Introduction: Cardiovascular diseases are a major global health concern, with atherosclerosis being a significant contributor. Diabetes mellitus is a well-known risk factor for atherosclerosis, and SGLT2 inhibitors are more effective in reducing cardiovascular disease and mortality compared to other antihyperglycemic agents in patients with type 2 diabetes. Endothelial dysfunction, VSMC phenotypic alterations, inflammation, autophagy, oxidative stress, signaling hormones and dysbiosis are crucial factors and predictors of atherosclerosis and other cardiovascular events. SGLT2 inhibitors have been shown to alleviate these components in atherosclerotic models. Material and Methods: To proceed we analyzed and took into account all publications, including clinical trials, animal studies, in vitro observations, reviews, and meta-analyses from various scientific databases. Results: Evidently, SGLT2i attenuate the progression of atherosclerosis by repressing vascular inflammation, oxidative stress, endothelial dysfunction, mitigating vascular smooth muscle cells function, impairing foam cell formation, preventing platelet activation and restoration of normal autophagic function. Conclusion: Based on these findings, it can be inferred that SGLT2 inhibitors exhibit anti-atherosclerotic characteristics and may have positive implications for the management of atherosclerosis, particularly in individuals with diabetic complications.

Introduction: It has been suggested that coronavirus infection (COVID-19) in pregnant women may be influenced by vitamin D deficiency (VDD). The physiological changes brought on by pregnancy, and the body's partial immune suppression make pregnant women more susceptible to vitamin D deficiency and viral infections. Therefore, this review aims to synthesize the current information on the link between vitamin D levels and the risk of COVID-19 in pregnant women. Material and Methods: A systematic search is conducted in PubMed, ScienceDirect, and Google Scholar. Articles retrieved were screened based on the PRISMA 2020 guidelines. Studies that assessed the effect of vitamin D levels on pregnant women with COVID-19 infection were considered for the review. Odds ratios with their 95 percent confidence intervals (CI) from a meta-analysis using a random-effects model were reported. Results: Three eligible studies were relevant to the relationship between vitamin D deficiency and COVID-19 infection in pregnant women (n=1005). The metanalysis showed that vitamin D deficiency in pregnant women was 1.8 times (95% confidence interval, OR 1.72 to 1.88; p=0.0005) more likely to be infected with COVID-19. Conclusion: According to our results, vitamin D deficiency in pregnant women may increase the risk of COVID-19 infection. Therefore, we recommend adequate vitamin D levels to prevent COVID-19 and its severity.

Human immunodeficiency virus (HIV) infection and sexually transmitted infections (STIs) remain a public health problem and extend to social, economic, and cultural issues. HIV cases in the Southeast Asia region account for 10% of the total global HIV burden. In Indonesia, there are five provinces with the highest number of HIV cases as of December 2021, including DKI Jakarta (73,442), East Java (68,112), West Java (49,435), Central Java (42,012), and Papua (40,277). In Indonesia in 2021, the number of people living with HIV (ODHIV) reported was 36,902 and in 2022 up to the third quarter (July - September 2022) there were 34,213 people. New HIV infections in Indonesia continue to decline, in line with the global decline in new HIV infections. However, this decline has not been as large as expected.

Introduction: The syndrome of HELLP, often a complication of severe pre-eclampsia, is influenced by factors like multiparity, advanced maternal age, and potential genetic associations. Intramural Myoma have been linked to a 44% increased risk of hypertension in pregnant women, potentially contributing to the initiation and progression of pre-eclampsia, particularly due to their rapid expansion during pregnancy. This study reported a patient with intramural myoma and HELLP Syndrome in 35-36 weeks of gestation age. Case Presentation: A 40-year-old woman in her 35-36 weeks of gestation sought emergency care at General Hospital Dr. Saiful Anwar Malang due to escalating severe headaches. As a third-time expectant mother with a history of five antenatal visits, she presented with elevated blood pressure (219/110 mmHg), a BMI of 32 kg/m2, and various concerning findings, leading to a diagnosis of impending eclampsia, severe preeclampsia (HELLP syndrome), fetal distress, severe hypoalbuminemia, intrauterine growth restriction (IUGR), and other complications. The patient underwent an urgent cesarean section, revealing an intramural uterine myoma, followed by bilateral ligation of uterine arteries to address bleeding and myomectomy. Postoperatively, she received a magnesium sulfate infusion, her blood pressure stabilized at 143/92 mmHg and Hemoglobin 12,40 g/dl. Conclusion: Intramural myoma increases the risk of preeclampsia during pregnancy. Emergency C-section is an effective measure to address complications for both the mother and the baby, and bilateral ligation of uterine arteries can minimize surgical bleeding.

Introduction: Pseudomyopia, resulting from excessive accommodation or nerve-related effects, creates false myopia corrected by cycloplegic refraction, which differs from secondary myopia caused by identifiable factors such as cataracts or trauma. If underlying hyperopia remains undetected, symptoms such as asthenopia and headaches occur, potentially resulting in conditions such as amblyopia. We presented a case of pseudomyopia in a pediatric patient to describe its clinical features and treatment. Case Presentation: A 7-year-old patient, who often uses smartphones for approximately 1–3 h daily in a well-lit room, initially reported blurry distant vision, headaches, eye discomfort, and difficulty reading from a distance. At the first visit, the visual acuity of the right (oculus dexter, OD) and left (oculus sinister, OS) eyes was 6/18 and 6/24, respectively. A cycloplegic was administered to both eyes, and subjective refraction of OD S +1.00 and OS S +1.25 was obtained. The patient was diagnosed with pseudomyopia and was administered glasses treatment and cycloplegic topical eye drops. After 12 weeks of treatment, the best-corrected visual acuity was 6/6. Conclusion: Pseudomyopia clinical features in pediatric patients could vary and should be distinguished from accommodative spasms. Treatment approaches vary widely, reflecting the lack of consensus on management despite consistent assessment and diagnostic approaches.

