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Background Recurrent abdominal pain is 2-4% of all cases encountered by pediatricians. Risk factors vary among countries. There is no data on prevalence and risk factors of recurrent abdominal pain in adolescents in Indonesia. Objective To evaluate prevalence and risk factors of recurrent abdominal pain in junior high school students. Methods A cross-sectional study was performed among junior high school students in South Jakarta who experienced recurrent abdominal pain according to Roma III criteria. Students allowed by their parents to participate to this study were asked to complete a Roma III questionnaire. Data about sociodemographic and history of recurrent abdominal pain among the parents were also collected using a questionnaire. ResultsThree hundred ninety-six adolescents participated in this study, 17.2% among them experiencing recurrentabdominal pain. Irritable bowel syndrome (IBS) was the most common type (42.6%), followed by functional dyspepsia (30.9%), functional abdominal pain syndrome (11.8%), functional abdominal pain (10.3%), and abdominal migraine (4.4%). The risk factor most responsible was anxious personality (OR 3.86; 95%CI 2.05 to 7.29, P 13 years, and middle to lower family income. Conclusions Prevalence of recurrent abdominal pain in adolescents is 17.2%. Irritable bowel syndrome is the most common type. The risk factors are anxious personality, female, age > 13 years, and middle to lower family income.

Background: The incidence of coronavirus disease 2019 (COVID-19) is still increasing rapidly, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aimed to describe the characteristics of children with COVID-19 with fatal outcomes in a tertiary referral hospital in Indonesia. Methods: This cross-sectional study used data collected from the medical records of patients with COVID-19 admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from March to October 2020. Results: During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, and 20 (40%) had a fatal outcome. The fatality rate was higher in patients aged ≥10 years, categorized with severe disease upon admission, PaO2/FiO2 ratio ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase and presepsin levels were found in all fatal cases. One patient met the criteria of multisystem inflammatory syndrome in children. Conclusion: Our work highlights the high mortality rate in paediatric patients with positive SARS-CoV-2 polymerase chain reaction test. These findings might be related to or co-incided with COVID-19 infection. Further studies are needed to improve understanding of the role of severe acute respiratory syndrome coronavirus-2 in elaborating the mechanisms leading to death in children with comorbidities.

Background: C-reactive protein (CRP) is widely used as an early predictor of anastomotic complications such as anastomotic leakage (AL) after abdominal surgery. There are no data available regarding the AL in A.W.Sjahranie Regional General Hospital (RSUD AWS). This study analyzed the CRP values and their relationship with AL after bowel resection and anastomosis surgery at RSUD AWS Samarinda.Methods: This is an observational analytic cross-sectional study. Sample data were collected from the medical records of 40 patients who underwent bowel resection between May and December 2019. Patients were between 18-75 years old and showed clinical signs of AL. CRP laboratory data were examined on the fifth-day post-operation. After tabulation, the data were analyzed using Chi-square (Fisher’s exact) test, t-test, and receiver operating characteristic curve analysis.Results: The average sample age was 46.3 ± 1.31 years, with a 1:1 male and female ratio. The analysis showed that an increase in CRP values and white blood cell counts was not related to AL (p > 0.05). The mean CRP value of patients with AL (48.0±0.00 mg/L) was not significantly different if compared to non-AL patients (25.89 ± 18.93 mg/L) (p = 0.139). The CRP cut-off value of 36 mg/L had 100% sensitivity, 60.5% specificity, 71.7% positive predictive value and 100% negative predictive value with an area under the curve of 0.80 (p=0.153). These results showed that the CRP cut-off value of 36 mg/L couldn't be used as a predictor of AL.Conclusion: CRP level of 36 mg/L can be used as a predictor of non-AL; therefore, it can be used as a criterion for patient discharge.

BACKGROUND Septic children cause high protein degradation and inadequate nutritional intake would worsen the outcomes. In addition, there are conflicting results of association between tumor necrosis factor-α (TNFA)-308 polymorphism and poorer outcomes. This study was aimed to investigate the impact of high protein feeding in septic children and to examine the role of the TNFA-308 polymorphism in outcome of sepsis. METHODS In this randomized controlled trial, septic children were randomly assigned to receive either high protein feeding (amino acid of 4 g/kg of body weight [kgBW]/day) or standard nutrient (amino acid of 2 g/kgBW/day) for three days in the pediatric intensive care unit of four hospitals in Indonesia. The patient’s enrollment was done between April 2016 and May 2017. The primary outcome was the pediatric logistic organ dysfunction (PELOD) score. TNFA-308 polymorphism was investigated using restriction fragment length polymorphism method in both groups. PELOD score was analyzed as mean differences and gene polymorphism was analyzed with mortality in a subgroup. RESULTS There were 40 children in each group. PELOD score on day-1 (22.4 versus 20.5, p = 0.429), day-2 (20.5 versus 19.8, p = 0.815), and day-3 (18.8 versus 19.8, p = 0.772) were not lower in high protein feeding compared to standard feeding. TNFA-308 polymorphism had no role in mortality of both groups (high protein, p = 0.426; standard, p = 0.456). CONCLUSIONS From this study, researchers concluded that a high protein intervention did not significantly decrease the PELOD score, length of stay, and duration of ventilator use in both groups.

Decompensated cirrhosis in children is a leading indication of liver transplantation (LT). Granulocyte-colony stimulating factor (G-CSF) therapy has shown promising results in adult decompensated cirrhosis. Our study aimed to investigate the effect of G-CSF on liver function, Pediatric End-stage liver disease (PELD) score, CD34+ cells mobilization, nutritional status, short-term side effects, and survival in children indicated for liver transplantation (LT).We performed an open-label, randomized controlled trial with decompensated liver cirrhosis between 3 months to 12 years old. The intervention group received a subcutaneous injection of G-CSF (5 μg/kg/day) for twelve courses in addition to standard medical treatment (SMT) for liver cirrhosis. We measured liver function, PELD scores, CD34+ cell mobilization, the change of leucocyte and neutrophil count, nutritional status, side effects, and survival within three months. Thirty-five pediatric patients were randomized into 17 interventional groups and 18 control groups. During the trial, 14 (82%) of the interventional group completed the intervention course. The median age was 18 months in the interventional group and 14.5 months in the control group. The alanine aminotransferase (ALT) level showed significant improvement in the intervention group, while other liver parameters, PELD score, nutritional status, and survival, did not. CD34+ cells mobilization rose in the interventional group but was statistically insignificant. Minor side effects of G-CSF were found in the intervention group.Multiple doses of G-CSF significantly improve ALT but did not improve PELD score, nutritional status, and survival in three months.

