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A skeletal-related event (SRE) is an event occurring due to bone metastasis in prostate cancer. SREs are usually marked by pain, pathological fractures, spinal cord compression, hypercalcemia, or bone metastasis requiring radiotherapy or operation. Case I: A 64-year-old male was diagnosed with a pathological fracture of the left femur. Thoracal CT scan showed osteoblastic lesions in the thoracal vertebrae, sternum, clavicle, and humeral head. Spinal MRI showed destruction of the cervical to sacral vertebral bodies. The histopathological result with Adenocarcinoma Gleason scores 8 (4+4) and an initial prostate-specific antigen (PSA) level of 689,7 ng/dL. Afterward, subcapsular orchiectomy was performed. However, his PSA level was still high (>100 ng/dL) even after serum testosterone had reached a castration level. The patient died during the first chemotherapy using docetaxel. Case II: A 61-year-old male was diagnosed with inferior paraplegia and neurogenic bladder, paraparesis, urinary retention, and pain in the flank area. Spinal MRI showed a pathological compression fracture of the 8th thoracic vertebrae. Thoracal CT scan showed costal and 8th thoracal vertebrae destruction as well as multiple nodules in the lungs. Histological results with Adenocarcinoma Gleason score 9 (4+5) and an initial PSA level of 750 ng/dL. Afterward, subcapsular orchiectomy was performed. Serum testosterone reached castration level with the lowest PSA concentration of 21.6 g/dL. The patient declined chemotherapy and agreed to palliative treatment. He died one year after diagnosis. A high PSA level (>500 ng/dL) could potentially be used as a predictor for severe SRE.

BACKGROUND: Normal pressure hydrocephalus (NPH) is characterized by an abnormal buildup of cerebrospinal fluid in the ventricles or cavities of the brain. The objective of the case report was to define the importance of physical medicine and rehabilitation intervention as an approach for an elderly patient with NPH. CASE REPORT: A 75-year-old woman presented with a balance and gait disturbance after injury from a motor vehicle accident. The patient experience Hakim’s triad (gait disturbance, urinary frequency, and mild cognitive impairment), and her computed tomography scan of the head revealed ventriculomegaly, multiple lacunar infarctions on the paraventricle, and cerebral atrophy, which could indicate NPH. Balance and gait training, cardiopulmonary training, and environment modification were interventions from physical medicine and rehabilitation provided to this patient. CONCLUSION: An elderly patient with NPH should receive physical medicine and rehabilitation intervention to prevent falls, improve functional ability, and improve quality of life.

Introduction: Increased aerobic exercise capacity appears to reduce all-cause mortality and cardiovascular mortality. Aerobic exercise improves functional capacity (FC) is strongly recommended.However, evidence regarding the most efficient exercise intensity for patients post Coronary Artery Bypass Surgery (CABG) is still limited. This study aimed to assess the effects of high-intensity intervalexercise (HIIT) compared to moderate-continous intensity exercise (MCT) for increasing FC in patients post CABG. Methods: True experimental pre-post study included 6 men post CABG participating in a phase II cardiac rehabilitation (CR) with age ≤ 65 years old, ejection fraction ≥ 40%, no heart failure, no valve disease.Each group had 3 participants. HIIT group exercise at 80-90% Heart Rate Reserve (HRR) followed by 60-70% HRR active rest periods, MCT group exercised at 60-80% HRR. Both groups trained 3 days/week for 4 weeks. FC measured at baseline and after 4 weeks of rehabilitation. FC was assessed by maximal exercise testing through indirect VO2 max measurement. Results: After training, FC increased significantly in both group HIIT: 0,98±0,48 METs (8.07±1.51 METs to 9.05±1.21 METs), p=0.03 and MCT : 0,79±1,03 METs (5.74±2.24 to 6.53±1.69 METs), p=0.04).Differences in FC improvement between the two groups are p=0.792. Conclusion: HIIT exercise had no difference with MCT in increasing FC in patients post CABG. Keywords: CABG, cardiac rehabilitation, continuous moderate training, functional capacity, highintensity interval training

Diabetic feet ulcer is four times more likely to be found in patients who suffer from diabetes mellitus than in those who don't. Diabetic feet ulcer is one of chronic complications of diabetes mellitus which causes defects even deaths. Diabetes mellitus in one of the ten most frequent diseases in Indonesia. According to Riskesdas (Riset Kesehatan Dasar - Basic Health Research), the increment number of patients with diabetes mellitus from 2007 up to 2013 is 330,512.1 The research is aimed to find out the effect of oral hydrotherapy on risk reduction of diabetic feet ulcer in patients with type-2 diabetes mellitus. The research was done by applying quasi-experimental design (pre-test and post-test design with control group). By total population sampling, there were 68 respondents who participated. About 34 of the respondents were in experimental group at Dr. Soediran Mangun Sumarso of Wonogiri, and 34 respondents were patients who had check-ups at RS PKU Muhammadiyah of Surakarta. The research result shows that oral hydrotherapy can minimize risk reduction of diabetic feet ulcer in patients with type-2 diabetes mellitus significantly with p-value of 000.0 (α=0.005).

Background: Physiotherapy service standards are used as a basis for risk management in preparing strategies to anticipate unexpected events that appear in the management of the physiotherapy process. This research aims to improve the quality of physiotherapy services through the calculation of the risk of the physiotherapy process and risk mitigation measures using the Workload Indicator Staffing Need (WISN) method from the World Health Organization (WHO). Methods: The research uses the stages of risk management as a method of analysis and WISN as a method for risk mitigation. Risk analysis begins with the identification of risks and then measures the risks by calculating the probabilities and impacts of these risks and designing risk management as mitigation. Results: Based on the research that has average 50-60/day, which is not proportional to the number of only 4 physiotherapists. In addition, there is a lack of physiotherapy intervention tools. Conclusion: In this research it has concluded that to improve the quality of physiotherapy services must be done by making policies to mitigate unexpected events and reducing the probabilities such as: increasing the number of physiotherapists and arranging the separation schedule of examination days for physiotherapy been done, events with the highest risk are found in the stages of examination and measurement, documentation, and physiotherapy intervention where there is an opportunity to reduce the type and duration of long or unsuccessful healing interventions. The trigger for the occurrence of potential risks is the number of patients on measurements from intervention days and increasing the number of physiotherapy intervention tools.

