Introduction: Coronary heart disease (CHD) has been recognized as a leading cause of death globally. The mortality rate of ST elevation myocardial infarction (STEMI) patients is 6-14% of the total deaths of acute coronary syndrome patients and as much as 30% of STEMI mortality occurs within 24-48 hours post symptom onset. To date, percutaneous coronary intervention (PCI) has been the primary management procedure for STEMI. However, various factors are known to influence major cardiovascular events (MACEs) which are associated with patient prognosis. Atherogenic index of plasma (AIP) and lipid ratios (non-HDL-C and LDL-C/HDL-C ratio) are novel markers that can be used as predictors of cardiovascular disease. This study aims to determine whether AIP and lipid ratios can be used as predictors of MACEs during hospitalization in STEMI patients after reperfusion with primary PCI. Methods: This study was a retrospective cohort study located at Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali and conducted for 20 weeks. Determination of research subjects and sampling was done consecutively according to the inclusion and exclusion criteria. Blood samples were taken when the patient was admitted to the emergency department and the patient was assessed for MACEs after primary PCI during hospitalization. The collected data were analyzed with SPSS for windows version 26.0. Results: There were 45 people who experienced MACE in this study and 26 others did not experience MACE. AIP (0.49 ± 0.29 Vs. 0.38 ± 0.24), non-HDL-C (141.11 ± 5.73 Vs. 107.23 ± 27.62), and LDL-C/HDL-C ratio (3.76 ± 0.25 Vs. 2.19 ± 0.62) values were higher in the group that experienced MACE compared to those without MACE (p<0.05). Non-HDL-C and LDL-C/HDL-C ratio showed AUC values >0.7 (p<0.05). Multivariate analysis showed that high non-HDL-C (Adjusted HR 1.12; 95% CI 0.61-2.03; p=0.025) and LDL-C/HDL-C ratio (Adjusted HR 4.51; 95% CI 1.94-10.46; p<0.001) were the most important variables for the incidence of MCI during hospitalization. Conclusion: This study shows that high non-HDL-C values and high LDL-C/HDL-C ratio are predictors of hospitalized MACE in patients with AMI after primary PCI.

Introduction: Hepatitis B immunization is stated in Indonesia's child immunization policy. It consists of four doses of a combination vaccine containing HBV, following a monovalent birth dose, to provide immunity against the Hepatitis B virus (HBV) infection in childhood. Anti-hepatitis B surface antigen (HBsAg) antibodies (anti-HBs antibodies) as low as 10 IU/L are considered protective. Undetected anti-HBs antibodies after an up-to-date immunization still occur and are worrisome for parents. Booster immunization is an option to achieve a good anamnestic response. Pre-booster anti-HBs antibodies below 2 IU/L predict a poor post-booster response. Case Report: An 8-year-old girl with an up-to-date HBV was taken to the outpatient clinic to assess the need for a booster Hepatitis B immunization. Her parents felt that their daughter frequently had common colds since elementary school, so a general check-up was done abroad. Undetected anti-HBs antibody levels after an up-to-date HBV immunization were found, so her parents wanted to know the meaning of the undetected anti-HBs antibody level and why it happened. She had no complaints at the time of the examination, and there was nothing remarkable from the physical examination. This patient was deemed unprotected against subsequent HBV infection and received a Hepatitis B booster immunization. Despite the undetected anti-HBs antibodies, a good anamnestic response was achieved. Result: A good anamnestic response following a booster immunization was proven by a laboratory examination one month later. Conclusion: Anti-HBs antibody levels < 10 IU/L warrant a booster immunization, regardless of the pre-booster level. It is beneficial to measure the post-booster level to determine the next action. Further research should be done to further explore this topic.

Breast cancer remains a women's health problem worldwide. Its prevalence rises every year, with the mortality rate does not decline. Younger women around 40-50 years old tend to suffer the breast cancer in the Asia region. This problem must be considered to draw attention. Breast cancer surgery is one of the treatment options for breast cancer patients. However, some conditions could mark the surgery area and cause an inconvenience to the aesthetic aspect of the patient. However, breast cancer surgery has been developed in the last three decades by establishing a less invasive technique. Moreover, the breast reconstruction also improved, which could offer various options. Therefore, this review describes a collective update of breast reconstruction in breast cancer patients.

Introduction: Massive subcutaneous emphysema is an extremely rare complication of laparoscopic live donor nephrectomy (LLDN), especially in the retroperitoneal approach. We reported a case of subcutaneous emphysema after the retroperitoneal LLDN approach. Case illustration: A 47-year-old female patient decided to donate her kidney and underwent the retroperitoneal LLDN. Intraoperatively, there are no complications except for the subcutaneous emphysema during the operation. The patient was strictly monitored on her vital signs, physical examinations, and laboratory tests in the Health Care Unit (HCU) unit. However, the emphysema resolved spontaneously and the patient was in a stable condition. Subcutaneous emphysema and gas leakage outside the peritoneal cavity can impact laparoscopy surgery. Conclusion: Understanding the factors that raise the risk of these complications is crucial for ensuring safe laparoscopic procedures.

