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This study aims to analyze user sentiment towards Islamic banking applications in Indonesia, focusing on Islamic banking applications that have the lowest ratings on Google Playstore. The analysis was conducted to understand perceptions, satisfaction, and factors that influence user experience towards both applications in the context of Islamic economics. The research method used is a quantitative approach with sentiment analysis techniques on user reviews taken from Google Playstore. Data was collected by scraping user reviews and analyzed using the Natural Language Processing (NLP) method to identify positive and negative sentiments. In addition, descriptive analysis was used to explore the main themes that emerged in the user reviews. The results showed that the trust factor was the main contributor to positive sentiment, reaching 45.16% of the total positive sentiment. The feature factor was also significant, contributing 27.90%, while the Sharia aspect factor contributed 6.29%. The technical and service factors contributed 11.61% and 5.97%, respectively. These findings indicate that trust in the application, including security and integrity, as well as relevant features, is an essential element in shaping positive user sentiment. This study provides valuable insights for Islamic banking application developers and related parties to understand user needs and expectations. In addition, these findings highlight the importance of improving aspects of trust and application features to increase user satisfaction and loyalty. These findings contribute to the literature on Islamic economics and Islamic banking app development in the digital era and provide practical guidance to improve application performance in the Indonesian digital banking market.

As fossil fuels were depleting at an alarming rate, the development of renewable energy has become necessary. One of the promising renewable energy to be used is biodiesel. The interest in using third-generation feedstock, which is microalgae, is rapidly growing. The use of third-generation biodiesel feedstock will be more beneficial as it does not compete with food crop use and land utilization. The advantageous characteristic which sets microalgae apart from other biomass sources is that microalgae have high biomass yield. Conventionally, microalgae biodiesel is produced by lipid extraction followed by transesterification. In this study, combination process between hydrothermal liquefaction (HTL) and esterification is explored. The HTL process is one of the biomass thermochemical conversion methods to produce liquid fuel. In this study, the HTL process will be coupled with esterification, which takes fatty acid from HTL as raw material for producing biodiesel. Both the processes will be studied by simulating with Aspen Plus and thermodynamic analysis in terms of energy and exergy. Based on the simulation process, it was reported that both processes demand similar energy consumption. However, exergy analysis shows that total exergy loss of conventional exergy loss is greater than the HTL-esterification process.

Mealybug (Hemiptera: Pseudococcidae) attacks many citrus plants over the world. This study reveals mealybug species attack on citrus grown at three different altitude levels: lowlands (800 m asl) in Bengkulu Province. The results record nine species of mealybugs namely Dysmicoccus arachidis Williams, Dysmicoccus lepelleyi (Betrem), Ferrisia dasylirii (Cockerell), Ferrisia virgate (Cockerell), Paracoccus tripurae Williams, Pseudococcus comstocki (Kuwana), Pseudococcus cryptus Hempel, Planococcus dischidiae (Takahashi) and Rastrococcus chinensis Ferris. The species of R. chinensis is only found in the lowlands. Furthermore, P. comstocki is only found in the moderate lands and P. discidiae is only found in the highlands. D. arachidis, F. dasylirii, and R. chinensis are new insects pest on citrus. The key of those species is also included.

University sites are generally used as conservation areas in many countries. The secondary forest plays pivotal role in maintaining biodiversity in urban area. One of the creatures that live in secondary forest areas is arthropods. Moreover, there is only limited study about the diversity of soil arthropods in secondary forest of University of Bengkulu (UNIB). This study aimed to calculate the diversity of arthropod species as one of the measurement parameters in biodiversity. The samples were collected from soil and litter taken randomly in the secondary forest area at University of Bengkulu. A total of 5 locations within five replications were placed in the Berlese funnel. The results showed moderate diversity with an index value of 1.18, moderate evenness with an index value of 0.41, and moderate dominance with an index value of 0.56 in the habitat. UNIB secondary forest is being habituated and is still in the category of developing ecosystem. It is estimated that the number of species and populations will increase over time.

Recently, algae have received a lot of attention as a new biomass source for the production of renewable energy, such as biodiesel. Conventionally, biodiesel is made through esterification or transesterification of oils where the process involves a catalyst and alcohol to be reacted in a reactor. However, this process is energy intensive for drying and extraction step. To overcome this situation, we studied simulation of a new route of hydro-esterification process which is combine hydrolysis and esterification processes for biodiesel production from wet microalgae. Firstly, wet microalgae treated by hydrolyzer to produce fatty acids (FAs), separated with separator, and then mixed with methanol and esterified at subcritical condition to produce fatty acid methyl esters (FAMEs) while H2SO4 conducted as the catalyst. Energy and material balance of conventional and hydrolysis-esterification process was evaluated by Aspen Plus. Simulation result indicated that conventional route is energy demanding process, requiring 4.40 MJ/L biodiesel produced. In contrast, the total energy consumption of hydrolysis-esterification method can be reduced significantly into 2.43 MJ/L biodiesel. Based on the energy consumption comparison, hydro-esterification process is less costly than conventional process for biodiesel production.

Introduction: Oesophageal atresia (EA) is a life-threatening congenital oesophageal deformity that causes considerable newborn morbidity and death. Many prognostic variables have been linked to the survival of infants with EA, although the results of the studies are still conflicting. Furthermore, studies on EA effects in developing countries still need to be included. Here, we aimed to determine the survival of children with EA and link it to prognostic variables in a particular developing country., Materials and Methods: A cross-sectional observational retrospective study was conducted using medical records of paediatric patients with EA at our institution from January 2014 to December 2020., Results: A total of 53 children with EA were included in the study. Log-rank analysis showed that definitive surgery and thrombocytopenia were significantly associated with the survival of children with EA, with a p-value of 0.007 and 0.002, respectively, whereas, sex, EA type, pneumonia and sepsis were not (p = 0.898, 0.919, 0.255, and 0.499, respectively). Multivariate analysis revealed that thrombocytopenia and definitive surgery were strongly associated with the survival of children with EA with a pvalue of 0.014 (hazard ratio (HR) = 2.67 [95% confidence interval (CI) = 1.22-5.85]) and 0.022 (HR =0.39 [95% CI = 0.17- 0.87]), respectively., Conclusion: Our study shows that thrombocytopenia might increase mortality, while definitive surgery might be beneficial for the survival of paediatric patients with EA. It implies that definitive surgery should be performed as early as necessary to prevent further morbidity and mortality. Our study comprehensively provides the survival of children with EA and links it to prognostic variables in a particular developing country. It serves as a potential research project that can be applied to the clinical setting to help clinicians manage EA better.

