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Selvi Apriliana Putri,1 Rani Maharani,1 Iman Permana Maksum,1 Teruna J Siahaan2 1Department of Chemistry, Faculty of Mathematics and Natural Sciences, Padjadjaran University, Bandung, 40173, Indonesia; 2Department of Pharmaceutical Chemistry, School of Pharmacy, The University of Kansas, Lawrence, KS, 66047, USACorrespondence: Iman Permana Maksum, Department of Chemistry, Faculty of Mathematics and Natural Sciences, Padjadjaran University, Bandung, 40173, Indonesia, Email iman.permana@unpad.ac.idAbstract: Melanogenesis is a biochemical process that regulates skin pigmentation, which is crucial role in protecting against ultraviolet radiation. It is also associated with hyperpigmentation conditions such as melasma and age spots, which negatively impact aesthetics and self-confidence. Tyrosinase (TYR), a key enzyme in the melanogenesis pathway, catalyzes the biosynthesis of melanin in the skin. Inhibition of tyrosinase particularly by blocking its active site and preventing the binding of natural substrates such as tyrosine, can reduce melanin production, making it a promising therapeutic target for treating hyperpigmentation. Peptides have emerged as promising therapeutics to regulate melanogenesis by minimizing the side effects associated with conventional skin whitening therapeutics. This review is designed to offer a comprehensive analysis of current strategies in peptide design aimed at optimizing anti-melanogenic activity, by focusing on the role of molecular weight, polarity, and cyclization strategies in enhancing peptide efficacy and stability. It was found that optimal peptide size was within the range of 400– 600 Da. The balance between hydrophilic and hydrophobic properties in peptides is crucial for effective TYR inhibition, as higher hydrophilicity enhances affinity for the TYR active site and stronger catalytic inhibition, while hydrophobicity can contribute through alternative mechanisms. Cyclization of peptides enhances their structural stability, serum resistance, and binding affinity while reducing toxicity. This process increases resistance to enzymatic degradation and improves target specificity by limiting conformational flexibility. Additionally, the rigidity and internal hydrogen bonding of cyclic peptides can aid in membrane permeability, making them more effective for therapeutic use. Peptide optimizations through size modification, polarity change, and cyclization strategies have been shown to be promising as reliable and safe agents for melanin inhibition. Future studies exploring specific amino acid in peptide chains are required to improve efficacy and potential clinical applications of these anti-melanogenic peptides as a hyperpigmentation treatment. Keywords: anti-hyperpigmentation, anti-melanogenesis, amino acid, tyrosinase, TYR

There were two most found genera of plant parasitic nematodes from garlic plantation in Magelang, Central Java, Indonesia which suffered losses due to bulb rot, Aphelenchoides and Helicotylenchus. Polymerase Chain Reaction (PCR) was conducted using a pair of universal nematode primer (D2A/D3B) to determine the Aphelenchoides and Helicotylenchus species from those host. Both genera were amplified at ~780 bp. The Blast-N results for the Aphelenchoides showed high identity to Aphelenchoides varicaudatus from Yunnan China (HQ283353) with 99.47 % identity, while the Helicotylenchus showed 95.22 % identity to Helicotylenchus erythrinae from Colombia (MT321739). From morphological and molecular data, we confirm that the Aphelenchoides species is A. varicaudatus. Based on female morphological character, Helicotylenchus species refers to H. erythrinae. Which is also supported by its nucleotide alignment which has same region character as H. erythrinae (MT321739). This is the first report of molecular characterization of H. erythrinae in Indonesia.

