Studies about the prevention effect of Moringa oleifera on liver fibrosis has been reported. However, its curative effect has not been reported, yet. This study was conducted to evaluate the curative effect of M. oleifera leaf extract on liver fibrosis. It was a laboratory experimental study with a post-test-only control group design. Rats were divided into 5 groups i.e. normal control which received intraperitoneally injections of 1 mL/kg BW of 0.9% NaCl solution twice a wk for 11 wk. Liver fibrosis control which received intraperitoneally injections of 1 mL/kg BW of 10% CCl4 solution twice a wk for 11 wk. Three M. oleifera treatment group which received intraperitoneally injections of 1 mL/kg BW of 10% CCl4 solution twice a wk for 11 wk continued by M. oleifera leaf ethanolic extract at dose of 600 mg/kg BW daily for 3 (MO3), 6 (MO6), and 10 (MO10) wk, respectively. The liver fibrosis level was assessed based on the METAVIR score. Histopathological analysis of liver tissues demonstrated that the 11-week CCl4 induction successfully resulted in liver fibrosis in rats (F3 and F4). The administration of M. oleifera leaf ethanolic extract decreased METAVIR scores ranged from F3 to F1. The optimal reduction of the METAVIR scores (F1) was observed in MO3 group after 6 wk administration (p<0.05). It was indicated that M. oleifera leaf ethanolic extract ameliorated liver fibrosis. In conclusion, M. oleifera leaf ethanolic extract has a curative effect against liver fibrosis.

Allergic bronchopulmonary aspergillosis (ABPA) is a common form of fungal-related asthma disease mainly caused by Aspergillus fumigatus. The increasing prevalence of asthma globally and the characteristic of Aspergillus are very easily dispersed in the air to inhale, leading to increased cases of ABPA in asthma patients. Inhalation of conidia Aspergillus spp. can trigger asthma exacerbations due to poor mucociliary clearance. However, the exact pathogenesis is still unclear. Clinical features commonly found in ABPA patients are productive cough with dark green or brown mucus or even hemoptysis. Several criteria for establishing the diagnosis of ABPA can be based on clinical features, laboratory examinations, and imaging, but none has become the gold standard. However, the primary laboratory test utilized for ABPA screening is the measurement of serum-specific IgE levels to A. fumigatus, owing to its high sensitivity. Despite the challenges in finding the most fitting universal consensus, most clinicians still follow the criteria proposed by Rosenberg et al. in 1977. The recommended ABPA treatment is prednisone and/or azole antifungal agents such as itraconazole. In addition, the potential of monoclonal antibodies in ABPA therapy is still under further research. Long-term diagnosis and treatment delays can lead to complications such as bronchiectasis and fibrosis. This review aimed to highlight ABPA in asthma patients, from etiopathogenesis to managing the disease

Fine needle aspiration biopsy (FNAB) is a relatively non-invasive diagnosis of musculoskeletal lesions that is very challenging in some musculoskeletal cases. This study aimed to evaluate the diagnostic utility of FNAB in musculoskeletal lesions. This was a retrospective cross-sectional study involving 180 musculoskeletal patients who underwent FNAB procedure, with or without ultrasound-guided in the Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta between 2018 and 2021. The obtained data were then statistically analyzed for sensitivity, specificity, and accuracy. Of 180 cases, 90 (50%) were confirmed with histopathology examination. Further analysis revealed that 33 cases were confirmed positive, 45 patients were true negative, 2 cases were false positive, and 10 were cases false negative. The overall diagnostic sensitivity, specificity, and accuracy of FNAB in musculoskeletal lesions were 76.8, 95.7, and 83%, respectively. FNAB can lead to misinterpretation in cases that show similar morphologic features. Therefore, clinical information and imaging results are necessary to be correlated. In conclusion, FNAB is an efficient and effective technique for early diagnosis in musculoskeletal cases. FNAB can be used to establish the diagnosis of an inoperable tumor because of its high accuracy.

