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, Dragica Pavlović, Robert Smolić, Dijana Hnatešen, , Ksenija Marjanović
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 28-33; https://doi.org/10.3889/oamjms.2021.6013

Abstract:
BACKGROUND: Despite positive effects of research utilization on improving the quality of care, nurses meet numerous obstacles when trying to bridge the gap between the theory and utilization of research findings in nursing practice. AIM: The study was conducted to identify barriers to research utilization in daily nursing practice among registered nurses in University Hospital Center Osijek, Croatia. PARTICIPANTS AND METHODS: A cross-sectional study was conducted in University Hospital Center Osijek, Croatia in 2014. The study included 415 registered nurses, randomly selected. The BARRIERS Scale and a demographic data questionnaire were used to collect data. RESULTS: The study identified organizational barriers as major obstacles to implementing research findings. The items rated highest were “there is insufficient time on the job to implement new ideas” (78.2%), “nurse does not feel she/he has enough authority to change patient care procedures” (77.5%), “relevant literature is not compiled in one place” (72.1%), “physicians will not cooperate with implementation” (70.5%), and “nurse does not have time to read research” (70.4%). The item “relevant literature is not compiled in one place” belongs to communication subscale, while the other items belong to organizational barriers subscale. CONCLUSION: Registered nurses employed in University Hospital Center Osijek, Croatia perceived organizational barriers as major obstacles to research utilization.
Sumarti Endah Purnamaningsih Maria Margaretha, Sri Mulatsih, , Hari Kusnanto
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 1-7; https://doi.org/10.3889/oamjms.2021.6202

Abstract:
Background: Many children with cancer are faced with fatal diagnosis and unbearable pain, and palliative care is highly needed. In Indonesia, the provision of palliative care is only accessible in a few major cities where most cancer treatment facilities are located and development has been slow. While, the implementation of family center care identified a number of challenges related to family empowerment to be included in the development and implementation of interventions. Objectives: This study aimed to assess the perspectives of nurses regarding family-centered treatment in Indonesia’s palliative wards for children with cancer. Methods: A qualitative approach to content analysis was employed. The study participants were 10 primary nurses in pediatric units who worked with cancer patients regularly. These participants were purposefully chosen. The interview session included 10 study participants. Participants’ work experience ranged from 2 to 11 years, and their age ranged from 27 to 51 years. Data were collected via face-to-face, semi-structured interviews that lasted for an average of 30 to 45 minutes. The interviews were performed to explore the participants’ understanding about the definition of family-centered palliative care, including the needs and obstacles to implementation. These were analyzed using content analysis methodology that includes five main segments: introduction, coding, theme creation, thematic classification, and reporting. Results: The themes from the study included an appreciation of palliative and family-centered care, palliative care capability and family-centered care, and multidisciplinary cooperation under three principles concerning needs and barriers. Conclusion: Integrating family-centered care approaches in providing palliative care for children with cancer as well as the resources required for such programs to be implemented by hospital management in working toward improved quality care for patients. Communication and continuity of care remain a challenge; training and equipping clinicians with skills and confidence to carry out family-centered care approaches and palliative care for children with cancer can aid in this process.
, , Hendri Purwadi, Dewa Gede Sanjaya Putra, Herlinda Wulandari, Edy Soesanto
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 19-27; https://doi.org/10.3889/oamjms.2021.6443

Abstract:
BACKGROUND: Coronavirus is a health problem that is happened worldwide and impacted on many sectors. However, there is no research that provides information on health professional survivors from coronavirus disease 2019 (COVID-19) experience in self-management. AIM: The purpose of this study is to explore self-management experience among health professional survivors from COVID-19 in West Nusa Tenggara, Indonesia. METHODS: Purposive sampling, one-on-one, in-depth with semi-structural interviews was conducted to collect the data in this study. Data saturation was achieved after interviewing twelve health professional survivors from COVID-19 in West Nusa Tenggara, Indonesia. Narratives were analyzed by Colaizzi’s (1978) seven-step method. RESULTS: Four emergent themes were identified in this study including self-awareness (preventing transmission, improving immunity system, dietary adjustment and accessing appropriate treatment), social relationship (negative feeling and social support), stress management (sharing experience each other’s, reducing negative emotional, and self-introspection), focus on learning (looking for information from survival COVID-19, looking for information from YouTube and looking for information from google search). CONCLUSION: The experience among health professionals in self-management while struggling to recover quickly from COVID-19 can be used as valuable information for Indonesian society.
Anjarwati Anjarwati, Endang Koni Suryaningsih
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 47-51; https://doi.org/10.3889/oamjms.2021.6586

Abstract:
BACKGROUND: Many studies support the hypothesis that pregnancy-related anxiety (PRA) is strongly linked to postpartum depression, preterm births, low birth weight, fetal growth restriction, pregnancy complications, and negative infant outcomes. PRA has also been associated with mother-fetal bond during pregnancy that a special relationship between the mother and infant and growth beyond before the infant is born. Although extensive studies on PRA and maternal-fetal attachment (MFA) have been carried out, little attention on these issues is done in the Indonesian context. AIM: To fill such a gap, the present study aimed to investigate the relationship between maternal PRA and MFA. METHODS: Expectant mothers who visit their antenatal care in the primary health community services at Yogyakarta participated in this study. They were recruited using a purposive sampling technique based on the criteria: (a) The 1st time pregnancy, (b) in the late stage of pregnancy, (c) have no complication, (d) mother at any age range, and (e) mother at any education level. G-power 3.1.9.2 with effect size 0.15 has used to determine the number of samples, 84 people. Statistical analysis Pearson correlation has been applied and calculates the t relationship between two variables. General linier model analysis conducted the contribution of demographic variables to PRA and MFA. RESULTS: There is a significant relationship between maternal anxiety during pregnancy and MFA (p < 0.001) and a significant correlation between PRA and maternal age. However, there were no correlation between MFA and demographic variables. IMPLICATION FOR PRACTICE: Findings study provides the crucial information as the new approach to enhance the quality of care of mother’s and infant’s health during pregnancy as well as to promote maternal mental health.
Ni Komang Ari Sawitri, Indah Mei Rahajeng, Luh Putu Eva Yanti, Ida Ayu Agung Novi Jayanti
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 34-40; https://doi.org/10.3889/oamjms.2021.6486

Abstract:
BACKGROUND: Health protocol compliance among family members can help curb the spread of COVID-19. However, not all families or family members can easily navigate the changes brought about by the pandemic; hence, minimizing virus transmission remains a challenge. AIM: Therefore, observing how families implement health protocols in daily life will reveal the challenges and opportunities, and inform public health policies. METHODS: We conducted a qualitative study by collecting data through phone interviews from November 2020 to February 2021. Eighteen families with a total of 30 individuals participated in this study. The interview data were transcribed verbatim and analyzed using thematic analysis. RESULTS: The analysis shows that participants were actively involved in implementing protective measures to prevent transmission among their family members. Five themes emerged from the data, namely fundamental concerns, restraints and constraints, pandemic roles, compromises, and intergenerational attitudes. The themes described the families’ lives during the pandemic, their efforts in protecting family members, and the dynamic within the families related to the implementation of COVID-19 protective measures. CONCLUSION: This study indicates that families could play a key role in both protecting and compromising the health of their family members. Families respond to the health crisis actively, but at times increase the risk to virus exposure because they have to continue going about their daily lives.
Febriana Sartika Sari, Winda Fitriani, Innez Karunia Mustikasari, Imam Rosyada, Heni Nur Kusumawati, S. Dwi Sulisetyawati, Ika Subekti Wulandari, Rufaida Nur Fitriana, Mellia Silvy Irdianty
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 52-56; https://doi.org/10.3889/oamjms.2021.6755

Abstract:
BACKGROUND: Anxiety occurs in cancer patients who are undergoing chemotherapy for the 1st time. Excessive anxiety which occurred in the pre-chemotherapy phase can contribute to the failure of chemotherapy programs. One of attempts to reduce anxiety is providing musical therapy Langgam Jawa. AIM: The purpose of the research is to identify the effect of musical therapy Langgam Jawa to pre-chemotherapy anxiety score. METHODS: The research used quasi-experimental design which involved pre-posttest with control group. The research was conducted at a hospital in Central Java. The population was cancer patients who undergoing chemotherapy for the 1st time and experienced pre-chemotherapy anxiety. Samples were selected with purposive sampling technique that met inclusion criteria. Subjects were 42 respondents consisting of 21 in each group obtained by simple random sampling technique. Health education and deep breathing exercise were provided to the control group, while the treatment group obtained health education, deep breathing exercise, and musical therapy Langgam Jawa. The measurement of pre-chemotherapy anxiety in the cancer patients was using State-Trait Anxiety Inventory. An independent t-test performed the analysis. RESULTS: The results showed that pre-chemotherapy anxiety score decreases significantly in those two groups (p-value: 0.001; α: 0.05). The treatment group showed a higher decrease of pre-chemotherapy anxiety than the control group. CONCLUSION: The finding highlights musical therapy Langgam Jawa is effective to reduce pre-chemotherapy anxiety of cancer patients. It is recommended to apply musical therapy Langgam Jawa for cancer patients who’re undergoing chemotherapy.
Hanik Endang Nihayati, , Rr Dian Tristiana, Yuli Anggraini, Iskandar Iskandar, Hidayat Arifin
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 14-18; https://doi.org/10.3889/oamjms.2021.6206

