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31	Clinical Practice	ABS-9
The Relation Between Diagnostic Delay to the Incidence of Perforation in Patients with Acute Appendicitis at Rumah Sakit Dustira in 2016-2020 Lukmana Lokarjana (a*), Sony Ramdhani (b), Atha Aurellia Adinata (c), Andri Anugrah (a) a) Department of Surgery, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia * lukmanalokarjana[at]gmail.com b) Department of Forensics and Medicolegal, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia c) Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia Abstract Acute appendicitis is an inflammation of appendix, leading to perforation with prevalence of 30-70%. Mortality rate of perforation multiplies 3,5-10 times. It is necessary to diagnose perforation pre-operation. Signs and symptoms of perforation manifest in the first 12 hours, it is possible to prevent perforation by considering diagnostic time, expecting an improvement in prognosis. Research was conducted at Rumah Sakit Dustira in 2017-2020 to determine the relationship between diagnostic delay to the incidence of perforation in patients with acute appendicitis at Rumah Sakit Dustira in 2017-2020. Research used medical records on patients >18 years diagnosed with acute appendicitis and underwent appendectomy at Rumah Sakit Dustira in 2017-2020. This was an analytical research with cross-sectional approach, data was collected using non probability and purposive sampling. The minimum sampling determination using hypothesis testing for two sample proportions formula, resulting in 21 samples. Data was analyzed in univariate and bivariate. The research^s results showed there is no relation between diagnostic delay and the incidence of perforation in patients with acute appendicitis (p-value 0,229>0,05) using Fisher^s Exact test, there is no significant difference between diagnostic time of patients with perforation and without perforation (p-value 0,984>0,05) using Mann-Whitney test. There were 24 patients (80%) with delayed diagnosis and appendix perforation. Prevalence ratio was 1,6, explaining perforation occurred more in patients with diagnostic delay. It is concluded that diagnostic delay is not related to the incidence of perforation in patients with acute appendicitis. Upcoming research could categorize diagnostic time into <24, 24-72, and >72 hours. Keywords: Acute appendicitis, Diagnostic delay, Perforation of appendix Share Link | Plain Format | Corresponding Author (Atha Aurellia Adinata)

32	Clinical Practice	ABS-10
Rehabilitation for A 10-Year-Old Patient Without Left Patella Bone Post Total Patellectomy: A Case Report Fatrika Dewi, Marietta Shanti, Ellyana Sungkar, Arnengsih Nazir Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Padjadjaran University, Dr. Hasan Sadikin Academic Teaching Hospital, Bandung, Indonesia Abstract Overview: Total patellectomy was conducted for cases with disrupted extensor mechanism with loose component and poor bone stock. Patients should immobilize for 6-8 weeks post operation. During this time the patients were allowed to begin partial weight bearing. At 3 months post operative, full weight bearing was allowed and full range of motion was encouraged as tolerated. Case description: A 10-Year-Old patient was consulted to rehabilitation clinic for rehabilitation after undergoing muscle and patellar tendon repair with patellectomy. Patient complaint unable to stand and walk. She got lower extremity orthosis. She was trained to stand and walking using Knee Ankle Foot Orthosis (KAFO). Discussion: Due to patellectomy, there will be disruption of the extensor mechanism. Extensor mechanism is responsible for extending the tibiofemoral joint. Patella serves as a mechanical pulley for quadriceps and contribute to increase progressive extension. Without patella, the patient will lose stability when doing activities, so the patient needs KAFO to stabilize the knee motion. After 6 months rehabilitation, the patient can walk independently and there were improvements in quality of life of patient. Conclusion: The management of patient post patellectomy has good functional prognosis for mobilization using knee orthosis Keywords: Knee Orthosis- Patellectomy- Rehabilitation Share Link | Plain Format | Corresponding Author (Fatrika Dewi)