Background: Urethral stricture is a narrowing of the urethral lumen caused by the formation of fibrotic tissue or spongiofibrosis within the urethra. In ADSCs, hypoxic culture with approximately 5% oxygen has been reported to enhance proliferation capacity and improve stem cell viability following transplantation. This study aims to investigate the effects of hypoxic culture conditions on the expression of IL-10, TNF-α, FGF-2, and myofibroblasts, as well as on fibrotic tissue formation, in comparison to ADSCs cultured under normoxic conditions. Methods: This study is experimental research conducted on male Wistar rats, using a randomized post-test-only control group design. The study consisted of three groups: (1) the control group, which received urethral injury without ADSC injection; (2) the treatment group that received ADSCs cultured under hypoxic conditions; and (3) the treatment group that received ADSCs cultured under normoxic conditions. The number of cells injected was 2 × 10⁵ cells periurethra. We evaluate IL-10, TNF-α, FGF-2, Myofibroblast, and Fibrotic tissue formation. Analysis data using SPSS 20.0 Results: The group that received ADSC injections cultured under hypoxic conditions exhibited significantly higher IL-10 expression, with a mean value of 240.83 pg/mL on day 3 and 238.83 pg/mL on day 8 (p < 0.05). TNF-α expression was lower in the group that received ADSC injections cultured under hypoxic conditions, with mean values of 113.33 ng/L on day 3 and 133.83 ng/L on day 8 (p < 0.05). The group that received ADSC injections cultured under hypoxic conditions exhibited significantly higher FGF-2 expression, with a mean value of 571.83 pg/mL on day 3 and 601.5 pg/mL on day 8 (p < 0.05). On day 14, myofibroblast expression in the group that received ADSC injections cultured under hypoxic conditions was significantly lower than in the control group and the group that received ADSC injections cultured under normoxic conditions (p < 0.05). Based on the results of this study, the area of fibrotic tissue formation in the group that received ADSC injections cultured under hypoxic conditions was lower than that observed in both the control group and the group that received ADSC injections cultured under normoxic conditions. Conclusion: The administration of 2 × 10⁵ ADSCs into periurethral tissue was shown to increase IL-10 expression, reduce TNF-α expression, increase FGF-2 expression, reduce myofibroblast expression on day 14, and reduce fibrotic tissue formation in Rat urethral tissue.

Keloids and hypertrophic scars are two common forms of pathological scarring with overlapping pathogenesis. The key distinction lies in their growth patterns: keloids extend beyond the original wound margins, while hypertrophic scars remain confined to the site of injury. Recent studies have identified mesenchymal stem cells (MSCs), especially those derived from Wharton's jelly (WJ-MSCs), as promising antifibrotic agents. WJ-MSCs have demonstrated potential as a cell-free regenerative therapy. These findings highlight WJ-MSCs as a novel and promising therapeutic strategy for managing keloids. This secretome contains a complex mixture of bioactive molecules, including anti-inflammatory cytokines (e.g., IL-10), growth factors (e.g., VEGF, HGF), and extracellular vesicles that modulate wound healing, reduce inflammation, inhibit fibroblast overactivity, and prevent fibrosis. The secretome also exhibits antifibrotic effects by downregulating TGF-β1 and promoting matrix remodeling through MMP activation. Additionally, WJ-MSCs meet the International Society for Cell and Gene Therapy (ISCT) criteria for MSCs.

Background: Zinc is essential for neuronal development and inhibitory neurotransmission. Deficiency in zinc has been associated with increased seizure susceptibility. However, limited studies have evaluated hair zinc levels in children with epilepsy, especially in the Indonesian population. This study aimed to determine whether low levels of hair zinc are a significant risk factor for epilepsy in children. Methods: A case-control observational study was conducted at the pediatric outpatient and inpatient wards of Prof. I G. N. G. Ngoerah Hospital from June 2021 to June 2022. Hair zinc levels were measured using inductively coupled plasma–mass spectrometry (ICP-MS). Bivariate and multivariate logistic regression analyses were performed, with significance set at P < 0.05. Results: A total of 64 children were enrolled, comprising 32 children with epilepsy and 32 neurologically healthy controls, matched by gender. The mean duration of antiepileptic drug use in the epilepsy group was 4.2 months. The average hair zinc level across all subjects was 66.8 mg/kg, used as the cut-off to classify zinc status. Zinc levels <66.8 mg/kg were significantly more frequent among children with epilepsy (P = 0.019). Multivariate analysis showed that low zinc levels were associated with a 4.84-fold increased risk of epilepsy (95% CI: 1.399–16.743; P = 0.013), independent of age, sex, and nutritional status. Conclusion: Low levels of zinc are significantly associated with epilepsy in children and may serve as a potential long-term biomarker and modifiable risk factor in pediatric epilepsy.