Abstract:
Background: The level of independence among schizophrenia patients is still a problem that must be resolved. The development of appropriate relevant instruments is needed. This study aims to develop a nursing rehabilitation therapy instrument to increase the independence of schizophrenia patients in the hospital setting. Methods: This study used a research and development study design. The study was conducted in a Psychiatric Hospital in Surabaya, Indonesia from August to December 2020. The total sample in this study consisted of 100 nurses determined by a simple random sampling technique. In addition, 50 medical records were observed. The inclusion criteria were nurses who cared for patients with schizophrenia with a minimum work experience of 1 year. Respondents were excluded from the study if they did not follow the study through to completion. The data collection process was done online by filling in a Google form. The data was analysed using descriptive statistics and a FGD followed with 10 nurses to discuss the new instrument. Results: The data found that a rehabilitation therapy instrument is not currently available (53%). The FGD results show that it is necessary to develop the nurse’s knowledge and to provide adequate facilities and rooms, as well as to develop instruments to use as measuring tools in order to evaluate the rehabilitation therapy given. Conclusion: Rehabilitation therapy instruments are important to develop for schizophrenia patients. It is hoped that the development of the instrument in this study will optimise the rehabilitation of schizophrenia patients.
Siti Nur Hasina, Iis Noventi, , Dodik Hartono
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 41-46; https://doi.org/10.3889/oamjms.2021.6487

Abstract:
BACKGROUND: The spread of coronavirus disease (COVID-19) has spread throughout the world and has created a level of fear, uncertainty that has an impact on several aspects of life including mental health. The rapid spread of the Corona Virus or COVID-19 throughout the world has damaged the order of life starting from the economy, social, politics, education, culture, religion and health. Various efforts have been made by the Indonesian government with social distancing or physical distancing, washing hands with soap and staying active at home. Conditions that change suddenly will make people unprepared to deal with it, especially in the psychological condition of the Indonesian people who experience a lot of anxiety. AIM: The purpose of this study was to analyze the effect of mindfulness meditation based on spiritual care on the level of community anxiety due to the COVID-19 pandemic. METHODS: This type of research uses experimental quantitative research using a randomized controlled trial research design. This research was conducted for 4 weeks in January-February 2021. The population of this study is the Surabaya community. The sampling technique used consecutive sampling technique and was divided into two groups, namely the intervention group as many as 61 respondents and the control group as many as 61 respondents. Data analysis used paired t test and independent t test with a significance value of p < 0.05. This research questionnaire uses the DASS 42 questionnaire has reliability 0.82 and the validity test gets the Cronbach alpha value is 0.85. RESULTS: The average level of anxiety before doing the spiritual care-based mindfulness meditation intervention in the intervention group was 17.28 (severe anxiety) and 17.18 in the control group (severe anxiety) with p = 1.000 which means there is no difference in the average level of anxiety whereas After being given the intervention, the average level of anxiety in the intervention group was 6.03 (normal anxiety) and 18.06 in the control group (severe anxiety) with p = 0.000, which means that there is a difference in the average level of anxiety in the intervention group and the control group after being given the intervention. CONCLUSION: Mindfulness meditation based on spiritual care can reduce people’s anxiety levels during the COVID-19 pandemic.
Mustafa Mahmud Amin, Elmeida Effendy
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 87-91; https://doi.org/10.3889/oamjms.2021.6322

Abstract:
BACKGROUND: The study was intended to find one of the cytokines, that is, tumor necrosis factor (TNF)-alpha correlation with PANSS scores of people with schizophrenia (PwS) and their differences compared to the healthy people of Malayan- Mongoloid Race. AIM: The aim of this study was providing a profile of TNF-alpha level in PwS of Malayan-Mongoloid race and its correlation with positive and negative symptoms in schizophrenia. METHODS: It was conducted using cross-sectional and following sampling methods, with inclusion and exclusion criteria set for the PwS and control groups. RESULTS: The result was no correlation between TNF-alpha levels with PANSS scores on PwS (p > 0.005), with very weak correlation and positive correlation direction, and there were differences in TNF-alpha levels.between PwS and control groups. CONCLUSION: It can be concluded that the higher levels of TNF-alpha would impact on the severity symptoms experienced by PwS.
Muhammad Rizki Ashari, Nur Asri Zuhria, Bambang Dwicahya
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 566-573; https://doi.org/10.3889/oamjms.2021.6181

Abstract:
BACKGROUND: Breastfeeding has an important role in maintaining the health and survival of babies because when they are exclusively breastfed, they will have a good immune system compared to babies who are not exclusively breastfed. Exclusive breastfeeding in Indonesia is regulated in Government Regulation Number 33 of 2012 concerning Exclusive Breastfeeding which explains that breast milk is given to babies from birth for 6 months, without being added or replaced with other foods/drinks. This is emphasized in Article 6 of Government Regulation Number 33 of 2012 concerning Exclusive Breastfeeding, that every mother who gives birth is obliged to provide Exclusive Breastfeeding for her baby unless there is a medical indication that makes it impossible for a mother to breastfeed, or the mother is separate from the baby. Data from the Palu City Health Office shows that the lowest amount of exclusive breastfeeding is in the Bulili Community Health Center with a proportion of 37.17%. AIM: The aim of this study is to find out the Determinants of Exclusive Breastfeeding in the work area of Bulili Public Health Center. MATERIALS AND METHODS: This research used a quantitative method with cross-sectional study approach, and simple random sampling method. The population in this study was all mothers who had babies aged 0–6 months with a total sample of 103 respondents. Data collection was carried out using a questionnaire using a Likert scale for the variables of exclusive breastfeeding and the Guttman scale for the variables of maternal employment status, family support, health workers support, and policy. RESULTS: Data were analyzed using univariate and bivariate analysis. Chi-square test results summarizes the following: maternal work (p = 0.434), formula milk promotion (p = 0.029), family support (p = 0.019), health workers support (p = 0.572), and policy (p = 0.001). Mothers who have babies aged 0–6 months are obliged to fulfill the children’s rights, which is to provide exclusive breastfeeding for 6 months without providing any other foods/drinks such as water, bananas, honey, or formula milk. CONCLUSION: Mother’s occupation and formula milk promotion are not related to exclusive breastfeeding, while variables such as supports from families, health workers, and policy are related to exclusive breastfeeding.
Sri Mulyani, Azam David Saifullah
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 592-597; https://doi.org/10.3889/oamjms.2021.6392

Abstract:
BACKGROUND: The number of patients with dementia has increased globally. Caring for these patients is very challenging and demanding. There are many patients with dementia in long-term care facilities in Yogyakarta, Indonesia. However, most staff members do not have proper training regarding how to care for patients with dementia. AIM: This research aimed to investigate the effect of dementia care skills training on knowledge and attitudes about dementia among long-term care staff in Yogyakarta, Indonesia. METHODS: A pre-experimental study was conducted using a one-group pre-test and post-test method. There were 30 staff members in a long-term care facility in Yogyakarta, Indonesia, who participated in this study in July 2019. Training given was the Dementia Care Skills 18 h version for care workers provided by Alzheimer’s Indonesia by two certified trainers. Outcomes measured were knowledge and attitudes of the participants, which were measured using the Dementia Knowledge Assessment Scale and Dementia Attitude Scale. Data were analyzed using paired and independent t-tests as well as Pearson correlation tests. RESULTS: The results showed that staff knowledge of dementia (t = 4.78, p = 0.000) and attitudes toward persons with dementia (t = 3.27, p = 0.003) were improved significantly after the dementia training provided by the Alzheimer’s Indonesia trainers. CONCLUSIONS: Training in dementia care can improve knowledge and attitude of long-term care staff. This study recommends that dementia care skills training be provided for staff and nurses in long-term care to improve their knowledge and attitudes regarding patients with dementia and their care.
Dwi Safitri, Anna Kurnia, Much Al Jihad
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 309-314; https://doi.org/10.3889/oamjms.2021.5804

Abstract:
BACKGROUND: Intensive care unit (ICU) treatment can lead to fear, anxiety, depression, panic, and tension in the family. Place of the family as active presence, guardian, facilitator, historian, and coaching of the family cannot be separated from the recovery process. During the assistance of ICU patients, the family is faced with a strange environment, strict rules, emotional stress, and everyday life changes that have caused them to encounter psychological and physiological concerns. AIM: This study aims to describe and interpret of the family’s experience during assistance patient in the ICU. METHODS: A phenomenological methodology is used to explore experience of family. In-depth interviews were conducted on nine participants who were selected using purposive sampling. Data were analyzed by Colaizzi techniques, began with read transcripts, look for phenomenon, formulated data, organized, and verified to the participants. RESULTS: The result is presented in three themes; physically and psychologically tired; good language is a medicine, strengthens each other’s companion. CONCLUSION: The support of the patient in the ICU helps the family face a number of stressful circumstances. Adaptive coping and psychosocial help from health care workers and friends build a supportive family to cope with the difficulties when supporting patients in the ICU.
Eman Elsayed Sedik Ebrahim, Mayssa Ibraheem Ali, Mohamed Adel Foda, Eman Ibrahim Bosila
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 614-619; https://doi.org/10.3889/oamjms.2021.6479

Abstract:
BACKGROUND: Although it is well established that family medicine/primary care is the backbone of a successful healthcare system, family medicine clinics (FMC) services are still underutilized. Social marketing can be used as an effective approach to increase people’s awareness and change their attitude and behaviors related to primary care then promote service utilization. AIM: The objective of this study is to detect the causes of underutilization of FMC services and to study the role of a social marketing campaign on increasing the utilization of these services. METHODS: This is an experimental study where 1120 participants attending the primary health care center were interviewed pre- and post-campaign to assess the rates of FMC services utilization and the causes of underutilization. A 3 months social marketing campaign was held through internal and external marketing seminars then evaluating the campaign effect through service output indicators and comparing questionnaires’ results pre- and post-campaign. RESULTS: Underutilization of FMC services was caused mainly by the lake of knowledge about the presence of service (94.9%) and this decreased postcampaign to be (75.9%). The new patients attending the FMC increased from 61 to 2093, the frequency of weekly visits of the regular attenders increased by 32% and the number of new files opened post-campaign increased by 56%. CONCLUSION AND RECOMMENDATION: Social marketing is a successful technique to increase the utilization of the services provided by FMC. According to the results, it is recommended to promote social marketing activities to increase awareness of the FMC services and improve its utilization.
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 505-509; https://doi.org/10.3889/oamjms.2021.6440