Yuni Elsa Hadisaputri,1,2,* Rheza Andika,1,2,* Iyan Sopyan,3 Ade Zuhrotun,1 Rani Maharani,2,4 Rachmaniar Rachmat,5 Rizky Abdulah6 1Department of Pharmaceutical Biology, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia; 2Division of Biological Activity, Central Laboratory, Universitas Padjadjaran, Jatinangor, Indonesia; 3Department of Pharmaceutical and Pharmacy Technology, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia; 4Department of Chemistry, Faculty of Mathematic and Sciences, Universitas Padjadjaran, Jatinangor, Indonesia; 5Oceanographic Research Center, Indonesian Institute of Sciences, Jakarta, Indonesia; 6Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia*These authors contributed equally to this workCorrespondence: Yuni Elsa HadisaputriDepartment of Pharmaceutical Biology, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Bandung-Sumedang KM.21, Jatinangor, West Java, 45363, IndonesiaTel +62-22-84288888 Ext. 3510Email yuni.elsa@unpad.ac.idIntroduction: In this study, Callyspongia aerizusa (CA), one of the most popular marine sponges for cancer therapy research, was investigated for its phytochemical compounds and evaluated for its anticancer activity in various cell lines. Since lung cancer is the most frequently diagnosed cancer, a solution from this marine source is a good choice to address the resistance to anticancer agents. Elucidation of the underlying mechanism of cell death elicited by a CA extract in human lung carcinoma cells A549 was undertaken.Methods: The presence of secondary metabolites in CA methanol extract was revealed by gas chromatography-mass spectrometry (GC-MS) and evaluated on four cancerous cell lines and a non-cancerous cell line using Cell Counting Kit-8. Since the activity of CA extract in A549 cells was then evaluated through clonogenic assay, morphological detection of apoptosis, polymerase chain reaction (PCR) and Western blot assay, were also presented in this study.Results: GC-MS analysis revealed the presence of two ergosteroids, ergost-22-en-3-one, (5β,22E), and ergost-7-en-3-ol, (35β) in the sponge extract that was suggested to suppress A549 cells (IC50 9.38 μg/mL), and another cancerous cell’s viability (IC50 3.12– 10.72 μg/mL) in 24 h, but not in the non-cancerous cells. Moreover, CA extract was also able to reduce the colony-forming ability of A549 cells, and through A549 cells morphology seems that apoptosis is the underlying mechanism of cell death. Further, the treatment with CA extract induced the up-regulation of caspase-9, caspase-3, and PARP-1, and the down-regulation of BCL-2, in both mRNA and proteins expression level, promoting apoptotic cell death via caspase cascade.Conclusion: These findings suggest that the compounds in CA extract possess the ability to induce apoptotic cell death in A549 cells and could become a promising candidate for future anticancer therapy.Keywords: Callyspongia aerizusa, ergosteroids, lung cancer, A549, apoptosis

Pati Aji Achdiat,1 Dyah Ismiranty,1 Reti Hindritiani,1 Trustia Rizqandaru,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, Indonesia, 40161, Tel +6281225955478 ext. 3449, Fax +62222032426, Email pati.aji.achdiat@unpad.ac.idAbstract: Anogenital warts (AGW) including multiple types of human papillomavirus (HPV) are prevalent. In this context, oncogenic HPV infection leads to anogenital cancers and the lesion is more persistent. Several research on AGW therapy with measles, mumps, and rubella (MMR) vaccine injections have been successful without adverse effects. However, the effects of MMR immunotherapy for AGW on multiple HPV infections have not been reported. This research is a case report of AGW in a 17-year-old male treated with MMR. The inclusion criteria specified young age, indicative of a strong immunological status. Meanwhile, the exclusion criteria comprised immunocompromised conditions, such as HIV confirmed to be negative. Dermatological examination showed that the pubic region and penile shaft presented 51 verrucous papules for 6 months, with histopathological results supporting the diagnosis of AGW. Polymerase chain reaction (PCR) examination reported the inclusion of HPV types 6, 11, and 16. The subcutaneous MMR vaccine was injected into the deltoid area every 2 weeks for three sessions. Meanwhile, the treatment response was assessed by counting the number and measuring the size of the lesion. After three sessions of MMR immunotherapy, there was no improvement in the size or quantity of lesions. Based on previous reports, a higher clearance rate for MMR immunotherapy was found in warts with a duration of < 6 months, while oncogenic HPV genotypes, particularly HPV type 16, take longer to clear than others. The efficacy of subcutaneous MMR injection for AGW treatment was unfavorable due to oncogenic HPV types. AGW treated with MMR immunotherapy should investigate oncogenic HPV genotype. However, further research needs to be carried out to justify this conclusion due to the limitations.Keywords: anogenital warts, immunotherapy, MMR vaccine, multiple HPV infections

Pati Aji Achdiat,1 Raka Ghufran Wibowo,1 Ranisa Larasati,1 Rasmia Rowawi,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Email pati.aji.achdiat@unpad.ac.idAbstract: Sexual abuse is any non-consensual sexual act or behavior using force, with significant concern in “men who have sex with men” (MSM), and younger individuals. The incidence of sexually transmitted infections (STI) is also prevalent in the cases of sexual abuse in this population, showing the need for comprehensive medical and psychological intervention. This study presents a case of a 15-year-old Indonesian MSM adolescent who experienced three forced sexual intercourse with a mid-thirties male friend 6 months before the consultation. Psychological evaluation showed signs of moderate depression, then the patient reported erythematous macules and collarettes on the palms and soles. These symptoms appeared 1 month before consultation, without associated pain or pruritus. Additionally, moist, skin-colored verrucous papules and plaques were observed in the perianal area, along with a history of unintentional weight loss. The Kinsey score was calculated as three, showing bisexuality. Testing confirmed positive results for both HIV and syphilis, leading to the secondary diagnosis. The patient tested negative for additional STI and was treated with benzathine benzylpenicillin G 2.4 million international unit (IU) and antiretroviral therapy. After one month, the skin lesions improved and the patient was referred to the psychiatric department for psychological treatment. Syphilis and HIV are the predominant infections, showing the critical necessity of administering appropriate medical treatment, such as antiretroviral therapy and comprehensive STI management, with psychological assessment and management to enhance the psychological well-being of sexually abused individuals.Keywords: bisexual, human immunodeficiency virus, Indonesian, men sex with men, secondary syphilis, sexual abuse

