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Yopi Simargi,1– 3 Yuda Turana,4 Aziza Ghanie Icksan,5 Alida Roswita Harahap,1 Kristiana Siste,6,7 Muchtaruddin Mansyur,8 Triya Damayanti,9,10 Maryastuti Maryastuti,11 Vininta Fazharyasti,12 Indah Puspita Dewi,13,14 Yetty Ramli,15,16 Marcel Prasetyo,17,18 Cleopas Martin Rumende19,20 1Doctoral Program in Medical Science, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 2Department of Radiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia; 3Department of Radiology, Atma Jaya Hospital, Jakarta, Indonesia; 4Department of Neurology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia; 5Department of Radiology, Prima Indonesia University, Medan, Indonesia; 6Department of Psychiatry, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 7Department of Psychiatry, Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia; 8Department of Community, Occupational and Family Medicine, Faculty of Medicine, University of Indonesia, Depok, Indonesia; 9Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 10Department of Pulmonology and Respiratory Medicine, National Respiratory Center Persahabatan Hospital, Jakarta, Indonesia; 11Department of Radiology, National Respiratory Center Persahabatan Hospital, Jakarta, Indonesia; 12Department of Radiology, Gatot Soebroto Army Hospital, Jakarta, Indonesia; 13Department of Radiology, Faculty of Medicine and Health, University of Muhammadiyah Jakarta, Jakarta, Indonesia; 14Department of Radiology, Jakarta Islamic Hospital Cempaka Putih, Jakarta, Indonesia; 15Department of Neurology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 16Department Neurology, Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia; 17Department of Radiology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 18Department of Radiology, Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia; 19Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 20Department of Internal Medicine, Cipto Mangunkusumo National Central General Hospital, Jakarta, IndonesiaCorrespondence: Yopi Simargi, Department of Radiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jl. Pluit Raya No. 2, RT.21/RW.8, Penjaringan, Kec. Penjaringan, Jkt Utara, Daerah Khusus Ibukota, Jakarta, 14440, Email yopi.simargi@atmajaya.ac.idPurpose: The exact link between cognitive impairment (CI) and chronic obstructive pulmonary disease (COPD) is still limited. Thus, we aim to find the relationship and interaction of quantitative CT (QCT), lung function, HIF-1α, and clinical factors with the development of CI among COPD patients.Patients and Methods: A cross-sectional multicentre study was conducted from January 2022 to December 2023. We collected clinical data, spirometry, CT images, and venous blood samples from 114 COPD participants. Cognitive impairment assessment using the Montreal Cognitive Assessment Indonesian version (MoCA-Ina) with a cutoff value 26. The QCT analysis consists of lung density, airway wall thickness, pulmonary artery-to-aorta ratio (PA:A), and pectoralis muscles using 3D Slicer software. Serum HIF-1α analysis was performed using ELISA.Results: We found significant differences between %LAA− 950, age, COPD duration, BMI, FEV1 pp, and FEV1/FVC among GOLD grades I–IV. Only education duration was found to correlate with CI (r = 0.40; p < 0.001). We found no significant difference in HIF-1α among GOLD grades (p = 0.149) and no correlation between HIF-1α and CI (p = 0.105). From multiple linear regression, we observed that the MoCA-Ina score was influenced mainly by %LAA− 950 (p = 0.02) and education duration (p = 0.01). The path analysis model showed both %LAA and education duration directly and indirectly through FEV1 pp contributing to CI.Conclusion: We conclude that the utilization of QCT parameters is beneficial as it can identify abnormalities and contribute to the development of CI, indicating its potential utility in clinical decision-making. The MoCA-Ina score in COPD is mainly affected by %LAA− 950 and education duration. Contrary to expectations, this study concludes that HIF-1α does not affect CI among COPD patients.Keywords: chronic obstructive pulmonary disease, cognitive impairment, emphysema lung, hypoxia inducible factor