Abstract:
BACKGROUND: Loss of vision and irreversible blindness are the main consequences of glaucoma. There are two main types of glaucoma: Chronic and acute. AIM: This work aimed to evaluate the intraocular effect of levamlodipine on the acute model of glaucoma in rabbits. METHODS: Eighteen white albino rabbits of both sexes weighing about 2 kg. We divided them into three groups (six animals in each group) used in the experiment. We use the right eye to evaluate the effect of the test drug and used the left eye as a control (vehicle only). We used the first group to evaluate levamlodipine (0.25%), the second group to estimate levamlodipine (0.5%), and the third group to assess pilocarpine 2% (positive control). Drugs were administered 30 min before induction. RESULTS: Glucose (5%) fluid produces a significant intraocular pressure (IOP) elevation after 30 min of administration in the left eye (p ˂ 0.001). Pre-treatment topical administration of levamlodipine (0.25%) prevents the rise in the IOP significantly (p ˂ 0.001) in the right eye when compared to the control group (left eye). Moreover, compared with the eyes of the control group at all stages of the experiment, the topical administration of levamlodipine (0.5%) has a significant preventable effect (p ˂ 0.001), compared with the control group. The IOP of the local pilocarpine (2%) in the third group was significantly decreased (p ˂ 0.001). Finally, compared with levamlodipine (0.5%), pilocarpine has a more significant effect in preventing a rapid increase in intraocular pressure (p ˂ 0.001). CONCLUSION: Levamlodipine is a promising therapeutic agent for patients vulnerable to acute glaucoma.
Evi Naria, Heru Santoso, Kintoko Rochadi, Nurmaini Nurmaini
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 547-551; https://doi.org/10.3889/oamjms.2021.5720

Abstract:
BACKGROUND: Community empowerment-based sanitation development by prioritizing participation has been implemented; however, it still shows insignificant progression. Even though the family is the manager of basic sanitation starting from the household, personal empowerment, and family participation miss from the focus of attention. AIM: This study thus aimed to develop a participatory model of family empowerment in the management of basic sanitation at the household level. METHODS: This type of qualitative research employed a participatory action research approach. It involved stakeholders who managed sanitation as the informants and 30 families who fulfilled the criteria namely having children over 10 years old and having no assistants as the participants. The data collection was conducted through in-depth interviews, observation, focus group discussion, and documentation. The basic sanitation includes water supply, latrines, garbage, and household waste was also examined to support the data obtained. The data were then analyzed by applying Miles and Huberman flows. RESULTS: It was found that household sanitation management was potentially implemented by managing family resources, sources of information and knowledge, motivation in family empowerment, and household sanitation support facilities. Sanitation management actions were carried out by assistance and division of tasks to family members accounting for 80%–100%. Conditions of basic sanitation in households thus were significantly better after the implementation of the sanitation management. CONCLUSION: The basic sanitation management model can be improved based on participatory family empowerment by employing assistance and the division of tasks to family members. This model also can be applied both at the local and national level and can become a guide for sustainable short or medium-term sanitation development.
Andi Rizky Arbaim Hasyar, Haerani Rasyid, Irfan Idris, Irawan Yusuf
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 527-531; https://doi.org/10.3889/oamjms.2021.6591

Abstract:
BACKGROUND: Peripheral blood circulation disorder is one of the global health problems. Balneotherapy that uses CO2 springs may be one of the complementary treatment options. The device to produce artificial CO2-rich water is needed to achieve an improvement effect, at least almost like the improvement effect of natural balneotherapy. AIM: This study aims to investigate the effect of artificial CO2-rich water immersion on peripheral blood flow using Bicarbonated JesC CREA BC-2000. METHODS AND MATERIALS: Thirty-nine healthy volunteers participated in this study. Each subject immersed both of their legs in a mixed solution from water and CO2 at temperature 38°C. This solution was mixed using a device, namely, “Bicarbonated JesC CREA BC-2000”. Peripheral blood flow was measured for 5 min before immersion (in this study, we denoted it as the mean basal blood flow), 10 min during immersion, and 5 min after immersion using pocket JMS laser Doppler flowmetry MBF-IIA. Repeated analysis of variance was used for statistical analysis. RESULTS: There is the difference in peripheral blood flow among before, during, and after immersing the legs into artificial CO2-rich water using Bicarbonated JesC CREA BC-2000 (p < 0.001). CONCLUSION: Bicarbonated JesC CREA BC-2000 may be used as the device to produce an artificial CO2-rich water bath that may affect peripheral blood flow in healthy volunteers.
Akerke Chayakova, Marjan Dauletyarova, Daulet Aldyngurov, Aiman Mussina, Roza Suleimenova, Aigul Utegenova, Murat Orazbayev, Gulnara Tuyakova
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 665-669; https://doi.org/10.3889/oamjms.2021.6629

Abstract:
BACKGROUND: The new coronavirus infection (coronavirus disease [COVID]-19) has become a serious obstacle on the health-care systems in Kazakhstan, as well as throughout the world. Certainly, the extent of emergency medical services (EMSs) use at some stage within the COVID-19 pandemic has been increased. However, the impact on the use of EMS in Kazakhstan during the COVID-19 pandemic has not been studied. AIM: The aim of this study was to analyze the dynamics of changes in the number of emergency medical calls during the COVID-19 pandemic, depending on the time of year, day of the week, and the causes for the calls. METHODS: This study retrospectively evaluated the Nur-Sultan (capital of Kazakhstan) EMS data for the period after the pandemic was first seen in Kazakhstan. The necessary permissions for the study were obtained from the Nur-Sultan City Public Health Department. EMS data for the same time interval (February 1–May 1) in the past 3 years (2018, 2019, and 2020) were compared. The data were taken from the database of the automated control system “Komek 103,” which is used in the ambulance station since the end of 2019, and the automated dispatch information systems “ADIS” used by the ambulance station in Nur-Sultan. RESULTS: During the COVID-19 pandemic, EMS call rates had been maximum common on Mondays and Thursdays by 13, 75%. The evaluation suggests that the quantity of male sufferers extended by 14, 05% in the course of the pandemic length, as compared to the pre-pandemic length. The quantity of patients with inside the 65+ age group in the course of the pandemic length has extended by 31.5%. During the pandemic, the signs and symptoms of fever enlarged significantly by 83%. Moreover, suicides elevated by 61% during the pandemic period. During the COVID‐19 pandemic, using EMS particularly for time touchy illnesses, which include hypertension (−31%), surgical emergencies (acute abdomen) (−40%), cerebrovascular illnesses (−11%), and other heart illnesses (−29%) decreased. CONCLUSIONS: During the pandemic period, there was an increase in the calls from male patients, compared to the pre-pandemic period. Moreover, during the COVID-19 pandemic, EMS call rates had been increased on Mondays and Thursdays. We found an alteration with inside the sample of obtained calls. Furthermore, the quantity of patients with inside the 65+ age group in the course of the pandemic length has extended.
Kamonwon Ienghong, Takaaki Suzuki, Somsak Tiamkao, Vajarabhongsa Bhudhisawasdi, Dhanu Gaysonsiri,
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 443-446; https://doi.org/10.3889/oamjms.2021.6197

Abstract:
BACKGROUND: Coronavirus disease 2019 has caused a major worldwide disruption to nearly all aspects of the medical education process, which includes the teaching of point-of-care ultrasound (POCUS). However, the impacts of the pandemic on POCUS training during this time have not been well studied. AIM: This was a retrospective observational study of the 1st year of emergency medicine (EM) residents at the Department of EM who had received POCUS training at a tertiary university hospital in Thailand. METHODS: The study was conducted throughout the 2019–2020 Academic year. The primary aim of this study was to evaluate the new POCUS training methodology, which, due to health and safety protocols, was carried out through virtual learning. RESULTS: A total of 18 1st-year EM residents were evaluated. The average pre-training scores in the 2019–2020 academic years were 5.25 and 5, respectively. The average post-training scores in the 2019 and 2020 academic years were 8.5 and 8.67, respectively. In terms of the ultrasound (US) skills test, the total average scores in the 2019–2020 academic year were 17 out of 20 (85%) and 14.875 out of 20 (74.38%), respectively (p < 0.001). CONCLUSIONS: Virtual learning is effective for teaching theoretical US knowledge. However, it was not suitable for teaching practical skills, including US skills.
Bambang Wispriyono, Lia Arsyina, Iqbal Ardiansyah, Laura D. Pratiwi, Ririn Arminsih, Budi Hartono, Nurmalasari Nurmalasari, Randy Novirsa
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 641-644; https://doi.org/10.3889/oamjms.2021.6152

Abstract:
BACKGROUND: Drinking water is a vital aspect in human life. The quality of drinking water should be monitored to ensure public from any health effects caused by contaminated water. Escherichia coli (E. coli) is one of the indicators of fecal contamination should not be present in drinking water (0 cfu/100 ml). However, poor hygiene and sanitation contributes to E. coli contamination in drinking water, particularly in developing countries. AIM: We investigated the household hygiene and sanitation factors and the relationship with E. coli detection in the household drinking water. METHODS: A cross-sectional study design was conducted to collect the data from three districts in the Depok city, that is, Sawangan, Bojongsari, and Cipayung. A total of 300 houses and the corresponding drinking water samples were collected during August–September 2019. E. coli was determined as microbiological indicator using total plate count method. RESULTS: The results showed that E. coli was detected in 174 (58%) of household water samples. The water container condition (OR = 2,60; CI 95%: 1.18–5.71) and the hand washing practice with soap (OR = 1,65; CI 95%: 1.04–2.62) were significantly correlated with the presence of E. coli in the water samples. CONCLUSIONS: The condition of the water container was the most dominant factors which contributed to E. coli content in the household drinking water.
Masrul Lubis
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 219-223; https://doi.org/10.3889/oamjms.2021.6482