Background: Diagnosing non-gestational uterine choriocarcinoma in children is challenging because of its rarity and nonspecific imaging findings. Herein, we report a case of non-gestational uterine choriocarcinoma in a child, which was unexpectedly found during exploratory laparotomy and confirmed by histopathological findings. However, the tumor did not respond to chemotherapy., Case Presentation: A 4-year-old Indonesian female patient was brought into the emergency unit with chief complaint of vaginal bleeding. She had suffered from vaginal spotting 4 months before being admitted to the hospital. Physical examination revealed a distended abdomen in the left lumbar region and a palpable fixed mass with a smooth surface. Abdominal computed tomography scans revealed a large mass (10 × 6 × 12 cm) with fluid density and calcification. Thus, we suspected left ovarian teratoma. The patient's luteinizing hormone, follicle-stimulating hormone, and lactate dehydrogenase levels were 25.2 mIU/ml, 0.1 mIU/ml, and 406 U/l, respectively. According to the clinical and radiological findings, we decided to perform an exploratory laparotomy and found a tumor originating from the uterus, not the ovarium. We did not observe liver nodules and any enlargement of abdominal lymph nodes. Subsequently, we performed hysterectomy. The histopathological findings supported the diagnosis of choriocarcinoma. The patient was discharged uneventfully on postoperative day 5. Thereafter, the patient underwent nine cycles of chemotherapy, including carboplatin (600 mg/m 2 IV), etoposide (120 mg/m 2 IV), and bleomycin (15 mg/m 2 IV). However, on the basis of the clinical findings of a palpable mass and partial intestinal obstruction, the tumor relapsed soon after the ninth cycle of chemotherapy. Currently, the patient is undergoing chemotherapy again., Conclusions: Although pure non-gestational uterine choriocarcinoma is rare, it should be considered as one of the differential diagnoses for intraabdominal tumors in a child, so as to better guide and counsel families regarding the surgical plan and prognosis, respectively. In the present case, the patient's response to chemotherapy was poor, implying that the treatment of non-gestational choriocarcinoma is still challenging, particularly in the pediatric population., (© 2024. The Author(s).)

Background: Coronavirus disease 2019 (COVID-19) surges, such as that which occurred when omicron variants emerged, may overwhelm healthcare systems. To function properly, such systems should balance detection and workloads by improving referrals using simple yet precise and sensitive diagnostic predictions. A symptom-based scoring system was developed using machine learning for the general population, but no validation has occurred in healthcare settings. We aimed to validate a COVID-19 scoring system using self-reported symptoms, including loss of smell and taste as major indicators., Methods: A cross-sectional study was conducted to evaluate medical records of patients admitted to Dr. Sardjito Hospital, Yogyakarta, Indonesia, from March 2020 to December 2021. Outcomes were defined by a reverse-transcription polymerase chain reaction (RT-PCR). We compared the symptom-based scoring system, as the index test, with antigen tests, antibody tests, and clinical judgements by primary care physicians. To validate use of the index test to improve referral, we evaluated positive predictive value (PPV) and sensitivity., Results: After clinical judgement with a PPV of 61% (n = 327/530, 95% confidence interval [CI]: 60% to 62%), confirmation with the index test resulted in the highest PPV of 85% (n = 30/35, 95% CI: 83% to 87%) but the lowest sensitivity (n = 30/180, 17%, 95% CI: 15% to 19%). If this confirmation was defined by either positive predictive scoring or antigen tests, the PPV was 92% (n = 55/60, 95% CI: 90% to 94%). Meanwhile, the sensitivity was 88% (n = 55/62, 95% CI: 87% to 89%), which was higher than that when using only antigen tests (n = 29/41, 71%, 95% CI: 69% to 73%)., Conclusions: The symptom-based COVID-19 predictive score was validated in healthcare settings for its precision and sensitivity. However, an impact study is needed to confirm if this can balance detection and workload for the next COVID-19 surge., (© 2023. The Author(s).)

