lower initial Glasgow coma scale (GCS) scores on admission by approximately 6.53 times (p < 0.001), thus increasing the risk of developing multiple lesions by 3.98 times (p = 0.029) and worse outcomes by 5.27 times (p = 0.003), but it did not correlate with length of stay (p = 0.392). CONCLUSIONS: ADH concentrations in intoxicated TBI patients can be taken into consideration to decide about the therapeutic action and further informed consent to the family.

AIM: To evaluate the safety and efficacy of augmented trabeculotomy with Ologen versus perfluoropropane in management of pseudophakic glaucoma. METHODS: This is a comparative randomized study included 57 pseudophakic eyes of 57 patients with medically uncontrolled open angle glaucoma (OAG). Twenty-nine patients were allocated in group I (trabeculectomy with Ologen; trab-ologen group), while 28 patients were assigned in group II (trabeculectomy with perfluoropropane gas bubble; trab-C3F8 gas bubble group). RESULTS: The intraocular pressure (IOP) was significantly reduced in both study groups at all postoperative follow up intervals (1wk, 3, 6, 12, 18, 24, 30 and 36mo, P

Aim: To assess the psychological impact of the COVID 19 pandemic on practicing ophthalmologists in Egypt. Methods: A cross-sectional study with convenience sampling technique was conducted on 300 ophthalmologists from July to September 2020 through personal interview and online questionnaires including data about i. Characteristics of the participants, ii. Medical and surgical procedures that have risk for transmission of COVID 19 and usage of protective precautions, iii. Generalized Anxiety Disorder Assessment (GAD), and iv. Patient Health Questionnaire-9 (PHQ-9). Results: The study was conducted on 300 ophthalmologists distributed as 138 were male(46%) and162 were females(54%). Symptoms of anxiety were reported in 93.3% while depression symptoms were reported among(72.7%) of the participants. Anxiety significantly increased among ophthalmologists who are married(p=0.001), being resident doctor(P=0.001), having been infected with COVID-19(P=0.034) and knowing a colleague in the same specialty infected with COVD-19(0.001). Severe anxiety was significantly reported among those took all precautions against COVID-19(p=0.004) and at the same time these precaution were uncomfortable(p=0.001) where usage of face shield or slit lamp partition makes the examination difficult(p=0.029,0.001 respectively). Also severe anxiety was reported among those who decided to continue all infection control precaution incase COVID-19 continues(p=0.001). Depression symptoms were significant among ophthalmologists who are married(p=0.001), being resident doctor(P=0.001), having been infected with COVID-19(P=0.004) and knowing a colleague in the same specialty infected with COVD-19(P=0.003). Conclusion: COVID-19 pandemic had a great effect on young aged, married and resident, who taken much precautions and who are previously infected or knew a colleague infected with COVID-19.

AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy (SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb. METHODS: This randomized prospective study included 28 eyes from 28 patients (age range: 42-55y) with primary open angle glaucoma (POAG) presented with elevated intraocular pressure (IOP) with fibrotic bleb despite previous SST for more than 4mo. The eyes enrolled in the study were divided into two groups: group I (subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C (MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity (VA), visual field (VF), and postoperative complications. RESULTS: A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg (P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg (P=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF. CONCLUSION: Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.

BACKGROUND: Normal pressure hydrocephalus (NPH) is characterized by an abnormal buildup of cerebrospinal fluid in the ventricles or cavities of the brain. The objective of the case report was to define the importance of physical medicine and rehabilitation intervention as an approach for an elderly patient with NPH. CASE REPORT: A 75-year-old woman presented with a balance and gait disturbance after injury from a motor vehicle accident. The patient experience Hakim’s triad (gait disturbance, urinary frequency, and mild cognitive impairment), and her computed tomography scan of the head revealed ventriculomegaly, multiple lacunar infarctions on the paraventricle, and cerebral atrophy, which could indicate NPH. Balance and gait training, cardiopulmonary training, and environment modification were interventions from physical medicine and rehabilitation provided to this patient. CONCLUSION: An elderly patient with NPH should receive physical medicine and rehabilitation intervention to prevent falls, improve functional ability, and improve quality of life.

BACKGROUND: Cardiovascular disease is a leading cause of death globally with the 287,000 deaths per years, characterized by declining of heart function caused by the reduction of heart capacity and lead to heart failure. Cell therapy using endothelial progenitor cells (EPCs) has a big potential for cardiovascular regeneration. EPCs are cells that have ability to differentiate into endothelial cells that can be mobilized and integrated into the defected blood vessel by angiogenesis. AIM: We aimed to seek the superior EPCs derived from MNCs for functional improvement of advanced heart failure patient by cell therapy using EPCs. MATERIALS AND METHODS: We did preliminary analysis to compare umbilical cord blood (UCB), healthy adult peripheral blood (PB)-, and myocardial infarct PB-derived EPCs characteristic and surface phenotypes. Different sources of each EPCs mononuclear cells were characterized by the expression of endothelial (cluster of differentiation [CD] 31, acethylated low-density lipoprotein, and von Willebrand) and hematopoietic stem cell (CD45, CD34, and CD133) surface markers with flow cytometry. RESULTS: In this study, EPCs and the conditioned medium (CM) have been produced and characterized in laboratory scale by comparing several sources of EPCs for instance UCB, PB from healthy people, and patients with myocardial infarction. We have shown that EPC characterizations from each group were not significantly different, but vascular endothelial growth factor and hepatocyte growth factor in UBC-derived CM-EPCs were higher than in PB. CONCLUSION: In conclusion, the UBC-derived EPCs might have a better potential for cardiovascular regeneration.

BACKGROUND: Moyamoya disease (MMD) is a peculiar disease, characterized by progressive steno-occlusion of the distal ends of bilateral internal carotid arteries and their proximal branches. Numerous studies of MMD investigated as a singular pathway, thus overlooked the complexity of MMD pathobiology. AIM: In this study, we sought to investigate the gene expression in the involved arteries to reveal the novel mechanism of MMD. MATERIALS AND METHODS: Eight middle cerebral artery (MCA) specimens were obtained from six patients underwent surgical procedure superficial temporal artery to MCA (STA-MCA bypass) for MMD and two control patients. We performed RNA extraction and microarray analysis with Agilent Whole Human Genome DNA microarray 4x44K ver.2.0 (Agilent Tech., Inc., Wilmington, DE, USA). RESULTS: From 42,405 gene probes assayed, 921 gene probes were differentially regulated in MCA of patients with MMD. Subsequent pathway analysis with PANTHER database revealed that angiogenesis, inflammation, integrin, platelet-derived growth factor (PDGF), and WNT pathways were distinctly regulated in MMD. Among genes in aforementioned pathways, SOS1 and AKT2 were the mostly distinctly regulated genes and closely associated with RAS pathway. CONCLUSION: The gene expression in MCA of patients with MMD was distinctly regulated in comparison with control MCA; presumably be useful for elucidating MMD pathobiology.