Abstract:
Inflammatory bowel disease (IBD) is a chronic inflammation consisted of ulcerative colitis and Crohn’s disease. IBD is a global disease with heavy economic burden. Coronavirus disease-2019 (COVID-19) is a novel disease which spread rapidly and becomes a pandemic. This pandemic situation affects the management of IBD. Severe acute respiratory syndrome coronavirus-2 as the etiology of COVID-19 requires angiotensin-converting enzyme (ACE2) as its receptor. ACE2 is found to be abundant in the gastrointestinal tract, particularly the small intestine and colon. This causes the presence of gastrointestinal symptoms in COVID-19 and interacts with gastrointestinal diseases including IBD. The diagnosis of IBD in patients with COVID-19 is similar with general population with precautions regarding endoscopic procedure. IBD does not increase the risk for contracting COVID-19 nor worsen the outcome of COVID-19. The first step in managing patients with IBD during pandemic is by implicating strict health protocol. There is still a controversy regarding surgery for IBD during pandemic. Medications for IBD are safe during pandemic except systemic corticosteroids. IBD patients without COVID-19 should continue their medications until the goal of disease remission is achieved. If asymptomatic COVID-19 is present, corticosteroid dose should be lowered, tapered, and stopped if available. Anti-tumor necrosis factor (TNF) administration should be postponed for 2 weeks. If COVID-19 manifestations exist, systemic corticosteroid, thiopurine, methotrexate, and anti-TNF should be discontinued. Supporting treatment for COVID-19 can be administered safely. In case of relapsing, the treatment of IBD must be started with the limitation of systemic corticosteroid.
Suskhan Djusad, Alfa Putri Meutia, Arresta Suastika, Gita Nurul Hidayah, Ilham Utama Surya, Muhammad Priangga, Raden Fadhly, Achmad Kemal Harzif
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 103-108; https://doi.org/10.3889/oamjms.2021.6250

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BACKGROUND: As of January 2021, Indonesia had the 21st highest number of total COVID-19 cases and the 17th highest total deaths among all countries. COVID-19 infection in pregnant women seems to negatively affect both maternal and neonatal outcomes. CASE REPORT: We describe four cases of pregnant women confirmed with severe and critical COVID-19 that resulted in maternal death from November until December 2020. The first case was complicated with thrombocytopenia, her condition quickly deteriorated post-delivery. Pulmonary embolism was suspected as the cause of death. Second and third cases were complicated with preeclampsia, obesity, and advanced maternal age. Second case came in sepsis condition. Her SARS CoV-2 RTPCR swab test came out after her death. Third patient did not have COVID-19 symptoms at admission. She starts having symptoms on second day and was confirmed positive a day after. She falls in septic shock. Fourth patient has history of fever, cough, and dyspnea. She was confirmed positive on first day and her condition worsened, diagnosed with bacterial co-infection sepsis on day eight. All patients underwent cesarean section. CONCLUSION: Limited information and studies for COVID-19 management in pregnant women are challenging for obstetricians. Management should be individualized weighing the benefit and risks in presence of comorbidities or accompanying disease.
Muhammad Rusda, Ichwanul Adenin, M. Fidel Ganis Siregar, Andrina Y. M. Rambe, Yudha Sudewo
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 6-8; https://doi.org/10.3889/oamjms.2021.5904

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BACKGROUND: Candida albicans was the common causes of vulvovaginalis candidiasis (VVC) in human. To avoid complications, prompt and proper treatment of VVC must be performed. The pharmacological effects of Nigella sativa include antimicrobial, anti-inflammatory, immune stimulation, and anti-cancer properties. AIM: N. sativa has been shown to have an in vivo antifungal effect and the purpose of this study was to determine the antifungal and potential in vivo therapeutic effects. METHODS: This research was an empirical study which evaluated the therapeutic effect of the vaginal candidiasis model of N. sativa in rats. The subjects were 28 rats inoculated with C. albicans and were divided into four groups: Control group (G1), fluconazole group (G2), N. sativa group (G3), and N. sativa and fluconazole group combinations (G4). The colony of C. albicans was assessed to determine the treatment’s therapeutic effect. RESULTS: There was no difference in the number of colonies of C. albicans between all the pre-inoculation (p = 0.274) and post-inoculation (p = 0.323) classes. A substantial decrease in the number of C. albicans colonies within 48 h of treatment was observed between the three control group treatment forms (N. sativa group p = 0.046; fluconazole group p = 0.002; and N. sativa + fluconazole group p = 0.002). CONCLUSIONS: The therapeutic effect of N. sativa has been achieved by reducing the number of colonies of C. albicans.
Ketut Suarayasa, Elli Yane Bangkele, Sumarni Sumarni, Haerani Harun, Bohari Bohari
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 43-49; https://doi.org/10.3889/oamjms.2021.5623

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BACKGROUND: Early detection of risk factors for pregnancy is carried out through regular prenatal examinations from an early age to detect abnormalities/disorders/illnesses suffered by pregnant women early. Mobile applications are very helpful in the process of early detection and recording of health workers’ reports, especially during a pandemic. AIM: This study aims to assess the knowledge, attitudes, actions, and skills of pregnant women in the early detection of high-risk pregnancy before and after the intervention and the effectiveness of M.D-Risti modules and applications. METHODS: This study used a quasi-experiment design research design with a pre-post only group design consisting of an intervention group and a control group at 4 health centers in Palu City with a purposive sampling technique of 43 respondents per group with univariate and bivariate analysis. RESULTS: The results showed that there was a significant difference in the level of knowledge (p = 0.00), attitude (p = 0.00), action (p = 0.00), and the skills of pregnant women in early detection of pregnancy (p = 0.00) before and after treatment in the intervention group. There was a significant difference between the two groups with a significant value on knowledge (p = 0.00), attitude (p = 0.00), action (p = 0.00), and skills of pregnant women in doing early detection of pregnancy risk independently (p = 0.00). CONCLUSION: The intervention of M.D-Risti modules and applications had a significant effect on changes in knowledge, attitudes, actions, and skills of pregnant women in early detection of pregnancy risk compared to pregnant women who were not given intervention at all. The M.D-Risti application is one of the solutions during the COVID-19 pandemic and in the long term, all health centers in Palu city can use it to help monitor the risk of pregnancy more quickly
Yetty Machrina, Dharma Lindarto, , Novita Sari Harahap
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 124-128; https://doi.org/10.3889/oamjms.2021.6362

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BACKGROUND: Peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) has an important role in mitochondria biogenesis which generated cellular metabolism. Carbohydrate metabolism in the liver is crucial to maintain plasma blood glucose. AIM: This research aimed to determine the expression of PGC-1α gene in the liver type-2 diabetes mellitus (T2DM) rat model, after treatment with a focus on exercise. METHODS: We used 25 healthy male Wistar rats as subjects. Rats were modified to T2DM models by feeding a high-fat diet and low-dose streptozotocin injection. We divided the rats into five groups, that is, sedentary group as a control and four others as treatment groups. The exercise was assigned for treatment groups by a run on the treadmill as moderate intensity continuous (MIC), highintensity continuous (HIC), slow interval (SI), and fast interval (FI). The treatment groups were exercise throughout 8 weeks with a frequency of 3 times a week. RESULTS: The results showed that expression of PGC-1α gene was lower in all treatment groups compared to controls (p < 0.05). Expression in HIC was higher than MIC (p < 0.05), so was the expression in FI more than SI (p < 0.05). CONCLUSIONS: Exercise affected PGC-1α gene expression in the liver of the T2DM rat model. The expression of PGC-1α was linear with exercise intensity.
Delfi Delfi, Vanda Virgayanti, Julham Alandy
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 156-159; https://doi.org/10.3889/oamjms.2021.6287

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BACKGROUND: Cystoid macular edema (CME) is a serious complication of cataract surgery in a diabetic patient. CME was found 1–19% after phacoemulsification surgery. Nonsteroidal anti-inflammatory drugs inhibit cyclooxygenase-1, cyclooxygenase-2, and endoperoxides. Inhibition of these enzymes also reduces macular thickening. AIM: The aim of the study was to assess macular thickness alteration after application of 1.00 mg diclofenac sodium eye drops in diabetic patients who receive phacoemulsification surgery. METHODS: This study was a quasi-experimental study. A total of 40 eyes diabetic retinopathy patients having phacoemulsification surgery were randomized to 100 mg diclofenac sodium (n = 20) or placebo eye drops (n = 20), three drops daily on 1 day before surgery until 30 days post-operative. The main outcome measures macular thickness using Ocular Coherence Tomography before and after (14 and 30 days) phacoemulsification. RESULTS: Utilizing an independent t-test, this study had significantly inner macular (p = 0.0001) and central macular (p = 0.008) thickness differences in the diclofenac sodium group during surgery until 14 days postoperatively. However, significant changes in the outer macular thickness were absent. There were no notable alterations in the center, inner, and outer macular thickness in the diclofenac sodium group until 30 days postoperatively. In the placebo group, no significant changes were found in the macular thickness at every point of time. CONCLUSION: Two statistically significant central and inner macular thicknesses in the diclofenac sodium group until 14 days postoperatively were present. There were no significant changes in the center, inner, and outer macular thickness in the diclofenac sodium group until 30 days postoperatively.
Sattar J. Abood, , Mohanad Y. Al-Radeef
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 356-363; https://doi.org/10.3889/oamjms.2021.5997