Background: Coping mechanism is a process whereby individuals try to handle and master stressful situations that suppress the consequences of the problems it faces, it is very necessary in patients with psychiatric. Purpose : The purpose of this study was to analyze the effect of pre- and post-intervention therapy on cooperative mechanisms of cooperative schizophrenia Methods : The research design used in this research is experimental pre with one group pretest and posttest approach where the mechanism of client cloning before and after Schizophrenia is given intervention in the form of prayer therapy. The analysis used is descriptive where the data is taken directly on each respondent, the score obtained from each respondent will be adjusted with the standard assessment, while testing the hypothesis using t test Dependent analysis. Result : Based on the result of statistical test, the mechanism of cooperative schizophrenia client cooperate in outpatient care in health center of Puskesmas Karanganyar Gandusari District Trenggalek mean difference of therapy of prayer in Islam before therapy and after therapy is 0,400 with standard deviation 0,503. Beside that got value p value = 0,002. Conclusion :The results of this study indicate there is a significant difference between before prayer therapy and after therapy do'a to coping mechanism of client of schizophrenia

INTRODUCTION AND OBJECTIVE:The feasibility of ultrasonic propulsion and burst wave lithotripsy (BWL) to noninvasively reposition distal ureteral stones to facilitate passage and relieve pain was te...

INTRODUCTION AND OBJECTIVE:We report stone comminution in the first human subjects by burst wave lithotripsy (BWL), which is the transcutaneous application of focused, cyclic ultrasound pulses.METH...

Objective: to determine the patient’s characteristics, correlation between staging and chemotherapy response, furthermore two years overall survival rate. Methods: a retrospective analytic study was conducted. Data were obtained from medical records in January 2008 to December 2014 and analyzed using SPSS 17.0. All of correlation between staging and chemotherapy response, primary tumor staging (pT) and metastasis (M), regional lymph nodes staging (N) and metastasis (M), serum tumor marker and chemotherapy response were tested by Spearman correlation test. Two years overall survival rate was analyzed by Kaplan-Meier. Data ratio with normal distribution was tested by Paired T-test. Results: the mean age of patients were 31.03 ± 13.751 years, with seven patients (15.6%) had previous history of undescended testis. Based on TNM staging, we found that most patients had already develop into stage pT3 (46.7%), N3 (57.7%), and M0 (57.7%). A significant correlation between staging and chemotherapy response was shown with stage I of testicular seminoma had completely chemotherapy response (100%) and two years overall survival rate in stage I was 100%, whereas in metastatic seminoma (stage II and III) was 60%, with Hazard Ratio 0.63 (p=0.294; 95%CI 0.276-1.476). Conclusion: patients in early stage of testicular seminoma will give a better response to chemotherapy and will have better survival rate compared to those with metastatic seminoma.

Rhabdomyosarcoma is the fifth most common type of soft tissue solid tumor in children and the most common in the last two decades. Rhabdomyosarcoma of the urogenital organ is a rare mesenchymal tumor, covering 22% of all Rhabdomyosarcoma cases. The two most common histologic types are alveolar and embryonal, whereas botryoid and spindle cells are rarely found. We reported a case of embryonal Rhabdomyosarcoma of the prostate. In this study, we improved the understanding of Embryonal Rhabdomyosarcoma of the prostate on 23 years old male who had a history of swelling in the perineal area and a history of falling from a height in the groin area 5 months before. The patient complains of the difficulty of urinating and hematuria one month after falling. We underwent drainage of the swelling area, found pus 100cc and took a sample for pathological examination. The result was embryonal rhabdomyosarcoma. Prostate volume was 122cc, PSA 5,32 and PSAD 0,04. The CT scan result was solid mass size 15x8x18 cm at perineum enhance to the pelvic cavity, push the bladder to the superior, rectum to posterior, and urethra posterior to the left side. We diagnosed this patient as Embryonal Rhabdomyosarcoma prostate T2bG1N0M0 (stage 3) group 3 and intermediate-risk group. The patient underwent VAC chemotherapy based on D.9803 (IRS V) protocol and planned radiotherapy, but it stopped at halfway because of profuse bleeding. Embryonal Rhabdomyosarcoma is an aggressive tumor, especially in adults. However, there was limited evidence and guideline to diagnose and manage the disease.

The purpose of this study was to find a method of determining laser models and intra vaginal progesteronesponge in Bali Cattle. An assessment was carried out at Sapi Loka Grati, Pasuruan, Indonesia. The parametersobserved included the symptoms of estrus, response of estrus, and the level of pregnancy. Twenty Balinesecows were divided at random in two groups. P1 treated with laser puncture at a certain point and P2 treatedwith 1.5 g of progesterone + 10 mg of estradiol benzoate intra vaginal sponge. The diagnosis of subsequentpregnancies was done by ultrasonographic examination on day 40th after artificial insemination (AI). Thelaser used in this study was a soft laser with power supply specifications as follows: 50 Hz, 220 Volts, 50Watts, ranging from 0.2 Joules to 0.5 Joules. These lasers include semiconductor lasers and laser probes.Three acupuncture points were used (GV 4, BL-22, and GV-2). Furthermore, the intra vaginal progesteronesponge used was made from silicone plastic similar to the drugs containing medroxyprogesterone acetate.Data testing was done by using the T-test. Results demonstrated that the P1 responses of estrus appeared onday 3rd, while P2 on day 9th. There was no significant difference (p >0.05) in the accumulation of estrus andpregnancy. In conclusion, estrus synchronization and pregnancy rate could be efficiently achieved in Balicattle using either laser puncture or intra vaginal progesterone sponge. However, laser puncture treatmentinduced more spread estrus with higher pregnancy rate.

Background: Accuracy of preoperative brain tumor’s histopathologic differentiation is very important to determine preoperative staging, intraoperative management and postoperative therapy. Diffusion weighted magnetic resonance imaging is an advanced technique developed as an important method for brain tumor assessment. Objectives: This study aimed to investigate correlation between diffusion weighted imaging (DWI) profile and apparent diffusion coefficient (ADC) value with brain tumor’s histopathology. Methods: This study examined 86 subjects with brain tumors using magnetic resonance imaging and histopathology examination at Dr. Soetomo Teaching Hospital and evaluated DWI profile and ADC maps. The spherical ROI on ADC maps was placed on the solid part of the tumor to measure ADC value. Spearman’s correlation test was conducted to determine correlation between DWI profile and ADC values with histopathological grading and types of brain tumor. Results: There was a significant correlation between DWI profile and ADC values (p = 0.000), as well as DWI and ADC values with histopathological grading and types of brain tumor (p = 0.000). There was an inverse corelation between ADC value and histopathological grading. The higher the ADC value, the lower the brain tumor grade, while lower ADC value resulted in high tumor grade. The average ADC value of grade-1 meningiomas was 1.061±0.257 x 10-3 mm2/sec, pilocytic astrocytoma was 1.301±0.107 x 10-3 mm2/ sec, glioblastoma multiforme was 0.831±0.080 x 10-3 mm2/sec, and medulloblastomas was 0.600±0.078 x 10-3 mm2/sec. Conclusion: Evaluation on DWI profile and ADC value could provide additional information on conventional magnetic resonance imaging examination to determine histopathological grading and types of both intra and extra-axial brain tumors.

INTRODUCTION AND OBJECTIVE:Medical malpractice (MP) is an important issue in our country. There has been controversy surrounding PSA testing and prostate cancer screening, specifically the United S...