Background: This work was designed to clarify, for the first time up to our knowledge, the effects of high-fructose diet (HFrD)-induced metabolic syndrome (MetS) on the pituitary-gonadal axis of adolescent male rats continuing through adulthood period and to evaluate the possible role of ginger extract in ameliorating these effects. Materials and methods: Forty 4-week-old male albino rats, treated for 8 weeks, were randomly divided into four equal groups; control (fed standard diet), ginger extract-treated (500 mg/kg once daily orally by gavage), HFrD-induced MetS (fed a diet containing 60% fructose), HFrD and ginger groups. The assessment methods included biochemical, histological and immunohistochemical studies. Results: High-fructose diet-fed rats exhibited a picture similar to MetS in the form of increased body weight and serum levels of glucose and insulin with an elevated HOMA-IR reflecting insulin resistance as well as dyslipidaemia. Lipid peroxidation (increased malondialdehyde) and oxidative stress (decreased superoxide dismutase) were implicated in this syndrome. This group exhibited a significant decrease in testicular weight and the levels of reproductive hormones (LH, FSH and testosterone). The pituitary gonadotrophs showed electron dense nuclei, large cytoplasmic vacuoles, destructed organelles in addition to decreased number of secretory granules. Furthermore, testicular specimens presented marked alterations. There were disorganised shrunken tubules with irregular basement membranes, reduced germinal epithelial thickness, vacuolations and degenerated mitochondria in the spermatogenic cells. Beclin 1 and proliferating cell nuclear antigen immunoexpressions were significantly downregulated with HFrD-induced MetS. Ginger extract supplementation proved to be a potent protective agent against these harmful effects through its antioxidant, hypoglycaemic, insulinotropic, androgenic and hypolipidaemic effects in addition to its ability to induce testicular autophagy. Conclusions: Consumption of HFrD induced MetS and proved to have harmful effects on the pituitary-testicular axis. Moreover, this work provided a new insight into the possible use of ginger extract to alleviate the main features of MetS and protect the pituitary-gonadal axis from the damaging effects of HFrD-induced MetS.

BACKGROUND: Coronavirus (CoV) disease (COVID-19) has become a global health pandemic by early 2020; it has pushed the health-care system to its limit. From the initial estimates, 15% of COVID-19 patients caused by severe acute respiratory CoV 2 syndrome present with severe symptoms and requires hospitalization or even intensive care. There is no specific treatment against COVID-19, particularly for those with severe symptoms. Desperation caused by COVID-19 has driven clinicians to try an alternative therapies with little or even no-evidence previously. Convalescent plasma therapy (CPT) has emerged as a promising COVID-19 therapy. AIM: We aimed to review current state of convalescent plasma therapy. METHODS: We summarize the historical CPT, COVID-19 pathology and evaluate potential of CPT for COVID-19; raising the question regarding routinely administrating CPT to the COVID-19 patients, whether it is safe and effective. RESULTS: From cases in Indonesia and other countries, there is bunch of examples that healthcare workers being negatively stigmatized in case of COVID-19. They lost their rights to have a normal life in this pandemic era. A reasonable basis is found in many literatures to advocate the CPT. Convalescent plasma from COVID-19 patients who had been recovered with high neutralizing antibody titers was reported to be effective on transfusion to other COVID-19 patients. CONCLUSION: CPT is one good option to treat COVID-19 patients, but it not without risk; many potential candidate treatment that promising in theory but somehow fall apart when translated into clinical study; only time will tell, including our ongoing CPT clinical study.

Background: Light chain3 is a sensitive autophagy-related protein distributed within the mammalian tissues. The role of LC3 localization in psoriasis pathogenesis is still poorly understood. Objective: This study aimed to investigate, for the first time up to our knowledge, the localization of Light chain3 (LC3) in the keratinocytes of psoriatic skin by immunohistochemical study. Materials and methods: This prospective case case-control study was carried out on 30 patients presented with chronic plaque psoriasis versus 30 age and gender-matched apparently healthy volunteers. Clinical data were collected and Psoriasis Area and Severity Index (PASI) was assessed. From all controls and cases (lesional and perilesional), skin biopsies were taken and the epidermis was assessed for histopathological changes and LC3 immunoreaction. Results: There was a highly significant difference (P

Background: Chronic pancreatitis is a progressive inflammatory disease that causes damage and fibrosis of the parenchyma of pancreas, thus leads to endocrine and exocrine dysfunction. Objective: The goals of this review were to analyze morphological alterations in pancreatic tissue during chronic pancreatitis and this analysis addresses the effect of pancreatic stellate cells (PSCs), on chronic pancreatitis, and collagen fiber deposition. Results: This review also discussed the different immunohistochemical markers for PSCs. Alpha smooth muscle actin (α-SMA) is an excellent marker for activated PSCs. Transforming growth factor beta (TGFβ) is an important profibrogenic cytokine that appears to act by stimulating collagen production by PSCs. Conclusion: It was concluded that chronic pancreatitis caused a significant and progressive serious effects on the acinar cells, duct system, and islets of Langerhans in the form of intracellular vacuolations, decreased zymogen granules, pyknotic nuclei and thickening of the duct wall, and extensive fibrosis. It is hypothesised that during pancreatic injury, PSCs are activated and proliferated exhibiting positive staining for the cytoskeletal protein α- SMA, and synthesising amounts of extracellular matrix proteins, particularly collagen.

BACKGROUND: Adenocarcinoma (ADC) of the lung is the most common subtype of non-small cell lung cancer (NSCLC), occurring in ~40% of all patients with significantly higher incidence of brain metastasis compared with other subtypes of NSCLC. Among the five subtypes ADC of the lung, micropapillary predominant ADC may be more likely to metastasize. There are almost no reports of micropapillary ADC of the lung initially discovered to metastasis into the same site in the brain that has been previously operated. CASE REPORT: We reported a 54-year-old woman who was referred to ICU of Dr. Hasan Sadikin Hospital, Bandung, due to a decreased of consciousness. Head computed tomography scan revealed multiple isohypodense lesions in the right frontal with brain edema. She had craniotomy total tumor removal 8 months earlier and diagnosed as brain metastasis due to micropapillary ADC of the lung. She refused to receive chemoradiotherapy. At the operation site, multilobulated lesions were found, and hence, she was operated for the 2nd time at the same site with the first one, exhibited the same histology. Immunohistological shown positive results for thyroid transcription factor (TTF)-1 and cytokeratin (CK)-7; negative for CK-20, led to a diagnosis of micropapillary ADC of the lung. CONCLUSION: Herein, we reported our experience regarding a case of micropapillary ADC of the lung, considered as poorly differentiated ADC and associated with a high-grade lesion that metastasized to the same site that had been previously operated, twice. A definitive diagnosis was possible only through a histopathological examination along with a good communication between the surgeon and the pathologist.

Schwannoma are benign peripheral nerve tumors derived from the Schwann cells in the neural sheath. Sciatic nerve schwannoma in the lower extremity is uncommon, accounting for only 1% of all schwannoma cases. This report aimed to describe the functional recovery after lower limb surgery of sciatic nerve schwannoma with peripheral nerve block and without intraoperative neurophysiological monitoring (IOM) performed in Semen Padang Hospital in 2019. A 78-year-old woman presented with a complaint of pain on her slowly growing mass at the right popliteal region, which had existed for 22 years. Microsurgical resection was performed with local peripheral nerve block and without intraoperative neurophysiological monitoring. Tumor was removed en-bloc by sharp dissection using a microscope without any complication. The patient had significant pain relief without any neurologic deficit three weeks after the surgery. Penyembuhan Secara Fungsi Kasus Langka Schwannoma Saraf Sciatic dengan Blok Saraf Perifer Tanpa Pemantauan Neurofisiologis Intraoperatif Schwannoma adalah tumor saraf tepi jinak yang berasal dari sel Schwann dalam selubung saraf. Pada ekstremitas bawah, schwannoma saraf sciatic jarang terjadi, terhitung 1% dari semua schwannoma. Laporan ini bertujuan menggambarkan pemulihan fungsional dengan blok saraf perifer setelah operasi tungkai bawah schwannoma saraf sciatic tanpa pemantauan neurofisiologis intraoperatif (IOM) di Rumah Sakit Semen Padang, 2019. Seorang wanita 78 tahun datang dengan keluhan nyeri pada massa yang tumbuh perlahan di daerah popliteal kanannya selama 22 tahun. Reseksi bedah mikro dilakukan dengan blok saraf perifer secara lokal dan tanpa pemantauan neurofisiologis intraoperatif. Tumor terangkat secara en-bloc dengan diseksi tajam menggunakan mikroskop tanpa ada komplikasi. Pada minggu ketiga pascaoperasi, pasien mengalami pengurangan rasa sakit yang signifikan tanpa defisit neurologis.