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BACKGROUND: In most families around the world, medicines can be used to treat chronic or acute diseases. Simple access to medicines at home has led to high drug consumption rates for self-limiting diseases. Incorrect use of these home-stocked medications may also contribute to severe health risks, increase pathogens’ tolerance, prolonged distress, increased adversity, medication reactions, and delays in seeking adequate care if misdiagnosis occurs. Nothing is known about how Iraqi people store their medicines at home. AIM: The purpose of this study is to obtain data on the prevalence and related factors of drug storage in Diyala Governorate, Iraq. METHODS: A community-based cross-sectional descriptive study was conducted in Diyala Province, Iraq in July 2019. A total of 200 students participated in this study. A pre-tested standardized questionnaire was used to collect data and the analysis was performed using descriptive statistical methods. All the participants (100%) enrolled reported to keep medicines at their homes. RESULTS: The average number of drug users per household is 12.32%. Refrigerators are the main storage location (65%), followed by kitchen counters (33%). The majority of stored drugs were prescribed by physicians (78.5%) and the leading source of those drugs is a private pharmacy (55.71%). The most popular medicinal products stored were analgesics (23.1%), followed by antimicrobials (antibiotics, antibacterial, and antifungal) (19.44%). Among all medicines, currently used drugs accounted for 43.34%, remaining drugs accounted for 29.78%, and reserved drugs accounted for 26.87% for future use. The most common dosage forms of these drugs are tablets (21.16%) and capsules (20.95%). Most participants (82.5%) revealed that they always check the expiration date before use, and (37%) admitted to sharing drugs with others. CONCLUSION: The prevalence of drug storage in households in the Diyala Governorate of Iraq is high because all participants keep drugs at home. Regardless of the method used, these drugs should be retained, and proper storage procedures and conditions are rarely observed.
Elmeida Efffendy, Mustafa Mahmud Amin, Nurul Utami
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 160-163; https://doi.org/10.3889/oamjms.2021.6289

Abstract:
Background: Neuroinflammation and excitotoxicity play a key role as triggers and support for neurodegenerative processes, increase levels of TNF-α have been found in schizophrenic patients. Improved inflammatory processes have been demonstrated in acute and chronic schizophrenia. In schizophrenia is characterized by a collection of core symptoms that trigger individuals experiencing several cognitive disorders. Objective: To investigate the relationship of serum TNF-α levels to impaired cognitive function in schizophrenic patients in Medan, Indonesia. Method: This research is cross sectional analytical correlative study involving 40 male schizophrenic patients at Prof. Dr. M. Ildrem Mental Hospital through July to September 2019 that fulfilled our inclusion and exclusion criteria. Serum TNF-α levels were analyzed using Quantikine HS Human TNF-α Assay with a minimum detection limit of 0.1062 pg/ml while in the other hand, cognitive function test was carried out by using the Mini Mental State Examination. Results: Serum TNF-α levels with a mean of 25.1216 with a standard deviation of 1.7629. There is a positive correlation with moderate correlation (r = 0.4 - <0.6) on cognitive function with the strength of correlation r = 0.434 Conclusion: We found that there is a link between serum TNF-α level and cognitive function as assessed with the Mini-Mental State Examination (MMSE).
Ahmed Fawzy, Samira Mahmoud Abd Allah, Mostafa Mohammed Salem, Lobna Omar Al Farouk
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 106-113; https://doi.org/10.3889/oamjms.2021.5671

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BACKGROUND: Adenocarcinoma of the lung is the most common tumor type of primary lung cancer and is characterized by heterogeneity on the molecular, clinical, and pathological levels. The presence of an anaplastic lymphoma kinase (ALK) fusion oncogene defines a molecular subset of non-small cell lung cancer with distinct clinical and pathologic features. Furthermore, the tyrosine-kinase receptor (C-kit) is considered to be expressed in various solid tumors, including carcinomas of the lung. AIM: This study aims to correlate immunohistochemical (IHC) expression of ALK and C-kit with pathological features of lung carcinoma and to correlate IHC expression of ALK with IHC expression of C-kit in lung carcinoma. MATERIALS AND METHODS: The material of this study consists of paraffin blocks of 60 cases of patients with bronchogenic carcinoma, IHC staining with ALK and C-kit then analysis of immunoreactivity scoring was done. RESULTS: As regards ALK expression, 3 (5%) cases showed positive expression of ALK and 57 (95%) cases showed negative expression of ALK with no statistically significant correlation between the ALK expression and the histopathological type. While C-kit expression, 4 (6.7%) cases showed positive expression and 56 (93.3%) cases showed negative expression of C-kit with statistically significant correlation between the C-kit expression and the histopathological type. CONCLUSION: There is an association between expression of c-kit and tumor histological type in lung carcinoma. Expression was notably significant among adenocarcinomas and small cell carcinomas.
Sesca D. Solang, Brigitte Inez Maitimo, Jeanny J. Winokan, Dian Pratiwi, Bohari Bohari
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 127-131; https://doi.org/10.3889/oamjms.2021.5691

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AIM: This study aims to determine the determinants associated with the productivity of women of childbearing age in North Sulawesi Province. METHODS: The research design used is an analytic study with a cross-sectional approach. This research uses the raw data of the North Sulawesi Province Program Performance and Accountability Survey (SKAP) of 2019. The sample of this study was all women of childbearing age (15–49 years), married and unmarried in North Sulawesi Province based on the SKAP raw data of 2019, totaling 1454 women of childbearing age. The variables in this study consisted of independent and dependent variables. The independent variables in this study were age, education, marital status, the ideal number of children, decision using contraception, age at first sexual intercourse, and contraceptive use in women of childbearing age. RESULTS: Fertility with >2 children is 349 people (24.01%). There is a significant relationship between age, education, marital status, ideal number of children, the decision to use contraception, age at first sexual intercourse, and use of contraception on fertility with p < 0.05. The multivariate test showed that ideal children (odds ratio [OR] 5.555), age (OR 5.619), age at first sexual intercourse (OR 9,486), and use of contraception (OR 0.450). CONCLUSION: The age of sexual intercourse had the most significant influence on the fertility of women of childbearing age with an OR of 9.486. This indicates that the age at sexual intercourse in women of childbearing age will affect fertility 10 times compared to other variables, namely, the ideal number of children, age, and use of family planning.
Silviya Kyuchukova, Albena Andonova, Mima Nikolova, Mariana Penkova-Raditcheva
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 76-79; https://doi.org/10.3889/oamjms.2021.5645

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BACKGROUND: In the context of health education, the lifestyle of each individual includes social and behavioral factors that are potentially manageable and preventable in general. A health-educated person adheres to healthy lifestyle, which is characterized by the presence of: active attitude to his own health, positive health motivation, skills for health protection and strengthening, and useful health habits. Stimulating one of them is the systematic monitoring and registration of the main vital indicators, as a good prerequisite for active monitoring of the health condition. As of December 31, 2019 the population of Bulgaria is 6,951,482 people, and the people, aged 65 and over are 1,504,088, or 21.6% of the country’s population. AIM: The objective of this study was to establish the degree of personal commitment and responsibility for their health of people over 65-year-old, living in Bulgaria. Tasks: (a) To make a questionnaire, (b) Processing of the received information and analysis of results, (c) Formulation of conclusions regarding awareness, health motivation and lifestyle of the respondents, (d) Reporting the degree of responsibility for their health of the respondents. METHODS: Mathematical-statistical – dispersion, comparative analysis, Spearman’s rank correlation coefficient/p/;desk research; interview. Contingent: 113 people; average age – approx. 68.168 ± 8.80 years. Time: 2019. RESULTS: (1) A statistically significant relationship was found: p = 0.001 and x2 = 21.886. The respondents with two chronic diseases – 40.5% are well aware of the normal values of the measured indicators. (2) Two thirds of the respondents/74.3%/are well informed about the normal and pathological values of the main vital indicators, which they can measure and register themselves. (3) 76% of the respondents have received the necessary health information from the medical team/partnership model. (4) Only half of the older respondents in the study/51.4%/follow a diet complied with their health status. CONCLUSION: In our professional medical care for the elderly people in Bulgaria, we must place emphasis on their preventive and prophylactic commitment to their own health. The useful and practical combination of properly received and internalized medical information from the elderly people is an important prerequisite for their informed commitment to their own health.
Yasmine S. Galal, Walaa A. Abuelhamd, Tamer A. Abdel Hamid, Nema R. Elsayed
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 80-88; https://doi.org/10.3889/oamjms.2021.5703

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BACKGROUND: Insufficient knowledge and negative attitude toward coronavirus disease 2019 (COVID-19) among health care workers (HCWs) could lead to faulty practices resulting in delayed diagnosis and spread of the disease. AIM: this study was conducted to assess the knowledge, attitude, practice, and perceived barriers to infection control toward COVID-19 among Egyptian HCWs. METHODS: A cross-sectional study was conducted in Cairo University Children Hospital, with 537 HCWs (doctors and nurses) enrolled. RESULTS: HCWs had an overall good knowledge level about COVID-19 where 61% had a knowledge score of ≥18 points (out of 23). Doctors were more knowledgeable than nurses. About 64% of HCWs were considered as having positive attitude (scored ≥10 out of 13 points), with a significantly higher positive attitude among nurses. The mean practice score of HCWs was 1.0 ± 2.0 with a significantly higher good practice among nurses. Younger age, being a doctor, and higher qualification were the significant positive predictors of acquiring knowledge about the disease. The most commonly perceived barriers for applying infection control measures in hospitals were overcrowdings in health-care facilities (78.2%) and insufficient infection control policies (62.6%). CONCLUSION: HCWs in general expressed good knowledge, positive attitude, and good practice toward COVID-19 despite some gaps that were detected in specific items. Proper planning of educational programs that are directed according to the needs of different groups of HCWs is crucial. Effective policies should be established to overcome the barriers for applying infection control in health facilities.
Vasilka Rendzova, Julijana Nikolovska, Sonja Apostolska, Nikola Petričević
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 19-23; https://doi.org/10.3889/oamjms.2021.5582

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AIM: The aim of the study was to investigate the prevalence of work-related musculoskeletal problems in 3rd, 4th, and final year of study in Ss. Cyril and Methodius University Dental School. METHODS: All 3rd, 4th, and final year regular dental students were invited to take part in the study, which involved completing the extended Nordic Musculoskeletal Questionnaire. This questionnaire facilitates an assessment of troubles (ache, pain, or discomfort) with neck, shoulders, upper back, elbows, wrists/hands, low back, hips/thighs, knees, and ankles/feet. RESULTS: Out of a maximum possible number of 146 students, 116 agreed to participate and completed the questionnaire (33 males and 83 females). The response rate was 79.5%. The mean age of students was 22.6 years (SD = 1.52), ranging from 20 to 26 years. During the past 12 months, students have problems mostly with neck 48 (41.4%), upper back 43 (37.1%), and low back 43 (37.1%). Working hours/week was 12 h for 3rd year, 20 h for 4th, and 30 h for 5th-year students. There is a significant difference between the students from third study year with these from 4th and 6th study year regarding the neck (χ2 (2)= 6.46, p < 0.05), upper back (χ2 (2) = 7.38, p < 0.05), and low back (χ2 (2)= 13.79, p < 0.05). CONCLUSIONS: This study reported high prevalence of musculoskeletal symptoms among the dental students. Preventive measures and more ergonomic recommendations are indicated.
Rianto Noviady Ramli, Almas Prawoto, Nyoman Putu Riasa, Iswinarno Doso Saputro, Ahmad Fawzy Mas'Ud
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 101-108; https://doi.org/10.3889/oamjms.2021.5649