Background : Research in pain especially in patient undertake hemodialysis is important to be conducted in order to help this population in the process of their hemodialysis therapy. Aim: The aim this study is to identify pain characteristic on hemodialysis patient using Visual Analogue Scale (VAS) and mnemonic PQRST. Method: This is a descriptive quantitative cross-sectional research. The number of respondent were 72 and they routinely undertake hemodialysis therapy twice a week. Research was conducted in one Central Hospital in Yogyakarta, Indonesia on February to March 2017. Univariate analysis was used to describe respondents’s pain characteristic. Results: The majority of respondents (51.39%) experience moderate pain, following by mild pain (33.33%) and severe pain (15.28%). In Provocation aspect the most characteristic was movement (87.50%), for the Quality characteristic the most aspect was knife-like pain (83.33%). Moreover, in Regio characteristic was on hand (84.72%), No Radiation of pain (91.67%), and for Time characteristic was intermitten (97.22%). As many as 53% respondents expressed that pain have an impact on their life. Consequences of pain most was in their activities (52.63%), following with others (15.79%.), nausea/vomiting (15.79%), sleep disturbance and appetite (both 13.16%). However, pain did not have an impact on their emotion. Conclusion: Respondents experience mostly moderate pain. The percentage of characteristics on PQRST mnenomic each percentage of Provocation, Quality, Regio, Radiation and Time reach was above 80% of respondents, while for Severity more than half of the respondent experienced moderate pain. The majority of respondents felt the impact of pain in their life.

Feasibility of ultrasonic propulsion and burst wave lithotripsy (BWL) to noninvasively reposition distal ureteral stones to facilitate passage and relieve pain was tested. Patients presenting to the clinic or emergency department were recruited. Thirteen subjects underwent ultrasonic propulsion (lower amplitude, longer duration pulses) alone, and 10 subjects also received intermittent BWL (higher amplitude, shorter duration pulses). All participants were awake and underwent a pain assessment pre- and post-procedure. For analysis, subjects were sub-categorized based on whether their stone was acute or chronic (present for ≤10 days or >10 days from their initial ED or symptomatic presentation, respectively). Seventeen subjects were enrolled in the acute study population and 6 subjects were enrolled in the chronic population. Overall, 94% of acute stones passed in an average of 3.4 days post-procedure relative to 54% in 7.5 days in the American Urological Association guidelines. 67% of chronic cases passed stones or fragments, and two surgeries were cancelled. Pain reduction was statistically significant ( p = 0.0215). Adverse events were limited to hematuria on initial urination post-procedure (BWL only, n = 3) and a mild sensation, akin to a pinprick, associated with fewer than 10 of 620 propulsion bursts ( n = 3). [Work supported by NIH-P01-DK04331.]

The goal is to test effectiveness and safety of transcutaneous ultrasound pulses for facilitating clearance of residual urinary stone fragments in a randomized control trial (RCT). The study is conducted in a clinic setting with the control and treatment arms undergoing all the same activities with the exception of the ultrasonic propulsion procedure and associated pain questionnaire. Subjects are followed 90 days for assessment of adverse events and for up to 5 years for stone growth and symptomatic stone visits. Twenty-six of 33 subjects have been recruited in each arm The most recent treatment is reported. The subject received shock wave lithotripsy and did not pass any fragments for 17 months. The subject was randomized to the treatment arm. Fragments began moving with the third 3-s propulsion pulse at output 2 of 5 levels. Fifty-two percent of propulsion pulses (41 of 79) resulted in fragment movement. The subject reported no pain at the beginning or end of the procedure and telephoned within 2 h to report passing 9 fragments, no hematuria, and no adverse events. The treatment results of this RCT are compelling as an immediate and casual effect was measured. [Work supported by NIH-P01-DK043881 and VA Puget Sound resources.]

Background : The cumulative of HIV/AIDS cases in Surakarta are 1.212 cases, and 376 of them died in the span of Oktober 2005 until Januari 2014 . HIV infections have not found a cure, so it is possible someone with AIDS often experience psychological problems, especially anxiety, depression, which can suppress the immune system, making people more vulnerable against illness and pain. AIDS can not be cured, but the life expectancy of people living with HIV/ AIDS (PLWHA) can be extended with antiretroviral treatment (ART). This treatment can boost immunity so that the quality of life of PLHIV increased Subjects and Method: The study was observational analytic research with cross sectional design. The location of research in PHC Manahan Surakarta total of 36 patients with HIV / AIDS who do ARV therapy. The data analysis using logistic regression. Results : There is a positive correlation was not statistically significant from the knowledge of the drugs with antiretroviral therapy adherence (OR=4.03; 95% CI= 0.22 to 73.32; p=0.347). There is a positive correlation was statistically significant on the perception of the seriousness of the disease with antiretroviral therapy adherence (OR=26.70; 95% CI= 1.30 to 550.51; p=0.033). There is a positive relationship and statistically significant on the perception of the benefits and barriers to compliance with antiretroviral therapy (OR=17.73; 95% CI= 1.12 to 279.59; p=0.041). There is a positive correlation was statistically significant from family support with antiretroviral therapy adherence (OR=28.89; 95% CI= 1.24 to 647.71; p=0.036). Conclusion: The perception of the seriousness of the disease is the most variable bergubungan with antiretroviral therapy adherence (p=0.033). Keywords : knowledge about ARV, seriousness of the disease, barriers and family support, adherence ARV therapy Correspondence: Sunaryo. Department of Health, Surakarta. Email: Sunaryomanahan@gmail.com. Journal of Health Promotion and Behavior (2016), 1(1): 54-61 https://doi.org/10.26911/thejhpb.2016.01.01.08

Objective: To evaluate the effect of quadriceps muscle strengthening exercise on quadriceps and hamstring strength ratio in knee osteoarthritis (OA). Methods: This was a quantitative study with quasi-experimental design. The subjects in the study were 16 female patients with knee OA grade 2 and 3. Quadriceps muscle strengthening exercise was given to the subjects 3 times a week during 8 weeks. The study was conducted at the Department of Physical Medicine and Rehabilitation of the Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin General Hospital in August–September 2015. Results: It was revealed that the quadriceps muscles improved significantly. However, the hamstring muscles did not show significant improvement based on the comparison between before and after performing the exercise. The average right quadriceps muscle strength before exercise was 12.46 and after exercise was 18. The average left quadriceps muscle strength before and after exercise were 11.59 and 17.7, respectively. The average right hamstring muscle strength before and after exercise were 7.29 and 7.94, respectively. Conclusions: There are quadriceps muscle strength improvements after practicing quadriceps muscle strengthening exercise. However, no significant hamstring muscle strength improvement is seen after practicing quadriceps muscle strengthening exercise. An improvement in quadriceps and hamstring muscle ratio is observed. Keywords: Osteoarthritis, quadriceps and hamstring muscle strength ratio, quadriceps muscle strengthening exercise DOI: 10.15850/ijihs.v5n2.1041

