Hyperglycemia can be experienced by corona virus disease (COVID-19) patients due to the invasion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) into pancreatic cells or other mechanisms such as insulin resistance, counter-regulatory, stress induction, and glucocorticoid therapy. Hyperglycemia can stimulate the production of reactive oxygen species (ROS) and pro-inflammatory cytokines leading to an increase in the disease severity. Based on the clinical and laboratory criteria, the severity of COVID-19 patients is classified into asymptomatic, mild, moderate, severe, and critical. This study aimed to investigate the association between blood glucose levels at admission and the severity of COVID-19 patients with and without diabetes mellitus (DM). It was a cross-sectional study using secondary data from COVID-19 patients in Pondok Kopi Jakarta Islamic Hospital from April to June 2021. This study involved 340 patients with comorbid DM (n=78) and without comorbid DM (n=262). The Mann-Whitney and Spearman correlation test were used. A significant difference between random blood glucose levels in comorbid DM patients and patients without comorbid DM (p<0.05). However, there is a weak correlation between random blood glucose levels and severity with comorbid DM (r=0.112) and without comorbid DM (r=0.129). In conclusion, a positive and weak correlation between blood glucose levels at admission and the severity of COVID-19. The severity increases as the blood sugar level increases. Further study needs to be performed considering other comorbid conditions.

Skin aging can be divided into intrinsic and extrinsic aging. Even though it is inevitable, symptoms of skin aging are a common concern for patients. As a result, there is a surge in the making of anti-aging cosmeceuticals. However, there is a lack of evidence-based data to support the usage of topical preparations as anti-aging treatments. Therefore, further studies are needed to explore topical treatment options for skin aging. This literature review discusses the mechanism of commonly used topical anti-aging agents and their adverse reactions.

Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare female congenital anomaly of urogenital tract. The definite etiology of HWW syndrome is still unknown. It may be caused by the abnormal development of Mullerian and Wolffian ducts. The characteristic triad of this syndrome includes didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis, recently known as Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome. A 17 y.o. presented with intermittent lower abdominal pain. Physical examination revealed in normal limit. From the ultrasonography examination, it was found uterus didelphys with left hemiuterus hematomethra, hematocolpos, with normal anatomy and function of the right kidney, but there was no left kidney. From pelvic magnetic resonance imaging (MRI) and laparoscopy showing a complete duplication of the uterus from the horn to the cervix with no connection between the two uterine cavities. Both ovaries were normal. The right fallopian tube was normal. The left tube was enlarged, attached to the uterus and the left ovary. No left kidney was found. From the previous surgery, there was a misdiagnosed with brown cyst. Physical examination such as rectal toucher often missed, regardless it can be used to determine some differential diagnosis. MRI is most accurate for providing details regarding the altered anatomy and for identifying associated hematocolpos, hematosalping or hematometra for HWW syndrome cases. The laparoscopy guiding diagnostic and operative management of the vaginal septectomy procedure was performed. In conclusion, misdiagnosis of HWW syndrome can be occurred on ultrasound examination. MRI is an examination that is considered appropriate to help confirm the diagnosis. Laparoscopy can be used with the aim of establishing a diagnosis or in surgical management, in this case, a septectomy is performed.

Primary demodicosis is an infestation of Demodex colonization >5 mites/cm2 without pre-existing or concomitant inflammatory skin disease. Primary demodicosis is divided into 3 variants i.e. spinulata, papulopustular and nodulocystic. Several topical and systemic agents are used in the Demodex facial treatment. A 22 y.o. man complained of acne on his face three months ago. On physical examination, there were pustules, multiple erythematous papules, ice pick atrophic scars, and box and rolling scars. KOH examination found the Demodex number > 5 mites/cm2. No spores were found. The patient received oral and topical metronidazole therapy. Papulopustular demodicosis is a follicular inflammation caused by Demodex mites. The inflammatory stage shows a predilection for the perioral, periorbital, and periauricular regions. According to the pattern of morphology and localization of the centrofacial area, some cases of demodicosis are often referred to as Rosacea-like (rosaceiform) demodicosis. The treatment goals are to reduce the overall number of mites and treat the underlying condition. This paper reports a case of papulopustular demodicosis of the face. The diagnosis was made by history taking and physical examination using the diagnostic criteria for demodicosis. Clinical improvement was obtained after oral and topical metronidazole therapy for two weeks.

Dermoscopy is a non-invasive tool mainly used to clarify pigmented and nonpigmented skin lesions. Based on its physical properties, dermoscopy is divided into non-polarized and polarized. Dermoscopy examination is a diagnostic technique that is often performed on skin disorders, including skin disorders due to fungal infections. Some of the fungal diseases that are examined bydermoscopy are tinea capitis, pityriasis versicolor and onychomycosis. The dermoscopy features found in tinea capitis are comma hair, corkscrew hair, black dots and short hair. Onychomycosis found dermoscopy chromonychia, white longitudinal stripes and opaque nails (cloudy). The dermoscopy in pityriasis versicolor shows hypopigmented and hyperpigmented patterns.