Background: The skin closure procedure should be technically simple, acceptable, quick, and cost-effective. Sutures remain the technique's mainstay, however tissue adhesive is becoming more used in clinical practice. Collagen ratios of types I and III play a significant role as postoperative wound healing parameters. Here, the authors aim to examine the collagen I/III ratio of tissue adhesive vs. non-absorbable sutures for abdominal skin closure in Wistar albino rats., Material and Methods: The authors allocated 20 rats into four experimental groups. Wounds in groups 1 and 3 were sealed with tissue adhesive (cyanoacrylate), while those in groups 2 and 4 were closed using suture material (monofilament non-absorbable nylon). Groups 1 and 2 were sacrificed on postoperative day (POD) 4, while those in groups 3 and 4 were euthanized on POD 7. Skin samples (1×0.5 cm) were collected for analysis, and the collagen I/III ratios were determined using immunohistochemistry staining techniques., Results: The levels of collagen I and III expression did not exhibit statistically significant differences between tissue adhesive and nylon suture groups at either POD 4 ( P =0.052, P =0.513) or POD 7 ( P =0.125, P =0.80). Similarly, the collagen I/III ratio did not significantly differ between the two groups at POD 4 (1.23±2.26 vs. 0.70±0.24; P =0.47) or POD 7 (0.68±0.96 vs. 0.77±1.22; P =0.857)., Conclusions: There were no statistical significance difference in collagen I/III ratio between the tissue adhesive and suture material groups, suggesting that the choice of wound closure material may not influence the abdominal skin closure., Competing Interests: No potential conflict of interest relevant to this article was reported., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Although most patients with Hirschsprung disease (HSCR) improve after pull-through, some patients still have persistent obstructive symptoms. Most previous studies reported persistent obstructive symptoms after pull-through in HSCR patients from developed countries. Our study determined the prognostic factors of persistent obstructive symptoms in patients with HSCR following pull-through from a particular developing country., Methods: A cross-sectional study was conducted using medical records of patients with HSCR at our institution from January 2017 to January 2022., Results: We ascertained 114 patients with HSCR: 79 males and 35 females. Most of them (90.4%) showed a short aganglionosis and underwent transanal endorectal pull-through (55.3%). Twenty-two percent of patients showed persistent obstructive symptoms following pull-through. Operative technique and age at definitive surgery were significantly associated with the persistent obstructive symptoms after pull-through (p = 0.011 and 0.019, respectively), while sex, aganglionic segment length, presence of global developmental delay, and Down syndrome were not (p = 0.873, 0.525, 0.647, and 0.301, respectively). Multivariate analysis revealed that age at pull-through was a significant independent factor for persistent obstructive symptoms after pull-through, with an odds ratio of 3.41 (95% CI = 1.18-9.91; p = 0.02)., Conclusions: Our study shows a moderate frequency of persistent obstructive symptoms after pull-through in our institution. In addition, patients who underwent pull-throughs at a younger age might have persistent obstructive symptoms following a definitive surgery. Our study provides new data on persistent obstructive symptoms after pull-through from a particular population that might be beneficial for pediatric surgeons' consideration before performing definitive surgery on patients with HSCR., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Balela et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

People with dementia (PWD) may exhibit symptoms that negatively affect their relationships with their families or friends which could cause social strain. The Negative Relationship Quality (NRQ) questionnaire can be used to measure social strain in PWD. There has never been an Indonesian adaptation of the NRQ. This preliminary study aimed to measure the validity and reliability of the NRQ among PWD in Indonesia (NRQ-INA). This study used a cross-sectional design. Forward−backward translation methods were conducted first. Pearson’s correlation and factor analysis were employed for the validity test. Cronbach’s alpha and test−retest were used to determine reliability. The NRQ-INA has four parallel items related to social strain that are divided into three subscales and asked to spouse/partner, family members, and friends, leading to a total of 12 questions. The results of validity testing from 60 respondents showed that all items in the NRQ-INA were strongly valid with correlation coefficients (r) of >0.8 (p < 0.01). Factor analysis showed a convergence with the variance explained of more than 50% for all items in each subscale, which also indicated that NRQ-INA had acceptable construct validity to measure social strain. Cronbach’s alpha values (α) were 0.926, 0.942, and 0.938 for the subscales of spouse, friends, and family members, respectively. The correlations of test−retest reliability for all items were >0.7 (p < 0.01), demonstrating a reliable NRQ-INA measurement. In conclusion, NRQ-INA had a good validity and reliability to measure social strain in PWD. Further study of the concurrent validity among PWD is still needed.

Objective: Some prognostic factors have affected the functional outcomes of patients with anorectal malformations (ARM) after definitive surgery, including the associated anomalies. Moreover, the anal position index (API) study in neonates from developing countries is minimal. We aimed to (1) compare the API between neonates with ARM and controls; and (2) determine the impact of associated anomalies on the API in neonates with ARM., Results: We ascertained 68 subjects: 35 neonates with ARM and 33 controls. The API of neonates with ARM was similar to controls, either male or female neonates (p = 0.51 and 0.90, respectively). Interestingly, the API in ARM males with associated anomalies (0.42 ± 0.07) was significantly lower than in control males (0.48 ± 0.02) (p = 0.005). Moreover, the API of ARM neonates with vertebral anomalies (0.35 ± 0.04) was lower than ARM neonates without vertebral anomalies (0.47 ± 0.07) (p = 0.021). In conclusion, associated anomalies and sex might affect the API in neonates with ARM. These findings should be considered and informed during counseling to the parents regarding the prognosis of functional outcomes in ARM neonates, particularly with associated anomalies., (© 2022. The Author(s).)

Necrotizing enterocolitis (NEC) is responsible for most morbidity and mortality in neonates. Early recognition of the clinical deterioration in newborns with NEC is essential to enhance the referral and management and potentially improve the outcomes. Here, we aimed to identify the prognostic factors and associate them with the clinical deterioration of preterm neonates with NEC. We analyzed the medical records of neonates with NEC admitted to our hospital from 2016 to 2021. We ascertained 214 neonates with NEC. The area under the receiver operating characteristic (ROC) curve and cut-off level of age at onset, C-reactive protein (CRP), leukocyte count, and platelet count for the clinical deterioration of preterm neonates with NEC was 0.644 and 10.5 days old, 0.694 and 4.5 mg/L, 0.513 and 12,200/mm 3 , and 0.418 and 79,500/mm 3 , respectively. Late-onset, history of blood transfusion, thrombocytopenia, and elevated CRP were significantly associated with the clinical deterioration of neonates with NEC (p =  < 0.001, 0.017, 0.001, and < 0.001, respectively), while leukocytosis, gestational age, and birth weight were not (p = 0.073, 0.274, and 0.637, respectively). Multivariate analysis revealed that late-onset and elevated CRP were strongly associated with the clinical deterioration of neonates with NEC, with an odds ratio of 3.25 (95% CI = 1.49-7.09; p = 0.003) and 3.53 (95% CI = 1.57-7.95; p = 0.002), respectively. We reveal that late-onset and elevated CRP are the independent prognostic factor for the clinical deterioration of preterm neonates with NEC. Our findings suggest that we should closely monitor preterm neonates with NEC, particularly those with late-onset of the disease and those with an elevated CRP, to prevent further clinical deterioration and intervene earlier if necessary., (© 2022. The Author(s).)