Objective: To analyze the correlation between cardiac autonomic neuropathy (CAN) and neutrophil-lymphocyte ratio (NLR) in DM type 2 patients. Methods: This was a cross-sectional study which was conducted at the Internal Medicine Clinic of Dr. Hasan Sadikin General Hospital, Bandung and Chronic Disease Management (CDM) Club in Garut District, West Java, Indonesia from October to December 2015. Subjects were 57 DM type 2 patients who met the inclusion criteria. Cardiac autonomic neuropathy examination and complete blood count (CBC) were performed to discover the subjects’ neutrophil-lymphocyte ratio. Results: A strong correlation was found between CAN in DM type 2 patients and NLR (r=0.679; p=0.000) based on Rank Spearman correlation test. The NLR to CAN cut off point was 1.34. Conclusions: NLR examination can be used as an indicator of CAN in DM type 2 patients with NLR cut off point. There was a correlation between CAN and DM type 2 diagnosis duration. Keywords: Cardiac autonomic neuropathy, diabetes mellitus type 2, Ewing test, neutrophil-lymphocyte ratio DOI: 10.15850/ijihs.v5n1.961

Background Systemic Lupus Erythematosus (SLE) is a multifactorial and heterogenous systemic autoimmune disease, involving multisystem organ and marked with the production of autoantibodies. SLE has general constitutional sympton such as fatigue and usually is the main symptom causing limited functional condition on patients. Assessment for cardiorespiratory fitness can be done with various methods, one of them measuring Metabolic Equivalents (METs). The purpose of this study was to examine the correlation between cardiorespiratory fitness and Fatigue Severity Scale (FSS). Method The sampling method used was the total sampling method. Out-patients diagnosed with SLE were screened via medical records according to inclusion and exclusion criteria. SLE patients filled an Indonesian version of the FSS questionnaire sheet and did the six-minute walk test based on standard protocol on a 30-meter track. The total distance patients had crossed was turned into VO2 max with Nury equation, then turned again into cardiorespiratory fitness with METs unit. A correlation analysis between cardiorespiratory fitness and FSS was done next. Results There were 28 patients participating in this research. Correlation analysis resulted in a negative correlation with no statistical meaning between cardiorespiratory fitness and FSS (r = -0,27; p > 0,05). Conclusion There is no correlation between cardiorespiratory fitness and FSS in SLE patients. Keywords Correlation, Cardiorespiratory Fitness, Fatigue Severity Scale, Systemic Lupus Erythematosus

Hilar tumors pose unique challenges during partial nephrectomy. We present the characteristics and outcomes of 263 patients with hilar tumors undergoing robot-assisted partial nephrectomy (RPN) in the largest series to date. Perioperative, pathologic, functional, and oncological outcomes were compared between 1467 (84.8%) patients with a non-hilar tumor and 263 (15.2%) patients with a hilar tumor undergoing RPN. Variables were compared in univariable (unadjusted) analysis and using multivariable linear, logistic, poisson, cox proportional hazards and linear mixed effects regression models adjusting for tumor diameter and RENAL Nephrometry score. Hilar tumors were larger (3.7 vs. 3.0 cm, p

Parts of motor development have an important role in the life and development of children, referred as movement abilities throughout the lifetime. Students with spastic cerebral palsy have spesific characteristics when their moving, the spastic muscle and rigidity, poor posture control are inhibiting factors in achieving functional movements. Qualitative research approach through interviews with parents and standard assessment tests on body awareness using BARS, RTc and posture, control posture sitting assess by PPAS and Gross Motor by GMFCS-R. The results of BARS, RTc and PPAS measurements in 4 spastic cerebral palsy students, show poor body awareness, release tension, the quality and quantity posture control data also show the similar result from front and side of sitting posture. Body awareness and posture control are preequisit factors for the quality of functional movements, profile of the student contain the strength and abilities, weakness and the needed of the student for services program. Development is a cumulative process, meaning that obstacles to previous developments will hamper further development, further research needs to be done in relation to body awareness and the release tension that occurs during movement

With the increased utilisation of chest computed tomography, solitary pulmonary nodules are increasingly being identified. It is not clear whether this is of an increased incidence, increased awareness (ie, recognition of an abnormality as opposed to considering it an inconsequential finding), or increased identification because of an increasing prevalence of CT imaging. Whatever the reason, how to approach these patients is an issue that increasingly confronts clinicians. Through the evaluation of patient risk factors combined with computed tomography characteristics of solitary pulmonary nodules, including size, growth rate, margin characteristics, calcification, density and location; a clinician can assess the risk of malignancy. This literature will describe the evaluation and follow-up of pulmonary nodules based on several guidelines and how they apply to populations in Asia because of the different patient populations compare with Western countries ranging from risk factors, high infectious factors that can be confounding diagnosis and different genetic predispositions.

Introduction: Expansion appliance that can imply tooth movement and opening maxilla suture might affect the blood vessels, bone cells, and formation of the new bone. HBOT accelerated the rate of osteoblast differentiation leading to an increase in bone formation during osteonecrosis. Research about HBOT during maxillary suture expansion has never been investigated. The purpose of this research was to correlate the blood vessels number, osteoblast by administered 2.4 ATA HBOT from day 8-14 to imply new bone formation during maxillary suture expansion. Methods: Eighteen male guinea pigs with randomised post-test only control group design divided into 3 groups. Negative control group K(-), positive control with expansion appliance K(+), expansion appliance and HBOT (P). After 14 days guinea pigs were decapitated. Histological slide of the blood vessels number, osteoblast, and new bone formation were examined under a light microscope then were analysed by regression test. Results: Descriptive test showed increasing blood vessels number, osteoblast, and new bone formation on the administration of HBOT during maxillary suture expansion. Regression test showed that there was a strong correlation between the blood vessels number and osteoblast to the new bone formation with R=6.95 during maxillary suture expansion. Conclusion: 2.4 ATA HBOT influences the intercausal relationship between increasing blood vessels number, increasing osteoblast, and new bone formation during maxillary suture expansion.

Background: Multidrug-resistant pulmonary tuberculosis (MDR-TB) is a major health problem worldwide. Prompt diagnosis is necessary for insuring appropriate therapy to lower morbidity and mortality, as well as to prevent disease transmission. Determination of drug-resistance patterns through microbiological examination is sometimes challenging, especially when the sputum acid-fast bacilli smear is negative. Therefore, it is worthwhile to investigate whether there may be radiographic patterns suggesting MDR-TB infection. The objective of this study was to evaluate the radiographic features of MDR-TB. Methods: From September 2015 to March 2018, 167 patients with microbiologically proven MDR-TB were enrolled in the study. All radiographs were obtained before the patients received MDR-TB chemotherapy regimen. Posterior-anterior chest radiography was performed using digital radiography system (Hitachi Radnext50 500mAs) and retrospectively reviewed as digital raw data. Results: Based on severity category, 60% had severe lesion, 31% had moderate lesion, and only 9% had mild lesion. The most frequently observed findings were ground glass opacity or consolidation, noted in 96% patients, with bilateral lung involvement in 81% patients; fibrosis (95%), cavity (78%; 87% of which were multiple), interstitial opacities (53%), pleural thickening and mediastinal shift (59%). Other radiological findings were calcification (16%), emphysema (13%), lung destruction (12%), atelectasis (10%), nodule (8%), bullae (8%), bronchiectasis (5%), miliary pattern (1%), pleural effusion (25%), pneumothorax (1%), and hilar lymphadenopathy (14%) which predominantly unilateral. Conclusion: The presence of severe pulmonary lesion, ground glass opacity or consolidation with bilateral lung involvement, fibrosis, multiple cavities, interstitial opacities, pleural thickening, and mediastinal shift are the main features of MDR-TB.

