Right Heart Failure (RHF) as a rapidly progressive syndrome with systemic congestion in the setting of impaired RV filling and/or decreased RV outflow output. A 28-year-old male patient, a photographer, lived in North Aceh was admitted to the ED of Cut Meutia Hospital. He was admitted with worsening dyspnea since 2 days before, initiated after a periode of fever. He also complained of fatigue, palpitations in ordinary activities and chest pain occasionally. He had history of presyncope and syncope. He denied any history of hypertension, type 2 diabetes, allergies, and active smoking. He had no congenital or family history of heart disease. Physical examination revealed full of conciousness with slightly abnormal vital sign. He had malar rash, dilated jugular vein. The apex of the heart shifts to the axilla anterior line, S1>S2 with systolic murmur (+). ECG showed complete RBBB with RAD and chest x-ray showed cardiomegaly. The transthoracic echocardiogram revealed severe TR (Tricuspid Regurgitation), dilatation of RARV (Right Atrium Right Ventricle), with severe PH (Pulmonary Hypertension). The patient was diagnosed with RHF (Right Heart Failure) caused by primary PH. The patient was placed on intravenous furosemide, spironolacton, digoxin, and sildenafil. Treatment and lifestyle modification were expected to improve the quality of life.

Rheumatic heart disease (RHD) is damage of the heart valves due to acute rheumatic fever (ARF) which results from the body’s autoimmune response to Streptococcus pyogenes (group A Streptococcus bacteria) infection which is a throat infection. Acute rheumatic fever is one of the most important causes of cardiovascular morbidity and mortality in the developing countries. A 25-years-old male patient, domiciled in Alue Dalam, Darul Aman, East Aceh, admitted to emergency department of Cut Mutia hospital, the patient was brought to the hospital by his family at 05.0o pm on January 27th, 2022. Patient referred from Graha Bunda hospital. Patient was admitted to the hospital with complaints shortness of breath. Shortness of breath is felt during activity and worsens at night. Shortness of breath since yesterday. The patient also complained of pounding. The pounding has been felt for five days before arriving at the hospital. The patient also has chest pain, and tired easily. Past medical history such hypertension and diabetes mellitus are denied. Physical examination before treatment was obtained: the patient looked restless, weakness, and akker. Echocardiography examination showed the MR Severe, MS moderate, AR moderate, TR moderate, PH mild, AML calsification, all chamber dilatation, and thrombus LV. The patient was given initial treatment in Cut Mutia General Hospital.

Background: Nanocrystalline cellulose has potential for biomedical applications due to its abundant material availability, biodegradability, biocompatibility, and low weight. Research on nanocrystalline cellulose as medical implants has rarely been studied in the past 10 years, although this material has tremendous potential such as bone implants and cardiovascular implants. Objective: This study aims to analyze the development of research on nanocrystalline cellulose as medical implants using a bibliometric approach with computational analysis using VOSviewer. Methods: The article data was obtained using the Publish or Perish software by retrieving the database from Google Scholar. The keyword “nanocrystalline cellulose, medical implants, biomedical" is used with the publication time span from 2012 to 2020. Data processing uses Microsoft Excel. Computational mapping using VOSviewer. Results: Research on the application of nanocrystalline cellulose has been carried out several times, this can be proven from computational mapping analysis using VOSviewer which shows the term "nanocrystalline cellulose" is in the same cluster as the term "medical implant". However, research on the application of nanocrystalline cellulose as medical implants is still rarely carried out, this is evidenced by the small frequency indicated by the two terms. Conclusion: Based on the results of mapping the collected article data, research on the application of nanocrystalline cellulose as medical implants is an interesting topic. However, this topic is still rarely studied. Therefore, this review can be a starting point for selecting the topic of research on the application of nanocrystalline cellulose materials as medical implants as a consideration for determining the research theme to be taken.

Background: A Study to determine the development of research can be done by bibliometric analysis technique. There are many studies that have been carried out on bibliometric analysis. However, research on bibliometric analysis of published data in the field of protein nanoparticles that has been carried out specifically to determine research development has not been carried out. Objective: This study aims to examine the development of protein nanoparticle research through a bibliometric approach. Methods: The article data was obtained from the Google Scholar database using the publish or perish reference manager software. The keyword "Protein Nanoparticles" is used with a publication time span from 2012 to 2022. Data processing uses Microsoft Excel. Computational mapping using VOSviewer. Results: The article data obtained and considered relevant were 390 articles. The results of the analysis of the development of protein nanoparticle publications in the last 10 years show quite frequent fluctuations. Research fluctuations occurred in 2012 to 2020. There was a decline in 2020-2022 from 35 in 2020 to 19 in 2022. In 2012 and 2014 research on protein nanoparticles became popular, with 47 studies each. Conclusion: Based on the results of mapping the collected article data, it can be seen that the keyword protein nanoparticles is still rarely used in research. It can be concluded that the field of protein nanoparticles is still very likely to be researched and associated with other terms, this will have a higher impact on the novelty of the research.

Rheumatic heart disease (rheumatic heart disease) is an acquired heart disease which is a heart valve disorder that persists due to previous acute rheumatic fever, mainly affecting the mitral valve (75%), the aorta (25%), rarely affecting the tricuspid valve, and never affecting the valves lungs. A 52-year-old male patient, domiciled in Mutiara (Alue Awe) Lhokseumawe City, Indonesia. Come for outpatient treatment at Polyclinic of Cut Meutia Hospital. Patients are who routinely go to the polyclinic every month to take medicine. The patient complains of left chest pain, shortness of breath, heart palpitations, cough, tired easily during activities, especially during strenuous activities. History of Diabetes Mellitus is denied, history of hypertension (+). The patient admitted that he was diagnosed with rheumatic heart disease at the age of 19 years. The patient has been undergoing treatment for 33 years by routinely complete checks related to his heart every year and regularly taking medication at the polyclinic every month. The patient admitted at junior high school age he often experienced attacks of fever that went up and down accompanied by pain in the throat. Physical examination found: Compos Mentis (E4V5M6), BP:140/40 mmHg, HR : 92x/i, RR: 23x/i, T; 37.1°C, SpO2 : 95%. Chest examination showed vesicular breath sounds, Rhonki (-), Wheezing (-), Diastolic murmur (+).Echocardiography showed an EF of 70%. AR Severe, MR Moderate. AML Prolapse, Calcification (+), LV Dilatation, LVH Eccentric

Background : Treatment of COVID-19 using IL-6 inhibitors, including Sarilumab or Tocilizumab, significantly decreased mortality risk. Though, Remdesivir therapy gave benefits, morbidity and mortality remained high. Baricitinib, a JAK inhibitor, can inhibit IL-6 activation pathway and has a potential effect of inhibiting disease progression to become severe. Objective : This study aimed to evaluate the use of Baricitinib for COVID-19 patients. Methods : This study was conducted by searching for observational and randomized controlled trial studies through online databases, “PubMed” and “Google Scholar”. Studies included must evaluate Baricitinib effectivity as therapy for hospitalized COVID-19 patients. This study included 11 studies (9 observational and 2 randomized controlled trial). Patients included had moderate-to-severe symptoms of COVID-19. Results : Standard dose of Baricitinib was administered at 4 mg daily dose. Length of therapy was varied between 5-14 days, or up to patients’ discharge. Baricitinib therapy among included studies was administered with intravenous Remdesivir, Steroid, Tocilizumab, or other complement therapies. Mortality rate within 7-day of hospitalization with Baricitinib was 4.4%. Requirement of invasive mechanic ventilation rate after Baricitinib administration was approximately 4%. Laboratory parameters were significantly getting better after Baricitinib administration: IL-6; CRP; ferritin; and D-dimer. Serious adverse events in a randomized controlled trial, occurred more often in placebo treated compared to Baricitinib treated group. Conclusion : Baricitinib as therapy for COVID-19 patients can decrease progression, morbidity, and mortality of the disease. Further studies are needed to evaluate the benefit of Baricitinib as main therapy for COVID-19.