It is estimated that 15 people for every 1000 Indonesian residents suffer from cardiovascular disease (CVD) including ST-segment elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) is often performed in patients with STEMI. Several factors affect clinical outcome after PCI procedure including multivessel coronary artery disease. This study aimed to measure the impact of multivessel coronary artery disease on the early and late outcomes of STEMI patients undergoing PCI procedures. This was a prospective cohort study on STEMI patients undergoing PCI procedures from the period of August to December 2021. Two expected cohorts were performed i.e. patients who suffered from single-vessel disease (SVD) and patients who suffered from multivessel disease (MVD). Forty six patients with STEMI were enrolled in this study consisting of 24 (52.17%) patients with MVD and 22 (47.83%) patients with SVD. No significant difference in baseline characteristics between MVD and SVD groups was observed (p > 0.05). The MVD group (91.67%) used a more radial percutaneous approach compared with the SVD group (54.55%; p = 0.04). In addition, no significant difference between the SVD group and the MVD group in major adverse cardiovascular events (MACE) and echocardiographic outcome after 90-d follow up was observed (p > 0.05). In conclusion, MVD has similar impacts on early and late clinical outcomes compared with SVD in STEMI patients undergoing PCI procedures.

Prostate cancer (PCa) is the most frequent cancer diagnosed worldwide and the second most common malignancy in men. IL-4 is one of cytokines related to the inflammation process. An increase level of IL-4 in patients with PCa might be related to progression to castrate-resistance prostate cancer. Programmedcell death-ligand 2 (PD-L2) plays an important role in the anti-tumor immune system, however the exact mechanism is not fully understood. This study aimed to investigate the correlation between IL-4 and PD-L2 expression with the clinicopathological characteristic of PCa. The IL-4 and PD-L2 examinations wereperformed using quantitative real-time polymerase chain reaction (qRT-PCR) while clinicopathological characteristics were described by the Gleason score and International Society of Urological Pathology (ISUP) grade. Data collected were then analyzed using Pearson and Spearman test. In total, 20 patients withPCa tissue were collected between 2015 and 2020. The mean level of IL-4 and PDL2 were higher in metastatic PCa/M-PCa (105.64 and 665.42 ng/mL) compared to non-metastatic PCa/NM-PCa (41.62 and 215.06 ng/mL). A significant difference with medium correlation between IL-4 and PD-L2 with Gleason score and ISUPgrade was observed on all samples (p = 0.035 and 0.045; r = 0.454 and 0.473). However, no significant difference with weak correlation was observed on each group (p = 0.136 and 0.858; r = 0.065 and 0.506). Interestingly, there was a significant difference with very strong correlation observed between IL-4 andPD-L2, both on all samples (p = 0.001; r = 0.955) and on each group (p = 0.001 and 0.001; r = 0.917 and 0.955). In conclusion, there is a correlation between IL-4 and PD-L2 with the clinicopathological characteristics of PCa.

Osteosarcoma is the most common primary bone tumor malignancy, accounting for 30 - 80% of all primary bone tumors. It is presented in a bimodal distribution manner with the age of onset divided into two groups, 10-20 and >60 y.o. Various factors have significance in the patient's prognosis, including the expression of cyclin-dependent kinase 4 (CDK4). This CDK4 has an essential role in the pathogenesis of osteosarcoma through inactivation of the Rb gene, which is associated with the patient's survival. This study was conducted to evaluate the correlation between CDK4 expression and the survival of osteosarcoma patients. It was a cross-sectional study involving 50 patients diagnosed with osteosarcoma based on clinical, radiological, and histopathological examination. Available formalin-fixed paraffin-embedded (FFPE) samples were retrieved for immunohistochemical (IHC) staining of CDK4. The survival data was collected from medical records. CDK4 expression and survival data were analyzed statistically using the Kaplan-Meier curve. Out of 50 subjects, CDK4 was found to be expressed in 38 samples (76%). The group with negative CDK4 showed a slightly longer overall survival (by 0.2 mo) than the positive CDK4 group. However, these results were not statistically significant (p = 0.821). In conclusion, the overexpression of CDK4 may not directly affect the survival rate in osteosarcoma. Other factors need to be considered to understand the complexity of the disease.