Objective: To compare the incidence of bacteruria, bacteremia, and Systemic Inflammatory Response Syndrome (SIRS) after Transrectal Ultrasound (TRUS) of prostate biopsy for the patients whom given intrarectal povidone iodine, enema, prophylactic antibiotic with given enema and prophylactic antibiotic. Material & Methods: A Randomised, experimental study, 20 samples of men with suspicious of prostate cancer were divided into two groups, first group (control) were given enema (dulcolax supp 10 mg) and prophylactic antibiotic (ciprofloxacin 1000 mg), second group (treatment) were given enema (dulcolax supp 10 mg) prophylactic antibiotic (ciprofloxacin 1000 mg), and intrarectal povidone iodine befotre TRUS of prostate biopsy. Urine and rectal swab culture examination were performed before biopsy then urine, blood culture, and blood leucocyte 2 days after biopsy. To assess any bacterial translocation from rectum to urinary tract, we match the post biopsy urine culture antibiogram and rectal swab culture antibiogram before biopsy. Complications and serious adverse effects were also monitored. Outcomes were assessed using Unpaired T Test and Mann Whitney depends on the data distribution and homogeneity. Results: There was no significant difference bacteriuria between groups (p=0.26). Bacteremia and SIRS were not found within two groups 2 days after prostate biopsy. Post biopsy bacteriuria positive patients antibiogram were compared with pre biopsy swab rectal culture antibiogram, there was no significant difference between two groups. But, significant correlation of pre biopsy rectal swab culture with post biopsy urine culture (p=0.04) were noted. Conclusion: Intrarectal povidone iodine before TRUS of prostate biopsy were not needed as part of rectal preparation, since enema and prophylactic antibiotic was proven to decrease the incidence of bacteriuria, bacteremia, and SIRS after TRUS of prostate biopsy. The occurrance of bacteriuria were caused by bacterial translocation from rectum to urinary tract.

Objective: The aim of this study was to determine the characteristics of the testicular cancer that were managed in Soetomo Hospital. Materials & Methods: This was a retrospective descriptive study. We reviewed the medical records of patient with testicular tumor admitted in Soetomo Teaching Hospital Surabaya, from January 2008 until December 2013. The data regarding demographic characteristics, clinical presentation, grading and staging based on pathological examination result, and the management of the cancer. Data was presented in tabular and narrative in order to know the number and percentage of testicular cancer in Surabaya. Results: There were 46 patients with testicular cancer with mean age of 27.1 ± 7.9 years. Peak incidence was 15–35 years old (54%). Testicular mass was the most frequent clinical presentation in 42 patients (91%), abdominal mass and other complaints in 4 patients (9%). Most of the patients live outside Surabaya in 34 patients (72%). Location of the tumor was more frequently in scrotum, which occured in 42 patients (91%). A total of 4 patients (9%) were found to have a history of UDT. Based on the TNM staging, patients with stage pT3 were as many as 20 patients (43%), pT4 11 patients (24%), pT2 7 patients (15%) and pT1 4 patients (9%). In regional lymph nodes staging (N) N3 were as many as 26 patients (57%), N0 9 patients (20%), N2 5 patients (11%) and N1 2 patients (4%). Metastase staging (M) M0 was found in 27 patients (58%) and M1 tumor was found 42%. The major pathological finding was seminoma in 37 patients (80%), Yolk sac tumor in 4 patients (9%), Embryonal Ca in 1 patient (2%), Teratoma in 1 patient (2%) and mixed germ cell tumor in 3 patients (7%). The most widely theraphy was underwent orchidectomy followed by PEB chemotheraphy in 29 patients (64%), 3 patients (6%) underwent EBRT and PEB chemotheraphy, 5 patients (11%) underwent PEB chemotheraphy, There were 9 patients (19%) underwent orchidectomy alone. Group of seminoma tumor show normal limit of tumor marker α-FP and β-HCG and increased in non seminoma. Conclusion: Testicular cancer mostly appears in younger males. Most of testicular cancer was seminoma, diagnosed in advanced stage with metastase 42% of the patient. Most of the patients received orchidectomy followed by PEB chemotheraphy.

Background : Acute Coronary Syndrome (ACS) is a shift manifestations pattern of ischemic myocardium. Revascularization either with Primary Percutaneous Coronary Intervention (PCI) or pharmacological therapy is an optional treatment for ST Elevation Acute Coronary Syndrome (STEACS) patients. The aim of the study was to compare the functional capacity using six-minute walking test on STEACS patients who underwent Primary PCI or pharmacological therapy. Methods : A cross sectional study was conducted from September to October 2012 to 35 STEACS patients who were treated after two years. The samples were obtained from the list of patients at Dr. Hasan Sadikin General Hospital. Inclusion criteria consisted of patients diagnosed as STEACS, cooperative and not experiencing cognitive disturbance. The exclusion criteria were STEACS patients with unstable angina or myocardial infarct in the last month, stable exertional angina, and pregnant women. The patients underwent 6 minutes walking test,VO2max was measured using theCalahin and Cooper formula, then Metabolic Equation Task (METs) was calculated. Data were analyzed by unpaired T-test. Results : There were 19 Primary PCI and 16 pharmacological therapy patients. The average of age between the two groups was distributed evenly. Most of the STEACS patients were male, had a college/academic degree and were retired. Patients treated with pharmacological therapy had higher average of VO2 max and METs than patients with Primary PCI. There was no significantly differences of METs between those groups (p>0.05) Conclusions : There were no significantly differences of functional capacity in STEACS patients treated with Primary PCI or Pharmacological therapy. [AMJ.2015;2(1):162–6]

Introduction: Medical malpractice and prostate cancer screening are important issues in the current landscape of health care. We identified factors contributing to litigation in the diagnosis of prostate cancer. Methods: We used the Westlaw database to search for jury verdict reports using the term medical malpractice combined with prostate cancer with dates ranging from January 2000 to December 2013. Each case was examined for trial year, patient age, prostate specific antigen at alleged breach of duty and at diagnosis, defendant specialty, alleged cause of malpractice, whether there was metastasis, the outcome of cases that went to trial or were otherwise settled, and the plaintiff award. Results: The initial search produced 256 results, which was narrowed to 106 cases. Of these cases 64.1% went to trial, including 66.2% that were decided for the defendant. The mean out of court settlement was $945,000, significantly lower than the mean plaintiff verdict award of $2.1 million (p ¼ 0.0009). Primary care physicians (74.1%) were the most commonly named defendants, followed by urologists (19.6%). The most common cause was failure to perform an initial prostate specific antigen test (26.8%), followed by failure to follow elevated prostate specific antigen (22.3%). Conclusions: Causes of malpractice revolved mostly around prostate specific antigen testing. Primary care physicians and urologists must continue to educate patients to minimize malpractice claims made in this setting. It will be important to follow data to see trends following recent guidelines.