This prospective study aimed to compare the surgical outcomes of ab externo 240-degree trabeculotomy and trabeculotomy–trabeculectomy in managing primary congenital glaucoma (PCG). The study included 30 eyes of 30 patients aged less than 3 years who were diagnosed with PCG and was conducted in Menofia University Hospital between November 2018 and January 2020. The studied eyes were divided into two equal groups. Ab externo 240-degree trabeculotomy and combined trabeculotomy with trabeculectomy with MMC were performed for groups I and II, respectively. Post-operative measurements included intraocular pressure (IOP), optic disc changes, alteration in corneal clarity and transverse corneal diameter, as they are needed for antiglaucoma therapy. Post-operative complications were followed up for 1-year. There was significant reduction in IOP in both groups during the follow-up period. The reduction was higher in group I, where mean preoperative IOP was 28.20 ± 1.74 mmHg. The IOP in the group II was 28.07 ± 3.51 mmHg. The mean IOP decreased to 13.93 ± 1.8 mmHg and 14.60 ± 1.24 mmHg in groups I and II, respectively, after 1 year (P

The triage system currently recommended by the Association of Emergency Physicians (ACEP) and Emergency Nurses Association (ENA) is a five levels triage, Emergency Severity Index (ESI) due to more structured, concise, and clear. Cibabat Hospital used a relatively new triage of four modified levels of the Australian Triage Scale (ATS) which accuracy and time triage have not been evaluated. The purpose of this study was to compare the four level triage of modification of ATS and five levels of ESI triage based on accuracy and time triage. The researcher used a quantitative quasi-experimental design with samples of triage activities totaling 38 in the control group and 38 intervention groups, using accidental sampling techniques. Univariate analysis consisted of frequency distribution for nurse characteristics, time triage and accuracy, bivariate analysis used the Mann-Whitney test. The results showed there were no differences, triage modification of ATS with ESI triage in accuracy (p-0.488), and length of triage (p-0.488) ESI triage accuracy was in the expected triage category (76.3%), under triage (13.2%), and over triage (10.5%). Triage modified ATS, expected triage (73.7%), under triage (18.4%), and over triage (7.9%). ESI triage has more expected and less under triage than ATS modification triage. Under triage caused prolong waiting times, unexpected risks, increases morbidity and mortality. Based on the length of time, ESI triage averaged 167 seconds, triage modification of ATS an average of 183 seconds. ESI flowchrat is easier to understand because is simple, has slight indicators in each category. Conclusion of this study is there is no significant difference in the level of accuracy and duration of triage. However, based on data distribution, ESI triage gives more expected triage decisions, less under triage and 16 seconds faster. Suggestions given to the Cibabat Hospital, can use ESI triage as an alternative triage assessment option because easy to use, structured, simple, and clear.

Background: Hepatitis C virus (HCV) is a major cause of chronic liver disease, including cirrhosis and liver cancer. Type 2 diabetes mellitus (T2DM) is a common comorbid condition in approximately one-third of individuals with chronic HCV infection. Objective: This study aimed at assessing the effect of the new direct acting antiviral drugs (DAAs) for chronic hepatitis C (HCV) on glycemic control of type 2 DM. Patients and method: This prospective cohort study was done on 32 diabetic patients with hepatitis C in the Internal Medicine Department, Al-Ahrar Teaching Hospital. The patients underwent history taking, clinical examination and laboratory studies including routine investigations and fasting blood glucose and glycosylated hemoglobin before and after treatment with direct antiviral agents (DDAs). Results: This study comprised 32 patients with diabetes. Their mean age was 57.65 ± 7.67 years. The females constituted (62.5%). There was statistically non-significant difference change before and after treatment regarding TLC, total bilirubin, HcvAb or HBSAG. There was statistically significant change between before and after treatment regarding hemoglobin, platelet count, prothrombin time (all of them increased after treatment), INR, s.creatinine, ALT and AST (all of them decreased after treatment). There was statistically significant difference between PCR1 and PCR 2 before and after treatment. All patients had negative PCR after treatment with complete response to DDAs. There was statistically significant decrease between FBG after treatment while there is significant decrease in HbA1c after treatment. Conclusion: HCV eradication leads to a statistically significant reduction in fasting glucose and HbA1c in patients with type 2 diabetes, which is an indirect indicator of improvement of insulin sensitivity in patients with T2DM.

This study aims to evaluate the torsional dynamics and 2D speckle tracking in heart failure with reduced ejection fraction on patients taking angiotensin receptor neprilysin inhibitors (ARNI) and none. ARNI has been shown to be superior to enalapril in the long term reducing the mortality and hospitalization of heart failure (HF). However short-term effects on diastolic function remain unclear. We sought to evaluate 6 months' effects of ARNI on left ventricular (LV) diastolic parameters determined by speckle tracking and tissue Doppler imaging. This study was carried out in Menoufia University Hospitals including 60 patients of HFrEF during the period from August 2019 to January 2020. (50%) of patients were treated with traditional treatment of heart failure and the remaining were treated with ARNI. Data were collected including history and clinical examination. ECG and speckle tracking and tissue Doppler imaging were done to evaluate the diastolic function. Our results showed no significant difference between the two groups at baseline. There was a significant improvement in the LV diastolic function parameters. Untwisting time and untwisting onset showed the highly significant parameters of improvement. This study concluded that ARNI showed short term improvement of diastolic function of the left ventricle that could be detected by STE.

Introduction: Glioblastoma is the deadliest malignant brain tumors in adults. The main challenges in treating glioblastoma are its resistance to the chemo-radiotherapy, poor outcome and low survival rate. The World Health Organization (WHO) 2016 classification identifies two types of glioblastoma by its mutational status of isocitrate dehydrogenase (IDH); since our national insurance experiences budget-limitation, we could not freely apply it in our institutions. We aims to find the prevalence and outcome of glioblastoma-not otherwise specified (NOS) based on its clinical manifestations and histopathology findings. Methods: We performed retrograde-analysis based on clinical and histology findings on 48 glioblastoma-NOS patients from 2012-2017. We analyzed its characteristic, primary complains, lesions location, macroscopic findings, therapy and the final outcomes. Results: Glioblastoma-NOS is the most common type of gliomas occurs in adults ages 49.29±12.13 years (range 17-72 years). The tumor predominantly involves the frontal lobe (25%) with chronic progressive headache as the chief complaint (90%); 93.8% of the patients underwent tumor removal and received chemo-radiotherapy after surgery based on the histopathology findings. The median survival is 18 months and the prevalence of glioblastoma-NOS in our tertiary referral hospital is 4.72%. Conclusion: Hopefully, our study will improve the understanding of the regional differences in glioblastoma-NOS prevalence and pave the way for identifying the regional risk factors that would allow us to improve the protocols on glioblastoma detection, prevention and management. Further studies, incorporating molecular techniques into a patient’s tumor analysis for IDH1 mutant or wild type are required for the promise of personalized medicine.