The research employs secondary data consisting of time series data on beef prices from the consumer regions (Jakarta, Banten, and West Java Provinces) and the producer regions (East Nusa Tenggara, West Nusa Tenggara, Bali, East Java, and Lampung Provinces) obtained from the Center for Information of Strategic Food Prices period January 2018–July 2022. The analytical model utilizes the estimated VAR (vector autoregression)/VECM (vector error correction model). The mean beef price in Indonesia’s producer regions exceeds the normal level (above the reference price), except for East Nusa Tenggara Province, as well as in the consumer regions, which are significantly above the normal level. Beef prices in the producer and consumer regions have a mutual influence in the current and previous periods. The presence of cointegration implies that in the long term, the beef market in the producer regions (East Nusa Tenggara, West Nusa Tenggara, Bali, East Java, and Lampung) is integrated with the consumer regions (Jakarta, Banten, and West Java Provinces) in Indonesia. The most substantial impact of the shock of beef prices in the region of the largest producer is Lampung Province. This research concludes that there is a cointegration of beef prices; in the long term, the beef market in producer regions is integrated with the consumers in Indonesia. Similarly, the beef market will be integrated into producer regions with the consumers in the short term. The VECM is a beef price forecasting model in the producer and consumer regions, which can be considered to have excellent performance.

Agnes Stephanie Harahap,1– 3 Imam Subekti,4 Sonar Soni Panigoro,5 Asmarinah,6 Lisnawati,1 Retno Asti Werdhani,7 Hasrayati Agustina,8 Dina Khoirunnisa,1 Mutiah Mutmainnah,1 Salinah,1 Alvita Dewi Siswoyo,9 Maria Francisca Ham1,2 1Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 2Human Cancer Research Center-Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 3Doctoral Program in Medical Sciences, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 4Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 5Department of Surgery, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 6Department of Medical Biology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 7Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 8Department of Anatomical Pathology, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia; 9Department of Radiology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, IndonesiaCorrespondence: Agnes Stephanie Harahap, Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia, Jl. Salemba Raya No. 6, Jakarta, 14320, Indonesia, Tel +62818765563, Email agnes.stephanie01@ui.ac.idIntroduction: BRAFV600E and RAS mutations are the most common gene mutations in papillary thyroid carcinoma (PTC) that may be correlated with its biological behavior. There are still limited data about BRAFV600E and RAS mutations in Indonesia. This study aims to determine the prevalence of BRAFV600E and RAS mutations, and their association with clinicopathologic characteristics.Methods: Patients who had total thyroidectomy from 2019 to 2021 and those who met our study criteria underwent PCR and DNA sequencing analysis for BRAFV600E, BRAFK601E, exon 2 and 3 of NRAS, HRAS, and KRAS. Analyses were performed to determine the associations of BRAFV600E and RAS mutations with clinicopathologic characteristics.Results: Of 172 PTC patients, BRAFV600E mutation was observed in 37.8% of the patients and RAS mutations were found in 21.5%. One patient harbored BRAFK601E mutation. There was a significant association of BRAFV600E with a high-stage (p = 0.033, OR: 3.279; 95% CI: 1.048– 10.259), tall-cell variants (p ≤ 0.001, OR: 41.143; 95% CI: 11.979– 141.308), non-encapsulated (p = 0.001, OR: 4.176; 95% CI: 2.008– 8.685), lymphovascular invasion (p = 0.043, OR: 1.912; 95% CI: 1.018– 3.592), extrathyroidal extension (p = < 0.001, OR: 3.983; 95% CI: 1.970– 8.054), and lymph node metastasis (p = 0.009, OR: 2.301; 95% CI: 1.224– 4.326). Follicular variant (p = 0.001, OR: 7.011; 95% CI: 2.690– 18.268), encapsulated (p = 0.017, OR: 2.433; 95% CI: 1.161– 5.100), and absent of extrathyroidal extension (p = 0.033, OR: 2.890; 95% CI: 1.052– 7.940) were associated with RAS mutations.Conclusion: A significant association between BRAFV600E mutation and high clinical stage, tall-cell variants, non-encapsulated morphology, lymphovascular invasion, extrathyroidal extension, and lymph node metastasis in PTC was observed. RAS mutations were associated with the follicular variant, encapsulated tumor, and no extrathyroidal extension. HRAS-mutated PTC frequently exhibited tumor multifocality.Keywords: papillary thyroid carcinoma, BRAFV600E, BRAFK601E, RAS, clinicopathological characteristics