Background: High or uncontrolled blood sugar levels are still widely found, one of which is due to the patient's lack of knowledge about the disease, diet and treatment of DM sufferers. Overcoming these problems by providing health education. Diabetes self management education (DSME) is a process to support knowledge, skills and abilities in diabetes self-care. Objective: This study examines the influence of diabetes self management education with ava on the knowledge of diabetes mellitus type 2. Methods: The design of this study used a quasy experiment with a pre-test and post-test nonequivalent control group approach. The population in this study were all elderly people with Diabetes Mellitus as many as 170 people, the sample was 60 respondents who were taken using the simple random sampling technique. The instrument used was a questionnaire given before and after the intervention. Data were analyzed using the Wilcoxon Signed Ranks Test with α = 0.05. Results: The research results obtained that the respondent's knowledge after (post test) giving intervention DSME with AVA obtained a Mean Rank value of 3.00 while the level of knowledge before it was carried out (pre test) obtained a Mean Rank value of 2.50 obtained a Sig value of 0.0001 which means if p

Background: Antioxidant is a substance that can catch and neutralize free radicals so that the process of oxidative stress can be stopped and cell damage can be avoided. Kaffir lime peel contains antioxidant compounds that have the potential to be the neuroprotective agent and can protect neurons from free radical-induced damage.Objective: To evaluate the effect of kaffir lime peel extract (Citrus hystrix) on the plasma malondialdehyde (MDA) level of mice induced by Scopolamine (SCM).Method: This research was a true experimental study with a post-test-only controlled group design. Thirty mice were randomly divided into 5 groups consisting of a healthy control (K+), Negative Control (K-), extract 5 mg/20gBW group (P1), 10 mg/20gBW group (P2), 20 mg/20gBW group (P3). SCM was injected intraperitoneally on days 1-7 and kaffir lime peel extract was given orally on days 2-7, the MDA levels testing of mice using TBARS method on day 8. Data analysis used One-Way ANOVA test and continued with Post Hoc LSD test.Results: The mean MDA levels of K+, K-, P1, P2, P3 were 4,212; 4,644; 3,481; 4,555; 4,733 nmol/mL, respectively. MDA levels of P1 were lower than K-, even though there were no statistically significant differences.Conclusion: There was no effect of administration kaffir lime peel extract (Citrus hystrix) on MDA levels in mice with scopolamine-induced dementia.Keywords: Citrus hystrix, malondialdehyde, dementia, mice

Backgrounds: Hypertension and Diabetes Mellitus are interrelated diseases and have a strong predisposition to the occurrence of cardiovascular disease and atherosclerosis. BPJS Kesehatan states that the cost of hypertension services has increased every year, indicating the need to control costs through pharmacoeconomic studies. One method that can be used is cost-effectiveness analysis. Find out the effective drugs in terms of cost and therapy. Aim: To determine the cost-effectiveness of Captopril and Amlodipine for hypertensive patients with co-morbidities of diabetes mellitus at the Magelang District Health Center. Methods: This study was conducted retrospectively with medical record data for 2019-2020. The sample in this study was 35 with 15 groups of 10 mg/day amlodipine and 20 groups of 25 mg/day captopril. The outcome assessed was the number of patients who achieved the therapeutic target for 1 month using the drug. Results: The percentage of therapeutic effectiveness of amlodipine 10 mg/day was 86,7% while captopril 25 mg was 60%. The average direct medical cost of the amlodipine 10 mg/day is Rp10.429,30 greater than captopril 25 mg/day, which is Rp7.298,80. The ACER value of amlodipine 10 mg/day was Rp. 12.023,00 and captopril 25 mg/day was Rp. 12.164,00. Calculation of ICER value of the average direct medical cost of the 10 mg/day amlodipine group is Rp10.423,93 greater than captopril 25 mg/day, which is Rp7.298,80. Conclusion : Amlodipine is more cost-effective than captopril with an ACER value of RP. 12.023,00.

Monkeypox disease (monkey smallpox) is a disease that has never been found in Indonesia since it was first discovered in humans in the Congo in 1970. So if there is one positive confirmed event, then the disease is an Extraordinary Event (KLB). This disease has become a global concern because since May 13, 2022, WHO has received reports of Monkeypox cases from non-endemic countries. It has expanded to 4 WHO regions: Europe, America, Eastern Mediterranean, and Western Pacific. Until now, further investigations and studies are still being carried out to understand more about the epidemiology, sources of infection, and transmission patterns in non-endemic countries that have reported new cases, such as Indonesia. Until now, no specific treatment has been proven to treat Monkeypox infection. Currently, the therapy used is symptomatic support. The antiviral tecovirimat, or TPOXX, developed by the European Medicines Agency (EMA) as a Monkeypox therapy in 2022 based on research, has not been marketed freely. In addition, antivirals such as cidofovir and brincidofovir have been shown to be effective against orthopox virus in vitro and in animal studies. However, the effectiveness of this drug against monkeypox in humans is not yet known. However, this disease can be prevented by vaccination. In Indonesia, the Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine is recommended to prevent Monkeypox disease. The existence of the outbreak report is important to discuss, explore, and understand more about the disease and its management and prevention.

Background: In recent years, Diabetes Mellitus (DM) has emerged as the world's leading cause of death with the potential to develop micro vascular complications in the form of retinopathy. HbA1c is an indicator to identify hyperglycemia and plays an important role in monitoring the development of complications due to DM. This study is undertaken determine the relationship between HbA1C levels and the severity of diabetic retinopathy in DM patients. Aim: To identify the relationship between HbA1c levels and different stages of diabetic retinopathy. Method: An analytic observational, cross sectional design, using patients’ medical record. Patient data consisted of gender, age, DM duration, HbA1c levels, and stages of diabetic retinopathy. Non parametric correlation Spearman’s rho was chosen for statistical analysis. Result: A total of 72 DM patients consisted of 29 men and 43 women with a mean DM duration 10.4 years. A total of 37 patients were diagnosed with diabetic retinopathy with 30 NPDR respondents (41.7%) and 7 PDR respondents (9.7%). The average HbA1C levels based on the patient's diabetic retinopathy stages, as follows; normal attained 6.49% (SD ± 0.95), NPDR 8.17% (SD ± 1.77), and PDR 8.47% (SD ± 1, 10). Spearman's non-parametric test showed a strong and significant relationship (p

Background: Physical activity has protective effects against the development of depression symptoms for all age groups. Cognitive training and aerobic training are lifestyle interventions that have been shown to have a positive impact on health, reducing cognitive impairment, and delaying the onset of dementia. Jump rope training is one type of aerobic training. Aerobic training is effective in improving mood. Objective: This study aims to prove the effect of jump rope training on adolescent’s mood as measured by the POMS score. Methods: This is an experimental study with 2 parallel groups pre-test and post-test design. The research subjects were 32 students of senior-high school 1 of Gunung Talang, Solok Regency, West Sumatra that were selected by purposive sampling and grouped into 2 groups. The control group without treatment (n=16), and the treatment group (n=16) were given jump rope training for 6 weeks. Mood scores were measured before and after the intervention using a profile of mood state (POMS) questionnaire and expressed as total mood disturbance (TMD) scores. Results: The research shown the significant decreases of TMD scores (p<0.001) on the treatment group rather than the control group. In addition, there was a significant difference between the post-test TMD scores of the control group and the treatment group (p=0.005). Conclusion: Jump rope training for 6 weeks can improve the mood of the adolescent.Keywords: aerobic training, jump rope training, mood, profile of mood state, total mood disturbance