BACKGROUND: Organ damage due to iron toxicity is one factor that increases the risk of getting cardiovascular and metabolic diseases in thalassemia patient. This study aims to determine glucose and lipid profiles in adolescents with thalassemia major and its association with iron overload in pancreas and liver. METHODS: This was a cross sectional study. Subjects were thalassemia major adolescents without any confounding factors that may affect glucose and lipid levels. Blood samples were collected to measure the glucose level, lipid profiles, ferritin level and transferrin saturation. T2-Magnetic Resonance Imaging was used to evaluate the iron overload in organs. RESULTS: From a total of 60 subjects, diabetes mellitus was diagnosed in 1 subject and impaired fasting glucose was diagnosed in 3 subjects. All subjects had high triglycerides/ high density lipoprotein-cholesterol (HDL-C) ratio, 59 subjects (98%) had low HDL-C, 18 subjects (30%) had hypertriglyceridemia, and none had abnormal high level of low density lipoprotein-cholesterol (LDL-C). The majority of subjects had ferritin ≥2,500 ng/mL (70%), mild pancreatic iron overload (56.6%), and moderate hepatic iron overload (43.8%). Degree of hyperferritinemia was not associated with glucose and lipid profiles. Blood glucose profiles were not associated with various degree of pancreatic iron overload. Similar result was also observed between lipid profiles and hepatic iron overload. CONCLUSION: Abnormal glucose and lipid profiles in thalassemia major can be found in adolescence. Normal blood glucose level isn’t necessarily associated with normal pancreatic iron deposition. Hepatic iron overload may worsen dyslipidemia in thalassemia major patients. KEYWORDS: glucose profile, lipid profile, pancreatic iron overload, hepatic iron overload, thalassemia major

BACKGROUND: Dyspareunia and pain due to the decrease of vaginal wall thickness usually happen in menopausal women. The reduction of estrogen levels cause the decreasing of cell proliferation and the thinning of vaginal wall epithelium. Tomato ( Solanum lycopersicum ) is a source of phytoestrogens, which produce estrogenic effects. This study aims to assess the effect of tomato juice on Ki-67 expression and epithelial thickness of the vaginal wall in menopausal rats. METHODS: This was an experimental study using Sprague-Dawley rats. Twenty-four female rats, aged 4 months and weighing 150-200 grams, were divided into 4 groups. Each group consisted of 6 rats. Negative control (NC) group was group of rats with sham procedure and performed by distilled water for 28 days. Positive control (PC) group was group of bilateral ovariectomized rats and performed by distilled water for 28 days. The first treatment (T1) group was group of bilateral ovariectomized rats, given tomato juice at dose of 11g/200g body weight (BW)/day. The second treatment (T2) group was group of bilateral ovariectomized rats, given tomato juice at dose of 15g/200g BW/day. Data analysis was done with Anova, multiple comparisons and regression test. RESULTS: The group with lowest Ki-67 expression was PC group (2.52±0.60). The expression of Ki-67 in treatment groups (T1 and T2) was higher than PC group, but lower than NC group. There was no significant difference between groups ( p =0.771). The lowest epithelial thickness was found in PC group (21.19±3.96) and the highest was found in the treatment groups (38.73±12.43). There was positive correlation between tomato juice and epithelial thickness ( p =0.647). CONCLUSION: Tomato juice increases Ki-67 expression and epithelial thickness on the vaginal wall of menopausal rats. The increase of epithelial thickness follows the administration dose, but Ki-67 expression does not exceed in the control rats. Tomato juice increases the cell proliferation of vaginal wall on menopausal rats, however the increase is still within normal limits. KEYWORDS: epithelial thickness, Ki-67, menopause, tomato juice

Objective To determine the nature and extent of misappropriation of medications and equipment from the ED. Methods We undertook a retrospective audit of medications procured and administered, and equipment replaced, in 2016, within a tertiary referral ED. Medication procurement and administration data were obtained from our MERLIN® pharmacy system and CERNER® electronic prescribing system, respectively. A medication ‘discrepancy rate’ was defined as the percentage of a medication procured that could not be accounted for by electronic administrations. The study also comprised a nested intervention sub-study where, from July 1, 2016, all Panadeine Forte tablets were stored in a locked facility. Victorian Hospital Healthcare Equipment invoices were audited to determine which major non-disposable equipment items most commonly needed resupply. Results Discrepancy rates for paracetamol 500 mg and 665 mg tablets were 23.3% and 54.9%, respectively. Following the Panadeine Forte intervention, the discrepancy rate for this medication fell from 70.5% to 8.8%. Orally administered medications with the potential for misappropriation had high discrepancy rates: caffeine (90.6%), cephalexin (62.9%), ondansetron (50.1%), pantoprazole (42.9%), amoxicillin (41.1%), metoclopramide (41.0%) and the ‘morning after pill’ (levonorgestrel) (36.4%). Parenterally administered medications had lower discrepancy rates: ceftriaxone (7.9%) and ampicillin (3.4%). The largest equipment replacement rates were for tourniquets and crutches. Conclusion Discrepancy rates for many medications, especially those administered orally, are high. Further research is required to determine how these medications ‘go missing’. Placing a medication with a high discrepancy rate in a locked facility with a ‘logbook’ substantially reduces this rate. Misappropriation of non-disposable equipment items is uncommon.

Background Obesity causes adipocytokines dysregulation and enhances the pro-inflammatory response. Low-grade chronic inflammation is related to cardiometabolic diseases. Objective To evaluate the status of low-grade chronic inflammation in pre-pubertal, obese boys and its potential correlation to adipocytokines and body fat mass. Methods This cross-sectional study included pre-pubertal, male, superobese children as the subjects. We determined obesity status using the CDC 2000 BMI-for-age chart. Body fat percentage was measured using bioelectric impedance analysis (BIA). Fasting blood specimens were collected to evaluate hsCRP, leptin, adiponectin, and TNF-α levels. Results Eighty subjects were recruited into this study, with a mean age of 6.9 years. Ten subjects (12.5%) had low-grade chronic inflammation (hsCRP level ≥ 1 mg/L). The levels of hsCRP was not correlated with leptin, adiponectin, and TNF-α levels. A weak, but significant correlation was observed between hsCRP level and body fat mass (r= +0.383; P

OBJECTIVE To determine the quality of reports of the randomized controlled trial (RCT) in the field of pediatrics conducted by Indonesian investigators. METHODS All pediatric RCTs conducted by Indonesian researchers were sourced from international and national (local) publications. The assessment was done using both the Consolidated Standards of Reporting Trial (CONSORT) 2010 statement and Jadad Scale. Overall scores from each assessment are reported with a comparison of overall scores between studies in international and local publications. RESULTS A total of 91 pediatric randomized control trials by Indonesian authors were gathered. National publications yielded a total of 44 studies (48.4%) whilst international publications yielded 47 studies (51.6%). Using the CONSORT statement the percentage of good reports was 38.3% in international journals and 33.3% in national journals. Using Jadad scale the percentage of good reports was 43.6% (international journals) and 37.0% (national journals). Both were not statistically significant. CONCLUSIONS Even though Indonesian investigators still need to be familiarized with good RCT reporting, the overall quality of the reports is fairly satisfactory. There is no significant difference in quality between studies published in international or national journals.

Introduction A hernia is a protrusion of an organ or tissue through an abnormal anatomical channel or opening. Epidemiological data indicated an increased prevalence of inguinal hernias in patients with connective tissue diseases. The biomechanical strength of connective tissue is highly dependent on the constituent of the matrix, including collagen. Fibroblasts produce and secrete procollagen containing high concentrations of proline and lysine. Collagen integrity plays an essential role in preventing hernia formation in the abdominal wall. To investigate the relationship between collagen proline levels of the anterior rectus sheath tissue in patients with lateral inguinal hernias (indirect inguinal hernia). Methods The study participants consisted of 67 inguinal hernia patients. A sample of anterior rectus tissue was obtained at the time of surgery, then being washed in a PBS buffer (pH 7.4). The measurement of collagen proline levels was subsequently carried out with enzyme linked immunosorbent assay (ELISA). Results All study participants were male with mean age of 44 years, mean body mass index of 22.6 kg/m2 and mean onset of events of 27 months. Study subjects with reducible, irreducible, and incarcerated hernias were 45.7% (44/67 cases), 14.9% (10/67) and 19.4% (13/67), respectively. The mean proline level of the study subjects was 9.20. Correlation tests showed a correlation of proline levels and age (p = 0.001), body mass index (p = 0.006), and the onset of events (p = 0.023). Meanwhile, correlation of proline levels and occupation (p = 0.235) and clinical degree (p = 0.164) were not statistically significant. Conclusion Presence if relationship between proline levels with age, and onset of incidence among indirect inguinal hernia patients., HIGHLIGHT • Collagen is the main structural protein in the muscle wall layer. • Defects in collagenases will result in abnormal collagen synthesis leading to pathological collagen degradation. • Decreases in hydroxyproline and collagen were observed in the fascia and muscle tissue of patients with inguinal hernias. • There are a relationship between proline levels with age, and onset of incidence among indirect inguinal hernia.