Pneumonia is the leading cause of death in children. Many factors can influence the increased incidence of pneumonia in young children, Among them are age, sex, nutritional status, low birth weight, immunization status, Exclusive breastfeeding, and vitamin A. This study aims to determine the relationship of exclusive breastfeeding, supplements vitamin A, and zinc intake with the incidence of pneumonia in children under five in sub-district Puskesmas Puuwatu Puuwatu Kendari This study uses a case-control design. Take place at sub-district Puskesmas Puuwatu Puuwatu Kendari. A sample of 32 samples taken using P = prevalence of LBW infants (0.092%), d = absolute precision (10%), Z = confidence interval (95% = 1.96). Taken with accidental sampling technique, and performed on samples Matching namely age, where the age of the sample of cases and controls were age 1 to 5 years. Data analysis was conducted to see the value Odds Ratio (OR), Odds Ratio (OR) = ad / bc with confidence interval (CI) = 95%. The results showed that young children who are not breastfed Exclusive 3.4 times greater risk of pneumonia compared with exclusive breastfeeding of children under five, which marked the value of OR = 3.40. Infants and children who do not complete vitamin A supplementation 2.4 times greater risk of developing pneumonia than children under five who complete vitamin A supplementation, which marked the value of OR = 2.49. Infants and children who lack their zinc intake were 2.4 times greater risk of pneumonia compared with toddlers sufficient intake of tin, which is marked with OR = 2.43. This study concluded that children who are not breastfed Exclusive have an increased risk of pneumonia. Supplementation with vitamin A complete and sufficient zinc intake in children under five among children could reduce the incidence of pneumonia.

Purpose: Assess the efficacy of combined α1-adrenergic blocker (tamsulosin 0,4 mg) and PDE5 inhibitor (tadalafil 5 mg) therapy compared to tadalafil or tamsulosin alone in treating patient BPH with LUTS and ED. Material and methods: A randomised, double blind experimental study assessed 36 sexually active men with ED and LUTS suggestive of BPH. All patients were randomized to 3 groups: tamsulosin 0,4 mg (n=12), tadalafil 5mg (n=12), and combination of tamsulosin 0,4 mg and tadalafil 5 mg (n= 12), once daily for 6 weeks. Changed in IPSS scores and QoL index, IIEF-5 scores, Qmax, PVR and blood pressure were assessed and compared to baseline. Complication and serious adverse event were also monitored. Outcomes were assessed using ranked analysis of variance (ANOVA) and Kruskall-Wallis depends on data distribution and homogenity. Results: Tamsulosin 0,4 mg once daily for 6 weeks were significantly improved IPSS score and QoL index and Qmax from baseline. Tadalafil 5 mg once daily for 6 weeks were significantly improved IPSS score, QoL index and IIEF-5 index from baseline. Combined tamsulosin and tadalafil therapy were significantly improved IPSS score, QoL index, IIEF-5 index and Qmax from baseline. Significantly better improvement on IIEF-5 dan Qmax from baseline were observed on the combination of tamsulosin and tadalafil compared to monotherapy with tamsulosin or tadalafil after 6 weeks in patients BPH with LUTS and erectile dysfunction. There was no significant decreased in systolic and diastolic blood pressure from combined treatment compared to single treatment. Conclusions: Combined tamsulosin and tadalafil therapy was significantly better in improving IIEF a Objective : Assess the efficacy of combined α1-adrenergic blocker (tamsulosin 0.4 mg) and PDE5 inhibitor (tadalafil 5 mg) therapy compared to tadalafil or tamsulosin alone in treating patient Benign Prostate Hyperplasia (BPH) with lower urinary tract symptom (LUTS) and erectile dysfunction (ED). Material & methods: A randomised, double blind experimental study assessed 36 sexually active men with ED and LUTS suggestive of BPH. All patients were randomized to 3 groups: tamsulosin 0.4 mg (n=12), tadalafil 5mg (n=12), and combination of tamsulosin 0.4 mg and tadalafil 5 mg (n= 12), once daily for 6 weeks. Changed in IPSS scores and QoL index, IIEF-5 scores, Qmax, PVR and blood pressure were assessed and compared to baseline. Complication and serious adverse event were also monitored. Outcomes were assessed using ranked analysis of variance (ANOVA) and Kruskall-Wallis depends on data distribution and homogenity. Results: Tamsulosin 0.4 mg once daily for 6 weeks were significantly improved IPSS score, QoL index and Qmax from baseline. Tadalafil 5 mg once daily for 6 weeks were significantly improved IPSS score, QoL index and IIEF-5 index from baseline. Combined tamsulosin and tadalafil therapy were significantly improved IPSS score, QoL index, IIEF-5 index and Qmax from baseline. Significantly better improvement on IIEF-5 dan Qmax from baseline were observed on the combination of tamsulosin and tadalafil compared to monotherapy with tamsulosin or tadalafil after 6 weeks in patients BPH with LUTS and erectile dysfunction. There was no significant decreased in systolic and diastolic blood pressure from combined treatment compared to single treatment. Conclusion: Combined tamsulosin and tadalafil therapy was significantly better in improving IIEF and Qmax, but not significantly better in improving IPSS and PVR compared to monotherapy with tamsulosin or tadalafil alone. Combined therapy was well tolerated without serious adverse effect. nd Qmax, but not significantly better in improving IPSS and PVR compared to monotherapy with tamsulosin or tadalafil alone. Combined therapy was well tolerated without serious adverse effect.

Objective: We studied the efficacy and safety of lubricating jelly instillation before ureterolithotripsy for prevention of retropulsion and improvement in stone-free rate. Material & methods: We enrolled 22 subjects with ureteral stone in this prospective, randomized, single-blind and controlled clinical trial. Each subject was randomly assigned to the lubricating jelly instillation group (n=11) and control group (n=11). Ureteroscopy and lithotripsy was performed according the standard protocol, using 9.8 F semirigid ureteroscope and pneumatic lithotripter. A 6 F ureteral catheter was advanced beyond the stone, and lubricating jelly was instilled through the catheter lumen. Retropulsion and the presence of residual fragments were evaluated with plain kidneys, ureters and bladder x-ray and ultrasonography, or Non Contrast-enhanced Computed Tomography. Any complication was reported and graded using the Modified Clavien Classification System.Results: The 2 groups had comparable preoperative characteristics. There were no statistically significant difference between the lubricating jelly instillation group and control group regarding the retropulsion rate (54.5% vs 72.7%, ρ=0.375), the stone-free rate (54.5% vs 36.4%, ρ=0.392), and the complication rate (45.5% vs 54.5%, ρ=0.670). Conclusion: Lubricating jelly instillation during ureterolithotripsy has limited value for prevention of retropulsion and improvement in stone-free rate.