Background Timely identification of people who are at risk of dying is an important first component of end-of-life care. Clinicians often fail to identify such patients, thus trigger tools have been developed to assist in this process. We aimed to evaluate the performance of a identification tool (based on the Gold Standards Framework Prognostic Indicator Guidance) to predict death at 12 months in a population of hospitalised patients in South Africa. Methods Patients admitted to the acute medical services in two public hospitals in Cape Town, South Africa were enrolled in a prospective observational study. Demographic data were collected from patients and patient notes. Patients were assessed within two days of admission by two trained clinicians who were not the primary care givers, using the identification tool. Outcome mortality data were obtained from patient folders, the hospital electronic patient management system and the Western Cape Provincial death registry which links a unique patient identification number with national death certificate records and system wide electronic records. Results 822 patients (median age of 52 years), admitted with a variety of medical conditions were assessed during their admission. 22% of the cohort were HIV-infected. 218 patients were identified using the screening tool as being in the last year of their lives. Mortality in this group was 56% at 12 months, compared with 7% for those not meeting any criteria. The specific indicator component of the tool performed best in predicting death in both HIV-infected and HIV-uninfected patients, with a sensitivity of 74% (68–81%), specificity of 85% (83–88%), a positive predictive value of 56% (49–63%) and a negative predictive value of 93% (91–95%). The hazard ratio of 12-month mortality for those identified vs not was 11.52 (7.87–16.9, p Conclusions The identification tool is suitable for use in hospitals in low-middle income country setting that have both a high communicable and non-communicable disease burden amongst young patients, the majority under age 60.

Background: Delayed subaponeurotic fluid collection (DSFC) is a relatively uncommon problem, probably under reported soft swelling in the scalp which usually develops in infancy that occurs weeks to months after birth. Although the exact etiology remains unclear, several theories have been postulated such as (i) cerebrospinal fluids (CSF) leak from microfractures of the skull and (ii) disrupted lymphatic drainage, gradually liquefying subaponeurotic bleeding. Here, we reported typical clinical findings of DSFC and analysis of the fluid aspirate from our patient. To the best of our knowledge, this is the first case reported from Asia, particularly from Indonesia. Case Description: A healthy 2-month-old girl infant presented with 2 weeks history of occipital painless fluctuant scalp mass with no swelling. She was born at term from a nulliparous mother; by emergency cesarean delivery following failed induction of labor. There was no history of scalp injury at birth nor recent head trauma; ultrasonography showed translucent fluid in subaponeurotic or subgaleal space. The fluid collection was noted to be fluctuant, free-flowing across suture lines, without discoloration or bruising; when placed supine, the fluid collected at her midocciput. A diagnostic tap confirmed the presence of serosanguinous CSF led to a diagnosis of DSFC. Conclusion: Herein, we reported the first DSFC case from Indonesia. With no previous experience of the condition, a definitive diagnosis was possible through a very carefully physical examination and history taking, along with a good communication among the neurosurgeon, pediatrician, and the clinical pathologist.

Purpose: A head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture at the base of the skull. Loss of consciousness and Glasgow coma score (GCS) may vary depending on an associated intracranial pathology. The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault. Aim of this study is to define the correlation between SBF and intracranial hemorrhage (ICH) in patients with HI. Methods: Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr. Hasan Sadikin Hospital, Bandung, Indonesia from January 1, 2012 to December 31, 2017. The exclusion criteria included age less than 15 years and no head computed tomography (CT) scan examination provided. Results: A total of 9006 patients were included into this study in which they were divided into 3 groups: group 1, HI with no ICH; group 2, HI with single ICH and group 3, HI with multiple ICH. In all the SBF cases, SBF at anterior fossa accounted for 69.40% of them, which were mostly accompanied with mild HI (64.70%). Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan, thus these factors were able to predict whether there were traumatic brain lesions or not. Most of the patients with epidural hemorrhage (EDH) has single traumatic lesion on CT scan, whereas most of the patients with cerebral contusion (CC) has multiple traumatic lesions on CT scan. On patients with both traumatic brain injury and SBF, most of the patients with anterior fossa SBF has EDH; whereas most of the patients with middle fossa SBF were accompanied with CC. Surgery was not required for most of the patients with SBF. Conclusion: SBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC. Key words: Skull base fracture; Intracranial hemorrhage; Traumatic brain injury

Although an open depressed skull fractures at the anterior cranial fossa is relatively common, comorbidity with a progressive vision loss at initial presentation, with acute communicating hydrocephalus is rare. Here we report a rare case of a progressive vision loss presented with communicating hydrocephalus following open depressed skull fractures at a mid-frontobasal. Fragments of skull were extracted and the dural tear was repaired. Within the first post-operative day, the patient already gained full consciousness and his headache was completely resolved. Unfortunately, the ophthalmologic examinations revealed his vision remains impaired. We discussed the pathological mechanisms of a progressive vision loss and acute communicating hydrocephalus in a patient who was diagnosed with traumatic open depressed skull fracture at a mid-frontobasal, with focus on surgical management of this intriguing case. This case makes a strong argument for an early neurosurgical intervention in frontobasal fractures. Keywords: Open depressed skull fractures at a mid-frontobasal, A progressive vision loss, Acute communicating hydrocephalus

In Indonesia results of efforts to attain a better quality of life in general, and the health development sector in particular are encouraging. Reduction of the number of cases admitted has been observed, and disease pattern seems to he changing. This article reviews the changing pattern of some infectious diseases in the Communicable Disease Ward, Department of Child Health dr Soetomo Hospital Surabaya. Further on it deals with the application of observations in respect of the Tridarma of the University e. i. Research, Education and Public/Medical seroice. Medical students, nowadays, have less practical experiences especially of the immunizable diseases. In the aspect of patient management, laboratory facilities seem to become more important, as the clinical manifestations of the diseases are less characteristic. Studies on the establisment of standard procedures for diseases that potentially become public health problems are needed.

Background Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low–middle-income countries, tetanus still occurs (mostly in adults) due to the lack of immunization related to religious tenets, cultural belief, or inaccessibility to medical care. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group. Case presentation We report a case of a 7-year-old girl presented to our institution with a history of falling 10 days prior to admission, with only skin laceration on her forehead. For 1 day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed her as an unimmunized child with an open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw.” Perioperative management of this rare case is reported and discussed. Conclusion The pediatric intensive care of such patients requires halting further toxin production, neutralization of circulating toxin, and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery.

Background: This study aims to describe the radiological findings in chest radiographs (CXRs) of patients with coronavirus disease (COVID-19) and the Middle East respiratory syndrome (MERS) and to compare the radiological patterns of the two diseases. Method: A retrospective cohort study was conducted in a tertiary care hospital in the Southern region of Saudi Arabia. The CXRs were evaluated for the presence and distribution of ground-glass opacities (GGO), consolidation, pleural effusions, pneumothorax, cavitation, and nodules. Results: A total of 120 CXRs from 15 MERS and six COVID-19 patients were assessed. In the first available CXR, GGO was present in 11 (73%) of the MERS patients (18% located in the middle zones and 67% located peripherally) and in 100% of COVID-19 patients (peripheral and middle zone involvement in all patients). In the first available CXRs, consolidation was present in 10 MERS patients (67%) and in all six COVID-19 patients, while it was present in all patients of both groups when all the available CXRs were considered. Confluent consolidation was present in 47% of the MERS patients and 50% of COVID-19 patients. All the fatal cases had confluent consolidation and radiological signs of acute respiratory distress syndrome (ARDS). Pneumothorax was present in 13% of patients, with 100% mortality, and pleural effusion was present in 47% of patients, with 57% mortality. Lung nodules were present in one patient of each group. Conclusion: COVID-19 patients showed earlier development of GGO and consolidation with greater involvement of the middle and peripheral lung zones. Confluent consolidation and ARDSlike radiological findings were associated with high mortality. Pneumothorax and pleural effusions were more frequent in MERS patients, with high associated mortality.