Introduction: Differentiating between TB and pneumonia is crucial to avoid treatment delays. Delayed diagnosis can result in reduced patient survival rates, increased treatment expenses and prolonged treatment durations. Several leukocyte ratios such as Neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR) will be compared to confirm whether it can be used to distinguished pulmonary tuberculosis from community-acquired pneumonia. Material and Methods: Retrospective study of 100 children aged 1-12 years who were treated at RSUD Dr. Haryoto Lumajang, period 1 January 2019 – 1 January 2023. Data on age, gender, diagnosis and laboratory results were obtained from medical records. Results: Of the 100 children included 50 had TB disease and 50 had pneumonia. The mean of neutrophil counts was significantly higher in the control group compared to the case group. NLR and MLR ratio were statistically significant. NLR were both statistically significant in both <5 years old and >5 years old, but MLR were not significantly different in both age groups. A significant but weak positive correlation was found between tuberculosis (case) group, pneumonia (control) group, and age of children (r=0.132; p=0.048). Younger children (less than 5 years old) had 0.571-fold odds for tuberculosis infection compared to the older children. Conclusion: NLR hold promise as readily accessible diagnostic biomarkers for distinguishing children with TB disease from those with pneumonia.

manifestations of inflammatory myopathy accompanied by cutaneous involvement. In patients with cutaneous DM, for the first line of therapy can be given photoprotection, topical steroids, Hydoroxychloroquin (HCQ) or Chloroquine and Quinacrine, while the gold standard in DM myopathy is systemic corticosteroids. Inadequate therapeutic regimens can result in morbidity or complications, especially calcinosis. Case Presentation: A 29-year-old woman had reddish spots on her face and hands accompanied by pain in her hands, hips, knees and elbows making it difficult for the patient to walk. Found it exists Heliotrop sign, Gottron papule and Gottron sign. The main aim of providing therapy to DM patients is to reduce inflammation, such as minimizing symptoms, especially those related to muscle weakness and improving the patient's quality of life. Glucocorticoids remain the first line therapy option for DM with the choice of oral prednisone 1mg/kgBW/day. Meanwhile, moderate to severe DM specifically should be treated with a combination which contains steroids and immunosuppressants, such as Methotrexate (MTX), Azathioprine (AZA), or Mycophenolate Mofetil (MMF). The therapy regimen must be given appropriately and adequately to minimize the occurrence of complications. Conclusion: A combination of Prednisone, Azathioprine, andHydoroxychloroquin is effective as a therapy for Dermatomyositis. This can be proven by an increase in muscle strength and the red spots disappearing in this patient.

Introduction: Endometriosis is a chronic condition characterized by the presence of endometrial-like tissue outside the uterus, which causes estrogen-induced inflammation. Pelvic severe pain, dysmenorrhea, and dyspareunia are known as the most common symptoms in endometriosis patients. Antioxidants can help alleviate endometriosis-related pain. However, the mechanism is not fully understood. A study is needed to elucidate the inherent potential of an antioxidant in women with endometriosis. Material and Methods: The literature search was conducted in two databases. The outcome of interest is to measure mean changes based on pain severity using the VAS score in endometriosis-related pain, including dysmenorrhea, pelvic pain, and dyspareunia. Some of the antioxidant agents formed in this study are vitamin D, vitamin C, vitamin E, livergol (silymarin), garlic tablets, resveratrol, and melatonin compared to placebo. Meta-analysis was done using RevMan 5.4 using mean change from baseline data with their 95% confidence intervals (CI) provided. Results: Twelve studies meeting the inclusion criteria were considered relevant for assessing the potencies of antioxidants in endometriosis patients (n=695). The antioxidant group had significantly better pelvic pain improvement (MD: -2.21, 95%CI: -3.40 to -1.03, p=0.0003), reduction in dyspareunia symptoms (MD: -1.47, 95% CI: -2.68 to -0.27, p=0.02) as well as improvement in dysmenorrhea with a mean difference -1.92 (95% CI: -3.41 to -0.43, p=0.01) than the placebo group. Antioxidants showed excellent potential to be an alternative treatment in managing endometriosis-related pain, particularly pelvic pain, dyspareunia, and dysmenorrhea. Conclusion: The efficacy of antioxidant agents can be a potential treatment to alleviate pain associated with endometriosis, such as pelvic pain, dysmenorrhea, and dyspareunia.

Introduction: Community welfare is confronted with a substantial challenge by Indonesia's burgeoning population, and the government's principal aim is the promotion of Long-acting reversible contraceptives (LARC). Post-placental IUD is an efficacious method that incorporates health promotion by means of midwife-delivered contraceptive counseling. Counseling promotes the development of positive relationships, knowledge, attitudes, and behaviors, thereby fostering responsible behavior and individual agency in decision-making. Nevertheless, the low utilization rate of postpartum IUD contraception can be attributed to the scarcity of information regarding the mother. The objective of this study is to examine the level of health promotion regarding post-placental IUD family planning in Malang Regency. Material and Methods: Descriptive methods will be employed, including verbal and written observations of behavior and descriptive data on individuals. The interview-based data collection process spanned the months of June to August 2023. Results: The research results suggest that inadequate efforts to promote postpartum IUD contraception are due to a dearth of understanding, motivation, resources, geographical proximity, and community customs. The objective is to improve the existing insufficiency of post-placental IUD family planning promotion in Malang Regency. Conclusion: From the beginning of pregnancy onwards, expectant women must be consistently motivated and educated about health promotion and family planning in order to develop an interest in and understanding of the choice of post-placental IUD family planning.