33	Clinical Practice	ABS-13
THE RELATIONSHIP OF EAR CLEANING USING COTTON BUDS WITH THE EVENT OF EAR COMPLAINTS (IN FACULTY MEDICINE STUDENTS OF UNJANI BATCH 2019) Asti Kristianti (a*), Siska Telly Pratiwi (b*), Nadya Safira (c*), Nurbaiti Nazarudin (a*) a) Otorhinolaryngology Departement, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi, Indonesia b) Microbiology Departement, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi, Indonesia c) Bachelor of Medicine, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi, Indonesia Abstract Ear cleaning using cotton buds is a risk factor of external ear infections, especially otitis externa which cause various ear complaints such as ear pain, itchy ears, fullness ears, and decreased hearing. This study aims to determine the relationship between ear cleaning using cotton buds and the ear complaints at Students of Medical Faculty Unjani Batch 2019. The population of this study were Students of Medical Faculty Unjani Batch 2019 who did ear cleaning using cotton buds with ear complaints fulfill the inclusion criteria. This was an analytical research with cross sectional. The data was collected with the hypothesis test formula of two different proportions of two groups with a minimum number of respondents were 30 respondents. Sampling was done by consecutive sampling techniques. The instrument used in this study was questionnaire. The data was analyzed with univariate and bivariate. The characteristics of respondents who use cotton buds to clean their ears are female rather than male (83.33%). In cleaning ears, respondents mostly used cotton buds, which caused complaints of itchy ears (45.28%), ear pain (33.96%), fullness ears (18.87%), and decreased hearing (1.89%). From the study, there was a significant relation between ear cleaning using cotton buds and the incidence of ear complaints at Students of Medical Faculty Unjani Batch 2019 with odds ratio 95.28 greater than those who did not use cotton buds. The majority ear complaints are itchy ears that indicate have entered the chronic inflammatory stage of otitis externa. Keywords: Cotton buds, ear cleaning, ear complaints Share Link | Plain Format | Corresponding Author (Nadya Safira)

34	Clinical Practice	ABS-14
Rehabilitation of Tetra-Amelia syndrome: A Case Report of a Very Rare Disorder Diah Safitri, Marietta Shanti, Ellyana Sungkar, Dian Marta Sari Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Padjadjaran University, Dr. Hasan Sadikin Academic Teaching Hospital, Bandung, Indonesia Abstract Overview: Tetra-amelia syndrome is a very rare disorder characterized by the absence of all four limbs and had been associated with a mutation in the WNT3 gene in one family. The limb malformations appears in about 6/10,000 live births. This syndrome can also cause severe malformations of other parts of the body, including the face and head, heart, lung, nervous system, skeleton, and genitalia. Cases are stillborn, or die shortly after birth. Case description: A three-months old female has chief complaint of not being able to roll from a supine position to a prone position, the strength of the head and neck extensor, rhomboid, back extensor and gluteal muscles was still weak. She has no complaint of heart and respiratory problem. X-ray showed right humeral and left femur deformity. She received strengthening exercise, proprioception exercise in the form of tactile and vestibular inputs to raise awareness of the remaining extremities and facilitation for rolling within 3 months. Discussion: There was improvement in the head and neck extensor and trunk control in the patient, she can roll, maintain a position when sitting without a backrest and she can put a spoon or teether into the mouth through the rubber band attached to the hand. The management of tetra-amelia syndrome requires a long term and multidisciplinary teamwork in order to achieve optimal functional abilities. Conclusion: The management of tetra-amelia syndrome requires a long term and multidisciplinary teamwork. Keywords: Pediatric Rehabilitation, Tetra-amelia syndrome, Very rare disorder Share Link | Plain Format | Corresponding Author (Diah Safitri)