Rakhmad Hidayat,1– 3 Al Rasyid,2,3 Salim Harris,2,3 Alida Harahap,2 Herqutanto,2 Melva Louisa,2 Erlin Listiyaningsih,4 Aldy Safruddin Rambe,5 Tonny Loho6 1Doctoral Program in Medical Sciences Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 2Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 3Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 4Harapan Kita Hospital, Jakarta, Indonesia; 5Sumatera Utara University, Medan, Indonesia; 6Faculty of Medicine and Health Science, Kristen Krida Wacana University, Jakarta, IndonesiaCorrespondence: Rakhmad Hidayat, Tel +62 813 88756299, Email rhidayat.md@gmail.comBackground: Stroke is one of the highest causes of disability and mortality in several countries worldwide. Secondary prevention is important in the management of stroke. Clopidogrel is widely used in Asia as secondary prevention for ischemic stroke, even though several studies in Western show limited data related to clopidogrel resistance in Asia. This study aims to determine the correlation between P2Y12 genetic polymorphism and clopidogrel resistance in Indonesia.Methods: This study was conducted on one-year duration, the subjects were chosen through the consecutive sampling method, all subjects were examined for genetics and resistance to clopidogrel. The data were analyzed through statistical analysis, a bivariate analysis was conducted to determine the correlation between several variables and the resistance variable. This study employed resistance diagnostic methods with VerifyNow. Polymorphism of receptor P2Y12 was tested with the Polymerase Chain Reaction method (PCR) and analysis of restriction fragment length polymorphism (RFLP). The genes tested in this study were G52T and C34T.Results: The number of participants in this study was 112. Examination of gene P2Y12 showed that the majority was homozygote, wild-type C34T allele (67%), and G52T (66.1%). There was no significant correlation between clopidogrel resistance and gene G52T and C34T of P2Y12 (p > 0.05). Hb levels significantly correlated with P2Y12 G52T (p = 0.024). Meanwhile, Fatty Liver significantly correlated with P2Y12 C34T (p = 0.037).Conclusion: Indonesia showed a low clopidogrel resistance rate and a very low C34T and G52T allele P2Y12 gene mutation, meaning that Indonesia had low mutations in the P2Y12. This is the cause of clopidogrel resistance in this study only 15%. Therefore, in a region with less clopidogrel resistance, examination of the P2Y12 gene would not give significant results.Keywords: clopidogrel resistance, P2Y12, stroke, antiplatelet

Agnes Stephanie Harahap,1,2 Fanny Kamarudy Lay,1 Ria Kodariah,1 Fresia Juwitasari Wongkar,1 Maria Francisca Ham1,2 1Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 2Human Cancer Research Center - Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaCorrespondence: Maria Francisca Ham, Email mariafranciscaham@gmail.comIntroduction: Immunohistochemical expression of programmed death-ligand 1 (PD-L1) has become a biomarker to predict the usefulness of cancer immunotherapy using PD-1/PD-L1 blockade in a variety of advanced-stage tumours. This emerging biomarker may serve to generate novel therapies for aggressive thyroid carcinoma (TC), which has not shown optimal results with existing treatments.Methods: The present study investigated the relevance of PD-L1 expression in aggressive histological types of TC compared with that found in less aggressive types. Surgically resected specimens were investigated, including 52 cases of TC consisting of 26 cases of aggressive histological types and 26 cases of less aggressive histological types. Immunohistochemical examinations were carried out on paraffin blocks of both groups using a mouse monoclonal primary antibody against PD-L1 (clone 22C3). PD-L1 expression was evaluated by calculating the tumour proportion score (TPS) in both groups.Results: The results revealed a significant difference in the median TPS value of PD-L1 expression between the two groups. The TPS values were found to be higher in the group of aggressive histological types of TC compared with those in the group of less aggressive histological types. A significant difference in TPS value was also found for the extrathyroidal extension variable.Discussion: In conclusion, the present study found a significant association between PD-L1 expression and the aggressive histological type of TC. In addition, a potential association between PD-L1 expression and the presence of extrathyroidal extension of TC was observed. These findings provide novel approaches for immunotherapy as a potential new treatment modality in patients with aggressive histological types of TC.Keywords: thyroid carcinoma, histological type, aggressive, programmed death-ligand 1