Background: In the last two decades, one of the critical factors of assisted reproductive technology (ART)has been identified as ovarian capacity. Consequently, ovarian capacity markers have evolved to be part ofdiagnostic testing conducted regularly before IVF. Several predictor factors, such as antral follicle count(AFC), is one of several factors to predict ovarian capacity. These diagnostic procedures and tests have thepurpose of identifying women at high-risk patient who respond poorly toward controlled ovarian stimulationthroughout the IVF cycle. The ovarian response toward ovulation stimulation within this research was assessedby peak estradiol (E2) serum levels and the total number of mature follicles. There is no clear relationshipbetween AFC and levels of estradiol serum and the number of mature ovarian follicles to identify womenwho respond poorly. Methods: This study is an analytical study with a cross-sectional design. Samples weretaken from secondary data of medical records using the total sampling method on women undergoing the IVFprogram at the Graha Amerta fertility clinic of General Hospital of Dr. Soetomo from January 1 to December31 2018 according to the inclusion and exclusion criteria. The AFC variables, estradiol serum levels, and thenumber of mature ovarian follicles in the study were analyzed using Spearman’s correlation. Conclusion:There is a significant relationship between antral follicle count (AFC) with the levels of estradiol serum andthe number of mature follicles in women undergoing the IVF program.

Fracture is defined by the loss of bone or cartilage continuity, either total or partial. Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both. HbA1c could be used as a diagnostic tool and determines the glycaemic control of DM patients. This study aimed to investigate the correlation between serum HbA1c levels and the healing process of postoperative fractures in DM patients. This was an observational study with a retrospective cohort design. The study population was DM patients who were admitted to the Department of Emergency, Dr. Wahidin Sudirohusodo General Hospital, Makassar due to long bone fracture within the period of September 2019-February 2020. The bone fractures healing was evaluated based on the radiographic union scale in tibial fractures (RUST) scores. The results are analysed using the Chi-square test. A total of 70DM patients who underwent fracture reduction surgery were involved in this study. Out of 35 patients with controlled DM (HbA1c 7%), and there were 13 (37.1%) patients and 22 (62.9%) patients with good and delayed union, respectively. The Chi-square test showed a significant relationship (p= 0.008). It can be concluded that the increase in HbA1c levels was related to the obstacles in bone fractures healing. Moreover, an infection contributes to the healing status of bone fractures.

Background: Infection remains a major pediatric health problem in Indonesia and usually leads to longer hospitalization due to the need for extended intravenous antibiotic administration. In developed countries, pediatric outpatient parenteral antibiotic therapy (P-OPAT) is well-established and proven to be safe and effective at reducing the length of hospital stay; however, data on low- and middle-income countries such as Indonesia remain limited. This P-OPAT service is new and the first service in Indonesia. Methods: The medical records of patients attending Indonesia's first P-OPAT clinic between April 2015 and March 2017 were retrospectively investigated. Results: During the 24-month period, 32 patients received treatment at the P-OPAT clinic, saving a total of 258 bed days. The majority of patients (n = 16; 50%) were diagnosed with urinary tract infection, followed by cellulitis (n = 4; 12.5%) and osteomyelitis (n = 4; 12.5%). Ceftriaxone was the most commonly used antibiotic (n = 16; 50%). All patients used a peripheral intravenous catheter and were sent home with this device. Twelve patients (37.5%) needed to change IV access more than once. None of the patients used elastomeric infusor device. The median duration of OPAT was 5 days (range 1-27 days). All patients were successfully treated with no recurrence after 30 days. One patient (3.1%) experienced drug-related complication and another one (3.1%) was readmitted due to an underlying medical condition. All the patients complied with P-OPAT schedules. Conclusions: P-OPAT service offers a safe and effective option for the delivery of outpatient intravenous antibiotics in selected patients even in resource-poor settings.

Objectives: This study aimed to observe the difference in the area of endometriosis lesions and the histopathology of inflammatory cells and granuloma masses in an endometriosis mouse model treated with endometrial cell implants, endometrioma capsules, and adenomyosis tissue. Materials and Methods: This is an experimental study with posttest-only research design which was conducted with the control group. Thirty-two mice (Mus musculus) were injected with 0.2 mL/mice cyclosporin A and then were divided into three groups which were injected with endometrial tissue from the uterine cavity (group A), endometriosis from endometrioma capsule (group B), and endometriosis from adenomyosis (group C). The injection was done slowly into the peritoneal cavity, 0.1 mL each, and followed by intramuscularly Ethinyl estradiol, 0.2 μG/mice. On the 15th days, mice were dissected to observe the peritoneal endometriosis implant and microscopic examination with hematoxylin-eosin (HE) staining to determine the inflammatory cell infiltration and mass granuloma presence. Data were analyzed using SPSS, version 19. Results: The study obtained that the area of implanted endometriosis lesions in group C covered a larger area of endometriosis implants than other groups (P < 0.05). The peritoneal damage in group C was the most severe based on the Klopfleisch method (P < 0.05), with mass granuloma and massive infiltration of inflammatory cells and fibrous connective tissue formation occurring in muscle tissue. Conclusions: The implantation of adenomyosis cell tissue is the best method to develop mice model of endometriosis based on its inflammatory infiltration, the extent of lesion implant, and granuloma mass

Obesity is characterized with excessive accumulation of the body fat which occurs when the energy intake exceeds the expenditure. It is routinely associated with insulin resistance and hyperinsulinemia. Additionally, suppressing insulin level protects female mice from weight gaining. Cinnamon [Cinnamomum burmannii (Ness) Bl. Cortex] suppresses hyperinsulinemia condition in the type 2 diabetic rat suggesting the possible beneficial its role in the obesity. We aimed to investigate the effect of Cinnamon extract in the normal obese subjects. In this preliminary cross-over clinical trial, 24 normal obese subjects were recruited and divided randomly into two groups i.e. treatment and placebo. Two grams of the cinnamon extract were given twice daily for 56 days in the treatment group. Normal obese subjects given placebo were allocated as the placebo group. After the treatment, each of the group ran a one month run-in period, then the groups were crossovered for the next 56 days. Body mass index (BMI), insulin serum level, cholesterol and triglyceride plasma levels were measured at the beginning and at the end of the study. No diet restriction nor exercise intervention was given during the study. At the end of the study, BMI in the treatment group (58%) were slightly reduced when compared to the placebo group (33%), however, it was not significantly different (p>0.05). Moreover, significantly reduction in the insulin serum level was observed in 63% subject in the treatment group compared to 33% subject in the placebo group (p < 0.05). Additionally, there were no significant differences of cholesterol and triglyceride plasma level observed in the both group. In conclusion, cinnamon extract may give beneficial role in the normal obese subjects by suppressing the serum insulin level. Further studies are required to elucidate the specific role of cinnamon in preventing weight gain.