Pati Aji Achdiat,1 Ranisa Larasati,1 Risa Miliawati Nurul Hidayah,1 Erda Avriyanti,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Email pati.aji.achdiat@unpad.ac.idAbstract: Verruca vulgaris is a cutaneous infection predominantly caused by human papillomavirus (HPV) type 1, 2, and 4. In immunocompromised individuals infected with human immunodeficiency virus (HIV) infection, HPV leads to a higher prevalence of infections and also has a greater likelihood of being infected with atypical types such as genital-associated HPV in extragenital sites. This case report describes a 48-year-old male patient who presented with skin-colored verrucous papules on the hands and feet, with no evidence of genital lesions. Polymerase Chain Reaction (PCR) genotyping identified the presence of HPV types 4, 6, and 16 as an etiology of verruca vulgaris, low-risk HPV with genital-associated lesions, and high-risk HPV. This atypical result may suggest a failure of the immune defense system of the body. Therefore, accurately identifying HPV types through PCR testing in immunocompromised patients is essential for appropriate clinical management and monitoring.Keywords: verruca vulgaris, human papillomavirus type 6, human immunodeficiency virus, genotyping, polymerase chain reaction

Fresh-cut fruit is a fruit product innovation that makes it easier for people to consume fruit, but it is not shelf-stable, which results in a decline in the physicochemical and organoleptic quality of the fruit. For example, cut apples are prone to browning and rotting, reducing their shelf life and quality. Fruit can be preserved in a variety of methods, one of which is by covering it with a solution of calcium chloride (CaCl) and sodium alginate (SA). This study aimed to assess the impact of different SA and CaCl combination coating concentrations on the physicochemical properties of fresh-cut apples (Malus sylvestris (L.) Mill.). This study is a descriptive experimental with 3 replications with 4 treatments, namely P1: 1% SA+1% CaCl, P2: 2% SA+2% CaCl, P3: 3% SA+3% CaCl, and control (no coating). The study was conducted at the Biochemistry and Food Laboratory of the Biology Study Program of UIN Maulana Malik Ibrahim Malang and the Animal Husbandry Laboratory of Universitas Brawijaya. Parameters observed included physicochemical characteristics (firmness, weight loss, color, moisture content, total soluble solids, titrated acidity). Data were analyzed by ANOVA followed by Duncan's test at 95% confidence level. From the results of the study, it is known that P2 is the best combination coating. We concluded that a coating of 2% sodium alginate and 2% calcium chloride on cut apples led to improved quality, including reduced weight loss, better color, and higher moisture content, compared to other coating combinations

Pati Aji Achdiat,1 Dini Atiyah,1 Fitri Yulianti,1 Endang Sutedja,1 Srie Prihianti Gondokaryono,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia; 2Department of Pathology Anatomy, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, West Java, 40161, Indonesia, Tel/Fax +62222032426 Ext. 3449, Email pati.aji.achdiat@unpad.ac.idIntroduction: Anogenital warts (AGW) are sexually transmitted infections (STIs) caused by the human papillomavirus (HPV), particularly types 6 and 11. The highest incidence of AGW occurs in the age group of 15– 24 years. However, as life expectancy increases, there is a significant rise in the geriatric population worldwide. This demographic shift is directly proportional to the increasing number of STIs cases within the geriatric group.Cases: A case of AGW was reported in a 75-year-old man who had a history of erectile dysfunction medication use and recent sexual contact. During the physical examination, a hyperpigmented plaque with a verrucous surface was observed at the base of the penis. The results of the histopathological examination were consistent with the characteristics of AGW. In addition, HPV genotyping, through polymerase chain reaction (PCR) showed the presence of HPV type 6.Discussion: The aging process leads to a decline in immune function among geriatric individuals, which causes susceptibility to infections, including STIs. Moreover, the geriatric population has a different level of susceptibility to STIs compared to younger individuals. Factors such as physiological changes, decreased sexual function, low awareness of STIs, and having multiple sexual partners further increase the risk of STIs in this age group.Conclusion: Sexual intercourse is an important component of the human life. However, the natural decline in sexual function due to the aging process often occurs with advancing age. As a result, many geriatrics seek various solutions in order to maintain sexual function and activity in old age. Since STIs can occur at any age, early detection and education are essential, particularly for the geriatric population.Keywords: anogenital warts, geriatric, HPV, immunosenescence, sexually transmitted disease