Nowdays with various kinds of needs and demands in life that must be met at any time can cause stress of someone. Medical students are often experience high level of stress due to the demands of high education standards requirements. Continous chronic stress can affect eating behaviour lead to the potential cause of eating disorder syndrome (EDS). This study aimed to evaluate the correlation between stress level and EDS in preclinical medical students of Nusa Cendana University, Kupang, East Nusa Tenggara. It was an analytic observational with a cross sectional design conducting on the preclinical medical students by filling out depression anxiety stress Scale (DASS-42) and eating attitude test (EAT-26) questionnaires. Respondents were selected by the probability sampling method with a stratifies random sampling technique. A total 141 respondents who met the inclusion and exclusion criteria were recruited. Bivariate analysis by using the Wilcoxon Theta correlation test was performed. Among respondents involved in this study, 13 (9.2%) respondents did not experience stress and 128 (90.8%) experienced stress including 43 (30.5%) mild stress, 68 (48.3%) moderate stress, and 17 (12.3%) severe stress. The EDS was observed in 15 (10.6%) respondents. A significant moderate correlation between stress level and EDS was indicated (θ = 0.58). In conclusion, there is correlation between stress level and EDS on preclinical medical students of Nusa Cendana University, Kupang.

Central nervous system (CNS) infections such as encephalitis, meningitis, or myelitis have high morbidity and mortality in Indonesia. High sensitivity C-reactive protein (hs-CRP) is a sensitive marker of acute inflammation, while albumin is the most abundant protein component in plasma and cerebrospinal fluid (CSS). Infection triggers an inflammatory response so that an increase in the hs-CRP/albumin ratio (CAR) can be a predictor of worsening clinical outcome in patients with CNS infections. However, studies examining the predictor value of serum and CSF CAR on worsening clinical outcomes of patients are limited, particularly in CNS infections. The purpose of this study was to prove the CAR as a predictor of worsening clinical outcome in patients with CNS infections. It was an observational study using a prospective cohort design. Fifty subjects recruited until October 2021 at Dr. Sardjito General Hospital were involved. The multivariate regression analysis showed that serum CAR (OR=3.604; 95%CI=1.487-8.736; p =0.005) could be a single predictor. However, by combining three variables, namely serum CAR, CSF CAR, and decreased consciousness at admission, could be a stronger predictor of worsening clinical outcome in patients with CNS infection (AUC = 97.1%; 95%CI = 0.929-1.00; p <0.001). The optimal cut-off value for serum CAR was 1.35 (Youden index = 0.88, sensitivity = 96%, specificity = 92%) while for CSF CAR was 0.14 (Youden index = 0.60, sensitivity = 76%, specificity = 84%). In conclusion, a combination predictive model of three variables, namely serum CAR, CSF CAR, and awareness at admission can be a stronger predictor of clinical outcome in patients with CNS infection than serum CAR alone.

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The older adult often experiences a low-grade chronic inflammation that commonly manifests in various conditions without infection, including hypertension. The serum neutrophil-to-lymphocyte ratio (NLR) and hyperuricemia are important markers for various diseases including hypertension. Older adult accounts for 17.33% of the total population of Yogyakarta Special Province, which is the highest compared to other provinces. The study aimed to evaluate the relationship between NLR and hyperuricemia with hypertension among adult patients in Sleman District, Yogyakarta, Indonesia. It was a community-based cross-sectional nested study involving 90 older adults aged ≥70 y.o. living around of the Sleman Health and Demographic Surveillance System (HDSS). Data of demographic and health characteristics of the subjects were collected. Independent t test, and Mann Whitney test were used to analyze mean differences between normotensive and hypertensive groups. Multivariate analysis with logistic regression was used to analyze correlation between all variables. The results showed 59 respondents (65%) suffered from hypertension and 31 (35%) respondents had normal and pre-hypertension. No significantly different in almost of the subject characteristics between the normotensive and the hypertensive groups was observed (p>0.05). However, significantly different between the normotensive group and the hypertensive group was observed in the history of hypertension, blood pressure/BP, mean arterial pressure/MAP, abdominal circumstance/AC, fasting blood glucose/FBG, triglyceride, and hemoglobin (p<0.05). No significantly different in the NLR and HsCRP levels of the normotensive group compared to the hypertensive groups were observed (p>0.05). However, the uric acid level of the hypertensive group [5.6 (2.9-9.4 mg/dL)] was significantly higher than that the normotensive group [4.7 (2.9-8.0 mg/dL)] (p=0.042), although it was no significantly relationship with hypertension (p>0.05). In conclusion, there is no relationship between NLR, HsCRP and uric acid with hypertension among middle old and oldest old in Sleman District.

Anatomical and physiological changes occur along with the aging process. One of the changes is decreased flexibility due to changes in the musculoskeletal system. Upper and lower limb flexibility is closely related to the ability to carry out daily activities, which affects the quality of life of the elderly. Surya Namaskar yoga is known to help increase flexibility because it integrates stretching components within its movement. This study aimed to investigate the effect of Surya Namaskar on flexibility in the pre-elderly and elderly. It was is quasi-experimental study with a pre-experimental one-group pretest-posttest research design. A total of 20 participants were selected using consecutive sampling according to the inclusion criteria. Flexibility measurements of the upper and lower limbs were carried out before and after the intervention using the back scratch test and chair sit and reach test methods. Surya Namaskar intervention was carried out for 8 wk. Data were analyzed using the Shapiro-Wilk normality test, paired t-test, and Wilcoxon test. The results showed that there was a highly significant difference between the mean value of the back-scratch test (for upper limb flexibility) before and after the intervention (p<0.001). Significant differences were also found in the mean values of chair-sit-and-reach test measurements (for lower extremity flexibility) before and after the intervention (p<0.001). In conclusion, Surya Namaskar exercises can improve the flexibility of the upper and lower extremities in the pre-elderly and elderly.