Background: Streptococcus mutans was the most dominant bacteria in caused caries. Caries could be prevented by chemical plaque control methods used toothpaste. Toothpaste had antibacterial properties by helped to prevent bacteria from colonized. There were two antibacterial ingredients in toothpaste, fluoride and herbal ingredients. Aim: Determined the antibacterial effect of toothpaste with herbal and fluoride content on the growth of Streptococcus mutans. Methods: This study was an experimental study with a post-test only control group design. This research method was a diffusion method by means of wells. The sample used was the Streptococcus mutans colony. The study was divided into four groups, namely herbal toothpaste, fluoride toothpaste, positive control (chlorhexidine), and negative control (aquadest sterile) which were replicated 16 times in each group. The results of this study was the diameter of the resistance zone. Results: The average diameter of the zone of inhibition results obtained 12.49 mm (herbal toothpaste), 14.66 mm (fluoride toothpaste), 21.70 mm (chlorhexidine) and aquadest sterile there were no inhibition zones. There was a significant difference with the p value

Background: According to the 2018 Global Cancer Observatory from the World Health Organization (WHO), breast cancer is the most common cancer in Indonesia. 3-dimensional conformal radiotherapy (3D-CRT) is one of the breast cancer treatment planning. Effect of radiation on the lungs can cause radiation pneumonitis. The incidence rate of pneumonitis in breast cancer patients who received radiotherapy using 3D-CRT techniques from several researchers is still varied and there is no accurate data yet at RSUP Dr. Kariadi. Objective: To determine the incidence of pneumonitis in breast cancer patients undergoing breast cancer 3D-CRT. Methods: The research design used in this study was cross sectional. The subject is chosen by consecutive sampling methods. The independent variables of this study was 3D breast cancer radiation therapy, while the dependent variable was radiation pneumonitis. This hypothesis test on this study is analyzed with chi-square test. Results: Forty one subjects were included in this study, two subjects were found with a picture of pneumonitis on chest radiographs. The incidence of radiation pneumonitis in breast cancer patients who received radiotherapy using 3-dimensional techniques was 4.9%. There is no significant relationship between breast cancer radiation therapy 3-dimensional techniques on the incidence of pneumonitis. And there was no significant difference in the proportion of pneumonitis in patients with breast cancer locations on the right and left sides. Conclusion: The incidence of radiation pneumonitis in breast cancer patients who received radiotherapy using a 3-dimensional technique is 4.9%. Keywords: 3 Dimensional Technique Radiotherapy, Breast Cancer, Radiation Pneumonitis

Background: Acne vulgaris or widely known as acne, is a skin disease in the form of inflammation of the pilosebaceous unit characterized by the appearance of comedones, papules, pustules, and nodules. Due to the Coronavirus disease 2019 (COVID-19) pandemic, masks have become personal protective equipment (PPEs), commonly used by health workers and the general public. The combination of friction, repeated pressure, sweat, or stress on the skin from wearing the mask causes acne or an exacerbation of existing acne. Meanwhile, the use of facial moisturizer can maintain skin moisture and help the repair process of the structure of the skin barrier. Objective:This study aims to determine the relationship between the use of facial moisturizers and the incidence of acne vulgaris due to masks. Methods: This study is an analytical observational study with a cross-sectional design. The subjects in this study amounted to 44 people who were nurses at the Diponegoro National Hospital who had approved the informed consent form, filled out a complete questionnaire, and included the research criteria. The research sample was selected using purposive sampling. The diagnosis of acne vulgaris was made by doctor-in-charge based on the subject's face photo. The statistical test used is Fischer's Exact Test. Results: Based on data analysis using Fischer's Exact Test, the results showed no significant relationship between the use of facial moisturizers and the incidence of acne vulgaris due to masks with a p-value = 0.722 (p>0.05). Conclusion: There is no relationship between the use of facial moisturizers with the incidence of acne vulgaris due to masks.

Background. Dementia is a syndrome due to brain disease, usually chronic or progressive and there is a disturbance of sublime function. Lack of knowledge and awareness of health workers about the occurrence of dementia can worsen dementia due to delays in diagnosis and treatment. Method. This study is a descriptive study with a cross sectional design involving 66 respondents who have agreed to the informed consent and are general practitioners who work in Primary Health Care Facilities. Sampling using consecutive sampling technique, samples that meet the inclusion and exclusion criteria. Data collection was carried out in November 2021. Data analysis used SPSS 22.0 ver. Results. The average knowledge of respondents before the training was described from the pretest score of 5.2. Conclusion. Lack of knowledge about dementia in general practitioners who work in primary health care facilities in the Semarang.

Background: Lung function has mutual correlation with exercise. Abnormal lung function can affect physical ability to exercise. Otherwise, exercise can increase lung function. Peak expiratory flow rate (PEFR) is a parameter to observe the lung function. High Intensity Circuit Training (HICT) is a combination of aerobic and endurance exercise which has total duration only 7-minutes long. High Intensity Circuit Training can be a good choice for young adults because it does not need much time, easy to be practiced, and beneficial for physical health as well. Objective: To analyze a significant increase in PEFR value after High Intensity Circuit Training for 8 weeks. Methods: This study was a quasi-experimental study with pre-test and post-test comparison group method. Samples were taken purposively from medical student of Diponegoro University (n=56, age=18-21 years old), who were divided into two groups, the control and training group. Peak flow meter was used to measure PEFR value before and after intervention. The data were analysed using Paired T test and Independent T test. Results: A significant increase of PEFR value was found after High Intensity Circuit Training for 8 weeks (p=0.000). The mean difference between pre-test and post-test PEFR value was found increased significantly (p=0.001), that training group had higher score as compared to control group. Conclusion: Regular High Intensity Circuit Training can improve lung function particularly PEFR value in male young adults.

Background: Stool examination is a gold standard that can be used to detect problems in the disgestive systems, which becomes a preliminary examination to determine a diagnosis. The variation characteristics of stool in malnuorished children are very possible due to the infection in the digestive tract, resulting in impaired absorption of nutrients and other health problems. Objective: To find out the profile of routine feces examination in malnourished children. Methods: This study was descriptive research with a cross-sectional method. This study was conducted from April—August 2021 with a sample size of 38 stunted and malnourished children of 6 month-old to 5-year-old in Rumah Gizi and Poli Anak RSUP Dr. Kariadi Semarang. Collecting the data of anthropometric, quisioners, and laboratorium stool macroscopic and microscopic analytic. Results: Macroscopic examination showed that 13 samples (34.25) had a normal brown color, 35 samples (92.1%) had a soft consistency. Moreover, mucus was found in 6 samples (15.8%). In microscopic examination found that 4 cases (10.5%) were positive for carbohydrates. In 17 cases (44.75), fibers were found. Leukocytes were found in 2 cases (5.2%), erythrocytes were found in 8 cases (21.1%), occult blood was found in 10 cases (26.3%), and fungal positive was found in 14 cases (36.8%). Conclusion: Most of the feces were brown, had soft consistency, did not have mucus and blood. Furthermore, fat, fiber, carbohydrates, leukocytes, erythrocytes, occult bold, and fungal were not found in most of the stools.

Background: Lower extremity pain from cycling with wrong technique or without adequate preparation could cause bodily injury and pain. Pain might cause reduced patient’s mobility and quality of life in physical and psychological aspects which results in disruption of sufferers when did their daily activities. Objective: Knowing relationship between uses of mountain bikes and folding bicycles with lower extremity pain. Methods: 65 respondents were involved in research conducted in Semarang online at the respective respondent's and researcher's premises. The study used cross-sectional method to assess relationship between certain types of bicycles uses with lower extremity pain presence and quality. Statistical test used in this study was the Mann-Whitney and Fischer's exact test. Results: There were significant differences in handlebar height, saddle height, and wheel diameter between two groups of respondents (p = 0.032, p = 0.001, p < 0.001). There was insignificant difference between mountain bikes and folding bicycles uses with lower extremity pain presence and quality (p = 0.481, p = 0.599). There was also non-significant correlation and very weak correlation mountain bikes and folding bicycles uses with lower extremity pain presence and quality (p = 0.613, p = 0.603), negative correlation to presence of pain (r = -0.088), and positive correlation to quality of pain (r = 0.066). Location of lower extremity which felt most painful by respondents was knee in both groups. Conclusion: There was insignificant relationship between certain types of bicycles uses with lower extremity pain.