35	Clinical Practice	ABS-17
The Overview of Characteristics of Work Stress and Work Readiness in Workers of Kantor Kesatuan Bangsa dan Politik Kota Cimahi Rr. Desire Meria Nataliningrum, Irwanto Ichlas, Tazkiya Qalby Yusnandar Universitas Jenderal Achmad Yani Abstract The mental health of workers holds an important role in determining the success of organization and company. One of the mental health disorders that are easily experienced by workers is work stress. Work stress has an effect on workers^ performance, decision making, relationship, planning, way of communicating, and readiness. This research aimed to determine the description of stress in the work environment and work readiness in workers of Kantor Kesatuan Bangsa dan Politik Kota Cimahi using Readiness Scale Staff Member and Diagnosis Stress Survey. This research design was descriptive research. The sample were all workers who were active and still working when the research was conducted namely 17 people. The sampling method in this research was non probability sampling with total sampling technique. The variables used in this research are gender, age, years of service, last education, position, work stress, and work readiness. The research instruments consist of Diagnosis Stress Survey and Readiness Scale Staff Member. The data used in this research is primary data obtained from the questionnaire which was carried out in November 2021. The research results showed that 14 respondents (82.35%) had a moderate level of work stress and 7 respondents (41.18%) had the highest level of readiness R4 (very capable and confident). It needs an effort to deal with the work stress experienced, such as periodic checks and a rotation system. Work readiness R4 means that workers have high ability and willingness to deal with the work they are doing. Keywords: Work Stress, Work Readiness Share Link | Plain Format | Corresponding Author (Tazkiya Qalby Yusnandar)

36	Clinical Practice	ABS-18
Relationship Between Visual Impairment With The Level of Independence of Low Vision Sufferers at Wyata Guna Bandung for the 2020-2021 Period Awan Buana Pranata Surya (1), Wendra (2), Hafsah Nursalsabil (3), Ike Hikmawati (1) 1) Departemen Mata Fakultas Kedokteran Universitas Jenderal Achmad Yani, Cimahi, Jawa Barat, Indonesia 2) Departemen Anatomi Fakultas Kedokteran Universitas Jenderal Achmad Yani, Cimahi, Jawa Barat, Indonesia 3) Program Studi Kedokteran Fakultas Kedokteran Universitas Jenderal Achmad Yani, Cimahi, Jawa Barat, Indonesia Abstract Low vision is defined as visual acuity worse than 6/18 to light perception or 1/~ in the better eye with best possible correction and is not correctible with glasses or contact lenses. By 2021 it is estimated that one billion people suffered from distance vision impairment of moderate, se-vere, or blindness. One of the social impacts of low vision patients is the problem of independ-ence in daily activities (activity of daily living), as measured by the Barthel Index questionnaire. This study aims to determine the relationship between visual impairment and the level of inde-pendence of low vision sufferers at Wyata Guna Bandung for the 2020-2021 period. This re-search is an analytic study using primary data from best corrected visual acuity examination and G-form which contains the Barthel Index questionnaire. The number of samples in this study was 20 people. Samples were selected by simple random sampling. Data were analyzed through Chi square test. The results of this study stated that the percentage of visual impairment among the subjects was moderate (10%), severe (5%), and blindness (85%). Based on the level of independence in basic daily activities, there were patients with moderate dependence (40%), slight dependence (50%), and independence (10%). The result of the Chi Square test indicates that there is a significant relationship (p < 0.05) between visual impairment and the level of in-dependence of low vision sufferers in Wyata Guna Bandung for the 2020-2021 period. Keywords: Visual impairment, Activity of daily living, Barthel Index Share Link | Plain Format | Corresponding Author (Hafsah Nursalsabil)