This research aims to describe the religious value in the novel Suluh Rindu by Habiburrahman El Shirazy and its implementation as literature learning material in high school. This type of research uses qualitative descriptive methods. The research data is in the form of quotations of words, phrases, clauses, and sentences containing religious value in the novel Suluh Rindu by Habiburrahman El Shirazy. This study's data source is the novel Suluh Rindu by Habiburrahman El Shirazy, designed with literary content analysis. Data collection techniques are reading, listening, taking notes, and documenting, and data validity using data triangulation. Data analysis techniques use dialectical methods. The results of this study show that the novel Suluh Rindu contains three religious values: creed, worship, and morals. The religious value of this novel can be implemented as literature learning material in high school based on reading and viewing elements with learning outcomes in the form of students being able to express ideas and views based on logical thinking principles from reading various types of texts (non-fiction and fiction) in print and electronic media. Students can appreciate fiction and non-fiction texts.

Pati Aji Achdiat,1 Rita Septharina,1 Rasmia Rowawi,1 Hartati Purbo Dharmadji,1 Diah Puspitosari,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia; 2Department of Anatomy Pathology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +6281322750101, Email pati.aji.achdiat@unpad.ac.idAbstract: Extragenital warts caused by HPV types 6 and 11 are rarely reported. However, major risk factors for anogenital warts (AGW) include men who have sex with men (MSM) and Human Immunodeficiency Virus (HIV) infection. The incidence of extragenital warts among these populations has not been reported. This study presented a case report of a 33-year-old male with high-risk sexual behavior who showed symptoms of flesh-colored and hyperpigmentation papules. Furthermore, verrucous surfaces were observed at genital and extragenital. The patient had a history of using the same razor for pubic and armpit hair, bathing with a mesh scrub, and scratching the anal area. The histopathological result showed koilocytes, while polymerase chain reaction (PCR) examination for both genital and extragenital lesions confirmed HPV type 6 and 11. This represented the first reported case describing the incidence of extragenital and AGW caused by HPV types 6 and 11. The transmission of extragenital warts was facilitated through fomites autoinoculation, particularly in the immunocompromised condition induced by HIV, which was common among MSM. Extragenital warty-like lesions were considered as warts caused by HPV type 6/11, in HIV-infected persons, specifically MSM.Keywords: anogenital warts, extragenital warts, human papillomavirus type 6, human papillomavirus type 11, human immunodeficiency virus

Pati Aji Achdiat,1,2 Oki Suwarsa,1,2 Yudi Mulyana Hidayat,2,3 Mohamad Nasir Shafiee,4 Reiva Farah Dwiyana,1,2 Reti Hindritiani,1 Endang Sutedja,1 Satiti Retno Pudjiati,5 Dany Hilmanto,2,6 Meita Dhamayanti,2,6 Ida Parwati,2,7 Retno Hesty Maharani,1 Eva Krishna Sutedja,1 Erda Avriyanti,1 Yunitasari1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Doctoral Study Program Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia; 3Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 4Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 5Department of Dermatology and Venereology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 6Department of Pediatric, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 7Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, IndonesiaCorrespondence: Pati Aji Achdiat, Email pati.aji.achdiat@unpad.ac.idIntroduction: Various treatments available today for anogenital and cutaneous warts have limitations, including time-consuming, challenging to perform, and the risk of scarring. A new treatment using tuberculin purified protein derivative (PPD) has been developed, which is expected to generate cellular immunity against HPV.Objective: To assess the evidence for the efficacy and safety of PPD treatment for cutaneous and anogenital warts.Materials and methods: A literature search was performed with the keyword-based search on digital libraries, including the National Library of Medicine, Cochrane Controlled Register of Trial, and Google Scholar, using the following terms: anogenital warts, condyloma acuminata, cutaneous warts, human papillomavirus, immunotherapy, and tuberculin purified protein derivative. Original studies on treating cutaneous or anogenital warts with PPD were included. The results were 47 clinical trials and 4 case reports. Most of the research was done in countries with common Mycobacterium tuberculosis infection. The treatment showed good efficacy. Comparative studies showed that the treatment has similar efficacy with other immunotherapies. No significant side effects were reported, with evidence of the safety use on the pregnant population.Conclusion: Based on good efficacy and safety, PPD can be considered an alternative therapy, especially in countries where tuberculosis is frequent.Keywords: anogenital warts, condyloma acuminata, cutaneous warts, human papillomavirus, immunotherapy, tuberculin purified protein derivative