Background: Furosemide as a diuretic loop is one of the main therapies given to heart failure patients with congestion, but in its use furosemide requires a lot of consideration related to toxicity, side effects, and drug interactions. Objective: To determine the toxicity, side effects and drug interactions of furosemide on heart failure patients. Methods: This research is a Systematic Review. Samples were obtained by searching for journals in the online databases of Pubmed, Scopus and Springer Link then adjusted to inclusion criteria and research questions. Data analysis was based on the PRISMA checklist, then searched for similarities and differences. Results: This study found the side effects of furosemide therapy in heart failure patients were: electrolyte disturbance such as: hyponatremia; hypokalemia; and hypomagnesemia, arrythmia, worsening renal function and worsening of AKI, hypotension, increase of plasma renin, and increased risk of fractures. No incidence of furosemid toxicity. The interaction of furosemide on heart failure patients may occur in several drugs like aspirin, digoxin, ACE-inhibitor, and bronchodilator. Conclusion: There is some side effect of furosemide and drug interactions occured in therapy of heart failure patients.Keywords: Furosemide, Toxicity, Side Effects, Interactions, Heart Failure.

Relationship between body mass index and postural balance among student of the martial arts club malikussaleh university. Postural balance is an important component in martial arts. Every player martial art needs fast and strong movements so that the body must be well controlled. Disturbances such as body mass index (BMI) that are not ideal can affect postural stability. The height and shortness or the weight and lightness of a person will affect the location of the center of gravity that later will affect the balance. The purpose of this study is to find out the relationship between body mass index and postural balance among students of the Martial Arts Club Malikussaleh University. This study used a cross-sectional design which was conducted in March 2021 at the Bukit Indah Campus, Malikussaleh University. The sample of this study used total sampling with 49 respondents. Data collection was carried out by measuring body weight, height, static balance with a standing stork test and dynamic balance with a modified bass test of dynamic balance. The results of this study obtained BMI with the highest proportion is normal category, with 31 people (63.3%), while the static balance commonly found in the very good category with 11 people (22.4%), and dynamic balance commonly found in the balanced category with 29 people (59.2 %). The results of the chi-square analysis showed that there was a relationship between BMI with static balance (p = 0.019) and dynamic balance (p = 0.012). This study concludes that there is a relationship between BMI and postural balance among students of Martial Arts Club Malikussaleh University.

Objectives: To determine the effect of lemongrass infusion on the growth of Streptococcus mutans at various concentrations. Methods: This study used post test only control group design with total sample is 9 samples, concentration 100%, 50%, 25%, 12,5%, 6,25%, 3,125%, 1,56%, positive control, and negative control with 3 replications. The research uses dilution method by looking at the turbidity which can be marked as MIC, for MBC used pour plate method was determined by looking at the presence or absence of bacterial growth on the plate. Data analysis was performed using the spss application using Kruskal-Wallis test with significance level if the result of p0,05) indicates that there is no significant difference between research groups. Conclusion: There was no effect of lemongrass stem infusion with various concentrations on the growth of Streptococcus mutans.

Background: Academic procrastination is defined as a learner's tendency to delay learning-related activities, which in many cases eventually causes anxiety and stress. Studying at home tends to cause a feeling of having a lot of free time, eventually postponing work. Students who often procrastinate tend to experience anxiety and depression more often than students who do not procrastinate. Aim: To prove the relationship between academic procrastination and stress, anxiety, and depression due to the COVID-19 pandemic. Method: This research was a cross-sectional study with 184 respondents. The research was conducted in November 2021. The respondents were UNDIP medical students batch 2020. The questionnaires used were the Procrastination Academic Scale for Student (PASS) and Depression, Anxiety, Stress Scale-21 (DASS-21). Data were taken from the questionnaire after the respondents agreed to the informed consent and were analyzed using the Spearman correlation test. Results: As many as 70,1% of respondents were female. Almost 50% of students have a high level of procrastination. A total of 21.7% of students experienced severe to very severe stress, 55.4% experienced severe to very severe anxiety, and as many as 50.4% experienced severe to very severe depression. The level of academic procrastination was positively correlated with stress levels (r=0.468, p<0.001), anxiety levels (r=0.468, p<0.001), and depression levels (r=0.401, p<0.001).Conclusion: Academic procrastination with stress, anxiety, and depression during the COVID-19 pandemic has a significant relationship with a moderate positive correlation. Keywords: Procrastination ; Stress ; Anxiety ; Depression ; COVID-19 Pandemic.

Background: The COVID-19 pandemic requires the government to take policies by establishing online learning. Online learning has significantly provided changes to students' daily activities, thus resulting in academic procrastination. Academic procrastination is defined as an act of postponing academic activities that may lead to decreased academic performance, increased physical, emotional, mental problems, and unhealthy sleep patterns. Sleep is referred to as a crucial activity of daily routines, and poor sleep quality may contribute to negative impacts on academic success. Aim: To evaluate the relationship between procrastination and sleep quality for students of the Medical Study Program, Faculty of Medicine, Diponegoro University, during the COVID-19 pandemic. Method: This research used a cross-sectional design. Subsequently, 84 active students of the Faculty of Medicine, Diponegoro University, Class of 2020, were found to meet the research criteria, agreed to the informed consent, and filled out the complete questionnaire. The statistical test used was Spearman's test analysis. Results: Referring to the results obtained, there was no significant relationship between academic procrastination and sleep quality for students during the COVID-19 pandemic. Moreover, 39 (46.4%) students were identified as having a high level of academic procrastination. Meanwhile, the majority of students with poor sleep quality during the COVID-19 pandemic was amounted to 52 (61.9%). Conclusion: There was no significant relationship between academic procrastination and sleep quality for students of the Medical Study Program, Faculty of Medicine, Diponegoro University, during the COVID-19 pandemic.

Background: Chronic kidney disease (CKD) patients are characterized by immune response dysfunction which increased susceptibility to infections. CKD is one of the Coronavirus disease-2019 (COVID-19) comorbidity that generally has a poor clinical outcome and patients undergoing hemodialysis had a 50% hospitalization rate and 20%-30% mortality rate. Seroconversion after confirmation of COVID-19 infection is close to 100% in the dialysis population, but the durability of the immune response and the extent as a protection against infection remains unclear. This study aimed to determine the immune response and prognosis of CKD patients undergoing hemodialysis against COVID-19. Objective: To determine immune response and prognosis of CKD patients undergoing hemodialysis against COVID-19. Methods: This is a systematic review study that used literature sourced from online journal databases on Google Scholar, PubMed, Cochrane, and Clinical Key sites. Literature that has passed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) staging and the journal quality review based on the Newcastle-Ottawa Scale (NOS) assessment is then synthesized qualitatively and presented systematically. Results: Based on the data analysis, there were positive immune responses in 460 of 735 (62.6%) CKD patients undergoing hemodialysis against COVID-19 and a higher mortality rate (10.5%) than the control group (6.9%). Conclusion: The immune response and prognosis of CKD patients undergoing hemodialysis against COVID-19 were worse than the control group. Therefore, COVID-19 vaccination should be prioritized in CKD patients undergoing hemodialysis.