37	Clinical Practice	ABS-27
DIFFERENCES IN VISUAL ACUITY AFTER PHACOEMULSIFICATION SURGERY IN SENILE CATARACT PATIENTS WITH HIGH-DEGREE MYOPIA AND WITHOUT MYOPIA AT PUSAT MATA NASIONAL RS MATA CICENDO Awan Buana (a*), Alexander Siagian (b), Rani Rahmalia (c), Wida Vianita Aziz (d) a) Department of Ophthalmology, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia *pranatasurya61[at]yahoo.com b) Department of Anesthesiology, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia c) Bachelor of Medicine Study Program, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia d) Department of Ophthalmology, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia Abstract Cataract is a clouding of the lens and the most common cause of visual impairment in the world. High myopia can be a risk factor for cataract. Cataracts in high myopia may occur earlier. In cataracts with high myopia, there can be errors in biometric calculations due to the pressure applied to the eyeball resulting in an error in determining IOL power. The longer axial length of the eyeball in high myopia can increase the risk of retinal detachment complications that can affect postoperative visual acuity. The purpose of this study was to determine the difference in visual acuity after phacoemulsification surgery in senile cataract patients with high myopia and without myopia at the Pusat Mata Nasional RS Mata Cicendo. This study used an analytical observational method with a cross-sectional design in September 2021 at the Pusat Mata Nasional RS Mata Cicendo, subsequently the data was analysed using Mann Whitney test. In this study, it was found that the high myopia group was 40 patients and the group without myopia was 40 patients. The results showed that 90% of senile cataract patients with high myopia had good visual acuity postoperative. In senile cataract patients without myopia there are 100% have good visual acuity postoperative. There is a significant difference between postoperative visual acuity in senile cataract patients with high myopia and without myopia. Several factors can affect postoperative visual acuity in high myopia such as posterior segment condition and inaccurate measurement of axial length. Keywords: High myopia, senile cataract, visual acuity Share Link | Plain Format | Corresponding Author (Rani Rahmalia)

38	Clinical Practice	ABS-31
THE RELATION BETWEEN HBA1C LEVELS AND SEVERITY OF DIABETIC RETINOPATHY IN TYPE 2 DIABETES MELLITUS PATIENTS Awan Buana(a), Rr. Desire Meria. N(b), Mohammad Fathussyifa(c), Diantinia(a) FAKULTAS KEDOKTERAN UNIVERSITAS JENDERAL ACHMAD YANI Abstract Retinopati diabetik merupakan komplikasi mikrovaskular akibat diabetes melitus dengan insidensi cukup tinggi dan memiliki prognosis yang buruk. Retinopati diabetik dibagi menjadi 2 jenis utama, yaitu Non-Proliferative Diabetic Retinopathy (NPDR) dan Proliferative Diabetic Retinopathy (PDR). Pengukuran HbA1C adalah cara yang paling akurat untuk menentukan tingginya kadar gula darah selama dua sampai tiga bulan terakhir. Tujuan penelitian ini untuk mengetahui hubungan antara kadar HbA1C dengan derajat keparahan retinopati diabetik pada pasien diabetes melitus tipe 2. Penelitian ini adalah penelitian analitik komparatif dengan desain potong lintang dengan cara pengumpulan data menggunakan rekam medis dengan jumlah sampel sebanyak 45 orang di Pusat Mata Nasional Rumah Sakit Mata Cicendo pada bulan Desember 2021. Hasil penelitian menunjukkan bahwa dari 8 orang pasien dengan kadar HbA1C terkontrol baik sebanyak 5 orang (62,5%) mengalami retinopati diabetik NPDR dan 3 orang (37,5%) mengalami retinopati diabetik PDR. Dari 37 orang pasien dengan kadar HbA1C tidak terkontrol sebanyak 8 orang (21,62%) mengalami retinopati diabetik NPDR dan 29 orang (78,38%) mengalami retinopati diabetik PDR. Pada penelitian ini terdapat hubungan antara kadar HbA1C dengan derajat keparahan retinopati diabetik (p=0,034). Keywords: Diabetic retinopathy, HbA1C, NPDR, PDR Share Link | Plain Format | Corresponding Author (MOHAMMAD FATHUSSYIFA)