Tiger-17 analog, a cyclo-undodecapeptide, is a promising antimicrobial peptide (AMP). This study evaluated the potency of the tiger-17 analog as an antimicrobial agent using molecular dynamics simulation. In this work, we employed 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphoglycerol (POPG) and zwitterionic 1-palmitoyl-2-oleoyl-snglycero-3-phosphocholine (POPC). POPG is the component of an anionic bacterial-mimicking membrane, whereas POPC represents the human cell membrane. We analyzed the membrane disruption by visualizing the snapshots and calculated some parameters, including total hydrogen bonds, area per lipid, surface accessible surface area, radial distribution functions, electron density profile, and nonbonded interaction energies. Our study suggested that the tiger17 analog approaches the POPG membrane within 100 ns of the simulation. The peptide interacts stronger with the POPG than the POPC membrane during the simulation, supported by all analysis parameters calculated in this work. The tiger-17 analog exhibits a potential antimicrobial property with selective toxicity towards the bacterial-mimicking membrane, according to molecular dynamics simulation results. Therefore, further development of the tiger-17 analog into an antimicrobial agent is worth trying [ABSTRACT FROM AUTHOR]

Pati Aji Achdiat,1 Muhamad Radyn Haryadi Widjaya,1 Rasmia Rowawi,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital, Bandung, West Java, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62222032426 ext 3449, Fax +62222032426, Email pati.aji.achdiat@unpad.ac.idAbstract: Vulvar intraepithelial neoplasia (VIN), the precursor lesion of vulvar squamous cell carcinoma (VSCC), may present as pruritic or asymptomatic lichenified plaques surrounded by single or multiple discrete or confluent macules or papules. VIN is divided into high-grade squamous intraepithelial lesion (HSIL), which is human papillomavirus (HPV)-driven, and differentiated VIN (DVIN), which develops independently of HPV. Histopathological examination and HPV genotyping polymerase chain reaction (PCR) tests should be performed to distinguish between HSIL and DVIN. Lichenified plaques surrounded by multiple papules are found not only in VIN but also in vulvar lichen simplex chronicus (LSC). This chronic inflammatory skin disease mostly appears in labia majora and is triggered by sweating, rubbing, and mental stress. IHC staining of p16 and p53 are recommended as the most commonly used biomarkers for VIN in diagnostically challenging cases. IHC staining is also beneficial to confirm the accuracy of the HPV detection technique, as p16-negative staining may also represent a false-positive result. We report a case of the importance of p16 and p53 IHC staining in diagnosing vulvar LSC mimicking VIN with false-positive HPV-66. The patient was previously diagnosed with VIN based on clinical examination. HPV-66 was detected by PCR from a vulvar biopsy sample. Histopathological examination revealed stromal lymphocytic infiltration with non-specific chronic dermatitis; neither atypia nor koilocyte was observed. Both p16 and p53 IHC staining were negative. The patient was diagnosed and treated as vulvar LSC with 10 mg cetirizine tablet, emollient, and 0.1% mometasone furoate cream. Clinical improvement was observed as the lesions became asymptomatic hyperpigmented macules in the 4 weeks of follow-up, without recurrence after 3 years of follow-up. Both p16 and p53 IHC staining might help distinguish HSIL and DVIN mutually and from other vulvar mimics in diagnostically challenging cases.Keywords: immunohistochemical staining, p16, p53, vulvar intraepithelial neoplasia, vulvar lichen simplex chronicus