Background: The non-operative management of blunt abdominal trauma had a high success rate and is expected to reduce the length of hospitalization and patients' morbidity. Here, we aim to evaluate the outcomes of patients with blunt abdominal trauma after non-operative management and associate them with prognostic factors., Methods: We performed a retrospective analysis on patients with blunt abdominal trauma who received non-operative management (NOM) at our institution from April 2018 to April 2021., Results: Two hundred eleven patients were included in this study who underwent non-operative management. Most of the subjects (73%) were males, with male to female ratio of 2.7:1. Most patients aged 20-29 years old (29.4%), FAST negative (62.1%), minor injured (45%), successfully managed nonoperatively (98.6%), received no transfusion (38.9%), and injured due to traffic accident (80.1%). ISS was significantly associated with FAST (p = 0.028), while male gender, NLR, PLR, and blood transfusion did not (p > 0.05). The presence of external injury was associated with FAST results (p = 0.039), while the head, facial, thoracic, pelvic, and skeletal injuries did not (p > 0.05). We also found a significant correlation between blood transfusion and patient survival with NOM outcomes (p = 0.047 and p = 0.041, respectively). Furthermore, external injury significantly correlated with NOM outcomes (p = 0.042). Multivariate analysis showed that external and pelvic injury was significantly associated with NOM outcomes (p < 0.0001 and p = 0.036, respectively)., Conclusions: The results of the FAST examination were not associated with the outcome of non-operative therapy. Moreover, the successful outcome of NOM might be affected by blood transfusions, the presence of external injuries, and pelvic injury., (© 2022 The Authors.)

Background: Due to the survival of preterm neonates being continually improved, the modifiable prognostic factors of necrotizing enterocolitis (NEC) are essential to be investigated and considered in making a suitable treatment to decrease the prevalence and effect of NEC. Many prognostic factors have been associated with the survival of neonates with NEC; however, the studies show conflicting results. Moreover, the study from developing countries regarding NEC outcomes is minimal. Here, we aimed to determine the survival of neonates with NEC and associate it with the prognostic factors. Methods: A retrospective study was conducted using medical records of neonates with NEC at our institution from January 2014 to December 2019. Results: Fifty-two neonates with NEC were involved with the overall survival of 44.2%. Log-rank analysis showed that NEC staging and birth weight were significantly associated with the survival of neonates with NEC with a p -value of 0.010 and 0.002, respectively, while sex, APGAR score, platelet count, and type of treatment were not ( p = 0.068, 0.752, 0.087, and 0.343, respectively). Multivariate analysis revealed that sex and NEC staging were strongly associated with the survival of neonates with NEC with a p -value of 0.018 [HR = 3.10 (95% CI = 1.21-7.93)] and 0.019 [HR = 0.44 (0.22-0.87)], respectively. Conclusions: Our study shows that sex and NEC staging might affect the survival of neonates with NEC. It implies that NEC staging should be closely monitored and intervened as early as necessary to prevent further morbidity and mortality., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Siahaan, Adriansyah, Sasmita, Fauzi, Dwihantoro and Gunadi.)