Background: Studies have shown type 2 diabetes mellitus (T2DM) accompanied by subclinical hypothyroid (SCH) leads to a higher retinopathy incidence, compared to T2DM without SCH. Furthermore, SCH patients are known to have a high risk of dyslipidemia. This study therefore aims to determine the relationship between dyslipidemia and retinopathy, in T2DM patients with SCH. Materials and Methods: This study used a cross-sectional design, and the study population consisted of adult patients diagnosed with T2DM over a year ago and visiting the Metabolic Endocrine Division’s outpatient ward at Cipto Mangunkusumo Hospital. The data collected include glycemic control, FT4, lipid profile TSHs, as well as retinopathy data. Results: According to the results, patients with T2DM and SCH accompanied by dyslipidemia, had a 2.76 times higher retinopathy risk, compared to patients without dyslipidemia ( p value = 0.014). Conclusion: A significant relationship was concluded to exist between dyslipidemia and retinopathy in T2DM patients with SCH. International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 478-483

Introduction and importance Conjoined twin is a rare congenital anomaly characterized by a fusion of certain anatomical structures. Coronavirus-19 (COVID-19) is a new emerging infectious respiratory disease affecting worldwide and potentially leads to acute respiratory distress (ARDS) in children. COVID-19 has reconstructed the healthcare system, including surgical care and decision-making. Case presentation Herein we describe a surgical separation of 2.5 months old omphalopagus conjoined twins, with one of them (Baby A) presenting COVID-19-associated respiratory distress, as well as the challenges faced during the preparation and the execution of the complex surgical procedure. Clinical discussion Baby A underwent antiviral therapy, oxygen supplementation, and ventilation in the ICU, while baby B remained stable and confirmed negative for SARS-CoV-2. The separation surgery was conducted after baby A had become clinically stable. Defect closure and reconstruction were accomplished. At one week follow-up, Baby A died of lung infection, while baby B remained well after one year. Conclusion The complexity of surgical separation requires careful planning by a multidisciplinary team. Surgical separation of conjoined twins during the pandemic era has not been reported much in the literature, more reports are required to provide further insight., Highlights • Omphalopagus conjoined twins separation surgery is an intricate procedure that requires a multidisciplinary team • The separation surgery of conjoined twins during the COVID-19 pandemic necessitate a unique surgical preparation and disciplined health protocols. • The ideal timing of separation surgery of conjoined twins in the COVID-19 pandemic era remains controversial, factors that may play a role in the decision making include the age, weight, general clinical condition, and the complexity of fusion identified

Objective: To evaluate the effectiveness of hematopoietic stem cell (HSC) on TNF-α expression, spiral artery remodeling, and placental apoptosis.Methods: The study used pregnant mice divided to five groups of treatment: Group 1, without treatment; Group 2, 1/12 LD50 of lead and Aquadest; Group 3, 1/16 LD50 of lead and Aquadest, Group 4, 1/12 LD50 of lead and 1 × 107 HSC; and group 5, 1/16 LD50 of lead and 1 × 107 HSC. Histopathology examination was performed to identify spiral artery remodeling. Immunohistochemistry analysis was conducted to characterize TNF-α expression and the apoptosis index. The data from all five groups were compared using the ANOVA test.Results: TNF-α expression differed significantly among the groups that were not exposed to lead, exposed to lead and exposed to lead after HSC treatment (P0.05).Conclusions: In lead-exposed pregnant mice, the administration of hematopoietic stem cell may decrease TNF-α expression, spiral artery remodeling, and placental apoptosis index but in the group of 1/16 LD50 of lead and HSC treatment, apoptosis index has no differences with those of control group.

Background Core body temperature measurement is not commonly done in pediatric populations because it is invasive and difficult to perform. Therefore, axillary and tympanic membrane temperature measurements are preferable, but their accuracy is still debatable. Objective To compare the accuracy of axillary and tympanic temperatures to rectal temperature in children with fever, and to measure the cut-off point for fever based on each temperature measurement method. Methods A diagnostic study was conducted among feverish children aged 6 months to 5 years who were consecutively selected from the Pediatric Outpatient Clinic, Pediatric Emergency Unit, and the inpatient ward in the Department of Child Health, Cipto Mangunkusumo Hospital (CMH), from December 2014 to January 2015. Subjects underwent three measurements within a two minute span, namely, the axillary, tympanic membrane, and rectal temperature measurements. The values obtained from the examination were analyzed with appropriate statistical tests. Results The cut-off for fever on axilla was 37.4 o C and on tympanic membrane was 37.4 o C, with sensitivity 96% (95%CI 0.88 to 0.98) and 93% (95%CI 0.84 to 0.97), respectively; specificity 50% (95%CI 0.47 to 0.84) and 50% (95%CI 0.31 to 0.69), respectively; positive predictive value/PPV 90% (95%CI 0.81 to 0.95) and 85% (95%CI 0.75 to 0.91), respectively; and negative predictive value/NPV 83% (95%CI 0.61 to 0.94) and 69% (95%CI 0.44 to 0.86), respectively. The optimal cut-off of tympanic membrane and axilla temperature was 37.8 o C (AUC 0.903 and 0.903, respectively). Conclusion Axillary temperature measurement is as good as tympanic membrane temperature measurement and can be used in daily clinical practice or at home. By increasing the optimum fever cut-off point for axillary and tympanic membrane temperature to 37.8 o C, we find sensitivity 81% and 88%, specificity 86% and 73%, PPV 95% and 91%, and NPV 95% and 91%, respectively.

The patient with dysmenorrhea was treated by needling at Taichōng (太冲 LR 3), 4 times of treatment was given and the nausea, migraine and pain scale of the patient were alleviated and finally disappeared. Until the next two menstrual period, patient did not have similar complaints. The author recommended for other acupuncturists to utilize LR 3 as complementary therapy for relieving pain at primary dysmenorrhea.

Purpose This study aimed to investigate the clinical and metabolic determinants of circulating soluble leptin receptor (CSLR) and free leptin index (FLI) in pre-pubertal obese male children. Methods We conducted a preliminary cross-sectional study at three tertiary hospitals and one public primary school. Eighty obese male children without growth and developmental abnormalities aged 5-9 years were recruited. In these children, obesity was solely caused by excessive food intake, and not by acute illness, medications, endocrine abnormalities, or any syndrome. Body mass index (BMI), body fat mass, carbohydrate intake, fat intake, high density lipoprotein cholesterol level, low density lipoprotein cholesterol level, triglyceride level, and Homeostatic Model Assessment for Insulin Resistance are the potential determinants for leptin regulation, which is represented by CSLR level and FLI. Results Carbohydrate was the main source of energy. BMI and body fat mass had negative weak correlation with CSLR and positive weak correlation with FLI. Furthermore, carbohydrate intake was found to be independently associated with CSLR based on the results of the multiple linear regression analysis. Following an increase in carbohydrate intake, CSLR level decreased progressively without any negative peak. Conclusion Leptin regulation in prepubertal obese male children is associated with body composition and dietary intake. Carbohydrate intake is useful for predicting CSLR. Lipid profiles and insulin resistance are not related to both CSLR and FLI. Treatment and prevention of leptin resistance in obese children should focus on reducing BMI, fat mass, and carbohydrate intake.

We assessed carotid intima-media thickness (cIMT) and arterial stiffness in 28 children and adolescents with previous dengue hemorrhagic fever (DHF) (mean interval between DHF and cardiovascular assessment, 8.4 years), and 34 controls in a low-resource setting. Participants with previous DHF had an adjusted increased cIMT of 42.6 µm (95% confidence interval [CI]: 10.0-75.3, P = 0.01), and 61.7 µm (95% CI: 21.5-102.0, P < 0.01) in a subgroup analysis on dengue shock syndrome. There were no differences in arterial stiffness. In this first exploratory study, children and adolescents with a history of DHF had an increased cIMT, which may be modulated by dengue severity.