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BACKGROUND: We investigated the epidemiology and the knowledge of first aid regarding to burns in the rural area of Kulon Progo, located in Indonesia. Although 44% of Indonesia’s population resides in rural areas, data of burn in Indonesia are very limited to national referral centers located in Indonesia’s largest cities. We also surveyed the patients and families of these burn patients to try to understand their knowledge on the first aid of burns. AIM: We wanted to explore and discover what myths and misperceptions existed in rural communities. MATERIALS AND METHODS: A retrospective study analyzing the medical records of patients with burns admitted to two of Kulon Progo’s largest referral hospitals between January 2018 and December 2019. A survey was distributed to the patients and their families regarding their knowledge on the first aid of burns. We wanted to analyze if certain groups of the population were more at risk for specific types of burn etiologies, the correlation between burn etiology and length of stay, the correlation between total body surface area (TBSA) of burns and length of stay in the hospital, and the correlation between education level of survey participants’ and their knowledge of first aid of burns. RESULTS: A total of 115 patients were reviewed in this study. The highest proportion of total burn injuries occurred in the age group of 1–14 years old (38%). The major etiology of all burn cases were caused by scald (54%). Housewives and children were at a higher risk for scalds and laborers were at a higher risk for electrical and chemical burns (p = 0.001). There was no significant correlation between etiology and length of stay (p = 0.29). There was a statistically significant correlation between the TBSA and the length of hospital stay (p = 0.0001). The majority of survey respondents (66%) had poor knowledge on the first aid of burns. There was no significant correlation between education level and knowledge of first aid of burns (p = 0.07547). CONCLUSIONS: Children, laborers, and housewives have a significant risk of suffering from a burn injury. A majority of people still have poor knowledge on the first aid of burns. There was no correlation between education levels and knowledge of first aid burns.
Filip Koneski, David Tipton, Jegdish Babu, Danica Popovic-Monevska, Vladimir Popovski, Alberto Benedetti, Suzana Dvojakovska-Bozovic, Aleksandar Iliev, Goran Panchevski, Antonio Kirkov, et al.
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 1-7; https://doi.org/10.3889/oamjms.2021.5592

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BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is of considerable concern among clinicians and researchers, with no clear pathology mechanism, preventive, or treatment protocols. AIM: This study aimed to assess the effects of geranylgeraniol (GGOH) on the toxicity induced by clinical doses of zoledronic acid (ZOL) on gingival epithelial cells and gingival fibroblasts in vitro. METHODS: Human gingival fibroblasts and gingival epithelial cells were treated with 5, 25, or 50 μM ZOL ± 50 μM GGOH for 3 days. Viability of the cells was determined using the 3-[4, 5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide assay. Calculation of percentage of the control group, analysis of variance and Tukey post-hoc comparisons were performed to test the significance between groups, which was set at p = 0.05. Cell morphology was evaluated using light microscopy. RESULTS: ZOL significantly reduced the viability of both epithelial cells and fibroblasts at all concentrations (p < 0.05), with the exception of fibroblasts at concentration of 5 μM (p = 0.44). GGOH had positive effects on the viability of the cells treated with ZOL at all concentrations. However, statistically significant improvement was obtained only in epithelial cells at 5 and 25 μM ZOL. The cell morphology of both types of cells was improved after addition of GGOH. CONCLUSION: GGOH reverses the toxic effects of clinical doses of ZOL on gingival epithelial cells and has slightly positive, but not significant effects on gingival fibroblasts. This study suggests that GGOH may be effective in the prevention and treatment of MRONJ.
Ebaa Alagha, Amira Mohammad Samy
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 14-18; https://doi.org/10.3889/oamjms.2021.5662

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AIM: This study evaluated the impact of two remineralizing agents containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and tricalcium phosphate (TCP) on white spot lesions. MATERIALS AND METHODS: A total of 90 freshly extracted upper premolars were divided in three equal groups (30 each): Group A: Control group, Group B: Varnish containing CPP-ACP, and Group C: Varnish containing TCP. The teeth were subjected to Diagnodent test after inducing white spot lesions to assess any surface changes present on the teeth. The readings were repeated post-demineralization and post-remineralization. RESULTS: Statistically significant difference was present in the mean values between the tested groups. CPP-ACP group recorded higher mean value at demineralization when compared to TCP group. Statistically significant difference (p < 0.00`01) was present between the baseline and the demineralization values. CPP-ACP group presented higher remineralization results when compared to TCP group. T-test proved a significant difference between the tested groups. CONCLUSION: CPP-ACP containing varnish had higher remineralizing effect when compared to TCP containing varnish. CLINICAL SIGNIFICANCE: Recently, the focus of restorative dentistry has been directed toward a conservative approach. Prevention and non-restorative treatment of initial enamel caries is the main concern. Remineralization procedures are the most preferred way of regeneration of lost tooth structure.
Assem K. Okassova, Oralbek Z. Ilderbayev, Akmaral Zh. Nursafina, Gulmira M. Zharmakhanova, Bibigul B. Rakhimova, Bayan T. Yessilbaeva, Bayan N. Dyussenbekova
Open Access Macedonian Journal of Medical Sciences, Volume 9; https://doi.org/10.3889/oamjms.2021.5781

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BACKGROUND: For many years, the world community has been concerned with the problem of the consequences of radiation exposure on the human body. A wide range of possible variants of radiation effects on humans and biota determines the range of necessary pharmacological means of protecting the organism and populations. In the mechanisms of the formation of radioresistance, the leading role is assigned to the processes of lipid peroxidation (LPO) and the antioxidant (AO) system. The study of the effect of such factors as radiation and immobilization stress on the body separately and in combination is relevant since the modern conditions of human habitation are characterized by high urbanization, physical inactivity, and a complex radioecological situation in a number of regions. AIM: The aim of the study was to study the role of free radical oxidation in the tissues of the adrenal glands and immunocompetent organs and cells under the combined effect of a sublethal dose of gamma radiation and immobilization stress in the experiment. MATERIALS AND METHODS: The work was carried out on 40 male Wistar rats: I-control; II-subjected to immobilization stress after 1 h; III-exposed to gamma irradiation; and IV-tested combined effects (immobilization stress and gamma radiation). Before the exposure, there was topometric-dosimetric preparation of the experimental animals. To this end, the object was placed on an isocentric therapeutic desk of Terasix X-ray simulator (Czech Republic), which is similar to the therapeutic desk of the γ-irradiator by its construction and parameters. RESULTS: The results obtained make it possible to assess the role of free radical oxidation under the combined action of ionizing radiation at a sublethal dose and immobilization stress in the experiment. The combined effect was accompanied by the accumulation of diene conjugates and malondialdehyde products in homogenates and the development of double oxidative stress in the test objects. The dominant role of ionizing radiation was revealed under the combined effects of immobilization stress and radiation factor. CONCLUSIONS: In animals of the 4th group, the state of oxidative-metabolic processes was characterized by overproduction of LPO products and subsequently by depression of AO defense. The urgency of continuing research on the combined effects of radiation and stress factors on public health and taking measures to eliminate negative effects on the population seems to be undoubted.
Arlina Dewi, Sri Sundari, Nursetiawan Nursetiawan, Supriyatiningsih Supriyatiningsih, Dianita Sugiyo, Dyah Tri Kusuma Dewi, Winda Azmi Meisari
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 18-26; https://doi.org/10.3889/oamjms.2021.5752

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BACKGROUND: Maternal mortality is a sentinel event used globally to monitor maternal health and the overall quality of reproductive health care. Globally, maternal mortality is mostly due to direct causes; apparently, it is not limited by the setting or geographic region. However, Indonesia has failed to achieve the Millenium Development Goals (MDGs) target for maternal mortality. AIM: This study aims to explore health workers' and stakeholders' expectations in maternal health services to reduce maternal mortality in urban areas. METHODS: It is qualitative research through naturalistic, conducted in one of the regencies in Indonesia, the urban area with the highest Maternal Mortality Rate (MMR) in one province by 2019. Data were obtained in the form of information from Focus Group Discussions (FGDs). FGDs were carried out with stakeholders at the Health Service level (n=3), first-level health facilities or public health centres (n=3), and advanced health facilities or hospitals (n=7). Data analysis in this study employed software (Nvivo Release 1.0) to utilise transcripts in coding and categorising. RESULTS: The expectations that emerged from health workers' perspectives in the field were an integrated system of collaboration between health facilities, affordability of Hospital with Comprehensive Emergency Obstetric Care (CEmOC) in action for maternal-neonatal referral urgency, and the skilled health workers as a golden opportunity. CONCLUSION: Health workers’ expectations can improve the quality of maternal health services in urban areas, thereby reducing the MMR with a system of collaboration between health facilities, the affordability of maternal-neonatal emergency referral facilities, and the availability of Obstetricians who standby.
Kristina Everentia Ngasu, Restiana Restiana
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 66-69; https://doi.org/10.3889/oamjms.2021.5779