Background: Nurses are one of the first-line fighters who treat Coronavirus disease 2019 (COVID-19) patients. They are prone to stress, anxiety, and sleep disturbances that can interfere with nurses providing medical services. Although some clinical research has established sleep quality and quality of life, the comparisons of sleep quality, quality of life, and each domain of quality of life for nurses who work in isolation and non-isolation wards is not well known Objective: This study examines the correlation between sleep quality and quality of life amongst Dr. Kariadi General Hospital nurses during the COVID-19 pandemic. Methods: This quantitative study uses a cross-sectional approach. 51 nurses who worked in the Rajawali rooms in the isolation and non-isolation wards for COVID-19 at Dr. Kariadi Semarang were included by the consecutive sampling method. The instrument used are the sociodemographic questionnaire, The PSQI, and The WHOQOL-BREF Indonesian versions. Bivariate analysis was analyzed using the Spearman test Results: There was a correlation between sleep quality and the quality of life of nurses (p=0.020,r= -0.325). There was a difference between the sleep quality of nurses who work in isolation and non-isolation wards (p=0.03). There was no difference between the quality of life of nurses who work in isolation and non-isolation wards (p = 0.698). Conclusion: There is significant correlation between nurses’ sleep quality and their quality of life. There’s bad quality of life for nurses who worked inward isolation so further examination and periodic screening are needed to optimize their care.

Background: Acute myeloid leukemia (AML) is a malignancy originating from multipotential hematopoietic cells, which is characterized by clonal proliferation of abnormal blast cells in the bone marrow and failure of normal cell production. Coronavirus disease-19 (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. COVID-19 infection in AML patients will affect laboratory examinations to support the diagnosis of COVID-19 and the patient's prognosis.  Case presentation: A 55-year- old man went to the hospital for chemotherapy and diagnosed of acute myelomonocytic leukemia. Patient complains of his gingival bleeding. The results of the routine haematological examination showed pancytopenia and the patient requires blood transfusion before chemotherapy. On the third day of treatment, the patient complained of fever, after several day patient complained cough, and shortness of breath. Physical examination showed pulse 100x/minutes, respiratory rate 26x/minutes, temperature 39.8˚C, crackles of the lungs. RT-PCR examination from nasopharyngeal swab showed a positive SARS-CoV-2. During treatment, the laboratory tests showed pancytopenia, increased D-Dimer, C-reactive protein, ferritin and procalcitonin. After the 42^th day of treatment, the patient had clinical improvement, the fifth evaluation swab showed a negative RT-PCR result. Conclusion: AML patients have a higher risk of infection, especially COVID-19 infection. Correct laboratory examinations and treatment will promote a better prognosis. It is necessary to educate leukemic patients so that they always take precautions against infection, especially the prevention of COVID-19.

Background: Pharmacological therapy to reduce serum uric acid levels in gouty arthritis and hyperuricemia patients is essential to prevent gout flare and other hyperuricemia-related morbidities. However, only about 50% of gout arthritis patients adhered to their treatment. Knowing the factors influencing adherence to therapy can be used as a reference for health services to improve adherence.Objective: This study aimed to analyze the factors that influenced the patient's adherence to gouty arthritis and hyperuricemia pharmacological therapy.Methods: This was an observational study with a cross-sectional approach. Subjects were the patients in Wuryantoro Community Health Center, Wonogiri Regency, diagnosed with gouty arthritis or hyperuricemia due to a disorder in purine metabolism. Sampling was done by a consecutive sampling method. Questionnaires with the related medical record were used to collect the necessary data. Research variables were knowledge, attitudes and behavior, gender, age, occupation, insurance, distance from residence to health care facilities, and adherence to therapy which was in binary.Results: Sixty-one percent from a total of 41 respondents were found to be non-adherence to pharmacological therapy. Knowledge, attitudes, and behavior towards therapy, educational level, availability of health insurance, and distance to health facilities were significantly correlated to treatment adherence (p < 0.05). Sex, age, and occupation were not correlated to adherence.Conclusion: Factors influencing adherence were knowledge, attitudes and behavior, academic background, insurance, and the distance from residence to health care facilities.

Background: Online motorcycle drivers work more than 10 hours a day, surpassing the international working hour regulations. Working hours are directly proportional to air pollution exposure generating reactive oxygen species (ROS). On the other hand, physical exercise also contributes to the generation of ROS due to greater oxygen utilization by mitochondria. The ratio of GSH to GSSG represents the oxidative stress level in body tissues. Objective: This study aimed to analyze the relationship between the length of air pollution exposure and the level of physical exhaustion to GSH:GSSG ratio of online motorcycle drivers. Methods: This research was a cross-sectional study of 16 male online motorcycle drivers. The GSH:GSSG ratio was assessed by ELISA with cyclic DTNB reaction principle. Length of air pollution exposure and level of physical exhaustion data were obtained from the interview. Statistical analysis was done to determine the correlation between variables. Results: The mean GSH:GSSG ratio in studied population is 0.69 ± 0.26, lower than 1 value of GSH:GSSG ratio represents high oxidative stress condition. Based on the correlation test, there are no correlation between length of air pollution exposure (r = -0.464, p = 0.070) and level of physical exhaustion (r = -0.439, p = 0.089) to GSH:GSSG ratio in online motorcycle drivers. Conclusion: Our findings suggested that online motorcycle drivers have a high level of oxidative stress, length of air pollution exposure, and status of physical exhaustion, which is not associated with the GSH:GSSG ratio.

Background: The most restoration material used currently in dentistry was composite resin. The newest generation of composite resin was bulk-fill composite resin. The bulk-fill composite resin had advantages of lower polymerization contraction and a more straightforward and faster restoration technique. One of the factors which could affect the hardness of composite resin was the consumption of acidic drinks. The acidic beverage that people often consumed is coffee. A few coffee brewing methods were espresso and drip brewing.Objective: This research aimed to identify the effects of coffee soaking through espresso and drip brewing methods on bulk-fill composite resin's hardness. Methods: his research was experimental research, with a post-test control group design and a total sample of 27 samples. The soaking process was taken for seven days at a temperature of 37˚C on artificial saliva, espresso, and drip brewing coffee methods. The hardness of bulk-fill composite resin was measured after seven days by using Vickers hardness. The statistic test exerted One-Way ANOVA. Results: This research found a significant difference in bulk-fill composite resin's hardness among all groups, p-value = 0.00 (p<0.05). The result of the post-hoc LSD test showed a significant difference in the change of bulk-fill composite resin hardness between the artificial saliva group and espresso group (p=0,00) and no significant difference found between the artificial saliva group and drip brewing group (p=0.85). Conclusion: Soaking with espresso coffee has the smallest hardness value compared to soaking with drip brewing coffee and artificial saliva, so soaking with espresso coffee is the most influential on the hardness of the bulk fill composite resin.

Background : Endometriosis is one of the gynecological disorders that affects women at reproductive age between 20-35 years. Based on the above, endometriosis can cause pain that can interfere daily activity and infertility.Aim : To found the incidence and characteristics of patients with endometriosis who undergoing treatment and surgery in RSUP Dr. Kariadi Semarang Method: This study was a descriptive study. Data retrieved from medical records of endometriosis’s patients who undergoing treatment and surgery at RSUP Dr. Kariadi Semarang 2018. The result presented in distribution and frequency characteristics tables.Result : The incidence of endometriosis in RSUP Dr. Kariadi Semarang in 2018 were 176 cases of 8690 inpatients in the obstetric and gynecology wards. Characteristics of endometriosis patients are most at the age of 20 - 35 years, nullipara, with complaints of menstrual pain / dysmenorrhoea, location in the ovary, by managing the surgery and using GnRH agonists, and not a recurrent endometriosis patient.Conclusion : The incidence of endometriosis in RSUP Dr. Kariadi Semarang 2018 was 176 cases of 8690 patients at the Obstetrics and Gynecology (2 %). Endometrosis highest incidence was in the reproductive age (20-35 years).