The purpose of this research is to know the relationship between leg mucle power, stomach muscle strength, body flexibility and ankle’s coordination on side kick’s speed in perguruan pencak silat kembang setaman wonosobo year 2020. This study is a corelation researcher, it needs one meeting to collect the data. The subject of this research is 14 athletes of Kembang Setaman Wonosobo. Source of data of this research is from the athletes and the researcher. Methods of collecting data that the researcher uses are test and observation. The researcher uses SPSS to test the data. Method of data analysis that the researcher chooses is descriptive quantitative. The study used 5 variables, namely variable x with leg muscle power, abdominal muscle strength, body flexibility and ankle coordination and variable Y with side kick speed / T. Based on the results of the analysis, it can be explained that (1) leg muscle power has a significant relationship to the side kick speed / right T indicated by the sig value. 0.008 0.005 (4) eye-foot coordination does not have a significant relationship as indicated by the sig value. 0.374 and0.472> 0.05. From the value of the contribution above, the contribution value is the leg muscle power compared to the abdominal muscle strength from the total value of the contribution, namely 55.6% for the side kick speed / T right and 71,1% for the contibution value for the side kick speed / T left. Based on the data above, it can be concluded from this study that there is a relationship between leg muscle power and abdominal muscle strength to side kick speed / T in the Kembang Setaman Wonosobo martial arts college in 2020 and there is no relationship between body flexibility and ankle coordination on side kick speed / T in Setaman Wonosobo Kembang Silat College 2020.

Background Currently, the prevalence of colorectal cancer (CRC) ranks among the top four diseases in the world. Indonesia ranks third in CRC, with poor survival rates. The high prevalence of CRC requires early diagnosis and intervention. This is expected to improve the survival rate of patients with CRC. The aim of this study was to compare the survival rate of patients based on age and pathological categories. Methods This study was an observational, analytic study with a cross-sectional approach consisting of 470 patients diagnosed with colorectal cancer in our institution. Data was obtained from medical records, and univariate, bivariate, multivariate data analyses and survival analysis were performed. Results Most CRCs occur in the rectal area (41.3%). Those who experienced metastasis (25.8%) were mostly liver cancer patients, mostly in stage 3 (67.2%), with a moderate differentiation rate of 82.8 percent. This study proves that there is a significant difference between survival rates for age categories where age ≥ 50 years tends to have a lower survival rate (HR 1.6; p Conclusion This study shows that the survival rate for colorectal cancer patients at our institution is mostly

Introduction Diabetic foot ulcers (DFU) are the main cause of amputations in non-trauma patients. There are risk factors, such as age, diabetic duration, smoking, obesity, hypertension, poor ankle-brachial index (ABI), and high neutrophil/lymphocyte ratio (NLR), for diabetes mellitus patients that can aggravate and are closely related to the occurrence of diabetic foot ulcers. Examining the correlation among these risk factors with the degree of the DFU according to Wagner's classification was the objective of the study. Method This study was a cross-sectional study examining 40 samples of DFU patients at our institution from 2016 to 2020. The results of this study were processed using Spearman's correlation test on SPSS software version 23. Results were considered significant if p-values Result From 40 samples, it was found that duration of diabetes (p = 0.018), smoking (p = 0.008), ABI (p = 0.0001), and NLR (p = 0.028) had a significant correlation with degree of DFU according to Wagner's classification. Age (p = 0.364), obesity (p = 0.87) and hypertension (p = 0.73) is not significantly related. Conclusion There is a significant correlations between diabetes duration, smoking, ABI, and NLR with the degree of diabetic foot ulcers according to Wagner's classification.

Introduction: The number of oocytes retrieved during in vitro fertilization related to the success of pregnancy. Today in vitro fertilization has been considered as definitive therapy for infertility problem. Age and duration of infertility is an important factor in infertility that should be evaluated in detail. The purpose of this study was to clarify the role of age and duration of infertility on the number of oocytes retrieved during in vitro fertilization. Method: This was an analytic observational study, including infertile female patients who followed the in vitro fertilization program at Fertility Clinic Graha Amarta Dr Soetomo Hospital Surabaya. Total sampling was conducted during January 1st-June 30th 2014 and found 66 study subjects. Evaluation was performed on age, duration of infertility and the number of oocytes retrieved following ovarian stimulation using FSH and GnRH antagonist injection. All data were analyzed by ANOVA test with level significance of ≤ 0.05. Result: In the group of age

Introduction: Chemotherapy has cytotoxic effect that induces follicular damage and abnormal folliculogenesis leads to ovarian failure. Two crucial growth factors in abnormal folliculogenesis, Growth Differentiation Factor-9 (GDF-9) and Kit-Ligand, will be disrupted and affect follicular development. In this study, we evaluate whether bone marrow transplantation (BMT) has a role on oocyte-granulosa cell interaction by analyzing GDF-9 and Kit-Ligand expressions and also follicular development by analyzing primordial, primary, secondary and graafian follicles of cisplatin-induced ovarian failure in rat. Material and method: Forty eight rats were divided into three groups: control, cisplatin and cisplatin + BMT. Ovarian failure was induced by administration of intraperitoneal cisplatin 5 mg/kg body weight for 1 week. BMT 2 x107 cells were injected through rat tail vein after cisplatin administration. Bone marrow was isolated from rat femur and characterized by CD44(+), CD45(-), CD105(+). Immunohistochemistry examinations for ovarian GDF-9, Kit-Ligand and follicle development evaluation were performed after 2 weeks of BMT injection. Results: The expressions of Kit-ligand among three groups by ANOVA were significant different (p=0.00), whereas by Post Hoc: cisplatin group lower than control group (p=0.00); cisplatin + BMT group higher than cisplatin group (p=0.00); and no significant different between control group and cisplatin + BMT group (p=0.955). The expressions of GDF-9 by Kruskal Wallis showed significant different (p=0.00) among three groups whereas cisplatin + BMT group higher than cisplatin group and control group. In cisplatin + BMT group the number of primordial, primary, secondary and graafian follicles were higher than those in cisplatin group; but were lower than those in control group (p=0.000). Positive Paul Kart Horan (PKH) labeling was seen in cisplatin + BMT group only. Conclusion: In cisplatin-induced ovarian failure in rat, bone marrow transplantation may improve oocytegranulosa cell interaction and follicular development.