Objective: Analyzing the differences between collagen thicknesses in periurethral region from transurethral resection of the prostate (TURP) specimens of Benign Prostate Hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and of those with urinary retention. Material & methods: This was an observation analytic study on 30 patients who underwent TURP. Patients who met the inclusion criteria were divided into 2 groups: BPH patients with LUTS and those with urinary retention. Each group consisted of 15 people. The first TURP specimen of proximal verumontanum resection were examined in anatomic pathology using mass on strichrome staining as an examination of periurethral collagen thickness. Collagen will be stained as blue. Periurethral collagen thickness was measured from the basal membrane of transitional epithelium to fibromuscle tissue. Data were then statistically analyzed using independent t-test. Results: The average patient age was 66 ± 7 years old and there was no significant difference between age and periurethral collagen thickness with p=0.175 (p>0.05). The mean prostate volume was 47.19 ± 13.2 ml and there was no significant difference between prostate volume and periurethral collagen thickness with p=0.148 (p>0.05). Average periurethral collagen thickness in BPH patients with urinary retention was 146.67 ± 39.80 micrometers and while in those with LUTS was 205.33 ± 85.6 micrometers. There were no significant differences between periurethral collagen thickness and the occurrence urinary retention with retention of urine with p=0.063 (p>0.05). Conclusion: There were no significant differences between periurethral collagen thickness patients in BPH patients with LUTS and in those with urinary retention. This suggests that periurethral collagen thickness is not associated with the occurrence of urinary retention or LUTS in BPH patients.

Objective: This study was conducted to determine the correlation between Presume Circle Area Ratio (PCAR) and IPSS score, Qmax, and post voiding residual urine (PVR) and to find PCAR cut-off value in determining the presence Bladder Outlet Obstruction (BOO) in Benign prostatic hyperplasia (BPH) Lower Urinary Tract Symptoms (LUTS). Materials & Methods: This study was observational analytic study with 30 BPH LUTS patients as subjects during the period September 2015 to January 2016. The determined variables were PCAR, IPSS score, Qmax, post voiding residual urine (PVR) and analyzed using the SPSS program v21. Results: There were 30 patients who met the inclusion and exclusion criteria with the mean age of 67.47 years. In the correlation test, there was insignificant correlation between PCAR with IPSS (r=0.138, p=0.467), a significant correlation between PCAR with Qmax (r=0.468, p=0.009), PCAR with PVR (r=0.399, p=0.029), PCAR with BOO (r=0.491, p=0.006) PCAR cutoff value is 0.65 with sensitivity of 69% and specificity of 71%. Conclusion: PCAR has a significant correlation with PVR, Qmax and BOO but no significant with IPSS score. PCAR value >0.65 indicating BOO in BPH LUTS. PCAR can be used as an alternative non-invasive examination in determining the existence of BOO.

Objective: To investigate free-stone rate after Percutaneous Nephrolithotomy (PNL) using S.T.O.N.E nephrolitometry scoring system, with regards of stone size (S), skin-to-stone distance (T), obstruction degree (O), number of calyx involved (N), and stone density (E) in Non Contrast CT Scan (NCCT). Material & methods: This is an analytic observational study on patients with renal stones undergoing PNL. All patients underwent NCCT before and after PNL; each variables was measured and counted for a total score. Post-operative evaluation was done using NCCT. Results: Thirty patients met inclusion criteria, 19 (63.3%) were stone-free, and 11 (36.7%) were with residual stone. Among the five variables, stone size (p=0.005), number of calyx involved (p=0.002) affected the outcome of surgery, while skin-to-stone distance, obstruction degree, and stone density did not. The overall total score of S.T.O.N.E nephrolithometry is correlated with the outcome of PNL (p=0.001). Conclusion: S.T.O.N.E nephrolithometry is a simple scoring system, while it is also easy to use, and can be used to predict the free-stone rate after PNL.

Objective: The aim of this study is to analyze the effect of perioperative and prophylactic antibiotics against the incidence of urinary tract infections (UTI) and surgical site infections (SSI) after hypospadias surgery (hypospadias repair operation). Materials & Methods: This study is an observational study of explanation with 24 hypospadias patients (2 groups) during the period of October 2015 to February 2016. Samples were divided into two groups, 12 patients received prophylactic antibiotics and 12 patients received perioperative antibiotics (random sampling). Inclusion criteria included patients with glandular hypospadias to proximal penile hypospadias, aged 6 months until 15 years and underwent hypospadias surgery with one surgical technique namely Tubularized Incised Plate (TIP). The examination of urine culture and evaluation of the wounds were performed on day 4, 10, and 20 day after surgery to determine the incidence of urinary tract infections and surgical site infections. Results: There is no significant difference in the incidence of UTI on on day 4, 10 and 20 in perioperative group and prophylaxis group with p=0.282 and p=0.500 at day 4 and 10 (p>0.05). There is no significant difference in the incidence of SSI on day 4, 10 and 20 in the group of perioperative antibiotic and prophylactic antibiotic with p=0.680 and p=0.217 at day 4 and 10 (p>0.05). Conclusion: There is no effect of the prophylactic antibiotic as well as perioperative antibiotic treatment on the incidence of UTI and SSI

Objectives: We analyze our data of patients with urinary retention that have been managed in Soetomo general hospital to know our prevalence, causes and its management. M aterial & m ethods : We retrospectively reviewed the medical records of the patients with urinary retention who admitted on our department between January 2011 and December 2012. Results : During 2 years between January 2011 until December 2012 , a total number of urinary retention was 295 cases among 1282 urology emergency cases, with sex ratio of urinary retention in men and women was 85.7% : 14.3%. Of the study population 264 (89.5%) presented with acute urine retention while 31 (10.5%) had chronic urine retention. Most of urinary retention was caused by bladder stone (33.3%) in children, urethral stricture (26.8%) in young adult men, BPH (71.3%) in elder men and cystitis (26.3%) in women. Trial of voiding without catheter (TWOC) that performed in 60 of the BPH patients, was succeeded in 43 (71.6%) of the patients and failed in 17 (28.4%). Emergency treatment of urinary retention were urethral catheter (83.7%) and cystostomy (16.3%). Conclusion : Urinary retention is one of emergency in urology that most common occur in men. Urine retention found among the participants was mainly AUR rather than CUR. Most of urinary retention was caused by bladder stone in children, urethral stricture in young adult men, BPE in elder men and cystitis in women. The most emergency management was urethral catheter. Trial of voiding without catheter showed a high success rate, so it can be considered as definitive non-surgical therapy in selective patient.