Background : Epilepsy is a chronic disease that increases the risk of interictal headaches, one of which is tension type headache (TTH). TTH in epilepsy is triggered by recurrent neurogenic inflammation and central sensitization leading to pericranial tenderness. Recurrent neurogenic inflammation can affect cognitive function. The frequency of TTH in epilepsy is thought to be related to cognitive function score.Objective : Analyzing the relationship between the category of TTH frequency, onset of epilepsy, seizure frequency, age and education with cognitive score. Methods : Our study is an analytic observational study with a cross sectional design that took place from April to September 2021. The subjects of the study were epilepsy patients suffering from TTH at Dr. Kariadi Hospital, Semarang who met the inclusion and exclusion criteria. Patients’s data was obtained by filling out a questionnaire form. Assessment of the category of TTH frequency used ICHD-3 beta 2013 criteria. Assessment of cognitive function used the MoCA-Ina score. Data was analyze with Spearman correlation test, the results were significant if the p value <0.05.Results : Forty one epilepsy patients consist of 14 infrequent episodic TTH, 14 frequent episodic TTH and 13 chronic TTH. There was significant relationship between the MoCA-Ina score and the TTH frequency category (r=0,362; p=0,02), and education level (r=0,493; p=0,001). There was a weak relationship between the MoCA-Ina score and the onset of epilepsy or seizure frequency, while there was no relationship with age.Conclusion : There was a moderate relationship between the TTH frequency in epilepsy with cognitive function.Keywords : epilepsy, tension type headache (TTH), Montreal Cognitive Assesment- Indonesian version (MoCA-Ina)

 Background : Epilepsy is a chronic condition with unprovoked seizures. One of the changes affected by anti-epileptic drugs is a decrease in bone density. Gender and sex hormones have implications on bone density. Objective : To determine the prevalence difference osteopenia between male and female, and relationship with clinical characteristics epilepsy patients taking a combination of carbamazepine and valproic acid. Methods: A cross-sectional study with 22 epileptic patients with age range of 18-60 years taking combination of carbamazepine and valproic acid at the Neurology Department Dr. Kariadi Semarang during June to October 2021 who met the inclusion and exclusion criteria. Patient data were obtained by filling out a questionnaire. The assessment of osteopenia was carried out by examination of Bone Mineral Densitometry. Data analysis was using Chi Square test and Spearman correlation test. The result was determined to be significant if the p value <0.05. Results : There were 11 male subjects and 11 female subjects. Chi Square resulted in significant difference between male and female (p<0.05). Spearman correlation test showed a relationship between osteopenia and duration before combination therapy, for men rho 0.734 (p<0.05), women rho 0.786 (p<0.001). There was a relationship between osteopenia and the onset of epilepsy, male rho 0.603 (p<0.05), female rho 0.757 (p<0.001). There was a relationship between osteopenia and age, male rho 0.487 (p=0.129), female rho 0.780 (p<0.001). There was also a relationship between osteopenia and seizure frequency, male rho 0.457 (p<0.05), female rho 0.467 (p=0.026). Conclusion: There was a significant osteopenia prevalence difference between male and female epilepsy patients taking combination of carbamazepine and valproic acid. Moderate and strong relationship were found between osteopenia and clinical characteristics epilepsy. Keywords : Epilepsy, osteopenia, carbamazepine, valproic acid

Background: Myopia is one of the visual disorders that has a high prevalence in the world. Based on the severity degree, myopia is divided into three criteria, namely mild, moderate and severe. Severe-degree myopia patients are more likely to suffer from certain eye diseases, especially those associated with the retina, such as retinal detachment. Objective: To analyze the relationship between the degree of myopia and the incidence of retinal detachment. Methods: This research is an observational analytical with cross-sectional approach. The research data was obtained using consecutive sampling from the medical records of myopia patients in Diponegoro National Hospital during 2015-2020. Research subjects used in this research were 70 patients who fulfill the inclusion and not the exclusion criteria. The data were analyzed using Chi Square test. Results: The prevalence of retinal detachment is dominated by the age group of 51-60 years old (18.6%), male (35.7%) and a severe degree of myopia (34.3%). The results of the Chi Square test show that there is a significant relationship between the severity degree of myopia and the incidence of retinal detachment. Conclusion: There is a significant relationship between the degree of myopia and the incidence of retinal detachment.

   Background of the Research Leprosy is a chronic infectious peripheral neuropathy caused by Mycobacterium leprae. Clinical presentations of leprosy neuropathy are obtained when the nerve damage is more than 30% of peripheral nerve fibers. The anti-inflammatory property of interleukin 10 is supposed to protect tissue from the damage caused by proinflammatory cytokines. Instead, it causes extensive nerve damage due to suppression of the cellular immune system, failure of forming granuloma to limit the growth of Mycobacterium leprae. As a result, it multiplies and spreads. Purpose of the Research The purpose of the research is to analyze the correlation between interleukin levels 10 serum and the severity of peripheral neuropathy. Methods of the Research The method used is cross-sectional research on 30 subjects with multibacillary leprosy aged 18-65 at the Neurology Department of Kelet Hospital Jepara from September to October 2021. The questionnaire was used to collect data of the patients. Interleukin level 10 serum evaluation is assessed by examining blood serum. Data analysis used Spearman Correlation Test. The significant result occurs if it is p<0.05. Research result Patients with multibacillary leprosy are mostly men (73.3%). There is also a strong significant correlation between interleukin 10 levels and the severity of peripheral neuropathy (p<0.001) with rho (0.7) Conclusion There is a strong and significant correlation between serum interleukin 10 levels and the severity of peripheral neuropathy in multibacillary leprosy Keywords: multibacillary leprosy, interleukin 10, peripheral neuropathy

Background: Composite resin often used as a restoration material due to its advantages in the aesthetic field. The bulk-fill type is one of the composite resin that can be applied directly into cavities as deep as 4 mm, so that restoration procedure becomes easy and effective. Hence, exposure to various acidic drinks can reduce the hardness of composite resins and eventually lead to failure of the tooth restoration process. Objective: This research aimed to evaluate the effects of several commercial acidic drinks, (carbonated, isotonic, and yogurt) on the hardness of bulk-fill composite resins. Method: This research was an experimental study with a post-test control group design. Twenty-four specimens were made with the size 10 x 4 mm using the metal mold rings. Specimens were divided into 4 groups for artificial saliva (served as a control), carbonated, isotonic, and yogurt. Specimens were immersed in storage agents for 5 seconds followed by artificial saliva for 5 seconds. This cycle was repeated 20 times for 14 days. The bulk-fill composite resin hardness was measured using a Micro Vickers Hardness Tester with a load of 100 grams for 10 seconds. Statistical analysis was performed using One Way ANOVA and Post Hoc LSD Results: Data were normally distributed and homogeneous with p > 0.05. The One Way ANOVA test showed the biggest difference in bulk fill composite resin between 4 groups (p < 0.001). The Post Hoc LSD test showed significant differences between all groups (p < 0.001) Conclusion: Carbonated, isotonic, and yogurt drink significantly decreased surface microhardness of bulk-fill composites resin but the carbonated drinks greatly reduce the hardness value since it has the lowest pH of 2.3.

Background: The most restoration material used currently in dentistry was composite resin. The newest generation of composite resin was bulk-fill composite resin. The bulk-fill composite resin had advantages of lower polymerization contraction and a more straightforward and faster restoration technique. One of the factors which could affect the hardness of composite resin was the consumption of acidic drinks. The acidic beverage that people often consumed is coffee. A few coffee brewing methods were espresso and drip brewing.Objective: This research aimed to identify the effects of coffee soaking through espresso and drip brewing methods on bulk-fill composite resin's hardness. Methods: his research was experimental research, with a post-test control group design and a total sample of 27 samples. The soaking process was taken for seven days at a temperature of 37˚C on artificial saliva, espresso, and drip brewing coffee methods. The hardness of bulk-fill composite resin was measured after seven days by using Vickers hardness. The statistic test exerted One-Way ANOVA. Results: This research found a significant difference in bulk-fill composite resin's hardness among all groups, p-value = 0.00 (p<0.05). The result of the post-hoc LSD test showed a significant difference in the change of bulk-fill composite resin hardness between the artificial saliva group and espresso group (p=0,00) and no significant difference found between the artificial saliva group and drip brewing group (p=0.85). Conclusion: Soaking with espresso coffee has the smallest hardness value compared to soaking with drip brewing coffee and artificial saliva, so soaking with espresso coffee is the most influential on the hardness of the bulk fill composite resin.  