Introduction: Prolonged hyperglycemia may lead to several detrimental microvascular or macrovascular complications in the chronic diabetes mellitus. Thus, achieving normal glycemic condition remains the most important strategy in the diabetes mellitus. Stevia rebaudiana plays an important role on the blood glucose reduction, however, its role in the chronic diabetes mellitus has not been fully elucidated yet.Method: Stevia rebaudiana dry extract (400 mg/kg BW) were given daily by oral gavage for 84 days in rat with diabetes. The measurement of blood glucose concentration were done monthly during the study. Urine output was analyzed on the day 1 and 84. Additionally, lipid profile were measured on the day 84.Results: Compared to the normal rat, significant hyperglycemia were observed in the diabetic rat. Blood glucose concentration tends to decrease in the rat received Stevia rebaudiana extract (St), however, significant difference was achieved on the day 84 of the study confronted to the diabetic rats. Moreover, lower concentration of plasma cholesterol concentration and urine output reduction was significantly observed in the St rat compared to the D rat on the day 84.Discussion: Daily intake of Stevia rebaudiana extract on its therapeutic doses may play beneficial role in the chronic diabetes mellitus by gradually reduced blood glucose concentration, urine output and plasma cholesterol concentration. However, further cellular analysis were required to explicate the exact mechanism.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 22-26

Background:According to some recent studies, a connection exists between type 2 diabetes mellitus (T2DM) and the occurrence of subclinical hypothyroid (SCH).This purpose of this research was therefore, to determine the proportion of SCH in those diagnosed with T2DM.Materials and Methods: Data was obtained for this cross-sectional study by analyzing 278 patients suffering from T2DM for at least 1 year. The collected data include glycemic control (HbA1c) and thyroid hormone. Those with triiodothyronine (fT3), thyroxine (fT4), and TSH (≥4 μIU/ml) were suffered from SCH and examined with ultrasonographic (USG) for clinical screening of thyroid diseases.Results:Approximately 7.2% patients with T2DM were above 60 years with significant differences in number of men and women diagnosed with diabetes mellitus. There is also a significant correlation between HbA1c and SCH in T2DM. Among 20 subjects with SCH, USG thyroid suggested thyroiditis in 15 subjects.Conclusions:The prevalence of SCH among T2DM patients is high, therefore, all those with T2DM need to be examined for thyroid dysfunction.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 12-15

Objectives: The morbidity and mortality rate of peptic ulcer disease (PUD) is quite high. For example proportion of PUD in China was 17.2%. There is a lack of epidemiological data available for this disease in Indonesia. This study aims to determine the proportion of PUD in Haji Hospital Jakarta and to describe the risk factors of age, sex, and patient history of NSAIDs medication.Materials and Methods: This was a cross sectional study. Samples were patients who undergo esophagogastroduodenoscopy (EGD) examinations at the Hajj Hospital Jakarta from 2015 until 2018. Samples who met the inclusion dan exclusion criteria were selected randomly as needed. Data of chief complaints, diagnosis, age, sex, and history of NSAIDs medication were taken from the medical record.Result and Discussions: 112 samples were selected in this study. Major chief complaint was dyspepsia (42.9%). The proportion of PUD was 16 (14.3%) and predominantly male (75%). Most of the samples with PUD were >46 years old (68.8%). History of NSAIDs medications were 81.3% and most commonly used was mefenamic acid (41.2%). There was no significant association between PUD with sex (p>0.005), but there was a significant association between PUD and age (p < 0.005). Furthermore, older people more than 46 years were 11.5 times more likely to develop peptic ulceration than below 46 years (PR= 11.556).Conclusion: Elderly people should be more aware of the risk of getting PUD, especially those who had a history of NSAIDs medication.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 27-30

Introduction: Hyperglycemia has become the main characteristic of diabetes mellitus. Persistent hyperglycemia directly activates cell death pathway that plays pivotal role in the diabetic complication including diabetic cardiomyopathy. Syzygium polyanthum plays a beneficial role in the diabetic condition by reducing the blood glucose concentration, however the role of this natural resources in preventing further complication of diabetes mellitus has not been revealed fully yet. Method: Syzygium polyanthum dry extract (300 mg/kg body weight) were given daily for 28 days in the streptozotocin-induced diabetic rat. Measurement of blood glucose concentration were done three times during the study, meanwhile cholesterol concentration, myocardial diameter and cardiac apoptosis were measured on the day 28 of the study. Cardiac apoptosis was analyzed by the TdT-mediated dUTP nick end-labelling (TUNEL Assay). Results: Persistent hyperglycemia as well as cardiac apoptosis was significantly observed in the diabetic rat (D) on the day 28 of the study confronted to the normal rat (N). Interestingly, significant blood glucose reduction in concomitant with a lesser concentration of cardiac apoptosis were observed in the diabetic rat received 28 days Syzygium polyanthum extract (DS) confronted to the D rat. Additionally, lower plasma cholesterol concentration was significantly observed in the DS rat confronted to the D rat. Discussion: Significant cardiac apoptosis was observed in consistent with persistent hyperglycemia in the D rat as well as lesser cardiac apoptosis was observed in accordance with blood glucose concentration reduction in the DS rat. Therefore, Syzygium polyanthum may play beneficial role in the diabetic-associated cardiac apoptosis through its direct effect on the blood glucose concentration reduction. However further analysis should be done to fully elucidate the apoptotic pathway that involved. International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 16-2 1

Background Working mothers have a higher risk to terminate breastfeeding earlier than stay-at-home mothers. Researchers reported that support from the workplace by creating lactation facilities and develop supportive programs are necessary to increase the success of exclusive breastfeeding. The aim was to achieve expert consensus on developing a workplace-based lactation promotion model. Methods A three-round online survey using Delphi approach was conducted to reach consensus on to the development of a lactation program at a workplace. Results Twenty-two experts from Indonesian health authority, community medicine, child health and obstetrics were invited to join the Delphi study; 15 (68.2%) enrolled in the first round. The response rate in the second and third round was 80.0% (12/15) and 86.7% (13/15), respectively. The first round categorized the workplace-based promotion model into seven dimensions, i.e. policy and regulation, facility, education material, target participants, promotion approach, human resources, and time. In the final round, “maternity leave of 3-6 months” (median (Q1;Q3):2 (1, 4)) and “employees have the right to breast-pumping every 3 hours” (median (Q1;Q3):3 (2, 4)) ranked as the two most important indicators regarding policy and regulation. A dedicated lactation room (median (Q1;Q3):1 (1)) is the highest ranked indicator regarding facility dimension. Regarding education materials, benefits of breast milk for babies ranked as the highest indicator while for the education and delivering methods dimensions, social media and interactive counseling were two highest ranked indicators. The top management in the company and lactation counselor are the two highest-ranked indicators in human resources dimension. Conclusion In the view of experts, involvement of a dedicated policy maker in the company, a workplace-based lactation counselor, regular promotion with interactive education and dedicated facilities are necessary to develop an effective workplace-based lactation promotion model.

Little is known about the effects of the 'cold calling' technique (telephone contact without prior warning) for patient follow up in ED research. Recently, we undertook a prospective, observational pain management study. Patients were cold called 48 h post-discharge and surveyed regarding their pain management satisfaction. We made contact with 778 patients. Among these, we observed 12 cases of patient anger: mistaken identity, disbelief that the hospital was calling, frustration that test results and appointment times could not be provided, abuse about ED management and outpourings of sadness. We also observed eight cases of an undesirable experience for either the patient, their family or the caller: five patients had died (including one 'at her last moments'), precipitation of patient distress and uncomfortable situations for the caller. Given our experience, we believe that cold calling should be avoided, where possible, and other techniques (e.g. limited disclosure) considered as alternatives.

Background We aimed to determine the barriers to optimal management of psychiatric patients in the emergency department (ED). Methods We undertook an observational study in a tertiary referral ED with a 24 h acute psychiatric nursing service (February to April, 2017). Following patient discharge, the attending psychiatric nurse completed a validated questionnaire to determine the barriers they encountered with their patient. Results Data were collected on 104 patient encounters. The environmental/resource barriers included limited space (30.8% of cases), limited time (25.0%) and ED overcrowding (22.1%). The ED staff barriers included insufficient knowledge and education regarding psychiatric illness (25.0%), negative attitudes (17.3%) and avoidance of psychiatric patients (16.3%). The patient barriers included dual diagnoses (26.0%), difficulty differentiating between psychiatric illness and social disorganisation (25.0%), and presentation issues complicating management (22.1%). The day of presentation, patient diagnosis and place of disposition were associated with the total number of barriers for each patient. Most barriers were reported on weekdays, for patients with substance abuse disorders or psychosis and for those discharged to home or an inpatient psychiatric ward. Conclusion Barriers to optimal psychiatric management are common and vary considerably. These findings will inform workplace reform and education strategies aimed at mitigating the observed barriers.