Retno Hesty Maharani,1 Tomi Nugraha,1 Endang Sutedja,1 Kartika Ruchiatan,1 Hermin Aminah Usman,2 Pati Aji Achdiat1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62 81322750101, Email pati.aji.achdiat@unpad.ac.idAbstract: Syphilis is a sexually-transmitted disease with various clinical stages. Secondary syphilis manifestations may mimic other skin lesions. Patient co-infected with Human Immunodeficiency Virus (HIV), with CD4 cell counts of 200– 499 cells/mm3, often manifests an atypical cutaneous lesion, which may also occur as nodular or ulcerative lesions. Generalized nodulo-ulcerative lesions without systemic symptoms in secondary syphilis patients with HIV co-infection are rarely reported. A 22-year-old man presented with generalized asymptomatic multiple erythematous papules and plaques with scales, as well as nodular and nodulo-ulcerative lesions on the trunk, both arms, and both legs. His lesions spread progressively without the presence of any prodromal symptoms or adenopathy. He was previously diagnosed with HIV and is currently on antiretroviral medications, with a CD4 cell count of 388 cells/μL. His venereal disease research laboratories (VDRL) result was reactive (titer of 1:256). His Treponema pallidum hemagglutination assay (TPHA) result was also reactive (titer of 1:10,240). A skin biopsy was performed from the nodulo-ulcerative lesion on his back. Hematoxylin-eosin staining revealed a hyperplastic epidermis, a massive influx of plasma cells, and lymphocyte infiltration into the deep dermis, especially in the peri-adnexal, peri-vascular, and peri-muscular regions. The patient was diagnosed with secondary syphilis with HIV co-infection. He had no previous history of drug allergy. A single dose of 2.4 million units of benzathine penicillin G was administered. Almost all the lesions became hyperpigmented macules after two weeks and resolved completely after one month. His VDRL titer declined to 1:32 after three months. The various atypical lesions of secondary syphilis may lead to misdiagnosis and delayed treatment. The presence of multiple asymptomatic nodulo-ulcerative lesion without prodromal symptoms may indicate the presence of secondary syphilis, notably in patients co-infected with HIV. Therefore, knowledge of atypical cutaneous manifestations of secondary syphilis is warranted in order to treat patients accordingly.Keywords: secondary syphilis, human immunodeficiency virus, nodulo-ulcerative lesions

Retno Hesty Maharani, Hartati Purbo Dharmadji, Reti Hindritiani, Pati Aji Achdiat, Hendra Gunawan, Reiva Farah Dwiyana Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Reiva Farah Dwiyana, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, West Java, 40161, Indonesia, Tel/Fax +62222032426, Email reiva@unpad.ac.idIntroduction: Vitiligo is an acquired depigmenting skin disorder due to the loss of melanocyte function in the epidermis and hair follicles. The pathogenesis of vitiligo is multifactorial, with genetics being a predisposing factor. Previous studies had varying results regarding whether or not polymorphisms of vitamin D receptor (VDR) gene are associated with the risk of vitiligo in specific populations. This study investigated the association between three frequently analyzed VDR gene polymorphisms (ApaI, BsmI, TaqI) and susceptibility to vitiligo in Indonesian population.Methods: Thirty-four vitiligo patients and 34 age- and sex-matched healthy subjects aged ≥ 18 years old were recruited in the Dermatology and Venereology Outpatient Clinic of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Genomic deoxyribonucleic acid (DNA) was extracted from the peripheral blood using a DNA isolation kit. VDR gene polymorphisms (ApaI, BsmI, and TaqI) were investigated using the polymerase chain reaction-restriction-fragment length polymorphism method. The differences of genotype distributions and allele frequencies were statistically compared between case and control groups using Chi-square test.Results: VDR gene polymorphisms were identified in 68 participants, consisting of Aa (n = 14), aa (n = 20), Bb (n = 15), bb (n = 19), and TT (n = 34) genotypes in the case group. In the control group, Aa (n = 6), aa (n = 28), Bb (n = 17), bb (n = 17), and TT (n = 34) genotypes were identified. However, only subjects with ApaI Aa genotype polymorphism had a 3.267-fold increased risk of developing vitiligo.Conclusion: This study showed that ApaI Aa genotype polymorphism of the VDR gene increases the risk of vitiligo in Indonesian population.Keywords: Indonesia, polymorphism, vitamin D receptor, vitiligo

Pati Aji Achdiat,1,2 Yunitasari,1 Hermin Aminah Usman,3 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia; 2Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia; 3Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +6281225955478 ext. 3449, Fax +62222032426, Email pati.aji.achdiat@unpad.ac.idAbstract: Anogenital warts (AGWs) are globally recognized as the most common sexually transmitted infections (STIs) caused by the human papillomavirus (HPV), particularly types 6 and 11. Meanwhile, immunotherapy is one of the treatments of choice for patients with extensive AGWs. Measles, mumps, and rubella (MMR) vaccine induce the production of various T helper 1 cytokines to elicit immune responses, resulting in the clearance of both treated and untreated warts. This study reported a case of extensive genital and extragenital warts in a 53-year-old male which had occurred for five years, with no pseudo-Koebner phenomenon. The history of MMR vaccination was uncertain but the patient received oral antibiotics for one week, one month before seeking consultation. Physical examination showed extensive verrucous and hyperkeratotic papules, plaques, and nodules in the lower abdomen, pubic, inguinal, genital, and gluteal regions. Acetowhite test results were positive, while polymerase chain reaction (PCR) results were positive for HPV types 6 and 11. The patient received an intralesional injection of 0.5 mL MMR vaccine into the largest warts with a 3-week interval. However, during the one-month follow-up after the third injection, no improvement was observed in either the size or number of warts. Based on the results, several factors must be considered to determine the best candidate for immunotherapy, particularly with MMR vaccine, to achieve an optimal outcome. These factors include the active state of diseases, duration of diseases, as well as a history of sensitization, and broad-spectrum antibiotics.Keywords: anogenital warts, human papillomavirus, immunotherapy, MMR vaccine