Wulyo Rajabto,1,2 Vitya Chandika,1 Agnes Stephanie Harahap,3 Maria Francisca Ham3 1Division of Hematology-Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital/ Faculty of Medicine Universitas Indonesia, Central Jakarta, Indonesia; 2Department of Internal Medicine, Metropolitan Medical Centre Hospital, South Jakarta, Indonesia; 3Department of Anatomical Pathology, Dr. Cipto Mangunkusumo General Hospital/ Faculty of Medicine Universitas Indonesia, Central Jakarta, IndonesiaCorrespondence: Vitya Chandika, Division of Hematology-Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital/ Faculty of Medicine Universitas Indonesia, Jalan Pangeran Diponegoro No. 71, Central Jakarta, 10430, Indonesia, Email vityachandika@gmail.comBackground: Salvage conventional chemotherapy followed by high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) is the treatment of choice for most patients with refractory classical Hodgkin lymphoma (cHL). In the era of pandemic COVID-19, there are obstacles to administering salvage chemotherapy followed by HDT and ASCT due to side effects and toxicities which make the patient more susceptible to COVID-19 infection. The toxicities and side effects of BV are different from salvage chemotherapy, but it has clear efficacy as monotherapy.Case Presentation: A 46-year-old female with a history of cHL nodular sclerosis subtype was presented with right cervical lymph node enlargement, after 3 cycles of first-line chemotherapy ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) 3 months ago. She was afraid to undergo second-line chemotherapy in the era of pandemic COVID-19 because of the side effects and toxicities; therefore, she was given 8 cycles of BV as monotherapy. The response of the treatment was complete remission.Conclusion: In this particular case of patient, BV as monotherapy can be an option during the pandemic COVID-19 for refractory cHL ineligible for second-line chemotherapy followed by HDT and ASCT.Keywords: brentuximab vedotin, COVID-19, monotherapy, refractory Hodgkin’s lymphoma

Cosphiadi Irawan,1 Martha Iskandar,1 Agnes Stephanie Harahap,2 Cleopas Martin Rumende,3 Maria Francisca Ham2 1Hematology and Medical Oncology Division, Internal Medicine Department, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia; 2Anatomical Pathology Department, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia; 3Internal Medicine Department, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, IndonesiaCorrespondence: Martha Iskandar, Tel +628161924095, Email marthaiskandar@gmail.comBackground: Treatment response in diffuse large B-cell lymphoma (DLBCL) is heterogenous. The Hans algorithm (using 30% cut-offs for CD10, BCL6, and MUM1 protein expression) has been the most favored method to categorize DLBCL into germinal center B-cell (GCB) and non-GCB subtypes in order to predict prognosis. However, the algorithm’s ability to prognosticate is not always consistent.Methods: This retrospective cohort study was conducted on DLBCL patients receiving R-CHOP therapy at Dr. Cipto Mangunkusumo Hospital, Jakarta from 2014 to 2017. We aimed to compare the prognostic value of Hans algorithm as well as the protein levels of CD10, BCL6, MUM1, and Ki67 at different cut-offs. Ninety-two patients were classified based on Hans algorithm and various proteins at different cut-off values were analyzed with regard to event-free survival at 24 months using survival analysis. The cut-off values were then compared using receiver operating characteristic curves.Results: A significant survival difference was observed with MUM1 expression cut-off of 50% or more (log rank p = 0.035). CD10, BCL6, Ki67, and Hans algorithm showed AUCs below or near 0.5 (0.405, 0.436, 0.498, and 0.413, respectively), whereas MUM1 showed an AUC of 0.835, in predicting events within 24 months. MUM-1 cut-off of 70.5% yielded an optimal trade-off for sensitivity and specificity.Conclusion: MUM1 expression of 50% or more can help predict prognosis in DLBCL patients receiving R-CHOP therapy and can be considered as for use as a single marker to predict prognosis.Keywords: DLBCL, RCHOP, MUM1, Hans algorithm, prognosisMeSH Terms: lymphoma, large B-cell, dIffuse, MUM1 nucleosome-binding protein, human, antineoplastic combined chemotherapy protocols/adverse effects, rituximab/therapeutic use, retrospective studies, prognosis

The purpose of this study is to determine whether increasing the use of project-based learning (PBL) by madrasa aliyah teachers in Indonesia enhances their capacity in leadership competences. This study employed a quasi-experimental approach to investigate how project-based learning (PBL) is connected with teachers' leadership competency and analyzed the data using a t-test. In general, we found that the PBL program positively affected the leadership competence of madrasa teachers in Islamic religious education learning. Also, that the PBL program positively affected students' perceptions of the level of effort a teacher exerted to provoke interest. Estimating an instrumental variable approach on the subset of schools with the most substantial increase in PBL use found that PBL was positively related to teachers' perceptions of class preparation, attempts to induce teacher interest, and the frequency with which students share ideas in class. This study introduces teaching practice as a mediating factor that affects the leadership competence of madrasa teachers, a contribution to the literature that seeks to understand the development of madrasa teachers' leadership competencies in Islamic religious education learning. This research has implications for developing the PBL model in improving the leadership competence of madrasa teachers in learning Islamic religious education.