Introduction Erectile dysfunction (ED) is a common problem with significant impact on patient quality of life. Penile prosthesis implantation provides an effective treatment for ED but as an invasive procedure carries with it an increased risk of medicolegal liability. Aim To investigate factors associated with malpractice litigation surrounding penile prosthesis implantation. Methods The Westlaw legal database was used to perform an advanced search for case reports using the term “medical malpractice” in combination with “penile” or “penis” and “prosthesis” or “implant” with dates between the January 1990 and December 2013. Main Outcome Measures Each report was examined for trial information including patient demographics, device model and indications, alleged breach of duty, alleged damages, progression to trial, case outcome, and plaintiff award(s). Results The initial search yielded 76 cases that were narrowed to 40 after exclusions. There were 23 (57.5%) cases that were found in favor of the defendant, while 17 (42.5%) cases led to indemnity payment to the plaintiff including two cases (5.0%) that were settled out of court and 15 (37.5%) favoring the plaintiff in front of a jury. The mean settlement received was $335,500 compared with the mean indemnity award of $831,050 for verdicts decided in favor of the plaintiff ( P = 0.68). The most common breach of duty was error in surgical decision making, present in 20 cases (48.8%). Informed consent was an issue in 13 filings (31.7%), and postoperative infection was seen in 13 cases (31.7%). In cases that identified the type of implant used, 58.3% were malleable implants, and 41.7% were inflatable devices. Conclusions The main issues involved in malpractice litigation for penile prosthesis implants included surgical performance, informed consent, and postoperative management. Urologists must be aware of these potential issues in order to minimize their malpractice liability. Sunaryo PL, Colaco M, and Terlecki R. Penile prostheses and the litigious patient: A legal database review. J Sex Med 2014;11:2589–2594.

Objective To evaluate the current practice patterns of vesico-ureteric reflux (VUR) management and screening among paediatric urologists and their relationship with the current American Urological Association (AUA) guidelines in managing and treating VUR. Subjects and Methods A 17-question survey was sent out to 476 paediatric urologists who are members of the Society for Pediatric Urology (SPU). In all, 133 respondents answered the survey and results were included for all questions. Results Paediatric urologists who were surveyed were consistent with the 2010 AUA guidelines in the initial evaluation of children with VUR, continuous antibiotic prophylaxis for the child aged 1 year, and follow-up evaluation in children with VUR. Most paediatric urologists do not obtain a serum creatinine on initial screening of children with VUR. The new guidelines address screening of siblings of patients with VUR and most paediatric urologists were consistent with these recommendations. Almost one third of responders screened all neonates diagnosed with prenatal hydronephrosis regardless of clinical history or findings on imaging despite the recommendations of the new guidelines. Conclusion We conclude that based on our present sample, most paediatric urologists follow the 2010 AUA guidelines on VUR management.

Background Schwannomas of the anterior skull base (ASB) and sinonasal tract are extremely rare. These lesions mimic other pathologies such as olfactory groove meningiomas, hemangiopericytomas, and esthesioneuroblastomas. Because of their low incidence, ASB and sinonasal tract schwannomas have not been well characterized. A systematic review of ASB and sinonasal tract schwannomas was conducted to further elucidate the presentation and surgical management of these lesions. Methods A MEDLINE/PubMed search was performed, identifying 71 articles representing 94 cases of ASB and sinonasal schwannomas. Each case was analyzed for demographics, clinical presentation, anatomic location, radiographic features, and surgical treatment. Results In 94 patients with ASB and sinonasal schwannomas, 44 (46.8%) were exclusively sinonasal, 30 cases (31.9%) were exclusively intracranial, 12 (12.8%) were primarily intracranial with extension into the paranasal sinuses, and 8 (8.5%) were primarily sinonasal with intracranial extension. Headaches and nasal obstruction were the most common presenting symptoms occurring in 30.9 and 29.8% of cases, respectively. Magnetic resonance imaging typically showed a hyperintense mass on T2-weighted imaging (70%) and hypointense (41%) on T1-weighted imaging. Most patients underwent surgical gross total resection via craniotomy, endoscopic endonasal approach, rhinotomy, or other sinonasal approaches. Recurrence occurred in three cases ranging from 4 months to 13 years. Postoperative complications included cerebral spinal fluid leakage, bacterial meningitis, epidural hematoma, and pneumocranium. Conclusion ASB and sinonasal schwannomas are rare lesions and should be considered in the differential diagnosis of ASB masses involving the cribriform plate with sinonasal extension. Gross total resection of these lesions should be considered the goal of operative management.

Non-communicable diseases (NCDs) are chronic diseases that are not transmitted from person to person. Each year 41 million people die due to NCDs. From 1995 to 2007 (12 years), Indonesia has undergone an epidemiological transition in which deaths from NCDs increased, while deaths due to infectious diseases declined. Prevalence of NCDs in the Special Region of Yogyakarta (DIY) has also continued to increase in 2007-2013. We conducted research to obtain a description of body mass index, blood pressure, and random blood glucose in Jaten, Sinduadi, Mlati, Sleman, DIY as early screening for NCDs. This research was a retrospective study using data obtained from the records from a medical check-up done in a community service program on August 19, 2018. Data obtained included age, height, weight, blood pressure, and random blood glucose levels. A total of 96 people were screened. Most (72.9%) participants were adults (aged ≥ 20 years to ≤ 59 years). Results of the screening showed that 43% of participants were overweight or obese, 70% had hypertension, and 5.7% had the random blood glucose of ≥ 200 mg/dL. The percentage of obesity, hypertension, and diabetes mellitus in Jaten Hamlet are relatively high, indicating a need for long term education and intervention to decrease NCDs prevalence and complications.

Background: Improved functional capacity (FC) and inflammatory marker reduction is a good prognostic factor in post-revascularization cardiac patients. However, there is still limited study investigated association of functional capacity and inflammatory marker after cardiac rehabilitation program. We studied the effects of cardiac rehabilitation (CR) program in the improvement of FC and high-sensitive-C Reactive Protein (hs-CRP) reduction and association between those variables.Methods: This was quasi experimental study in post-revascularization CAD patients who attended phase II CR program at CR gymnasium, Dr. Hasan Sadikin General Hospital, Bandung, from October 2014 to May 2015. The CR program included additional education sessions and consistently strict program intensity on 50-80% heart rate reserve based on formula and Borg scale 11 to 15. Functional capacity and hsCRP were measured before and after the program. Functional capacity was assessed by maximal treadmill test through indirect VO2 max measurement.Results: A total of 37 patients aged 56.05±7.3 years old were analyzed in this study. They consisted mainly of men (81.1%) which 78.4% of them underwent percutaneous coronary intervention (PCI). Our study revealed significant FC improvement after completion of this newly-modified CR program from an average of 6.76 to 8.68 METs (28.4%) ( p