Abstract:
BACKGROUND: Pain is a sensation of individual discomfort. Patients often experience pain, especially pain after undergoing surgery. Pain free is one of patient’s needs. Nurses should control and monitor the level of pain through pain reassessment, but this is not adequate. AIM: This study aims to get a picture about nurse’s knowledge, attitude and supervision, and its relationship to the implementation of pain reassessment. METHODS: A descriptive type of cross-sectional study was conducted among 36 inpatient’s nurses at Balaraja Regional Hospital applying total sampling technique. Data were collected using a self-made questionnaire, which passed validity and reliability test. Data entry and analysis were carried out using the Statistical Package for the Social Sciences with Chi-square test. RESULTS: Twenty-five (61.1%) nurses were in category good knowledge, 24 (66.7%) in category good attitude, 26 (72.2%) in good supervision, and 25 (69.4%) implementation of pain reassessment were in good category. There is no relationship between knowledge and implementation of pain reassessment (p = 0.467), but there is a relationship between attitude and implementation of pain reassessment (p = 0.020) and between supervision and implementation of pain reassessment (p = 0.039). CONCLUSION: This research concludes that there is no relationship between respondent knowledge and implementation of pain reassessment and there is a relationship between respondent’s attitude and supervision with the implementation of pain reassessment in Inpatient Unit at Balaraja Regional Hospital in 2019. Nursing Management, to provide this information or in-service training for respondents to increase knowledge and attitude and to have a tight supervision, especially for respondents at practical nurses level one (PK-1) so that it is expected that the implementation of pain re-assessment will be better.
Nina Dwi Lestari, Nur Rizkiyah
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 70-76; https://doi.org/10.3889/oamjms.2021.5802

Abstract:
BACKGROUND: Work stress has severe implications for employee health and the economy. It not only increases anxiety and depression but it also leads to an estimated 50% increase in the risk of heart disease, significant economic consequences, partly through the costs to employers of sickness, absence, and the costs to wider society of treating the health illness. It is essential for the nurse to identify the risk factors related to work stress and to make possible ways of reducing it. AIM: This study aims to determine the factors associated with work stress in academic staff. The samples were 76 academic staffs at Universitas Muhammadiyah Yogyakarta. METHODS: The samples were taken by simple random sampling technique. The instrument used was a work stress questionnaire from National Institute for Occupational Safety and Health that had been modified and a stress factor questionnaire. The analysis statistic was used Spearman rank. RESULTS: This study showed that most respondents had a moderate work stress level (72.4%). The factors affecting work stress were the length of work (p = 0.002), the role of individuals in the organization (p = 0.026), career development (p = 0.027), and relations in the organization (p = 0.03). CONCLUSION: There was no relationship between working hours with the work stress level (p = 0.148). It needs more reliable monitoring of stress levels and improvements in work organization to reduce stress risks as far as possible, by improvements in job design, forms of support, and higher levels of employee involvement.
Mona Hamdy, Iman Hassan Draz, Inas Talaat El Sayed, Azza Ali Fahmy Ayyad, Marwa Rashad Salemd
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 156-160; https://doi.org/10.3889/oamjms.2021.5692

Abstract:
AIM: This paper aimed at assessing the quality of life (QoL) among beta (β)-thalassemia major patients using the short-form-36questionnaire (SF-36) and determining the factors associated with it. METHODS: A cross-sectional study was conducted among β-thalassemia major patients who were attending the hematology outpatient clinic at Cairo University Hospital using the consecutive sampling technique. Data were collected between October 2016 and March 2017. The QoL was assessed for patients aged ≥17 years. During the study period, a total number of 112 patients were included for participation. RESULTS: The mean age of the studied group was 18.32 ± 1.33 years. Most of the included patients (93.63%) had 1 monthly blood transfusion. The mean total score of SF-36 was 44.90 ± 7.54. Among the QoL domains of the studied patients, the “general health perception” domain was the most affected one with a mean score of (add the value of the score here), while the “vitality” domain was the least affected one. No statistically significant difference was reported between males and females regarding different QoL domains except for the “vitality” domain which mean score was significantly higher in males compared to females (p = 0.05). The age at onset of the disease and at first blood transfusion was the most documented factors to be positively correlated with the QoL among the studied patients. CONCLUSION: This study revealed that the QoL in thalassemia major patients is compromised. QoL assessment should be performed for all thalassemia patients to determine and implement the necessary interventions that focus on the affected domains.
Ahmed Yamany Ali, Abeer Attia Abdelkhalik, Shereen Esmat, Walaa Alsharany Abuelhamd, Hend Abdullah Elshemy, Mervat Essam Behiry
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 167-178; https://doi.org/10.3889/oamjms.2021.5717

Abstract:
BACKGROUND: Coronavirus disease (COVID)-19 emerges worldwide consideration since their first proving. The knowledge and attitude of all medical personnel play an important role in the effectiveness of infection control policies among medical institutions. AIM: The study evaluates the knowledge of health care workers (HCWs) about infection control policies at the Egyptian institutions trying to identify the degree of their awareness to deal with such outbreak. METHODS: A cross-sectional study was implemented in public and private hospitals sectors at Cairo, Egypt, through a structured self-administered questionnaire that was delivered to HCWs in the selected hospitals. RESULTS: A total of 486 physicians working between university, governmental, teaching, private hospitals, and polyclinics submitted their replies. Of whom, 46.9% practiced internal medicine specialty, 35.4% were pediatricians, and only 17.7% specialized in the family medicine. Regarding the overall level of knowledge about infection control and prevention among HCWs, we found that 87.2% of participants reported presence of infection control program at their institutions and about 79% practiced these policies while only 60.5% received some training. Furthermore, we found that 64.2% of the participant did not know which infections are officially reported. There was some variation in response to causes related to the outbreak as 43.8% referred that to shortage of appropriate personnel protective equipment and only 7.4% assigned the carelessness of HCWs. Moreover, the insufficient resources to fulfill the infection control requirements were assigned as a primary factor to spread of infection (71.4%). The electronic surveillance system was believed the most efficient reporting system of infectious agents by staff (83.1%). The study revealed that there was a statistically significant difference of knowledge of infection control among medical staff according to their specialties (p ≤ 0.05). Moreover, there was a significant trend of orientation about infection control toward the highly certificated individuals (having PhD). Furthermore, there was a potential variance between the groups of higher and lower years of experience regarding in their answers about surveillance system institutions (p ≤ 0.05). In addition, there was variation in responses to questions related to various institutions as a higher percent of awareness of the presence of active infection control policy was found at the governmental and university hospitals (p < 0.05). CONCLUSION: HCWs had reasonable knowledge about infection control and surveillance during COVID-19 outbreak and we have discovered zones of concern about infection control experience in Egypt which differ between institutions and professions and years of experience.
Eman Moawad Elhabashi, Reham Farouk Tawfik, Fatma Maamoun Abou-Hashima, Arwa Mohamed El Shafei, Fayrouz El-Aguizy
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 179-186; https://doi.org/10.3889/oamjms.2021.5724

Abstract:
BACKGROUND: Since first confirmed case of coronavirus disease (COVID)-19 in December 2019 by Chinese health authorities and subsequent World Health Organization (WHO) declaration that COVID-19 is a global public health crisis, radical changes have occurred all over the world associating massive lockdown with increased numbers of infected cases and related mortalities. As health care workers (HCWs) are at a great risk to get COVID-19 infection and hence can be a dangerous source of spreading it to the community, it was important to assess HCWs knowledge, attitude, and practice toward COVID-19 infection prevention and control (IPC) to help limit the outcomes of COVID-19. AIM: The objectives of the study were to assess the knowledge, attitudes, and practices of physicians regarding COVID-19 IPC. METHODS: Research setting is “Kasr Al-Ainy” Faculty of Medicine, Cairo University Hospital. Design: A cross-sectional analytical observational hospital-based research in June 2020. Population: A convenient sample of 50 physicians working at Cairo University Hospital was included. Data collection: Self-administered questionnaires derived from the WHO IPC guide during health care when COVID-19 is suspected were used. RESULTS: Mean age of studied group was 30.5 ± 3.97, while their mean years of practice were 4.7 ± 3.55. Mean knowledge score among physicians was 5.6 (± 0.56), two-thirds of them had sufficient knowledge regarding COVID-19 IPC as their mean attitude score among 24.9 (± 2.8). While mean practice scores 5.6 (± 1.05), yet only 68% of the participating physicians use a new set of personal protective equipment when care is given to a different patient. CONCLUSION: Physician’s moderate knowledge, poor attitude, and modest practice toward COVID-19 IPC were found to be not sufficient, not favorable nor safe enough to expected standards.
Vina Yulia Anhar, Syamsul Arifin, Fauzie Rahman, Agus Muhammad Ridwan, Bohari Bohari
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 192-197; https://doi.org/10.3889/oamjms.2021.5685

Abstract:
BACKGROUND: Teenagers who smoke are very susceptible to product degradation which is seen in the low quality of human resources. Identification of risk factors needed as a first step before health interventions to prevent and reduce smoking rates in adolescents. AIM: This study aims to analyze the risk factors for smoking behavior in adolescents through the health believe model approach. METHODS: The design of this study is observational using a cross-sectional approach with the sample size, namely, 156 respondents. The instrument planned to be used in this study is a questionnaire that has been tested for validity and reliability. This study has received permission from relevant parties, including having received approval from the ULM FK Ethics Commission. The variables to be studied are, dependent: Smoking and independent behavior: Gender, knowledge, attitude, parental influence, peer influence, and cigarette advertising. The data analysis used Chi-square test and Fisher’s exact test with a significance level of p < 0.05. RESULTS: Frequency distribution, 139 (89.1%) respondents do not smoke, 81 (51.9%) respondents were female, 147 (5.8%) respondents are well-informed, and 141 (90.4%) respondents have a positive attitude, the number of respondents who are not affected by the smoking behavior of the elderly is 142 people (91%). Number of respondents who are not affected by peer smoking behaviors is 150 people (96.2%) and 144 people (92.3%) of the respondents were exposed to cigarette advertisements in the high category. Statistical tests show that the variables that have a significant relationship with smoking behavior are gender (p = 0.000), attitude (p = 0.000), parental influence (p = 0.000), and cigarette advertising (p = 0.000). CONCLUSIONS: There are four variables which have a relationship with smoking behavior, namely, there is a relationship between gender, attitude, the influence of parents, and cigarette advertising with smoking behavior.
Ariwan Selian, Bahagia Loebis, Mustafa M. Amin, Nazli Mahdinasari
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 9-12; https://doi.org/10.3889/oamjms.2021.6279