Johannes C Prihadi,1 Suwandi Sugandi,2 Nuryati C Siregar,3 Gunanti Soejono,4 Alida Harahap5 1Department of Surgery, Faculty of Medicine, Atma Jaya Catholic University, Jakarta, Indonesia; 2Department of Urology, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia; 3Department of Pathological Anatomy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 4Faculty of Veterinary Medicine, Bogor Institute of Agriculture, Bogor, Indonesia; 5Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia Background: Extracellular matrix degradation may play an important role in the etiology of urethral stricture. MMP1 and TIMP1 are involved in extracellular matrix degradation. The aim of this study was to investigate the roles of MMP1, TIMP1, and MMP1:TIMP1 ratio at the remodeling phase of urethral stricture in an animal model. Methods: This research was carried out in collaboration between the Bogor Institute of Agriculture, Universitas Indonesia, and the Eijkman Institute Indonesia. This was an experimental in vivo study in adult male New Zealand rabbits, divided into two groups: a urethral stricture group and a control group. Euthanasia was performed in four rabbits of each group on days 7, 14, 21, 28, and 56. Urethral stricture was confirmed with an 8 F urethral catheter. Several laboratory examinations were done, including H&E and Masson trichrome staining, immunohistochemistry, and ELISA, to determine levels of MMP1 and TIMP1. Percentages of total collagen and collagen type 1 were counted with ImageJ 1.46q software. A general linear model was used for statistic analysis. Results: We found that the level of MMP1 was lower, TIMP1 higher, and MMP1:TIMP1 ratio lower in the urethral stricture group than the control group. There was a correlation between MMP1 level with total collagen percentage (r=0.561, P=0.010) and no correlation between TIMP1 and total collagen (r=0.307, P=0.188). Conclusion: Imbalance in extracellular matrix degradation was marked by decreased MMP1 level and MMP1:TIMP1 ratio and increased TIMP1 level. This results showed that urethral stricture is not only caused by collagen decomposition, but also by the imbalance of extracellular matrix degradation. Keywords: collagen, MMP-1, TIMP-1, urethral stricture

Backgrounds Tuberculosis (TB) remains a significant health issue in Indonesia, ranking second globally in TB incidence in 2021. Diagnosing intestinal tuberculosis (ITB) is challenging due to its symptoms, which mimic other diseases, limited laboratory tests, and the need for invasive procedures like colonoscopy. This study aimed to develop a non-invasive laboratory panel for ITB using various biomarkers. Methods A cross-sectional study from November 2020 to December 2022 was carried out at Dr. Cipto Mangunkusumo National Central General Hospital. Laboratory parameters from 143 subjects were identified by Chi-square test and multiple regression analysis. The scoring system was developed based on the identified independent diagnostic parameters scored by regression coefficient β value and standard errors, with the cut-off value determined by the ROC curve. The sensitivity and specificity of the scoring system were determined using the ROC curve. Results Among 143 subjects, 22 were diagnosed with ITB and 121 Non-ITB (prevalence of 15.38%). This study was dominated by females (65.03%), with a ratio of 1.86: 1. The median age in this study was 41 years. The scoring system to differentiate ITB and Non-ITB consisted of 6 diagnostic parameters (referred to as the HEALTH scoring system) as follows: stool HBD-2 (1 and 0 points), ESR (1 and 0 points), blood ADA activity (1 and 0 points), Lymphocyte (0 and 1 point), stool TB PCR (2 and 0 points), and NLR (1 and 0 points). Subjects with scores ≥ 4 could be diagnosed as ITB. The sensitivity and specificity of the HEALTH scoring system were 68.18% and 95.04%, respectively. Conclusion This study developed and validated a laboratory panel called the HEALTH scoring system based on clinical biomarkers of stool HBD-2 level, ESR, blood ADA activity, lymphocytes, stool TB PCR, and NLR, which could be used to differentiate ITB from other gastrointestinal diseases.