Objective To report clinical effectiveness of acupuncture at Tai Chong (Liv3) as complementary therapy for relieving pain at dysmenorrhea. Method A single case of a 34-years-old female with dysmenorrhea. Single point selected was Liv3. Results After three times treatments; pain (cramp), nausea, migraine gradually disappear. Conclusion Acupuncture therapy in Liv3 effectively helps to relieve pain at dysmenorrhea.

Background Long-term anticonvulsant therapy, especially with enzyme inducers, has been associated with low 25-hydroxyvitamin D [25(OH)D] levels and high prevalence of vitamin D deficiency. However, there have been inconsistent results in studies on the effect of long-term, non-enzyme inducer anticonvulsant use on vitamin D levels.Objective To compare 25(OH)D levels in epileptic children on long-term anticonvulsant therapy and non-epileptic children. We also assessed for factors potentially associated with vitamin D deficiency/insufficiency in epileptic children.Methods This cross-sectional study was conducted at two pediatric neurology outpatient clinics in Jakarta, from March to June 2013. Subjects in the case group were epileptic children, aged 6-11 years who had used valproic acid, carbamazepine, phenobarbital, phenytoin, or oxcarbazepine, as a single or combination therapy, for at least 1 year. Control subjects were non-epileptic, had not consumed anticonvulsants, and were matched for age and gender to the case group. All subjects’ 25(OH)D levels were measured by enzyme immunoassay.Results There were 31 epileptic children and 31 non-epileptic control children. Their mean age was 9.1 (SD 1.8) years. Most subjects in the case group were treated with valproic acid (25/31), administered as a monotherapy (21/31). The mean duration of anticonvulsant consumption was 41.9 (SD 20) months. The mean 25(OH)D level of the epileptic group was 41.1 (SD 16) ng/mL, lower than the control group with a mean difference of 9.7 (95%CI 1.6 to 17.9) ng/mL. No vitamin D deficiency was found in this study. The prevalence of vitamin D insufficiency in the epileptic group was higher than in the control group (12/31 vs. 4/31; P=0.020). No identified risk factors were associated with low 25(OH)D levels in epileptic children.Conclusion Vitamin D levels in epileptic children with long-term anticonvulsant therapy are lower than that of non-epileptic children, but none had vitamin D deficiency.

Objective To determine the prevalence, predictors, and characteristics of health-related internet searches by adult emergency department (ED) patients; to examine the effect of searching on the doctor-patient relationship and treatment compliance. Design A multi-centre, observational, cross-sectional study; a purpose-designed 51-item survey, including tools for assessing e-health literacy (eHEALS) and the effects of internet searching on the doctor-patient relationship (ISMII). Setting, participants: 400 adult patients presenting to two large tertiary referral centre emergency departments in Melbourne, February-May 2017. Outcome measures Descriptive statistics for searching prevalence and characteristics, doctor-patient interaction, and treatment compliance; predictors of searching; effect of searching on doctor-patient interaction. Results 400 of 1056 patients screened for eligibility were enrolled; their mean age was 47.1 years (SD, 21.1 years); 51.8% were men. 196 (49.0%) regularly searched the internet for health information; 139 (34.8%) had searched regarding their current problem before presenting to the ED. The mean ISMII score was 30.3 (95% CI, 29.6-31.0); searching improved the doctor-patient interaction for 150 respondents (77.3%). Younger age (per 10-year higher age band: odds ratio [OR], 0.74; 95% CI, 0.61-0.91) and greater e-health literacy (per one-point eHEALS increase: OR, 1.11; 95% CI, 1.06-1.17) predicted searching the current problem prior to presentation; e-health literacy predicted ISMII score (estimate, 0.39; 95% CI, 0.20-0.39). Most patients would never or rarely doubt their diagnosis (79%) or change their treatment plan (91%) because of conflicting online information. Conclusion Online health care information was frequently sought before presenting to an ED, especially by younger and e-health literate patients. Searching had a positive impact on the doctor-patient interaction and was unlikely to reduce adherence to treatment.

Retrograde menstruation lead to I Kappa B Kinase (IKK) fosforilation in peritoneum macrophage and cause secretion of proinflammatory cytokine interleukin1β then stimulate endometriosis cell to produce Vascular Endothelial Growth Factor which lead to increasing of endometriosis lession seen as endometriosis implant area. Cytokine secretion was inhibited through prevention of NF-κB activation by dragon red fruit rind extract (Hylocereuspolyrhizus). The aim of this reserach is to know the effect of dragon red fuit rind extract with 0,25; 0,5; and 1 mg/g bodyweight dosage toward IL-1β, VEGF expression and implant area in endometriosis mice model. The design of this experiment was randomized post test only control group design.Endometrios mice model were made in 14 days and split into two group, positive control group and treatment group after two week negative control group and postive control group were given Na-CMC 0,5% solution consequetively, and treatment group were given dragon red fruit extract with different dosage. Signification number for IL-1β is p>0,05, signification number for VEGF is p>0,05, and implant area signification number is p>0,05. Administration of dragon red fruit rind extract can decrease IL-1β, VEGF, and implant area.

A randomized, double-blinded, placebo-controlled study was conducted to examine the effect of spatial repellent (SR) in households at risk of malaria in Indonesia. Following presumptive radical cure for malaria in 180 adult men representing sentinels of new infection in four clusters within two villages, all households were given either metofluthrin or placebo mosquito coils. Weekly blood smear screening and human-landing mosquito catches were done throughout the 6 months intervention. Malaria infections occurred in 61 subjects living in placebo households and 31 subjects living in SR coil households, suggesting a 52% protective effect of SR. Likewise, anopheles indoor human landing rates were 32% lower in homes receiving SR coils. Differences in the malaria attack rate between SR- and placebo-treated homes was significant when not accounting for the effects of clustering. When the analysis was adjusted for intra-cluster correlation, the differences between SR- and placebo-treated homes were not statistically significant. The findings provide evidence of SR public health benefit and support a larger trial statistically powered to detect those effects.

Accumulating evidence has implicated that GLP-1 may have a beneficial effect on cardiovascular and renal diseases but the mechanism is not fully understood. Here we show that GLP-1 analog, liraglutide, inhibits oxidative stress and albuminuria in streptozotocin (STZ)-induced type 1 diabetes mellitus rats, via a protein kinase A (PKA)-mediated inhibition of renal NAD(P)H oxidases. Diabetic rats were randomly treated with subcutaneous injections of liraglutide (0.3 mg/kg/12 h) for 4 weeks. Oxidative stress markers (urinary 8-hydroxy-2′-deoxyguanosine and renal dihydroethidium staining), expression of renal NAD(P)H oxidase components, transforming growth factor-β (TGF-β), fibronectin and urinary albumin excretion were measured. In vitro effect of liraglutide was evaluated using cultured renal mesangial cells. Administration of liraglutide did not affect plasma glucose levels or body weights in STZ diabetic rats, but normalized oxidative stress markers, expression of NAD(P)H oxidase components, TGF-β, fibronectin in renal tissues and urinary albumin excretion, all of which were significantly increased in diabetic rats. In addition, in cultured renal mesangial cells, incubation with liraglutide for 48 h inhibited NAD(P)H-dependent superoxide production evaluated by lucigenin chemiluminescence in a dose-dependent manner. This effect was reversed by both PKA inhibitor H89 and adenylate cyclase inhibitor SQ22536, but not by Epac2 inhibition via its small interfering RNA. Liraglutide may have a direct beneficial effect on oxidative stress and diabetic nephropathy via a PKA-mediated inhibition of renal NAD(P)H oxidase, independently of a glucose-lowering effect.