Pati Aji Achdiat,1 Syafira Andiani,1 Reti Hindritiani,1 Srie Prihianti Gondokaryono,1 Gempita Nuzuliyah,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Pati Aji Achdiat, Email pati.aji.achdiat@unpad.ac.idAbstract: Molluscum contagiosum (MC) is a benign papular skin infection caused by Molluscum contagiosum virus (MCV). Over the past 30 years, the incidence of MK has continued to increased association with sexually transmitted infections and human immunodeficiency virus (HIV) infection. The incidence of MC in HIV patients is quite high at 5– 8%. Until now there is no standard therapy used for the treatment of MC in patients with HIV. In HIV patients, anti retro viral therapy (ARV) is the main therapy with several other additional therapies such as cantaridin, chemical peeling agents such as glycolic acid (20– 70%) and trichloroacetic acid (20– 100%), cryosurgery, electrosurgery, incision, lactic acid, laser surgery, podophyllin, retinoic acid, and urea. There have been no studies regarding the administration of topical 20% glycolic acid in MC patients. We report a case of MC in an HIV patient who was treated with 20% topical glycolic acid after failing treatment with topical tretinoin. The diagnosis was made clinically, cytologically, and histopathologically, a white mass was found on compression of the lesion and Henderson-Paterson bodies. The lesions on the face, arms, and legs were given glycolic acid lotion 20% which was applied once a day at night. The lesions started to show responses to the treatment at week 6th as some of the MC papules became hyperpigmented macules. The side effects of therapy that appeared were itching and hyperpigmentation. Topical 20% glycolic acid can be used for MC therapy with minimal side effects, easy to apply and safe.Keywords: molluscum contagiosum, molluscum contagiosum virus, HIV patient, glycolic acid

Riset tindakan kelas ini memiliki tujuan untuk meningkatkan keahlian motorik halus murid usia dini di salah satu TK yang berada di Kota Tangerang Selatan. Identifikasi keahlian motorik dalam riset ini difokuskan kepada upaya pengembangan keahlian motorik halus menggunakan metode meremas memakai berbagai media, seperti plastisin, playdough, serta koran. 17 murid yang terdiri dari 8 laki- laki serta 9 perempuan ikut serta dalam riset ini. Kami mengamati kegiatan murid sepanjang 6 hari guna mengumpulkan informasi. Tidak hanya itu, kami melakukan wawancara terhadap 4 murid. Hasil riset menampilkan bahwa ada kenaikan motorik halus murid dengan metode meremas menggunakan plastisin, playdough, serta koran. Hal ini dapat dibuktikan dari hasil observasi siklus satu sebesar 47% serta siklus dua sebesar 53% yang artinya terjadi kenaikan sebesar 6%. Dengan demikian, dapat disimpulkan jika metode meremas bisa menaikkan keahlian motorik halus murid.