Objective Calcitonin receptor-like receptor (CRLR) regulates vasoconstriction and dilatation; the expression increases during hypoxia via activation of hypoxia response element (HRE) in CRLR gene promoter region. Variant in HRE, as well short tandem repeat (STR) variants near HRE in CRLR alters the gene expression. This study focused on a case–control study to investigate the expression of genetic typing CLRL promoter variant in pregnant women with severe preeclampsia and normal pregnancies, we also tried to describe interesting findings of the genetic expression in anemic patients in the severe preeclampsia group. Our aimed to observe the correlation of CRLR gene promoter variant and anemia in severe preeclampsia. Results There was no nucleotide variant in HRE; CACA box prior to HRE varied in length (15–24); CACA box with length > 20 was used as cut off point. Hb was lower in CACA box length ≥ 21 (10.33 ± 1.57) vs. p = 0.391). CACA box polymorphism and anemia were correlated in severe preeclampsia (p = 0.005) OR 0.038 (CI 0.003–0.544); not in normal (p = 0.069).

Background: Coronavirus disease 2019 (COVID-19) pandemic has affected global health system; in the context of the COVID-19 pandemic, both surgeon and anesthesiologist often dealt with emergency situation, optimal timing of surgery and safety protocol in hospital setting must be implemented with many facets for both patients and health-care providers. Case Description: We reported two cases. Case#1 - A 16-year-old male was referred to our hospital, due to a decreased of consciousness following a motor vehicle accident. Head CT scan revealed an epidural hemorrhage on the left temporoparietal. The patient was suspected for having COVID-19 from the reactivity of his serum against SARS-CoV-2 antigen. Procedures for the confirmation of COVID-19 and surgical preparation caused 12 h delayed from the admission. Nevertheless, the patient was deteriorated clinically before he was transported to the operating room and died after 6 cycles of cardiopulmonary resuscitation. Case#2 - A 25-year-old male was referred to RSHS, due to a decreased of consciousness, diagnosed as bilateral proximal shunt exposed with suspected COVID-19; delay occurred due to unavailability of negative pressure intensive unit for postoperative care. This caused 5760 h (4 days) delayed for bilateral shunt removal and temporary extraventricular drainage. Conclusion: Optimal timing of surgery, a good safety, and health protocol during pandemic in emergency setting are an obligation to protect health providers and patients. A decision-making plan must be organized precisely to maintain alertness, achieve the highest possible standard of care, and outcome in emergency surgical cases. Lack of monitoring must be abated to avoid fatality for patient, especially in emergency surgery setting.

Objectives. To evaluate the safety and efficacy of augmenting conjunctival autografting with intraoperative mitomycin C (MMC) application versus Ologen implantation in the management of recurrent pterygium. Materials and Methods. This prospective randomised study included 63 eyes of 63 patients, with recurrent nasal pterygium, who presented to the outpatient clinic of Menoufia University Hospital in Shebin El Kom and Manshiet Soltan from January 2016 to December 2019. Patients were randomly enrolled into two groups. Group A included 32 eyes of 32 patients who underwent conjunctival autografting augmented with the topical application of MMC (0.2 mg/mL), and group B included 31 eyes of 31 patients who underwent conjunctival autografting augmented with Ologen implantation. All the patients underwent follow-up examinations for a period of 24 months. During each visit, a complete ophthalmic examination was performed. Pterygium regrowth of 1 mm or more, over the cornea, was considered a recurrence. Results. In the MMC group, no recurrence was reported during the 24-month follow-up period. In the Ologen implantation group, recurrence was reported in 2 (8%) eyes. The time interval from surgery to recurrence was 5 months in one case and 8 months in the other. No other serious postoperative complications were reported, and there was no statistically significant difference between the groups in this regard. Conclusion. Ologen implantation with conjunctival autografting shows promising results in the surgical management of recurrent pterygium with mild non-vision-threatening postoperative complications comparable to that of MMC application with conjunctival autografting. Registration number: ClinicalTrials.govNCT04419038.

BACKGROUND: Progress has been made in developing systems of care that strives to minimize traumatic brain injury (TBI)-related morbidity and mortality. As the TBI survivors, one’s might be experienced cognitive function disorders that affect their quality of life. AIM: We sought to investigate the changes of cognitive function in patients with mild or moderate TBI. METHODS: This was a prospective study on 80 patients with mild and moderate TBI who had undergone surgery; 79 patients included in the study and one patient excluded due to incompletion of cognitive tasks. We assessed the cognitive function using a combination of mini-mental state examination (MMSE), digit span (DS), and constructional praxis (CP) tests. The correlations between clinical variables and neuropsychological tests were analyzed. RESULTS: In this study, majority of the patients were male (77.2%) with the mean of age 28.4 years, ranging from 15 to 74 years, predominantly was a young adult (15–20 years, 32.9%). In this series, majority of the patients had moderate TBI (69.6%). Most of the patients (55.7%) had 12 or more education years. MMSE examination revealed that 6.3% and 2.5% of patients had mild- and moderate-cognitive disturbances, respectively, significantly correlated with age (p = 0.049) and educational level (p = 0.008). From DS tests, 13.9% patients had attention disorders and significantly correlated with age (p = 0.015), educational level (p = 0.000), and the severity of TBI (p = 0.018). From CP tests, 24.1% and 5.1% had mild- and moderate-disturbances, respectively, significantly correlated with the severity of TBI (p = 0.025) and the type of intracranial lesion (p = 0.009). CONCLUSIONS: We found (using a combination of MMP, DS, and CP test) cognitive impairment more frequently in patients with moderate TBI, older age, and low education level, hence, emphasized the importance of holistic neuropsychological assessments and neurological rehabilitation for adequate management of patients with TBI.

Introduction: Among the diabetic complications, the diabetic nephropathy (DN) is the commonest reason for end-stage kidney failure all over the world, and a major indication for dialysis and transplantation. Despite the number of studies on humans and rodents of experimental DN, successful treatment isn’t accessible however So, the explore for drugs to prevent the progression of DN has a high priority in biomedical researchAim: To examine the effect of anise on a diabetic nephropathy rat model by streptozotocin and compare its effect with insulin and with their combination.Materials and Methods: Fifty-six adult male albino rats were divided into six main groups. Group I (control), Group II: received aniseed at a dose of 500 mg/kg, Group III (diabetic): received a single IP of 50 mg/kg STZ, Group IV: diabetic rats received aniseed for eight weeks (as group II), Group V: received SC of 2U/Kg once daily of an insulin mixture for eight weeks and Group VI: received aniseed and insulin as the previous doses for eight weeks. At the end of the study, blood samples were collected and the kidney specimens were processed biochemical, histological (light and transmission electron microscopic) and immunohistochemical studies. Morphometric and statistical studies were also performed.Results: Diabetic rats showed disturbed renal architecture involving the corpuscles and tubules, a significant increase in collagen fibers, glomerulosclerosis index, and desmin, VEGF, keratin 18immunoreaction. Administration of aniseed showed impressive improvement of histological structural changes induced by diabetes, insulin showed a mild improvement and use of these agents in combination appeared to have potential advantages especially in reducing of oxidative stress in improving DNConclusions: A combination of aniseed and insulin have a relevant therapeutic role in the kidney changes induced by diabetes So, they could potentially provide a possible solution for renal changes related to diabetes

Objective To explore the possibility of a new diagnostic approach of endometriosis based on immunocytochemistry scoring of Aromatase P450 expressions in endometrial cells collected from menstrual sloughing. This is a case control study. Immuncytochemistry scores vs. histopathological examination in one tertiary- and secondary-level hospital in Bandung; two secondary level hospital in Garut and Sumedang, West Java, Indonesia. Thirty-five patients with and without endometriosis were enrolled. All subjects had diagnostic procedures for endometriosis suspicion, with addition menstrual blood samples for cytopathological examination. The specimens were sent for immunocytochemistry assessment of P450 Aromatase expressions (ICAPEC). The previous procedure resulted in cut-off point of histo score (H-score), sensitivity, specificity, (+) and (−) ICAPEC predictive value. Results The P450 Aromatase expression in endometrial cells of women with endometriosis was significantly stronger than without one. The cut-off point of H-scores to detect endometriosis was > 4. By this criteria, H-score had 94.6% sensitivity, 90.9% specificity, 92% positive predictive value and 93% negative predictive value. Immunocytochemistry scoring of Aromatase P450 expression in endometrial cells (ICAPEC) derived from menstrual blood specimen was a good candidate as alternatives approach in diagnostic procedure of endometriosis. Application and evaluation in clinical practice would provide the economically benefit in diagnostic procedure.