Introduction Despite the considerable number of children with Do\Vll syndrome in Indonesia, there is little data available on the success of intervention programs. This study was performed to define factors affecting the intelligence of young children with Do\Vll syndrome. Objective To determine factors associated Mth lower intelligence in children with Down syndrome, including growth parameters and participation in intervention programs. Methods This cross􀁃sectional study was undertaken from December 2010 to March 2011. Subjects were 60 children with Down syndrome aged 2􀁃6 years who were enrolled in an intervention program at both the Medical Rehabilitation Department, Cipto Mangunkusumo Hospital, and the Growth and Development Clinic, Harapan Kita Women's and Children's Hospital. Parents' data was obtained through self history􀁃taking and perusal of medical records. Subjects' anthropometric data (body weight, body height, and head circumference) was obtained through measurements using calibrated instruments. A psychologist administered IQ tests on the subjects. Results of the anthropometric and IQ tests were given to parents one week following the examinations. Results From the 111 children with Down syndrome registered in the intervention programs, 60 children (36 boys and 24 girls) met the inclusion criteria. The mean age of subjects was 4 years 6 months. Most subjects were well􀁃 nourished. Fifty􀁃five subjects had microcephaly. Eighty􀁃two percent of subjects participated in the program regularly and 70% of subjects had started in the program at less than 1 year of age. Subjects' mean IQ was 52.8. Analysis showed that girls, subjects who were overweight and obese, subjects with microcephaly, those with irregular attendance in the program, and those living under the poverty line were at highest risk for severe mental retardation. Conclusion Factors associated v.ith the intelligence in children with Down syndrome were female gender, overweight/obesity, severe microcephaly, below􀁃poverty line economic status, and irregular participation in the program. [Paediatr Indones. 2012;52:194-9].

Aims/Introduction: Diabetic cardiomyopathy entails the cardiac injury induced by diabetes, independent of vascular disease or hypertension. Despite numerous experimental studies and clinical trials, the pathogenesis of diabetic cardiomyopathy remains elusive. Here, we report that chymase, an immediate angiotensin II (AngII)-forming enzyme in humans and hamsters, and NOX4-induced oxidative stress have pathogenic roles in myocardial fibrosis in diabetic hamsters. Materials and Methods: Expression of chymase was evaluated in the hearts of streptozotocin (STZ)-induced diabetic hamsters. The impact of chymase-specific inhibitors, TEI-E00548 and TEI-F00806, on myocardial fibrosis, and increased levels of intracardiac AngII, accumulation of 8-hydroxy-2′-deoxyguanosine (an oxidative stress marker in urine and heart tissue) and expression of heart NOX4 in diabetic hamsters were investigated. Results: Myocardial chymase expression was markedly upregulated in STZ hamsters in a glucose-dependent manner. A total of 8 weeks after STZ administration, the diabetic hamsters showed enhanced oxidative stress and NOX4 expression in the heart, in parallel with increased myocardial AngII production. Oral administration of chymase-specific inhibitors, TEI-F00806 and TEI-E00548, normalized heart AngII levels, and completely reversed NOX4-induced oxidative stress and myocardial fibrosis in STZ-induced diabetic hamsters, although they did not affect the activity of the systemic renin–angiotensin system or systolic blood pressure. Conclusions: Chymase inhibition might prevent oxidative stress and diabetic cardiomyopathy at an early stage by reducing local AngII production. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2012.00202.x, 2012)

ObjectivePain management in the ED is often suboptimal, with many patients not receiving analgesia. We aimed to determine why some patients refuse it, why others do not receive it, and whether these variables impact on patient satisfaction with their pain management.MethodsWe undertook a prospective, observational study in a large, Australian, tertiary referral ED (February–May 2017). A convenience sample of consecutive adult patients with a triage pain score of ≥4 were examined. Data were collected from the medical record and the treating nurses. At follow-up at least 48 hours postdischarge, patients were asked if they received analgesia in the ED (if not, then why not) and how satisfied they were with their pain management (very dissatisfied/dissatisfied/slightly dissatisfied/slightly satisfied/satisfied/very satisfied). The primary outcome was why patients refuse analgesia.ResultsOf the 651 enrolled patients, 171 (26.3%) did not receive analgesia; for 30 (17.5%), patients and their nurses agreed that analgesia was refused. Patients mainly refused analgesia because their pain was not bad enough, they had recent analgesia intake, and concerns about side effects and interactions. Patients who received analgesia were more likely to be ‘very satisfied’ with their pain management (difference in proportions 10.8%, 95% CI 2.1 to 19.4). The satisfaction of patients who refused analgesia and those who did not receive analgesia for other reasons did not differ.ConclusionPatient refusal is the most common reason for patients not receiving analgesia. Analgesia receipt is associated with greater patient satisfaction. However, a patient’s knowledge of their analgesia receipt status may be incorrect. Disregard of the reasons for patients not receiving analgesia may underestimate the number offered analgesia.

Background Leptin induced weight loss is completely specific for adipose tissue loss, whereas food restriction result in both loss of adipose tissue and lean body mass in mammals. Most obese person has high endogenous leptin levels, indicating leptin resistance. There has been lack of data regarding plasma leptin level in Indonesian obese children. Objective This study was aimed to investigate the plasma leptin level and lipid profile in super-obese children. Methods This was a cross sectional study performed in Pediatric Out Patient Clinic Mangunkusumo Hospital and Private Women & Children Hospital in Eastern part of Jakarta. Super-obese is defined as children with BMI above 97 centiles CDC 2000 chart. Blood sample was obtained from all subjects, consisted of peripheral blood picture, lipid profiles and leptin level. Results Seventy nine super-obese children were eligible with age ranged between 12 months and 180 months and mean of age was 84.9 months (SD 36.8). More than 60% subjects had high LDL cholesterol, while 19% had low HDL level. The lowest leptin blood level was 2.877 μ g/dL, while the highest was 70.430 μ g/dL (mean 23.990; SD 12.726). Forty five subjects, all boys, had increased plasma leptin level. Conclusions In super-obese children, most of the subject experienced hyperlipidemia (LDL cholesterol) followed by hypertriglyceridemia. There was small number of low HDL cholesterol found. Super-obese girls had normal serum leptin level, in contrast, more than 60% super-obese boys had elevated serum leptin level.

Speaking fundamental frequency (SFF) and its perceptual correlate "habitual pitch" have been considered important and contentious parameters in voice assessment and treatment. In clinical circles, disagreement exists regarding the role of habitual pitch in the development, maintenance, and treatment of disordered voices. Despite these divergent opinions, few studies have objectively evaluated SFF changes associated with voice improvement after therapy. To determine whether consistent directional and magnitude changes in SFF occur after management, pretreatment and posttreatment audio recordings of 40 women with functional dysphonia were analyzed. All subjects were treated with manual circumlaryngeal therapy, a treatment approach that does not directly target pitch as a perceptual entity to be manipulated. Results indicated that, as a group, no significant change in mean SFF was observed after successful management. Although no consistent directional pattern was identified, 80% of the subjects experienced pitch changes greater than one semitone; this suggests that voice improvement is often accompanied by a shift in SFF. Clinical implications of the data are discussed.