Background: Irritant Contact Dermatitis (ICD) is an eruption of the skin caused by the non-immunologic inflammatory response of the skin to the irritant agents. The government urged to implement health protocols 3M, one of them is hand hygiene by used hand sanitizer to prevent the spread of COVID-19 infection. Repeated use of hand sanitizer can cause skin irritation and inflammatory response such as dryness, cracks, and other symptoms of ICD. Objective: To analyze the relationship between the frequency of use of hand sanitizer and the incidence of ICD. Methods: Observational analytics study cross-sectional design. The research subject were 260 medical faculty students of Diponegoro University who had to agree with informed consent, filled questionnaires and qualified by research criteria. Diagnostic of ICD based on questionnaires and physical examination of ICD. The statistical analysis data was used Chi-square test. Results: The results showed after analyze data use Chi-square test that there was not significantly related frequency use the hand sanitizer to the incidence irritant contact dermatitis during the COVID-19 pandemic with a p-value is 0,078 (p>0,05). The most frequent use of hand sanitizers is 5-10 times a day (56,5%), the most symptoms in ICD are dry, scaly, and peeling skin (30%), and the incidence of ICD due to the use of hand sanitizers are 33,5%. Conclusion: There was no significant relationship between frequency of use of hand sanitizer and irritant contact dermatitis during pandemic the COVID-19.

ABSTRAK Background: Composite resins are able to generate the color of dental restorative materials based on the original teeth's color. Nanofilled composite resins have compressive strength, good polishing, and color stability compared to other types of composite resins. Color changes may occur due to intrinsic and extrinsic factor example mouthwash. Mouthwash that is commonly used is chlorhexidine. The use of chlorhexidine mouthwash continuously may stain the composite resins. Mouthwash that has a good anti-plaque other than chlorhexidine is chlorine dioxide which has a clear color and does not cause changes in taste on the tongue. Aim: To determine the effect of 0.12% chlorhexidine digluconate mouthwash and 0.1% chlorine dioxide mouthwash to the discoloration of nanofilled composite resins. Methods: This study is an experimental study with a pre-test and post-test control group design. Samples are nanofilledcomposite resins made into discs in total of 27 and divided into three groups with different treatments, soaked with 0.12% chlorhexidine digluconate mouthwash, 0.1% chlorine dioxide mouthwash, and sterile distilled water. Each group was soaked for 24 hours and tested for staining using chromameter. Result: ANOVA test showed the significant difference between group, that the greatest color change is the one soaked with 0.12% chlorhexidine digluconate mouthwash compared to 0.1% chlorine dioxide mouthwash Conclusions:  The use of 0.1% chlorine dioxide mouthwash does not cause discoloration as much as 0.12% chlorhexidine digluconate mouthwash. Keywords:Chlorhexidine digluconate, Chlorine dioxide, nanofilled composite resin, discoloration

Background: Heart failure is when the heart cannot pump enough blood to fulfill the body's needs. This disease is dangerous and can lead to death. The most common risk factors are hypertension, diabetes mellitus, and metabolic syndrome. Case Presentation: A 54-year-old man complained of shortness of breath for the last one month, which worsened during light activities and decreased when he was in a semi-sitting position. The patient had a history of hypertension and type-II diabetes mellitus for the last five years. On physical examination, the patient's blood pressure was 140/100 mmHg, respiratory rate was 25 bpm. There were paroxysmal nocturnal dyspnea, orthopnea, rales on both basal lung fields, dyspnea on exertion, ankle edema, a pansystolic murmur heard in the apex, ascites and ankle edema. Blood laboratory examination showed HbA1c 6%, chest X-ray and ECG showed cardiomegaly. Conclusion: The patient was diagnosed with NYHA Class III Heart Failure with stage 2 hypertension and type-2 diabetes mellitus and was treated with fluids, diuretics, ACE inhibitors, beta-blockers, low salt diet, restriction of fluid intake, and oral antidiabetics.

INTRODUCTION: WHO estimates more than 150 million diabetes patients worldwide. One of the complications of diabetes is diabetic retinopathy which is recognized as the leading cause of blindness in the working-age population and the cause of 12% of new cases of blindness each year due to macular edema, vitreous hemorrhage, and tractional retinal detachment. Macular edema is the most common cause of decreased visual acuity. The relationship between macular edema and the degree of retinopathy is unclear, so further research is needed. This study aimed to analyze the incidence of macular edema with the degree of diabetic retinopathy. METHOD: This study used a cross-sectional method. Samples were taken from the Retina Data Register at the National Diponegoro Hospital Eye Polyclinic of all diabetic retinopathy patients who attended National Diponegoro Hospital from July to December 2020 who were recruited as participants. The variables measured included the incidence of macular edema and the degree of diabetic retinopathy. Measurements using fundoscopy, slit lamp and condensing lens + 78D according to ETDRS (Early Treatment Diabetic Retinopathy Study) criteria by an ophthalmologist. Data analysis used a bivariate difference test for 2 groups. The statistical test used was the Kruskal-Wallis test, which was significant if p ≤ 0.05. RESULTS: In this study, out of 150 eyes examined, 28 (18.7%) had macular edema. 4 (2.7%) eyes were diagnosed with Moderate NPDR, 3 (2%) eyes were diagnosed with Severe NPDR. In eyes diagnosed with PDR with or without VH or TRD, 21 (14%) eyes had macular edema. The p-value was 0.03 with the Kruskal-Wallis test, where p ≤ 0.05. CONCLUSION: There is a significant difference between the degree of diabetic retinopathy and the incidence of macular edema. The incidence of macular edema is higher in the more severe degrees of diabetic retinopathy.

Background: Epilepsy is a chronic condition characterized by unprovoked seizure. Vitamin D is necessary in child development process and is strongly influenced by the presence of anti-epileptic drugs. Objective: To determine the correlation of treatment duration and serum vitamin D levels in children with epilepsy who use the combination of valproic acid and topiramate Methods: A cross sectional study among forty pediatric patients with epilepsy with age range of 5-10 years at Dr. Kariadi Hospital Semarang. Examination of serum vitamin D levels is done by ELISA. Statistical analysis using Spearman correlation test and partial correlation test with significance level p = 0.05. Results: The mean of serum vitamin D levels in patient with combination treatment after 24 months was 21.87±1.21ng/ml, in those who still having seizure was 27.94±2.40ng/ml, and among who received delayed therapy was 23.23±2.07ng/ml. Bivariate analysis depicted that there was negative correlation between duration of treatment (rho= -0.850, p<0.001), onset of therapy (rho=0.604, p<0.001) and seizure frequency (rho=0.559, p<0.001) with serum vitamin D levels. Partial correlation analysis showed a significant correlation between duration of treatment and serum vitamin D levels after adjusted by onset of therapy (rho=-0.839, p<0.001) and seizure frequency (rho=-0.856, p<0.001). Conclusion: There is a correlation between the duration of treatment and serum vitamin D levels among children with epilepsy

Background: The COVID-19 pandemic is still ongoing, and no one could predict when it would end. In some cases of COVID-19, patients experienced infection by SARS-Cov-2 and other microorganisms, including viruses, bacteria, and fungi.Objective: This study aims to determine Co-infection on clinical symptoms and mortality of COVID-19 patients in Bengkulu City, Indonesia.Methods: We reviewed and analyzed data on patients with confirmed COVID-19 who were co-infected, including basic information, clinical manifestations, radiological and laboratory examinations, to the final status.Results: A total of 105 patients with confirmed COVID-19 participated in this study with various clinical manifestation: mild case (12%), moderate case/ mild pneumonia (52%), severe pneumonia (20%) and critical case (16%). Of the 105 patients, six patients were co-infected with human immunodeficiency virus (HIV) (1 case), Mycobacterium tuberculosis (2 cases), Salmonella thypii (2 cases), bacterial pneumonia, and viral pneumonia (1 case). As many as three of the six patients experienced inferior clinical manifestations and died.Conclusion: The co-infection of other microorganisms in COVID-19 can affect the severity and mortality in COVID-19 patients.