Disuse muscle atrophy is one of the most important research topics in fields of rehabilitation and clinical medicine. It refers to morphological and functional alteration of skeletal muscle under the states of hypokinesia, immobilization and weightlessness. This review analyzes a number of structural and functional changes in the skeletal muscle tissue in case of muscle disuse which appeared in loss in the muscle mass, reduction in the transverse diameter of most of muscle fibers, wide spaces between muscle fibers, increase collagen fiber deposition and appearance of apoptotic nuclei in muscle fibers besides sensorial dysfunction such as hypo mechanical responsiveness and diminished contractile function. In addition to the ultrastructural alteration, which include loss of sarcomere organization, indistinguishable A and I bands, irregular distorted Z-line with disruption of myofilaments and fused giant accumulated mitochondria. The review summarizes also the molecular mechanisms of skeletal muscle disuse atrophy which could be resulted from an alteration in the activity of oxidative stress enzymes and lead to increase in protein degradation and/or a reduction in protein synthesis. Moreover, the review discusses the efficiency of potential countermeasures of stretching exercise as a very powerful stimulant of muscle growth and muscle protein synthesis to counteract the structural and functional alterations in muscle tissue caused by disuse. The review showed that stretching exercise can increase the transverse sectional area of muscle fibers, produce a rise in the number of sarcomeres in series and prevent muscle atrophy. Passive stretching also completely prevented the decrease in myonuclear number induced by inactivity. Moreover, stretching accelerated the amelioration of the range of motion limitation and prevent the deposition of connective tissue resulted from disuse muscle atrophy.

Purpose. To compare the outcomes of Ex-PRESS glaucoma filtration device and transscleral cyclophotocoagulation (TSCP) in the management of neovascular glaucoma (NVG).Patients and Methods. A total of 30 eyes (12 express shunts and 18 TSCP) of 28 patients were included. The eyes had NVG with intraocular pressure (IOP) more than 21 mmHg of the maximally tolerated medication treatment after previous panretinal photocoagulation and antivascular endothelial growth factor (anti-VEGF) injection, with no previous history of a cyclodestruction procedure or glaucoma surgery, were randomized either for Ex-PRESS glaucoma filtration device or TSCP. The patients were followed up weekly for the first month and then monthly for 12 months as regard to the IOP, number of topical antiglaucoma drugs required, visual outcome, and postoperative complications.Results. IOP was successfully controlled with both techniques in 83.3% of the eyes. Both techniques had fewer complications and required fewer subsequent procedures.Conclusion. Both the Ex-PRESS glaucoma filtration device and TSCP might constitute safe and alternative therapeutic tools for patients with NVG. However, TSCP is an easier procedure, less time consuming, and does not require a learning curve.

Objectives. To evaluate the internal morphology of blebs using anterior-segment optical coherence tomography (AS-OCT) and the surgical outcomes of Ahmed glaucoma valve (AGV) surgery with Tenon capsule resection compared to conventional AGV surgery in patients with refractory glaucoma. Patients and Methods. This randomised prospective study included 30 eyes from 30 patients (age range: 42–55 y) with refractory glaucoma from March 2018 to February 2020. The study included two groups: AGV with the Tenon capsule resection group (n = 15) and the conventional AGV surgery group (n = 15). Follow-up continued until 6 months after surgery. The primary outcome was intraocular pressure (IOP) and its association with the number of postoperative glaucoma medications, best corrected visual acuity, visual field, and postoperative complications. The internal morphology of the blebs in both groups was evaluated at 1-day, 1-week, 1-month, 3-month, and 6-month follow-up using AS-OCT in terms of the consequent changes in bleb wall thickness, bleb wall reflectivity, and bleb cavity morphology throughout the 6-month follow-up period. Results. A significant reduction in IOP was found in both groups, with a greater reduction in group I, where the mean IOP decreased from 32.73 ± 2.12 mmHg in the preoperative period to 13.33 ± 1.59 mmHg after 6 months, whereas in group II, the mean IOP decreased from 33.2 ± 2.21 mmHg in the preoperative period to 14.27 ± 1.44 mmHg after 6 months ( p value p value = 0.016 and 0.01 at 1 and 3 months, respectively). The bleb analysis revealed a significant reduction in the wall thickness in both groups at 1 and 3 months, which was mostly associated with the hypertensive phase. In group I, the bleb wall thickness decreased from 754.67 ± 53.93 μm in the first postoperative day to 684 ± 81.66 μm and 671.6 ± 69.48 μm at 1 and 3 months, respectively, while in group II, the bleb wall thickness decreased from 707.13 ± 31.7 μm in the first postoperative day to 499.53 ± 99.1 μm and 506 ± 76.91 μm at 1 and 3 months, respectively. There was a significant reduction in AS‐OCT, and bleb reflectivity was insignificant throughout the follow-up period ( p value >0.05). Regarding postoperative complications, the hypertensive phase occurred more frequently in group II (6 eyes, 40%) than in group I (2 eyes, 13.3%). Other complications were also reported more frequently in group II such as hypotony, shallow anterior chamber (AC), and tube exposure. Conclusion. AS-OCT was beneficial in the analysis of bleb morphology after AGV surgery where there were more diffuse functioning multicystic blebs and less thinning in the bleb wall thickness during the hypertensive phase after resection of the Tenon capsule, which might be related to the less incidence of fibrosis around the surgical site.

Objective. To compare between the surgical outcomes of Tenon capsule grafting and autologous scleral graft in Ahmed glaucoma valve (AGV) surgery in the management of refractory glaucoma and prevention of tube exposure. Patients and Methods. This prospective randomised study included 30 eyes of 30 patients with refractory glaucoma, who were aged between 46 and 58 years and diagnosed with refractory glaucoma. This study was conducted in Menofia University Hospital between July 2018 and December 2019. Informed patient consent was obtained. The studied eyes were divided into two groups: the first group included 15 eyes for which AGV with Tenon capsule grafting was performed, while the second group included 15 eyes for which AGV with autologous scleral graft was performed. All patients were followed up for one year after the surgery. The outcomes were evaluated according to intraocular pressure (IOP) and the number of postoperative glaucoma medications. Visual acuity, visual field, number of postoperative glaucoma medications, and postoperative complications were followed throughout the 1-year follow-up period. Results. There was a significant reduction in IOP in both groups, with more reduction in the Tenon graft group where the mean IOP after one year was 11.66 ± 0.89 mmHg, whereas in the scleral graft group, the mean IOP was 14.20 ± 4.0 mmHg (p value Conclusion. Tenon capsule grafting and autologous scleral grafting might be effective and safe techniques when applied with AGV in the management of refractory glaucoma. Tenon capsule resection with grafting showed relatively low incidence of tube exposure and hypertensive phase.