Digestive surgery is a treatment for diseases of the parts of the body involved in digestion, which has a fairly high risk of infection. The study aimed to obtain a description of the types and specific characteristics of patients and the rationality of antibiotic use among digestive surgery patients. This study was conducted using observational analysis. Data on antibiotic use was collected prospectively from medical records of digestive surgery inpatients at the Academic Hospital Universitas Gadjah Mada (UGM) from January to March 2023. The Gyssens method was used to evaluate qualitatively the use of antibiotics. A total of 76 patients met the inclusion and exclusion criteria. No significant difference between the number of male and female patients was identified. The results showed that 24 (31.58%) acute appendicitis patients are the primary diagnosis most often encountered in patients undergoing digestive surgery. The most frequently used prophylactic antibiotics for digestive surgery patients were ceftriaxone (53.85%) and cefazolin (41.03%). Meanwhile, the most frequently used therapeutic antibiotics were ceftriaxone (41.94%) and levofloxacin (29.03%). The Gyssens analysis shows that large irrational use of antibiotics is still observed.

Dry skin is one of the most common dermatoses found in the elderly. Vitamin D is an essential fat-soluble vitamin that has a role in repairing the skin barrier. Topical administration of vitamin D3 is expected to increase skin hydration in the elderly. Thirty-two participants were divided into two groups, namely 5000 IU vitamin D3 and the base lotion groups. The assessment was carried out by calculating the overall dry skin score (ODS), transepidermal water loss (TEWL), and skin capacitance every 4 wk for 12 wk. All groups showed an improvement in ODS, a decrease in TEWL, and an increase in skin capacitance value at the end of the measurement, and no significant side effects were reported. The 5000 IU vitamin D3 lotion group had the highest level of skin hydration compared to the other group (p>0,05). We conclude that the administration of 5000 IU vitamin D3 lotion may be administrated safely and improve skin hydration in the elderly but is not more effective than base lotion.

Venous thromboembolism (VTE) is a significant complication in patients after undergoing major surgery. The type of surgery is believed correlated with the incidence of VTE. This study aimed to evaluate the correlation between type of surgery and incidence of VTE among patients who underwent major surgery. It was a retrospective study conducted in Dr. Sardjito General Hospital, Yogyakarta using medical record data of patients who underwent major surgery and were diagnosed with VTE between 2016 and 2020. Patients were grouped by surgery type, and length of stay (LoS). All caused deaths were also analyzed. Among 29,120 patients who underwent major surgery, 76 (0.26%) experienced VTE with females patients accounting for 75%. The mean age of the patients was 55 yr. All VTE cases had the mean LoS of 25 d. The highest proportion of patients who experienced VTE were patients who underwent tumor removal (67.0%) followed by trauma patients (18.4%). A significant difference in the incidence of mortality between the surgical groups was reported (p = 0.02). Post-cardiology had the highest risk of mortality (OR=7.46; 95% CI: 0.322 - 172.61) while age had the lowest risk of mortality (OR=1.01; 95% CI: 0.953 - 1.071). In conclusion, surgery type is correlated with the incidence of VTE. Surgery due to cancer and trauma has a higher risk of VTE compared to the others.

Total atrioventricular (AV) block is the most common type of conduction disorder found in acute coronary syndrome (ACS), which requires timely recognition and treatment. This case report aimed to present conservative medical treatment for managing total AV block (TAVB) in a very high-risk non-ST-elevation myocardial infarction (NSTEMI) in a rural area. We reported a patient with TAVB in a very high-risk NSTEMI. The patient was hemodynamically unstable and needed immediate percutaneous coronary intervention (PCI). Due to limited facilities and difficult access to immediate PCI, the patient was treated conservatively with the NSTEMI protocol. Epinephrine, as a β-adrenergic agonist, was administered to improve hemodynamic status. During conservative treatment, TAVB was converted into the first-degree AV block on the third day of intensive care. In a setting where revascularization strategies and pacemaker implantation are not feasible, administration of antithrombotic agents and β-adrenergic agonists can be considered to manage TAVB with NSTEMI with close monitoring.