 Background: Nicotine is a major aspect of smoking. Nicotine cause damage to the lungs because the oxidative stress caused triggers an inflammatory response and lung damage to the alveoli. Garlic extract as an antioxidant agent so that it can against oxidative stress caused by nicotine exposure. Objective: This study is to proving the effect of multilevel dose of garlic extract on lung histopathology of BALB/c mice exposed to nicotine by inhalation Methods: The study used an experimental post test only control group design which was carried out for 24 days. Mice were given an adaptation period of 7 days followed by a treatment period of 14 days. On the last day, the lungs will be terminated and taken for histopathological tests. Mice were divided into 4 groups, namely a Healthy Control Group that was only given standard feed, a Negative Control Group that was given exposure to nicotine by inhalation at a dose of 10 mg/KgBW, treatment group 1 was given garlic extract 300 mg/KgBW orally and exposed to nicotine inhalation with a dose of 10 mg/KgBW, and treatment group 2 who were given garlic extract 500 mg/KgBW orally and exposed to nicotine by inhalation at a dose of 10 mg/KgBW. Histopathological preparations were made on each sample with Hematoxylin-Eosin paint which was then observed microscopically and assessed for severity of damage using scoring criteria. Results: Based on microscopic observations, the degree of lung damage is grouped into normal, mild, moderate, and severe degrees. The results in each group are in the following groups: Healthy Control Group : 73%,27%,0%,0% ; C(-) :0%,0%,33%,67% ; T1 : 0%,33%,67%,0% ; T2 : 0%,100%,0%,0%. The Kruskal Wallis test was performed to obtain significant differences, followed by the Mann Whitnney test which compared the treatment groups which showed significant results. Conclusion: By Giving garlic extract can reduce the degree of microscopic damage of mice lung due to nicotin inhalation exposure.

Background: Cigarettes increase cardiovascular risks by modifying lipid profiles through oxidation, alternating lipoprotein composition, and fat metabolizing enzyme activity. Vascular dysfunction can primarily identified by LDL cholesterol composition shift, one of atherosclerosis predictor. Rosella is a multifunctional herb that widely used as a pleasant tea. Aside from its rich components, anthocyanin, pectin, PCA and hibiscus acid are playing the role keys in lowering LDL cholesterol through lipid metabolism enzyme activity modification. Rosella is easy to find, relatively cheap, tasteful and also categorized as food-grade FDA approved.Aim: To investigate the effect of rosella infusion in decreasing LDL cholesterol serum on cigarettes exposed male Sprague dawley rat.Methods: This study is a true experimental study design with post-test only controlled group design. After 7 days of adaptation, a total of 30 male Sprague dawley rats were randomly divided into 5 groups (n=6 per group); KN received no special treatment; KP exposed to 4 rods of cigarette smoke/day; experimental groups (P1, P2, P3) exposed to 4 rods of cigarette smoke/day and rosella dried calyx infusion with 250, 500 and 1000 mg/kg respectively for 30 consecutive days. LDL cholesterol levels are measured using the CHOD-PAP method. Collected data were analyzed statistically using One Way ANOVA Test.Results: There is a significant difference between all experimental groups (p=0,00) in the post-hoc test.Conclusion: These lines of evidence suggest that rosella infusion significantly decreases LDL Cholesterol serum level in cigarettes exposed Sprague dawley rats in a dose-dependent manner.Keywords: Cigarettes smoke, LDL cholesterol, Rosella calyx infusion

Background: One of the dental and oral health problem that really need attention is caries. Lactobacillus acidophilus is one of the bacteria that play a role in the process of further caries in dentin. We can control it by using materials like antibacterial. Cinnamon barks (Cinnamomum burmannii) is a plant from Indonesia that contains antibacterial compounds such as sinamaldehid, flavonoid, tannins, alkaloids, and saponins Purpose: To know the effect of various concentrations of cinnamon barks extracts (Cinamomum burmannii) on the growth of Lactobacillus acidophilus in vitro Method: True experimental study with the post test control group design has 25 samples. Cinnamon barks was extracted by the soxhletation method then phytochemical tests were performed to determine the antibacterial compounds. Antibacterial tested using the diffusion method to determine the diameter of the inhibitory zone. Statistical tests using Kruskal-Wallis and Man-WhitneyResult:The mean inhibition zone diameters at concentrations of 6.25%, 12.5%, 25%, 50%, and positive controls were 4.80 mm, 10.99 mm, 16.83 mm, 19.14 mm, 29, 80 mm. Kruskal Wallis test showed significant differences in inhibition zone diameter in inhibiting the growth of Lactobacillus acidophilus p = 0,000321 (p <0.05). The Man Whitnney test showed a significant difference between the concentration of 6.25% with concentrations of 25% and 50% and concentrations of 12.5% with concentrations of 25% and 50%. There were no significant differences between the concentrations of 6.25% with 12.5% and 25 % with 50% Conclusion: There is an effect of cinnamon bark extracts from various concentrations on the growth of Lactobacillus acidophillus as assessed by the formation of inhibition zone diameters. The 25% concentration is the minimum concentration that can significantly inhibit bacteria

Background: Osteoarthritis is a long-term, chronic disease that is usually marked by cartilage degeneration in the joints, which in turn induces bone friction. One of the subtype of this disease is facet joint osteoarthritis or in short, FJOA. In Indonesia, FJOA has not been commonly documented. The most common method for FJOA inspection is X-Ray modality. The usage of other radiology imaging, such as CT-Scan or MRI, are also used to evaluate erosion, osteophyte creation, subchondral sclerosis, and joint constriction. Nevertheless, the most ideal FJOA inspection method is still an ongoing debate due to strengths and weaknesses of each methods. CT scans are more widely used than MRIs and are typically less expensive. MRIs, however, are thought to be superior in regards to the detail of the image. Objective: To understand the effect of age, sex, and spinal level towards FJOA on MRI scanning. Method: This research used cross-sectional approach. Sample taken in this research were all radiology results from patients that fulfills inclusion criteria and had gone through MRI inspection in Jatinegara Premier Hospital. Age, sex, disk degeneration degree, and spinal level are the main focus for this study since those are the most common risk factor for FJOA. Results: 46.8% of FJOA were found in male patients while the other 53.2% were found in females. L4-5 and Grade 1 FJOA had the highest incidence found, with the amount of 29% and 48.4% respectively. There was no correlation between sex and FJOA degree based on Asymp. Sig of 0.255. There was also no correlation between age and FJOA degree based on Asymp. Sig of 0.702. However, there was a correlation between spinal level and disk degeneration degree with FJOA degree due to Asymp. Sig <0.05. Conclusion: There was no significant relationship between age and sex to lumbar facet joint osteoarthritis and there was a significant relationship between spinal level and disk degeneration degree with lumbar facet joint osteoarthritis.

Background: Diabetes Mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels above the normal range. Type-2 diabetes mellitus can cause lipid metabolism disorder. This study analyzed the relationship between fasting blood glucose and LDL cholesterol levels in type-2 diabetes mellitus patients. Aim: To prove the correlation between fasting blood glucose levels with LDL cholesterol levels in patients with type-2 diabetes mellitus. Methods: This research is an observational analytical study with cross-sectional design on 40 subjects. The secondary data for this research was obtained from diabetic patients at Diponegoro National Hospital. The correlation analysis was done using Spearman Rank test. Results: Spearman Rank analysis showed no significant association between fasting blood glucose levels with LDL cholesterol levels in patients with type-2 diabetes mellitus (p = 0,119 and r = 0,250). Conclusion: There was no significant correlation between fasting blood glucose levels with LDL cholesterol levels in patients with Type-2 Diabetes Mellitus.