Objective: To describe cerebrospinal fluid (CSF) characteristics in tuberculous meningitis (TBM) with hydrocephalus patients as diagnostic criteria of TBM. Methods: A cross-sectional using retrospective method was applied in this study by obtaining medical records of TBM with hydrocephalus patients that were treated at Department of Neurosurgery Dr. Hasan Sadikin General Hospital, Bandung from January 2014–September 2016. Results: Sixty one records were included in the study. Patient characteristics such as age, gender, and CSF laboratory features such as color and clarity, cells and differential count, protein, and glucose were recorded and descriptively analyzed. The majority of CSF macroscopic appearance was seen to be clear (88%) and colorless (88%). Median for CSF cell count was 25 cells/mm3 with lymphocyte predominance (median: 76%). Increased protein from normal value range was seen in CSF (median: 50 mg/dL) while the mean for CSF glucose in this study remained in its normal value range (mean: 58.9±26.68 mg/dL) with lower CSF to blood glucose ratio (mean: 0.41±0.27). Conclusions: Clear CSF with colorless appearance, lymphocyte pleocytosis, high protein level, and low CSF glucose as well as blood glucose ratio remain typical CSF characteristics of TBM patients found at the Department of Neurosurgery, Dr. Hasan Sadikin General Hospital, Bandung. Keywords: Cerebrospinal fluid, hydrocephalus, tuberculous meningitis DOI: 10.15850/ijihs.v6n2.1129

Background: Traumatic Brain Injury (TBI) is a critical socio-economic problem throughout the world. Immediately after TBI, there is an increase in catabolic and counter-regulatory hormones, leading to a hypermetabolic state which causes specific nutritional needs and multiple metabolic and electrolytic abnormalities. Nutritional intervention is likely to limit the patient's inflammatory response and thereby improve the ultimate health outcome.Aim of Study: This study aimed to assess the effect of early nutrition on the rate of mortality in patients with severe traumatic brain injury.Methods: The current work is a prospective randomized study that was conducted on 60 patients with severe traumatic brain injury. Patients were randomly classified into three groups (each was of 20 patients). Group I received enteral nutrition after 48 hours of TBI. Group II received early enteral nutrition within 1st 24 hours after TBI. Group III received early parenteral nutrition within 1st 24 hours after TBI.Results: The three groups showed no statistically signif-icant differences as regard age, sex, mode of trauma, and presence of co-morbidities. As regard vital signs, laboratory investigations, finding of Computed Tomography (CT) of brain and surgical intervention, there was no statistically significant difference between both groups at baseline. There was significant improvement in GCS in groups II and III compared to group I despite there was no significant difference between the three groups at admission. As regard duration of mechanical ventilation, there was significant decrease in the duration of mechanical ventilation in group II compared to groups I and III. There was significant increase in infection in groups I (70%) and III (60%) compared to Group I (20%). There was significant difference in mortality rate between the three studied groups and between Group I and II. At 30 days of the study, 65% of patients in Group I died. While in Group II and III the percentage decreased to 20% and 45% respec-tively.Conclusion: Administration of early enteral nutrition in this study has been associated with decreased mortality, decreased duration of mechanical ventilation, less incidence of infection and improved GCS patients with severe TBI.

Summary Background A dose of 30 mg/kg of azithromycin is recommended for treatment of yaws, a disease targeted for global eradication. Treatment with 20 mg/kg of azithromycin is recommended for the elimination of trachoma as a public health problem. In some settings, these diseases are co-endemic. We aimed to determine the efficacy of 20 mg/kg of azithromycin compared with 30 mg/kg azithromycin for the treatment of active and latent yaws. Methods We did a non-inferiority, open-label, randomised controlled trial in children aged 6–15 years who were recruited from schools in Ghana and schools and the community in Papua New Guinea. Participants were enrolled based on the presence of a clinical lesion that was consistent with infectious primary or secondary yaws and a positive rapid diagnostic test for treponemal and non-treponemal antibodies. Participants were randomly assigned (1:1) to receive either standard-dose (30 mg/kg) or low-dose (20 mg/kg) azithromycin by a computer-generated random number sequence. Health-care workers assessing clinical outcomes in the field were not blinded to the patient's treatment, but investigators involved in statistical or laboratory analyses and the participants were blinded to treatment group. We followed up participants at 4 weeks and 6 months. The primary outcome was cure at 6 months, defined as lesion healing at 4 weeks in patients with active yaws and at least a four-fold decrease in rapid plasma reagin titre from baseline to 6 months in patients with active and latent yaws. Active yaws was defined as a skin lesion that was positive for Treponema pallidum ssp pertenue in PCR testing. We used a non-inferiority margin of 10%. This trial was registered with ClinicalTrials.gov, number NCT02344628. Findings Between June 12, 2015, and July 2, 2016, 583 (65·1%) of 895 children screened were enrolled; 292 patients were assigned a low dose of azithromycin and 291 patients were assigned a standard dose of azithromycin. 191 participants had active yaws and 392 had presumed latent yaws. Complete follow-up to 6 months was available for 157 (82·2%) of 191 patients with active yaws. In cases of active yaws, cure was achieved in 61 (80·3%) of 76 patients in the low-dose group and in 68 (84·0%) of 81 patients in the standard-dose group (difference 3·7%; 95% CI −8·4 to 15·7%; this result did not meet the non-inferiority criterion). There were no serious adverse events reported in response to treatment in either group. The most commonly reported adverse event at 4 weeks was gastrointestinal upset, with eight (2·7%) participants in each group reporting this symptom. Interpretation In this study, low-dose azithromycin did not meet the prespecified non-inferiority margin compared with standard-dose azithromycin in achieving clinical and serological cure in PCR-confirmed active yaws. Only a single participant (with presumed latent yaws) had definitive serological failure. This work suggests that 20 mg/kg of azithromycin is probably effective against yaws, but further data are needed. Funding Coalition for Operational Research on Neglected Tropical Diseases.

Objective: To describe the clinical characteristics and complications observed in tuberculous meningitis (TBM) patients with hydrocephalus who had undergone fluid diversion management. Methods : This was a cross-sectional descriptive observational study involving 28 TBM patients with hydrocephalus aged 0–5 years who had undergone ventriculoperitoneal shunt or extraventricular drainage in the period of July 2011 to July 2016 in Dr. Hasan Sadikin General Hospital, Bandung. Age, gender, head circumferences, nutritional status, and classical characteristics such as sunset eye, frontal bossing, cracked pot sign, venectation as well as complications such as infection, phlebitis, and exposed shunt documented in the hospital medical records were analyzed. Result : The study discovered that infant group was predominant (21/28). Some of the patients had macrocephalus (7/28) and 18 had good nutrition status (18/28). There were 4 patients with frontal bossing characteristics (4/28) and almost none was found with others classic hydrocephalus characteristics. This study found no complication such as infection, phlebitis, and exposed shunt in TBM patients with hydrocephalus who had undergone fluid diversion therapy in Dr. Hasan Sadikin General Hospital, Bandung. Conclusion: One of the most dominan characteristics of TBM patients with hydrocephalus is frontal bossing. Tuberculous meningitis patients with hydrocephalus in our center did not show any fluid diversion-related complications such as infection, phlebitis, or exposed shunt. Keywords: Tuberculous meningitis, hydrocephalus, fluid diversion DOI: 10.15850/ijihs.v6n1.1048