Background: COVID-19 pandemic has changed medical education from offline courses to online formats. Nowadays, offline skill demonstration lessons becomes unfeasible. This study assess the effectiveness of tutorial videos and online classes in delivering knowledge and skill in basic surgical knotting to medical students., Methods: A group of medical students (n = 95) was divided into two groups: the first group was allowed to watch the tutorial video that we have been made and uploaded into YouTube (https://www.youtube.com/watch?v=WyfOVGhAeVA) while the other group did not watch the video. All participants submitted a demonstration video to show their knotting skill. These videos were graded and made into the first evaluation. Then, all participants attended online classes for the surgical knotting skills via Zoom application. Participants submitted another demonstration video after the online classes. The videos were assessed, and the results were analyzed., Results: The experimental group (n = 50) who watched the tutorial video prior to class scored higher in the first video than the control group (n = 39) with a meanscore of 10.850 versus 7.462, p  = 0.000*, In the second video, the assessment showed no significant difference between the two groups with meanscore of 11.220 versus 10.897, p  = 0.706., Conclusion: The combination of tutorial videos and online classes is the optimal teaching method for surgical knotting skills., Competing Interests: None., (© 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: The gold-standard treatment for cholecystectomy, laparoscopic cholecystectomy, has remarkably variable outcomes and conversion rates. We investigated the gallbladder adhesion degree as a predictor of conversion surgery, common bile duct injury, and resurgery., Methods: We reviewed 157 medical records and video recordings of laparoscopic cholecystectomy on patients with cholelithiasis with or without cholecystitis at three hospitals in Yogyakarta, Indonesia from January 2016 to December 2018. The degree of gallbladder adhesion is classified into 4 categories: no adhesion, <50% adhesion, 50%-buried GB, and completely buried GB., Results: One hundred fifty seven patients were involved in this study, of whom 58 were males and 99 females with average age 49.2. Eighty-one patients out of 157 patients (51.6%) had gallbladder adhesion comprising of 61/157 (38.9%) with <50% adhesion and 20/157 (12.7%) 50%-buried GB. There is one incidence each of conversion surgery, CBD injury, and resurgery. The degree of GB adhesion has low degree of correlation with conversion surgery, CBD injury, and resurgery wirh r value of 0.156, 0.041, and 0.156 respectively. There is significant correlation between the degree of GB adhesion and conversion surgery and resurgery with p value of 0.032, and 0.032 respectively. There is no significant correlation between degree of GB adhesion and CBD injury with p value of 0.453., Conclusion: The degree of GB adhesion has low degree of correlation with conversion, CBD injury and resurgery. This study also showed that patients with high degree of gallbladder adhesion are still eligible for laparoscopic procedure performed by an experienced surgeon., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: The method of closing the abdominal wall, as well as, the choice of material for stitching are important aspects of efficient incision closure. Generally, transforming growth factor-beta (TGF-β) is involved in the wound healing process. Suturing procedures also play a part in the wound dehiscence occurrence. This study aimed to compare TGF-β expressions in rats after using the large stitch vs. small stitch technique for abdominal skin wound closure., Methods: A total of twenty Wistar rats ( Rattus norvegicus ) were used in this experiment. Small tissue bites of 5 mm were obtained by the small stitch group and the large stitch group received large bites of 10 mm. Abdominal skin incisions were closed by running sutures. On days 4 and 7, the animals were euthanized. For TGF-β expressions, histological parts of the tissue-embedded sutures were analyzed. With significance set at p < 0.05 , two-way ANOVA showed that on days 4 and 7, the TGF-β expressions of the rats in the small stitch group were nearly identical to those in the large stitch groups., Results: After including twenty rats in this study, results showed the TGF-β expressions on days 4 and 7 in rats in the small stitch group were equivalent to those in the large stitch group. ( p  = 0.45)., Conclusions: Between the small and the large stitch groups, the TGF-β expressions are similar, suggesting that the suturing methods do not have any significantly different beneficial impact on the frequency of wound dehiscence., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: Transmission within families and multiple spike protein mutations have been associated with the rapid transmission of SARS-CoV-2. We aimed to: (1) describe full genome characterization of SARS-CoV-2 and correlate the sequences with epidemiological data within family clusters, and (2) conduct phylogenetic analysis of all samples from Yogyakarta and Central Java, Indonesia and other countries., Methods: The study involved 17 patients with COVID-19, including two family clusters. We determined the full-genome sequences of SARS-CoV-2 using the Illumina MiSeq next-generation sequencer. Phylogenetic analysis was performed using a dataset of 142 full-genomes of SARS-CoV-2 from different regions., Results: Ninety-four SNPs were detected throughout the open reading frame (ORF) of SARS-CoV-2 samples with 58% (54/94) of the nucleic acid changes resulting in amino acid mutations. About 94% (16/17) of the virus samples showed D614G on spike protein and 56% of these (9/16) showed other various amino acid mutations on this protein, including L5F, V83L, V213A, W258R, Q677H, and N811I. The virus samples from family cluster-1 (n = 3) belong to the same clade GH, in which two were collected from deceased patients, and the other from the survived patient. All samples from this family cluster revealed a combination of spike protein mutations of D614G and V213A. Virus samples from family cluster-2 (n = 3) also belonged to the clade GH and showed other spike protein mutations of L5F alongside the D614G mutation., Conclusions: Our study is the first comprehensive report associating the full-genome sequences of SARS-CoV-2 with the epidemiological data within family clusters. Phylogenetic analysis revealed that the three viruses from family cluster-1 formed a monophyletic group, whereas viruses from family cluster-2 formed a polyphyletic group indicating there is the possibility of different sources of infection. This study highlights how the same spike protein mutations among members of the same family might show different disease outcomes.

Background: Necrotizing enterocolitis (NEC) is a common devastating inflammatory gastrointestinal disease and frequently occurs in premature infants. Here, we reported a case of late-onset NEC in a term neonate with good outcome after surgery for long-term follow-up., Case Presentation: Ten-week-old male came to emergency unit due to prolonged diarrhea and abdominal distention. He was born at gestational age of 40 weeks with birth weight and Apgar score of 2800 g and 7/8, respectively. He had no history of formula feeding. Two weeks before admitted to the hospital, the patient had frequent diarrhea with fever. He was found lethargic with abdominal distention, absence of bowel sounds and abdominal tenderness. Plain abdominal x-ray and CT scan showed gastric and intestinal dilatation and gasless colon, suggesting a small bowel obstruction, and bowel wall thickening indicating peritonitis, without any free subdiaphragmatic air (pneumoperitoneum). Moreover, the patient did not have a congenital heart disease. While in intensive medical treatment, he showed a continuous clinical deterioration. All findings were suggestive of intestinal inflammation with clinical deterioration, and we decided to perform an emergency exploratory laparotomy and found an ischemia along the jejunoileal with a perforation at 25 cm above the ileocecal valve. Subsequently, we performed a double-barrel ileostomy through a separate incision from the laparotomy. Histopathological findings confirmed the diagnosis of NEC. We closed the stoma at postoperative day 43. The patient was discharged uneventfully a month after stoma closure., Conclusion: Abdominal CT scan might be useful to establish an early recognition of late-onset NEC; thus, immediate surgical intervention might be performed to decrease its morbidity and mortality. Moreover, late-onset NEC in term neonates might occur without any risk factors or significant co-morbidities.

Background: Several modifications of the Kimura procedure for congenital duodenal obstruction (CDO) have been reported, however, their effects on the outcomes show conflicting results., Methods: We compared the CDO outcomes following the Kimura procedure with and without post-anastomosis jejunostomy feeding tube (JFT)., Results: A total of 52 CDO neonates were involved (JFT: 13 males and 2 females vs. non-JFT: 14 males and 23 females, p = 0.0019). Time to full oral feeding was significantly earlier in the JFT than non-JFT group (14 [interquartile range (IQR), 12-15] vs. 17 [IQR, 14-22.5] days; p = 0.04). Duration of parenteral nutrition given to infants with CDO after surgery was significantly shorter in the JFT than non-JFT group (12 [IQR, 10-15] vs. 17 [IQR, 13-23] days; p = 0.031). Moreover, enteral feeding was significantly earlier in the JFT than non-JFT group (2 [IQR, 1-3.5] vs. 5 [IQR, 4-6] days; p = < 0.0001). However, the length of stay following surgery was not significantly different between groups (16 [IQR, 14-22] vs. 20 [IQR, 17-28] days; p = 0.22). Also, overall patient survival did not significantly differ between JFT (66.7%) and non-JFT patients (59.5%) (p = 0.61)., Conclusion: Jejunostomy feeding tube shows a beneficial effect on the time to full oral feeding, duration of parenteral nutrition and early enteral feeding in neonates with congenital duodenal obstruction after Kimura procedure.