39	Clinical Practice	ABS-32
OVERVIEW OF HYPERTENSION IN ISCHEMIC STROKE PATIENTS AT NEURAL POLYCLINIC, RS DUSTIRA PERIOD JANUARY-DECEMBER 2019 Sandi Lesmana (a*), Prihati Pujowaskito (b), Saniyyatul Hasanah (c), Wahyu Harihardjadja (d) a) Department of Neurology, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia b) Cardiologist, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia c) Bachelor of Medicine Study Program, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia d) Department of Internal Medicine, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia Abstract Stroke is a clinical syndrome characterized by a neurological deficit in the brain in general or overall that develops rapidly and lasts for at least 24 hours due to vascular events,both spontaneous bleeding in the brain and inadequate blood supply to the area.Based on epidemiological data,the type of stroke that has a high prevalence rate in ischemic stroke, which is around 87%.Ischemic stroke has modifiable risk factors,one of which is hypertension. Hypertension is a major risk factor for ischemic stroke. This study aims to determine the description of hypertension in ischemic stroke patients at the Dustira Hospital Neurology Polyclinic.The method in this research is descriptive. The sample in this study was 102 medical records of ischemic stroke patients who had a history of hypertension and met the inclusion criteria.Sampling was done by systematic random sampling technique.The results of this study indicate that the sex of ischemic stroke sufferers in Dustira Hospital is more common in men as much as 51%.Most of the patients with ischemic stroke were in the age group 55-64 years and 65-74 years with a percentage of 27.5%. Overall, patients with ischemic stroke suffer from stage 2 hypertension with a percentage of 52% and an average systolic pressure with an interval of 153.53-162.54 mmHg while diastolic pressure has an interval of 91.19-95.71 mmHg.Based on these results, hypertension is one of the risk factors for ischemic stroke by triggering the formation of atherosclerotic plaque which causes blockage of blood vessels resulting in an ischemic state in the brain. Keywords: age and gender- hypertension- Ischemic stroke Share Link | Plain Format | Corresponding Author (Saniyyatul Hasanah)

40	Clinical Practice	ABS-33
Complications Of Patients With Acute Appendicitis Who Came For Treatment To Dustira Hospital In 2018-2020 Chairul Ismael (a), Yudith Yunia Kusmala (b*), Huzaifah Ikhwanus Shofa (c), Lukmana Lokarjana (a), Fitriardi Sejati (a) a) Department of Surgery, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia b) Department of Internal Medicine, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia *yudithyunia5671[at]gmail.com c) Bachelor of Medicine Study Program, Faculty of Medicine, Jenderal Achmad Yani University, Cimahi. Indonesia Abstract Appendicitis is inflammation of the vermiform appendix. The course of the disease from onset to the occurrence of perforation can take place quickly, 20% of cases of perforation of the appendix occur within 48 hours, even within 36 hours after symptoms appear perforation can occur. The purpose of this study was to determine the complications of patients with acute appendicitis who came for treatment at Dustira Hospital. The research method used is descriptive with a cross sectional approach taken from secondary data from medical records of acute appendicitis patients at Dustira Hospital in 2018-2020. The data was then sorted based on inclusion and exclusion criteria so that 66 medical records were obtained. The results of this study showed that the most complications of acute appendicitis were local peritonitis (71.2%), the highest prevalence in the age group was 17-25 years (27.3%) and >45 years (27.3%), based on sex more women (60.6%) than men. Clinical signs and symptoms that are most often found in patients with acute appendicitis are right lower abdominal pain and right lower abdominal tenderness (100.0%), the onset of complications of appendicitis is mostly at a duration of > 48 hours (65.1%). Based on the response time, the most surgery was 1 - <12 hours (60.6%) after the first arrival to the hospital. The conclusion of this study is acute appendicitis patients who seek treatment at Dustira Hospital generally arrive more than 36 hours late, causing complications. Keywords: acute appendicitis- complications- onset of complications Share Link | Plain Format | Corresponding Author (Huzaifah Ikhwanus Shofa)