Introduction: Epilepsy is a chronic disease and requires lifelong treatment, necessitating the need for an economic cost analysis. The most significant costs are related to the treatment of seizures, especially for drug-resistant epilepsy and status epilepticus. Method: Studies were collected from databases such as PubMed, ProQuest, and ScienceDirect. The search strategy included articles published in the last 10 years, using Boolean operators and Medical Subject Headings (MeSH) terms with main keywords such as "Health economic analysis" and "Epilepsy." Generally, the inclusion criteria focused on prospective and retrospective studies that provided data on the health economics of epilepsy. Result: The results showed that none of the included studies analyzed the incremental cost-effectiveness ratio (ICER). This is because the data collection in these studies was based on the usage of anti-seizure medications (ASMs) as the primary treatment, without comparing the efficacy between first-generation ASMs (FG-ASMs) and second-generation ASMS (SG-ASMs) or other interventions. Direct costs in all studies were dominated by SG-ASMs, ranging from $275,862.76 to $41,991,736.50 (in 2024 USD), compared to FG-ASMs, which ranged from $31,937.10 to $6,843,301.50. A decision model assessing the cost-effectiveness of ASMs found that second-generation drugs used as monotherapy for newly diagnosed partial epilepsy offered comparable benefits but at a higher cost compared to older drugs. Conclusion: Newer ASMs are more effective, but also more expensive than current monotherapies for patients with refractory partial epilepsy. SG-ASMs are more expensive than FG-ASMs, but the higher cost is justified by the greater effectiveness. These drugs can be considered cost-effective at higher cost-effectiveness thresholds, particularly for patients who respond well to the prescribed medication.

Background: Schizophrenia, a severe mental illness, is marked by disturbances in thought, cognitive impairments, negative symptoms, disorganized speech, hallucinations, catatonic behavior, psychotic symptoms, delusions, and behavioral changes. Schizophrenia has been associated with several gene polymorphisms and neurotransmitter imbalances. This study aims to analyze cognitive performance in schizophrenia patients using the Digit Span Test, with a focus on proline dehydrogenase (PRODH) gene polymorphisms. Material and Methods: This cross-sectional, observational analytic study included 99 individuals diagnosed with schizophrenia. Blood samples were collected and analyzed in the Biochemical Laboratory of the Medical Faculty of Andalas University using Polymerase Chain Reaction (PCR) to test for PRODH gene polymorphisms. The Structured Clinical Interview for DSM (SCID-1) was used to diagnose schizophrenia. Data were analyzed using the Chi-Square Test in SPSS 25.0, with statistical significance set at p = 0.05. Results: The cohort consisted of 99 patients who had been diagnosed with schizophrenia, most of whom were male (62.6%) with a median age of 37 years. A majority were unmarried (50.5%). PCR results revealed the following genotype distributions: homozygous dominant (CC) in 22 participants, heterozygous (TC) in 10, and homozygous recessive (TT) in 65. Cognitive function, as assessed by the Digit Span Test, yielded varied results in the forward span (p = 0.334) and higher deficit scores (score < 5) in the CT and TT groups than the CC group in the backward span (p = 0.314). However, these differences were not statistically significant. Conclusion: The PRODH gene polymorphism does not significantly affect cognitive function in patients with schizophrenia. Other factors may be more influential in shaping the cognitive function of individuals with schizophrenia.

Background: Japanese encephalitis (JE) infection is a significant health issue in Indonesia with high mortality. Currently, vaccination is the best way to prevent this disease. Recent study showed JE vaccination coverage in Bali was 74.9% with low score of knowledge level. However, the association between both of them is still unknown. Notably, knowledge level can influence the attainment of JE vaccination coverage. Aim: This study aims to establish the association between public knowledge and JE vaccination coverage in children in the Province of Bali. Methods: This research is an observational study with a cross-sectional design. The study subjects were mothers aged 18-65 years residing in the Province of Bali who have children aged 1-15 years from July to December 2023. Knowledge level was assessed using the validated Kyaw questionnaire, and reliability was ensured through data collection via Google Form. Hypothesis testing was conducted using Chi-square and Chi-square Eta (nominal-by-interval) statistical tests to establish the relationship between public knowledge level and JE vaccination coverage in children in the Province of Bali. Results: Around 72.7% of the study subjects were aware of the name of the JE disease, and 355 individuals (69.7%) had heard of JE. Information about JE was predominantly obtained from healthcare workers (58%). The majority of Bali residents' knowledge levels were categorized as satisfy (69.5%). There was a significant difference in proportions between knowledge level and vaccination coverage (p<0.001). The Eta correlation test for public knowledge and JE vaccination coverage showed p-value <0.001. These results indicate a significant association between public knowledge in the Province of Bali and JE vaccination coverage. Conclusion: There is an association between public knowledge in Bali and JE vaccination coverage in children in the Province of Bali.