Background: Disturbance in the wound healing can cause the wound turn into a chronic wound, which histologically shows fibroblast senescence with weak proliferation ability. Mitomycin-C could block cell proliferation that causes cell senescence which is similar to the chronic wound morphology. Platelet-Rich Fibrin (PRF) contains a large number of platelets, leukocytes, cytokines and growth factors. This study aims to determine whether PRF could improve the fibroblast proliferation after treatment with Mitomycin-C., Methods: Cultured normal human skin fibroblasts forth passage divided into five groups. The first group was treated with culture medium, and the second group with 10 μg/mL mitomycin-C for 2 h. The third, 4th and 5th group were treated with mitomycin-C for the same dose and period, then adding it with 100%, 50%, and 25% of PRF. The fibroblast proliferation was measured by MTT assay., Results: The fibroblast proliferation in the group with culture medium is 11.366,56 ± 4.073,32, meanwhile in the group with mitomycin-C treatment is 5.690,41 ± 2.834,22. The fibroblast proliferation in group with 100% PRF is 7.909,8 ± 3.392,19; group with 50% PRF 15.347,91 ± 8.413,02; and group with 25% PRF 13.449,56 ± 7.523,83. All of the PRF groups increased significantly compared to the group with Mitomycin-C treatment., Conclusions: Platelet-Rich Fibrin can improve normal dermal fibroblast proliferation after treatment with mitomycin-C in vitro., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2021 The Authors.)

Objective: COVID-19 pandemic has made impact both in clinical and educational settings. The number of surgeries has decreased; thus, the surgery videos of all cases are important for both documentation and education. This study aimed to compare three kinds of cameras in recording digestive surgery., Methods: We compared three cameras: Panasonic HV-770 Full HD Camcorder, Sony FDR-X3000 Action-cam, and Ordro EP7 Hands-Free FPV Camera. Each camera was used in several recording for superficial and visceral digestive surgeries and we compared the following: operation field, image focus, surgeon's comfort, practicality, and record settings., Results: Camcorder needs 10-15 min to set up and longer dismounting time, has steady vantage view and focus, good image quality, can be zoomed, but the recording may be obstructed by the surgeon's head. Action camera needs 5-10 min to set up and the dismounting time was equal between Camcorder and Ordro. Action camera depicts surgeon's vision, however, zoom could not be applied while recording. Sony FDR-X3000 used in this study had good image quality, but the use of this camera in a long surgery may generate neck stiffness due to its weight. Ordro EP7 was comfortable in any surgery but it had inferior image quality compared to the others., Conclusions: Panasonic HC-V770 and Sony FDR X3000 had good image quality, where camcorder excelled in longer surgeries due to its comfort, action-cam excelled for shorter surgeries due to ease of use and settings. Ordro EP7 was the most comfortable among all but has lowest image quality., Competing Interests: The authors declare that they have no competing interests., (© 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Introduction: Radiological evaluation of suspected COVID-19 patients is required for early detection of thoracic involvement, particularly in emergency units, while waiting for definitive diagnosis by real-time reverse transcription polymerase chain reaction (RT-PCR). Here, we report a case series of CXR findings in Indonesian patients with COVID-19 in our institution., Presentation of Cases: We included 7 patients with COVID-19 confirmed by RT-PCR, including 4 females and 3 males, with ages ranging from 36 to 71 years. All patients showed abnormal findings on CXR when admitted to the hospital, except one, composed of ground glass opacity (GGO) (n = 1), consolidation (n = 3), and both (n = 2). Both and one side of the lung were affected in three and three (left side = 2; right side = 1) patients, respectively. Pneumonia degrees of mild, moderate and severe were observed in three, one, and two patients, respectively. All patients eventually recovered., Discussion: CXR is the most common radiological examination for patients with respiratory disorders, including COVID-19, and it is readily available in almost all health care facilities. The imaging manifestation of COVID-19 is similar to viral pneumonia but also has its own characteristics, including GGO, consolidation, multiple plaque shadows, and interstitial changes that are mostly seen in peripherals and subpleural areas, as well as shadow infiltration in both lungs., Conclusion: CXR showed various abnormality findings in patients with COVID-19, including the type, location, and degree of pneumonia. Moreover, CXR is considered more effective and useful for initial screening and follow-up of the progress of patients with COVID-19., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2021 The Author(s).)