Background Certain risk factors have been shown to increase the mortality of patients with neonatal sepsis. This study aimed to determine the risk factors for neonatal sepsis-related mortality. Methods Google Scholar, MEDLINE, ProQuest, ScienceDirect, and Scopus databases were searched to identify relevant literature from 2014 to 2023. Observational analytical studies in English that reported the risk factors for neonatal sepsis mortality were chosen. We assessed the risk of bias by using the checklists of the Joanna Briggs Institute. Fixed-effect models were used when the number of included studies was 2 statistic. Publication bias was assessed using a funnel plot, and a sensitivity analysis was performed. Statistical significance was set at P Results Twelve out of 40,587 articles included a total of 2232 patients. The majority of patients were male (50.4%–70%). The I 2 statistics showed no heterogeneity across studies for sex, gestational age, birth weight, or requirement for inotropic support. History of invasive ventilation (OR = 35.06 [16.84–72.99]), requirement for inotropic support (OR = 18.04 [8.38–38.81]), low 1 st minute Apgar score (OR = 4.93 [2.1–11.58]), convulsive (OR = 4.69 [2.03–10.82]), poor feeding (OR = 3.95 [2.12–7.33]) episodes, preterm birth (OR = 3.63 [2.78–4.74]), low birth weight (OR = 3.02 [1.58–5.75]), early onset sepsis (OR = 2.52 [1.74–3.64]), and lethargy (OR = 2.14 [1.5–3.04]) were associated with neonatal sepsis mortality. Conclusions A history of invasive ventilation use, requirement for inotropic support, low 1 st minute Apgar score, convulsions, poor feeding episodes, preterm birth, low birth weight, early onset sepsis, and lethargy were identified as significant risk factors for neonatal sepsis mortality. Clinicians must be vigilant to improve outcomes and prevent death.

Effective leadership is needed when the organization faces difficult situations. When major earthquakes and pandemics successively hit North Lombok, the role of teachers and school principals significantly determined the resilience of the school organization's sustainability. The study aims to understand how elementary teachers and principals in Pemenang district, North Lombok regency, West Nusa Tenggara province, Indonesia built their school resilience in facing consecutive natural disasters; devastating earthquakes COVID-19 pandemic. This study focuses on how school leaders and their teams built the organization's resilience during consecutive disasters in North Lombok. The study used a qualitative phenomenology design. The data collection was conducted using semi-structured interviews, Forum Group Discussion, observations, and documentation. Purposive participants consisted of 17 teachers and two principals from 2 elementary schools. The authors found that teachers' and principals' resilience appears to be built through concrete action that the Education Office and principals facilitate to respond to challenges. It appears that concrete actions, management coordination processes, and choices of actions appropriate to the situation are essential factors in building resilience. It is concluded that efforts to build teachers' and principals'' resilience must align with the existing context and situation while paying attention to various resources at all levels and considering the diversity of perspectives regarding how individuals, organizations, or communities understand and respond to situations and events such as earthquakes and pandemic.

Background Prediabetes, a reversible condition before the onset of diabetes, is a significant concern in healthcare globally. The global prediabetes epidemic has emerged and has considerably impacted health expenditures. Various risk factors play important roles in the progression of prediabetes to diabetes. Intensive lifestyle and pharmacological interventions can significantly reduce the risk of diabetes progression. Objective This study aimed to determine the prevalence, characteristics, and risk factors of prediabetes state of Medan in August 2023. Methods The sample consisted of 89 participants. This was an analytical cross-sectional study in the community that met the inclusion and exclusion criteria. The determination of prediabetes is based on the results of blood tests, namely, the examination of fasting blood sugar levels (FBGL), 2-hour postprandial oral glucose tolerance test (OGTT), and hemoglobin A1c (HbA1C). Other examinations included lipid profiling (total cholesterol, HDL-C, LDL-C, and triglycerides). Data processing was performed using SPSS via univariate and bivariate analyses (chi-square test). Results Of the 89 participants, the prevalence of prediabetes based on HbA1c, FBGL and 2-hours OGTT levels was 28.1%, 50.6%, and 28.1%, respectively. 82% of the participants were female, and 53.9% were overweight or obese based on body mass index (BMI). The risk factors for prediabetes were age >64 years, female, physical inactivity, and diastolic blood pressure ≥90 mmHg ( pp>0.05). Conclusion This study found that the prevalence of prediabetes was 67.4% in Medan. Age >64 years, female, physical inactivity, and diastolic blood pressure ≥90 mmHg were the most important risk factors for prediabetes.