Abstract:
BACKGROUND: Depression is the most common psychiatric problem in the elderly. Suicidal thoughts or recurring thoughts of death are common in people suffering from depression. Depression in the elderly has a very poor prognosis compared to people in other age groups because they have a relatively higher risk of suicide and death. Elderly people in nursing homes is a condition that significantly affects the quality of life and survival and harms the psychology of the elderly, cause stress is due to elderly people in nursing homes associated with medical and psychosocial problems such as divorce/widows, poverty, and social isolation. AIM: We aimed to find out the factors that affect the Geriatric Depression Scale (GDS 15) score in elderly people at the Social Service of the Dharma Asri Binjai Nursing Home. METHODS: This study used a cross-sectional approach to 91 subjects at the Dharma Asri Binjai Nursing Home Social Service starting from June to July 2020 utilizing sampling, namely, simple random sampling. The tests conducted in this study consisted of a bivariate test and a multivariate linear regression test to determine which factors are associated with depression. The measuring instrument used was the GDS 15. RESULTS: After the multivariate test was carried out, the variables that were statistically significant to the total score of depression in the elderly at the Binjai Dharma Asri nursing home were Gender (p < 0.001) and activity of daily living (ADL) Score (p < 0.001). CONCLUSION: The factors associated with the GDS score of 15 and the occurrence of depression in the elderly were found in the gender variable and the ADL score variable.
Mustafa Mahmud Amin, Elmeida Effendy, Ferdinan Leo Sianturi, Munawir Saragih, Syaifuddin Nasution
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 31-34; https://doi.org/10.3889/oamjms.2021.6323

Abstract:
BACKGROUND: Mental retardation (MR) is a developmental condition that is associated with significant intellectual and adaptive behavioral limitations, whereas dissociative trance disorder (DTD) is a dissociative condition characterized by a temporary altered state of consciousness formed by one’s culture. Comorbidity between these two disorders has rarely been reported. CASE REPORT: We found a case of MR in a 32-year-old woman, Mrs. S, with a DTD who killed her five children during her trance. CONCLUSION: It was found that there is a relationship between psychosocial stressor factors, trauma, underlying psychiatric conditions, culture, and communication that influence trance conditions. Further research is needed to study and understand more about these disorders and comorbidities.
Salma Nadiyah, Pramudji Hastuti, Sunarti Sunarti
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 303-307; https://doi.org/10.3889/oamjms.2021.6045

Abstract:
BACKGROUND: The expression and activity of fatty acid synthase (FAS) enzymes determine de novo fatty acid synthesis, which can be enhanced by a high-fat and high fructose diet or inhibited by some bioactive compound diets. Beets are a great source of therapeutic compounds that have the potential to improve health and prevent disease. AIM: This study examined the effects of beets on liver FAS gene expression and FAS levels. METHODS: A total of 25 male Wistar rats divided into five groups: (1) Standard diet (n); (2) high fat and fructose diet (HFFD); (3) HFFD have given beet 6%-contained standard diet (B1); (4) HFFD have given beet 9%-contained standard diet (B2), and (5) HFFD have given beet 12%-contained standard diet (B3). The HFFD was given to rats in the 2, 3, 4, and 5 group diets for 8 weeks? and then 3, 4, and 5 groups received beet-contained standard diet for 6 weeks. At the end of the intervention, FAS levels were measured (please specify where it was measured from) using the ELISA method, liver FAS gene expression was analyzed by quantitative polymerase chain reaction, and triglyceride (TG) levels were determined by the colorimetric method. RESULTS: The beet-substituted diet significantly suppressed the hepatic FAS gene expression and decreased the serum FAS levels in rats previously given HFFD (p < 0.05). The expression of the FAS gene showed a significant positive correlation with the levels of FAS serum (p < 0.05), and also with the hepatic TG levels but not significant (p > 0.05). Substitution of beet 9% in diet gives the best effect in hepatic FAS gene expression and the serum FAS levels. CONCLUSIONS: The diet contained beet 9% was seen as a necessary physiological dose to improve the effects of high-fat and diet fructose diet through suppressing FAS gene expression and a decreased serum FAS levels.
Ludwig A. P. Pontoh, H. Dilogo Ismail, Jessica Fiolin,
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 153-162; https://doi.org/10.3889/oamjms.2021.5995

Abstract:
BACKGROUND: Double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) has been known to result in better functional outcomes, joint stability, and lower revision rates compared to single-bundle (SB) ACLR. However, given the increased invasiveness and damage to the surrounding tissue area, it is proposed that it may be associated with increased pain. AIM: This review aims to gather all studies and literature that reported pain as an outcome when comparing SB versus DB ACLR. METHODS: Literature searching was conducted across seven search engines for studies reporting pain as an outcome and comparing SB versus DB ACLR. RESULTS: Eight studies met the eligibility criteria and were included in the study. Overall, the studies show variable findings regarding pain in DB compared to SB ACLR, with the only statistically significant results from two studies indicating that DB ACLR is associated with more pain than SB ACLR. CONCLUSION: Based on the limited evidence available, no conclusions can be made regarding the pain experienced between people receiving either procedure. This constitutes a need for additional studies with increased follow-up time periods, larger sample size, and better study design.
Kamonwon Ienghong, Somsak Tiamkao, Vajarabhongsa Bhudhisawasdi, Dhanu Gaysonsiri,
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 386-389; https://doi.org/10.3889/oamjms.2021.6105

Abstract:
BACKGROUND: Point of care ultrasound (POCUS) plays an important role as a crucial tool for the diagnosis of various conditions in emergency and critical ill patients. However, POCUS examination in elderly populations has not been well studied. AIM: This was a retrospective observational study of elderly patients at the Department of Emergency Medicine who had received POCUS examination at a tertiary university hospital, Thailand. METHODS: The study was conducted throughout January 2020–December 2020. Patients’ characteristics and ultrasonography findings were recorded. RESULTS: A total of 191 elderly patients were evaluated. Median patient age was 75.65 years; 56.02% of patients were female. Chief complaints where POCUS scans were applied were respiratory (36.65%) and cardiovascular system-related (21.99%). The most frequent procedures performed were cardiac, lung, and inferior vena cava examinations. Abnormal ultrasound findings were discovered in 133 patients (68.91%). The 66.17% of abnormal ultrasound findings were associated with final diagnosis. The admission rate of elderly patients (56.82%) was highest among patients with positive ultrasound findings associated with final diagnosis. CONCLUSIONS: POCUS utilization in elderly patients was useful in aiding emergency physicians amid diagnosis of various diseases, especially life-threatening ones.
Ebaa Alagha, Mustafa Ibrahim Alagha
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 92-97; https://doi.org/10.3889/oamjms.2021.5878

Abstract:
AIM: This study compared the impact of two resin infiltration systems on microhardness of demineralized enamel before and after an acidic challenge. MATERIALS AND METHODS: A total of forty human maxillary molar teeth were used in this study. Each tooth has 4 groups (four standardized windows onto each tooth). Group A1: Untreated sound enamel surface (positive control), Group A2: Artificially demineralized enamel surface (negative control), Group A3: Icon resin infiltrating to demineralized enamel, while Group A4: Single bond universal adhesive applied to the demineralized enamel surface. All teeth were immersed in a demineralizing solution. The groups (A3 and A4) were further subdivided into two subgroups according to acidic ethanol challenge Subgroup B1: Specimens tested before an acidic challenge and B2: Specimens tested after an acidic challenge. Vickers microhardness test was done for all groups. One-way analysis of variance (ANOVA) was used to study the difference between tested groups on mean microhardness within each group. Tukey’s post-hoc test was used for pair-wise comparison between the means when ANOVA test was performed, and the significance level was set at p ≤ 0.05. RESULTS: Icon resin infiltration and single bond universal adhesive showed significantly higher mean microhardness than negative control, but significantly lower mean microhardness than positive control. However, insignificant difference was found between icon and single bond universal adhesive. After the acidic challenge, icon resin infiltration showed significantly higher mean microhardness than negative control. However, single bond universal adhesive showed insignificant difference as compared to the negative control. CONCLUSION: After an acidic challenge, icon resin infiltration was more successful than single bond universal total-etch adhesive system in microhardness. RECOMMENDATION: Icon resin infiltration technique is a promising, noninvasive approach that prevents the progress of the carious lesion.
Delfi Delfi, Vanda Virgayanti, Hendra Gunawan
Open Access Macedonian Journal of Medical Sciences, Volume 9, pp 19-22; https://doi.org/10.3889/oamjms.2021.6308

Abstract:
BACKGROUND: Cataract contributes to the most common cause of blindness worldwide. Cataract surgery is the most performed surgery in the world. To achieve optimal results, pre-operative biometric must be accurate and the use of a formula for measuring the strength of the intraocular lens (IOL) accurately must be used. SRK-T and Haigis are formulas applied in the calculation of IOLs. AIM: The objective of the study was to determine the evaluation of visual acuity after phacoemulsification using the SRK/T and Haigis formulas. METHODS: This was an observational prospective analytic study at Medan Baru Eye Hospital from June 2019 to August 2019. Following the examination, patients were required further follow-up on 7–30 days post-phacoemulsification. RESULTS: The number of subjects was 122 patients (122 eyes), 84 patients were observed, and 38 patients did not come back for control. This study was within the value of p = 0.053. Prediction of refractive errors after phacoemulsification for myopia identified using SRK/T formula was more common, resulting in 3 eyes (75.0%) compared to the Haigis formula. On contrary, the prediction for emetropia was mostly discovered on Haigis formula which amounted to 41 eyes (51.25%) compared to the SRK/T formula. CONCLUSIONS: There was no significant difference in predicting post-phacoemulsification visual acuity between SRK/T and Haigis formula.
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