Background: Surgical recording has become very important for digestive surgery skill training in the COVID-19 pandemic. In addition to high quality recordings, the directions of vantage points are also important. To assist our vantage point for our camera, we frequently use a laser pointer to increase accuracy in the shooting range., Materials and Methods: We recorded surgery more than 2 h with a fixed top-mounted Panasonic HC-V770 camcorder and otherwise with an action-cam Sony FDR. We installed a laser Pointer TaffLED Tactical Red Dot Laser Gun Picatinny Mount Airsoft Rifle HJ 11. We compared focus field video recordings with and without laser pointer guiding. We divided them into four groups: head mounted with, head mounted without, top mounted with and top mounted without. We recorded a total of five digestive surgery cases of superficial, visceral, and deep visceral procedures for each group after adjusting the laser pointer direction to the center of the cameras' focus., Results: The laser pointer on camcorder Panasonic HC-V770 can assist recording on operation fields to prevent the field of view from being blocked by movement of an object compared to either camera without laser pointer. The head mounted Sony FDR-X3000 action-cam can easily depict surgeon's eye while recording and be controlled by the slightest movement of the surgeon's head by tracking with a red dot., Conclusion: From either mounting, the laser pointer aided in focusing the surgical field of view and could increase visibility for surgical recording., Competing Interests: No potential conflict of interest relevant to this article was reportedNo potential conflict of interest relevant to this article was reported., (© 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: Composite graft as a reconstructive therapy option has limitations in size so that it is easily necrotic. Deferoxamine administration has been associated with increased neo-vascularity in wounds. We aimed to compare the administration of deferoxamine and Platelet-Rich Plasma (PRP) injection in a composite graft in rabbits., Methods: Thirty New Zealand rabbits were divided into three groups; the control group, the deferoxamine group, and the PRP group. The composite graft with a diameter of 2 cm was taken and replanted after rotating it 180°. The mean graft viability and the mean number of capillaries were evaluated on day 7 (POD 7) by macroscopic and histological evaluation using Hematoxylin-Eosin staining., Results: While the mean number of capillaries was not significantly different in control, deferoxamine, and PRP groups ( p  = 0.21), the mean survival rate in the control, deferoxamine, and PRP groups reached a significant level with p -value of 0.006 (66.6% vs. 63.8% vs. 99.6%, respectively)., Conclusions: Deferoxamine group had the highest number of capillaries, but had the lowest survival rate. In the PRP group, it had the lowest number of capillaries, but had the highest survival rate., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: Prolonged nucleic acid conversion and false-negative real-time polymerase chain reaction (RT-PCR) results might occur in COVID-19 patients rather than infection recurrence., Presentation of Cases: We reported four cases who had negative RT-PCR results, in addition to the last two consecutive negative results. Patient-1 had negative RT-PCR results twice (the 6th and 8th) from a total of 11 swabs. Patient-2 had negative RT-PCR results once (the 5th) from a total of 8 swabs. Patient-3 showed negative results of RT-PCR twice (the 4th and 6th) from a total of 11 swabs. Patient-4 had negative RT-PCR results twice (the 2nd and 10th) from a total of 14 swabs., Discussion: The fluctuating trend of our RT-PCR results in our cases might be due to insufficient viral material in the specimen, laboratory errors during sampling, restrictions on sample transportation, or mutations in the primary and probe target regions in the SARS-CoV-2 genome. Several factors might affect the occurrence of prolonged nucleic acid conversion, including older age, comorbidities, such as diabetes and hypertension, and impaired immune function., Conclusion: Here, we confirmed the occurrence of prolonged nucleic acid conversion and the possibility of false negative RT-PCR results in COVID-19 patients., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: Since the COVID-19 pandemic was declared by the World Health Organization on March 11, 2020, routine clinical practices were affected, including pediatric surgery services. We aimed to compare pediatric surgery practices, including the number and types of surgery, either elective or emergency surgeries and outpatient services, before the outbreak and during the COVID-19 pandemic in our institution., Material and Methods: We retrospectively compared pediatric surgery practices, including elective and emergency surgeries, and outpatient services between the previous one-year period (March 2019-February 2020), the last three months of that period (December 2019-February 2020) before the outbreak, and the three months (March-May 2020) during the COVID-19 pandemic in our hospital., Results: The frequency of elective surgeries during the pandemic was lower than during the last three months before the outbreak: 61 vs. 18 (~3-fold), 19 vs. 13 (~1.5-fold), 19 vs. 5 (~4-fold), and 30 vs. 15 (~2-fold) for digestive, neonate, urology and oncology cases, respectively. No laparoscopic procedures were performed during the pandemic compared with the one-year period before the outbreak (0 vs. 16 cases). The frequency of all emergency pediatric procedures before and during the COVID-19 pandemic was similar (29 vs. 20 cases, respectively). Moreover, a declining trend was also clearly apparent in the outpatient services during the pandemic compared with before the outbreak, both in the new and the established patients., Conclusions: The pediatric surgery practices in our institution have been severely affected by the COVID-19 pandemic, including elective and outpatient services. This setback needs a comprehensive strategy to avoid morbidity from the neglected elective surgeries during the pandemic, including the proper comparison between the real risk of COVID-19 cross-infection and the benefits of elective procedures., (© 2020 The Author.)

Objective: Incisional hernia is a frequent complication of midline laparotomy. The suturing technique is an important determinant of the risk of developing an incisional hernia. Moreover, IL-6 has crucial roles in the wound-healing process. We aimed to compare the large stitch vs. small stitch technique for abdominal fascial closure on IL-6 expressions in rats., Results: Twenty rats were used. The small stitch group received small tissue bites of 5 mm and the large stitch group received large bites of 10 mm. The incisions of fascia were closed by running sutures. Animals were euthanized on days 4 and 7. Histological sections of the tissue-embedded sutures were analyzed for IL-6 expressions. Two-way ANOVA showed that rats in the small stitch group had similar IL-6 expressions on days 4 and 7 to those in the large stitch group (p = 0.36). In conclusion, the IL-6 expressions are similar between the small and the large stitch groups, implying that different suturing techniques might not have an impact on the incisional hernia occurrence.

Background: The COVID-19 pandemic has changed patient management in all sectors. All patients need to be examined for COVID-19, including in digestive surgery emergency cases. In this paper, we report four digestive surgery emergency cases with clinical and radiological findings similar to COVID-19., Case Presentation: We report four digestive surgery emergency cases admitted with fever and cough symptoms. Case 1 is a 75-year-old male with gastric perforation and pneumonia, case 2 is a 32-year-old female with intestinal and pulmonal tuberculosis, case 3 is a 30-year-old female with acute pancreatitis with pleuritis and pleural effusion, and the last case is a 56-year-old female with rectosigmoid cancer with pulmonal metastases. All the patients underwent emergency laparotomy, were hospitalized for therapy, and discharged from the hospital. After 1-month follow-up after surgery, 1 patient had no complaints, 2 patients had surgical site infection, and 1 patient died because of ARDS due to lung metastases., Discussion: For all four cases, the surgeries were done with strict COVID-19 protocol which included patient screening, examination, laboratory assessment, rapid test screening, and RT-PCR testing. There were no intrahospital mortalities and all the patients were discharged from the hospital. Three patients were followed-up and recovered well with 2 patients having surgical site infection which recovered within a week. However, 1 patient did not show up for the scheduled follow-up and was reported dead 2 weeks after surgery because of ARDS due to lung metastases., Conclusions: Emergency surgery, especially digestive surgery cases, can be done in the COVID-19 pandemic era with strict prior screening and examination, and safety protocol., (© 2020 The Author(s).)