Penggunaan energi listrik di gedung-gedung pemerintahan terkesan kurang memperhatikan ketentuan penghematan energi listrik. Pada kenyataannya, banyak ruangan yang masih menyalakan lampu penerangan pada siang hari meskipun pencahayaan ruangan sudah cukup terpenuhi oleh sinar matahari. Penggunaan air conditioner (AC) banyak yang tidak sesuai dengan volume ruangan dan jumlah orang yang beraktivitas dalam ruangan tersebut. Hal ini menyebabkan terjadinya pemborosan energi listrik. Universitas Negeri Gorontalo (UNG) mempunyai permasalahan dalam pemborosan energi listrik. Berdasarkan data dari bagian rumah tangga UNG, penggunaan daya listrik bulan Maret 2021 adalah 65.291.330 VA. Hal tersebut sangat membebani anggaran biaya operasional universitas (±60,30% dari dana operasional rumah tangga UNG). Tujuan penelitian ini adalah menganalisis intensitas penggunaan energi listrik dan menetapkan kebijakan penghematan penggunaan energi listrik. Studi penelitian dilakukan di Fakultas Teknik UNG. Metode penelitian yang digunakan adalah metode analisis audit intensitas konsumsi energi (IKE). Tingkat pencahayaan ruangan sesuai cahaya lampu penerangan dan cahaya matahari yang masuk dalam ruangan diukur secara langsung dengan lux meter dan dianalisis sesuai ketentuan Standar Nasional Indonesia (SNI) 6197-2011. Penggunaan energi listrik pada ruangan ber-AC maupun tidak ber-AC dianalisis menggunakan metode analisis IKE. Tingkat penggunaan energis mengacu pada standar efisiensi sesuai Peraturan Menteri ESDM No. 13 Tahun 2012. Hasil penelitian menunjukkan bahwa rata-rata 23,43% dari 233 ruangan memiliki intensitas pencahayaan melebihi standar SNI. Penggunaan daya listrik pada ruangan ber-AC selama satu bulan (26 hari kerja) adalah 14,73 kWh/m2/bln. Berdasarkan standar efisiensi Peraturan Menteri ESDM, hal ini termasuk pada kategori agak boros. Penghematan energi listrik dilakukan dengan menerapkan efisiensi sistem pencahayaan ruangan dan penggunaan AC dengan daya sesuai standar kebutuhan kesejukan ruangan serta penerapan pola hidup hemat energi listrik.

Penjadwalan dalam proses reparasi sering kali tidak sesuai dengan perencanaan awal di main schedule dari kapal tersebut. Keterlambatan dari suatu proyek pengerjaan bangunan kapal baru atau reparasi kapal akan menimbulkan kerugian yang berdampak kepada banyak pihak; baik pihak galangan, owner, dan pihak ketiga. Salah satu cara yang efektif untuk meminimalisir terjadinya keterlambatan adalah melakukan percepatan dengan Critical Path Method (CPM). Objek penelitian yang dipilih adalah reparasi kapal TB. Patra Tunda 3001. Tujuan penelitian ini adalah mendapatkan durasi baru setelah dilakukan reschedule reparasi kapal, menemukan aktivitas pekerjaan pada lintasan kritis, mendapatkan nilai produktivitas tenaga kerja, mencari waktu dan biaya paling optimal untuk mempercepat durasi proyek dengan adanya crashing melalui opsi perbandingan dua alternatif yaitu penambahan jam kerja (jam lembur) dan penambahan tenaga kerja. Total biaya normal sebesar Rp 9.360.000. Dari analisa pengolahan data didapatkan kesimpulan bahwa penambahan jam kerja (jam lembur) dan penambahan tenaga kerja menunjukkan percepatan yang sama optimalnya dengan hasil 25% yaitu 4 hari lebih awal dari total durasi nomal proyek 16 hari. Terdapat selisih biaya 39,31% lebih besar dari durasi normal dengan alternatif penambahan jam kerja (jam lembur) dan selisih pengurangan biaya 27,35% lebih kecil dari durasi normal dengan alternatif penambahan tenaga kerja. Reschedule Repari Kapal TB. Patra Tunda 3001 dengan penambahan kerja lebih efisien dan optimal pengerjaannya.

This study aims to determine the feasibility of laboratory virtual mediaon straight motion kinematics using modelsproblem based learning as well as knowing how students perceive when using the productthat have been developed are reviewed based on the feasibility of the content, graphics, appearance and language.The method used in this study is a quantitative research methodobtained from the results of assessments by media expert validators, material expert validators, and the results of student perception questionnaires regarding the product being developedwith a sample of 28 students. The sampling technique used was purposive sampling. The instruments used were media validation questionnaires, materials, and perception questionnaires. The data analysis used is descriptive statistics, in which the average result obtained from the five assessment indicators is 79.76% which indicates that the media is suitable for use and is greeted very positively by students who use it.

This study aims to determine the feasibility of laboratory virtual mediaon straight motion kinematics using modelsproblem based learning as well as knowing how students perceive when using the productthat have been developed are reviewed based on the feasibility of the content, graphics, appearance and language.The method used in this study is a quantitative research methodobtained from the results of assessments by media expert validators, material expert validators, and the results of student perception questionnaires regarding the product being developedwith a sample of 28 students. The sampling technique used was purposive sampling. The instruments used were media validation questionnaires, materials, and perception questionnaires. The data analysis used is descriptive statistics, in which the average result obtained from the five assessment indicators is 79.76% which indicates that the media is suitable for use and is greeted very positively by students who use it.