Background Current treatment of osteoarthritis (OA) mainly focused on treating symptoms. Exosome from Adipose-derived Mesenchymal Stem Cell (Ad-MSC) have been shown to delay degenerative process. This study aimed to investigate the clinical, radiological and histological impact of combined intra-articular (IA) hyaluronic acid (HA) and exosome Ad-MSCs in-vivo using a larger animal model with low-grade OA. Methods Eighteen male Ovies aries sheep underwent total lateral meniscectomy and conventional radiography was performed to confirm low-grade OA after 6 weeks. The sheep were divided into three groups, Group 1 (G1; n=6) received thrice exosome injections, G2 (n=6) received twice HA injection, and G3 (n=6) received both treatments with a 1-week interval after 10 days of meniscectomy. Clinical evaluations were conducted using the Clinical Lameness Score (CLS), radiographic with X-ray using OA score by Innes et al, while macroscopic evaluation by Osteoarthritis Research Society International (OARSI) scores. Results Lameness parameter scored lowest in G3 significantly (2.0±0.0 VS 2.7±0.52 VS 2.7±0.52; p=0.024) at the second month although the overall CLS score did not significantly differ at the 3 rd month. The best improvement of conventional total OA radiographic score at the 3 rd month compared to all groups (5.2±1.17 vs 6.3±0.82 vs 6.7±1.03; p=0.053). Macroscopic OARSI evaluation showed no difference (p=0.711). Conclusions Combined repeated exosome Ad-MSC and HA IA injection proven to delay OA progression, however longer duration of follow up is required to evaluate its long-term effect.

Concern for the environment causes an increase in consumer demand for environmentally friendly products. The purpose of this study was to look at the relationship between knowledge about green products, social impact and perception value with green buying behavior. This research is a quantitative and observational type research with cross sectional approach conducted on junior high school students in Jakarta. The results show that there is a relationship between knowledge about the product and green buying behavior, namely p (0.02)

Indonesia has abundant ethanol biomass feedstocks. However the second-generation ethanol production process is still hampered by the unavailability of cellulase enzyme in the process of decomposition of lignocellulose into saccharides that can be processed into ethanol through fermentation. Cellulase is known as exozyme produced by Bacillus sp. in submerged fermentation. In this study, cellulase production by Bacillus sp. CC BPPT RK2 on natural and abundant agricultural waste substrates (rice bran and coconut water) was evaluated by investigating the optimum conditions for cellulase production in a 50 ml laboratory scale. Preliminary test using Luria Bentani (LB) medium with additional CMC (1%) were done to select optimum range of pH and Temperature. The preliminary tests results were then followed by optimization of pH and temperature, which were carried out using response surface methodology (RSM). RSM optimization model showed optimum values 6.23 for pH and 40.04 °C, with 14 terms (each with 1 degree of freedom), 4 linear effects, 6 interaction effects and 4 quadratic effects. These optimization by RSM results were slightly different compared to preliminary test, showing the effect of interactions between parameters. The characteristics of interaction among variables tested against the cellulase activity are reported in this study including: positive effects on cellulase activity of the resulting responses; negative interactions affecting the response of cellulase activity; synergistic interaction; and antagonistic interactions between each other.

High purity oxygen can be used for various things. Oxygen purification method to be applied on this research is the Pressure Swing Adsorption (PSA) technique. The adsorbent that would be used is a natural zeolite, namely ZAL (Zeolite Alam Lampung). Natural zeolite has non-polar properties, so it will adsorb gas with high quadruple moment, which is nitrogen. The varied variable is the size of adsorbent and the concentration of H2SO4. The sizes are 18-35 mesh, 35-60 mesh, and 60-100 mesh. While the H2SO4 concentration are 1M, 2M and 3M. Size of ZAL, and the concentration of sulfuric acid (H2SO4) were varied to get the optimum value. The adsorbent will be activated in aqua demine, H2SO4, NaOH, and through a calcination process. The purpose of this pre-treatment was to remove the impurities and to increase the specific surface area of zeolite. Moreover, ZAL will also be modified by wet impregnation technique using AgNO3 solution with 1%-wt loading nominal. The morphology, composition, and crystal phase were characterized by BET, scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX). The result of the adsorption process was analyzed by using GC (Gas Chromatograph). ZAL 35-60 mesh 1M showed the best performance on adsorbing nitrogen, with its lowest peak at 60356 μV. The result of this research suggested that ZAL itself has the main role on adsorbing nitrogen, while AgxO did not give any significant effect