Background: Incisional hernia is a frequent complication of abdominal wall incision and has a high rate of recurrence. Most of the studies stated that non-absorbable sutures decreased incisional hernia incidences, but some stated otherwise. We aimed to compare the collagen type I/III ratio between monofilament non-absorbable sutures and multifilament absorbable sutures for abdominal fascia closure in Wistar albino rats., Methods: Forty rats were divided into four groups. Groups 1 and 3 were sutured with monofilament non-absorbable ( polyvinylidene fluoride ). Groups 2 and 4 were sutured with multifilament absorbable ( polyglycolide ). Then, groups 1 and 2 were euthanized on day 4 (POD 4), while groups 3 and 4 were euthanized on day 7 (POD 7). Samples of fascia (1 × 0.5 cm) were taken for analysis. Collagen I/III ratios were measured using immunohistochemistry staining methods., Results: While the expression of collagen I was not significantly different between monofilament non-absorbable and multifilament absorbable at POD 4 and 7 ( p  = 0.45 and 0.81, respectively), the expression of collagen III reached a significant level with p -values of 0.0003 and 0.0004 for POD 4 and 7, respectively. Moreover, the collagen I/III ratio was also significantly different between the two groups either at POD 4 (0.88 ± 0.23 vs. 0.53 ± 0.08; p  = 0.0003) and 7 (1.77 ± 0.65 vs. 1.03 ± 0.28; p  = 0.004)., Conclusions: Monofilament non-absorbable sutures show a significantly higher collagen I/III ratio than multifilament absorbable sutures for abdominal fascia closure in rats. Our findings imply that the usage of monofilament non-absorbable sutures might have a beneficial effect on decreasing the incisional hernia occurrence., (© 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: The growth of children with Hirschsprung disease (HSCR) can be affected by many factors, including the environment, nutrient intake, and surgery. Our study compared the long-term ( i.e., at least 3 years of follow-up) growth outcomes in HSCR children after transabdominal Soave and Duhamel and transanal endorectal pull-through (TEPT) surgeries., Methods: A cross-sectional study was conducted in children <18 years of age diagnosed histopathologically with HSCR who underwent pull-through between January 1, 2012-December 31, 2015 in our institution. The postoperative anthropometric data were obtained prospectively through interviews during the outpatient clinic appointment or by telephone., Results: We recruited 21 patients (Soave: 7 vs. Duhamel: 4 vs. TEPT: 10; p  = 0.06). There were no significant differences between the three surgical methods in terms of preoperative and postoperative nutritional status categories ( p  = 0.52). Concerning the changes in nutritional status, after Soave surgery, it was improved, steady, and worsened in 28.6%, 57.1%, and 14.3% of the children, respectively. The nutritional status of the Duhamel group was worsened and steady in 25% and 75% of the children, respectively, while in the TEPT group, it was improved and steady in 40% and 60% of the children, respectively. However, these differences were not statistically significant ( p  = 0.42)., Conclusions: While some HSCR children show an improvement in their nutritional status after Soave and TEPT procedures, the overall nutritional status is similar among different procedures. Further multicenter studies with a larger sample size are important to clarify our findings., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: Without early recognition and Kasai procedure, biliary atresia (BA) results in liver cirrhosis and leads to either transplantation or death at a young age. We aimed to characterize the liver histopathological findings for prediction of cirrhosis and survival in BA patients after Kasai surgery., Methods: We retrospectively reviewed all histopathological results for BA patients who underwent liver biopsy during Kasai surgery from August 2012 to December 2018 in Dr. Sardjito Hospital, Yogyakarta, Indonesia., Results: Fifty infants with BA were ascertained in our study, of whom 27 were males and 23 were females. The median age of Kasai procedure was 102.5 days (interquartile range (IQR), 75.75-142.25 days). There were 33 (66%) and 17 (34%) BA patients with and without liver cirrhosis, respectively, while the overall survival was 52%. The patients with a severe bile duct proliferation, severe cholestasis, and severe portal inflammation have a higher risk by 27-, 22-, and 19.3-fold, respectively, to develop liver cirrhosis compared with patients with a moderate/mild bile duct proliferation, moderate/mild/without cholestasis, and moderate/mild portal inflammation, respectively (p = 3.6 × 10 - 6 , 5.6 × 10 - 4 , and 1.6 × 10 - 3 , respectively), while the giant cell transformation was not associate with the development of liver cirrhosis (p = 0.77). The bile duct proliferation was strongly correlated with cholestasis and portal inflammation (p = 7.3 × 10 - 5 and 2 × 10 - 4 , respectively), and cholestasis was also significantly correlated with portal inflammation (p = 0.016). Interestingly, the age at Kasai procedure was strongly associated with the development of liver cirrhosis (p = 0.02), but not with the patients' survival (p = 0.33), while the degree of fibrosis and cholestasis were significantly correlated with the patients' survival, with HR of 3.9 (95% CI = 1.7-9.0; p = 0.017) and 3.1 (95% CI = 1.4-7.0; p = 0.016), respectively., Conclusions: Histopathological findings of bile duct proliferation, cholestasis, and portal inflammation can predict the liver cirrhosis development in patients with BA. Furthermore, degree of fibrosis and cholestasis affect the patients' survival following the Kasai operation.