Introduction: Tuberculous meningitis (TBM) and tuberculous spondylitis (TBS) are the form of extra-pulmonary tuberculosis. Material and method: A retrospective cohort study was conducted among children with TBM (2009–2014) and TBS (2004–2014) who were treated in our center; Department of Child Health, Department Neurosurgery and Department Orthopedics. Results: Of 123 children diagnosed with TBM (53) and TBS (70); based on modified British Medical Research Council: Stage I (3 cases), Stage IIa (3 cases), Stage IIb (23 cases), Stage III (24 cases). TBM developed hydrocephalus: 36 cases performed ventriculoperitoneal shunt and 17 cases external ventricular drainage. In TBM: 9.4% (5/53) had vegetative state and mortality rate was 20.8% (11/53). TBM Hospital discharge correlated with Glasgow coma scale preoperation (p

Neurofibromatosis type 2 (NF-2) is an autosomal dominant inheritance, chromosome 22q12 mutations in peripher and central nervous systems. Several literatures have discussed rare cases of triple NF-2 tumor, known as multiple inherited Schwannomas, meningiomas and ependymomas or MISME. Incidence of MISME reported from many country, but never been reported from Indonesia. Hopefully the MISME presence can be more revealed in our country and adding the evidence in world literature. A 15-year-old boy presented to our center with a progressive bilateral hearing loss for 2 years and started to experience weakness of both lower extremities since 1.5 years. Patient underwent both craniotomy intracranial and spinal tumor removal. Histopathological result showed Schwannomas, meningiomas and ependymoma. Diagnosis of MISME was made and had been treated with excellent clinical outcome. We are reporting a rare case of MISME syndrome, which is an extremely exceptional case in our center due to rare occurrence of MISME and the need to confirm NF-2 diagnosis using molecular investigations. Keywords: Neurofibromatosis type 2, MISME syndrome, Rare case report

Objective: To analyze the correlation between the degree of angulation and neurological deficits as well as pain in spondylitis tuberculosis (TB) patients. Methods: This observational-analytic study included bivariate analysis on data collected from the medical records of patients with presented with spondylitis TB to Dr. Hasan Sadikin General Hospital, Bandung outpatient clinic from January 2014 to December 2015. The variables were the degree of gibbus angulation, neurological deficits, and pain. Results: The study showed significant positive correlation between gibbus angulation and sensory neurological deficits (r=0.375; p=0.009) and there was significant positive correlation between gibbus angulation and pain (r=0.638, p=0.000). The study showed an insignificant correlation between gibbus angulation and motoric neurological deficits (r=0.125; p=0.525). Conclusions: There is a significant correlation between the degree of gibbus angulation and pain as well as sensory neurological deficits. Meanwhile, no significant correlation is found between the degree of gibbus angulation and motoric neurological deficits. Keywords: Gibbus angulation, neurological deficits, pain, spondylitis tuberculosis DOI: 10.15850/ijihs.v5n2.1049

Traumatic brain injury (TBI) constitutes a critical public health and socioeconomic problem. As one of the leading causes of mortality and disability from road traffic crashes, the incidence of TBIs is increasing with increasing motor vehicle usage. Understanding the prevalence and describing the characteristics of TBI are crucial for successful implementation of prevention and treatment efforts to reduce the mortality and morbidity caused by TBIs.We studied cases of moderate and severe TBI resulting from motorcycle crashes from January 1, 2013 to June 30, 2014. Variables studied included sex, age, time interval (from crash to arrival at the emergency department), alcohol consumption, helmet use, severity of TBI, choice of treatment, and the outcome.A total of 2108 head injury cases were seen at the emergency department during this period, 1324 (62.8%) of which resulted from motorcycle crashes. Of those cases, 30.7% (407 cases) were categorized as moderate or severe TBI with 29.2% mortality. Most of the patients were male (80.8%),60 years old (96.1%), and did not wear a helmet (71.2%). More than half of the cases (56.7%) arrived at the emergency department within 6 hours, 14.0% of the cases were under alcohol intoxication, and 37.8% of the cases were operated on.This preliminary analysis highlights the need to address road safety, especially with respect to helmet use and drink driving, to reduce the burden of TBIs in Bandung.

INTRODUCTION Little is known about neurosurgery patient outcomes in Indonesia. Our study sought to describe patient characteristics, health care pathways, health-related quality of life, and health/rehabilitation care needs of patients admitted to, and discharged from, a major neurosurgery department. METHODS Eligible patients were aged ≥18 years admitted to the Neurosurgery Department in a regional referral hospital in Bandung, Indonesia. Baseline data was collected on admission. An in-person interview (in the Indonesian language) was held 1 to 2 days pre-discharge. Sociodemographic along with clinical characteristics, Glasgow Coma Scale (GCS), and EQ-5D-5L data were collected. RESULTS A total of 217 patients were admitted, 37 died before discharge, and a pre-discharge interview was undertaken by 178 (82%). Almost half (48%) were admitted because of injury, 38% brain tumour, 10% acute illness, and 4% other conditions. The mean age was 41 years. On admission, 63% had a mild Glasgow Coma Scale, 31% moderate, and 3% severe. The average hospital stay was 8 days for injury and 24 days for illness patients. Prior to discharge, one-third, or less, of the 178 patients interviewed reported "no problems" in the EQ-5D dimensions of mobility (32%), self-care (27%), usual activities (16%), and pain/discomfort (32%), whereas 70% reported "no problems" with anxiety/depression. CONCLUSION A large proportion of patients are being discharged with considerable levels of difficulty in four of the five EQ-5D dimensions. This stresses the importance of providing good follow-up and support of patients and their families.

Objective: To describe the cavum septum pellucidum (CSP) and cavum vergae (CV) findings. Methods: Thirteen samples were recruited in the study. The study was conducted at the Department of Neurosurgery, Dr. Hasan Sadikin Hospital, Bandung, Indonesia in the period of 2015–2016. Thirteen samples were recruited for the study. Cavum septum pellucidum and CV spaces are relatively rare. During neurology and neurosurgery examination of patients with head computed tomography (CT) scan and magnetic resonance imaging (MRI), CSP and CV were discovered accidentally. The incidence of these unique spaces reported from many countries, but have never been reported from Indonesia. Results: This is the first-time reported incidental finding of CSP and CV from Indonesia, 13 cases in one-year period. Since the presence of CSP and CV is usually asymptomatic, clinician seem don’t really care to put it in their report. Conclusions: The presence of CSP and CV as a common incidental finding can be more revealed in our country in years to come and hopefully can be more studied in term of anatomical landmark on neurosurgical field. Keywords: Cavum septum pellucidum, cavum vergae, incidental finding DOI: 10.15850/ijihs.v5n1.964

Introduction: The purpose of this study was to compare the efficacy and safety of canaloplasty versus viscocanalostomy in management of uncontrolled primary open angle glaucoma (POAG) with medication. Methods: Canaloplasty surgery was applied for thirty eyes of thirty patients (45- 55 years) with a mean age of 48 years (Group A) and viscocanalostomy surgery was applied also for thirty eyes of thirty patients (43- 54 years) with a mean age of 46 years (group B). All patients were with uncontrolled primary open angle glaucoma by maximally tolerated medical therapy. Results: Intraocular pressure (IOP) in both surgeries was significantly reduced through follow up period (p < 0.0.001). Complete success was 86.6% in group A and 80% in group B. Visual field deterioration was in 2 cases (6%) in group A and in 4 cases (13%) in group B. Low incidence of postoperative complications was reported as Descemet’s membrane detachment (3% in group A and 8% in group B), ocular hypotony (2% in group A and 4% in group B) and hyphema (3% in group A and 5% in group B). Conclusion: Canaloplasty was more effective and safer than viscocanalostomy in management of uncontrolled primary open angle glaucoma (POAG) with medication.