41	Clinical Practice	ABS-44
Development of Smart RnE (Rotation and Elimination) Diet in Overcoming Behavioral Problems in ASD (Autism Spectrum Disorder) Rudy Sutadi, Arneliza Anwar, Yulia Darmawi, Evie Rachmawati, Diana Dewi, Astri Pradini KID-ABA Autism Center Grand Wisata Blok AA 11 No.56-57-58 Bekasi 17510, Jawa Barat Indonesia rudysutadi123[at]gmail.com Abstract Background - Food affects the behavior of ASD children due to IgG food allergy or food sensitivity/intolerance. To detect and eliminate it, researchers have used the BALSH Rating Chart. But researchers found things that had to be corrected and developed. Purpose - The aim of this study is to improve on RnE (Rotation and Elimination) Diet procedures to pinpoint foodstuffs that cause negative effects in children with ASD (Autism Spectrum Disorder). Methodology - This study used an experimental method with a single-subject research design (SSR) that focused on behavioral changes caused by treatment using food rotation provocations on the subject. Findings - Researchers found that the upper limit value of 10 had to be removed because it would not reflect the actual condition, then researchers created an assessment involving the frequency, duration, and intensity of a behavioral problem, and created its calculation formula. This is combined with a single morning/noon/night meal time only or a combination of 2 mealtimes (mornings+noon or mornings+night or noon+night). Then the mealtime of foodstuff that caused a spike in the chart moved to other mealtime and/or different day. Its implementation resulted in pinpointing food ingredients that cause negative effects. Research Limitation - This study involved a small number of children with Autism Spectrum Disorder, therefore it requires multi-center experimental research with large samples to increase the validity and reliability. Originality - This novel Smart RnE (Rotation and Elimination) Diet procedure was developed by researchers based on the BALSH Rating Chart. Keywords: Autism, Diet, Rotation and Elimination, Behavior, IgG Food Allergy, Food Sensitivity, Food Intolerance, Food Provocation Share Link | Plain Format | Corresponding Author (Rudy Sutadi)

42	Clinical Practice	ABS-45
Hearing Loss in Tuberculosis Relapse Patient with Streptomycin Treatment : A Case Report Fiya Natilda (a) Yanti Nurrokhmawati (b) P.W. Prastianingsih (a) Judiawati Hayat (a) a. Otorhinolaryngology-Head and Neck Surgery Department at Cibabat General Hospital, Cimahi, West Java, Indonesia b. Otorhinolaryngology-Head and Neck Surgery Department at Dustira Hospital, Cimahi, West Java, Indonesia Abstract There are lots of possible causes of hearing loss and ototoxicity is an increasing cause of hearing loss in developing countries. Aminoglycoside antibiotics are the most common cause of ototoxic. Streptomycin belongs to the class of amynoglycosides, which is widely used as a part of treatment for relapse tuberculosis patient. Streptomycin is known to cause hearing loss. a study case of a 51-year-old man was referred to our otorhinolaryngology Department at cibabat general hospital with a month history of sudden bilateral hearing loss after 56 days of streptomycin treatment. The patient claimed that it was hard for him to walk and maintaining straight posture a week after first treatment and he had blurry vision three weeks after his first streptomycin treatment. Patient treated with ATT therapy (CAT IInd) which is included a daily dose of streptomycin (750mg) for 56 days. Pure Tone Audiometry showed bilateral sensorineural hearing loss. The patient is under observation after the discontinuation of streptomycin. Hearing rehabilitation with hearing aids will be considered if required. Untreated hearing loss and delayed treatment can leads to further damage and known to cause permanent hearing loss. Nowadays, early diagnosed of otoxicity related to the treatment of relaps tuberculosis remains a challenge. Therefore early detection and proper treatments of hearing loss are crucial to prevent the damage and lower the individual^s quality of life. Keywords: Hearing loss, Streptomycin, Ototoxicity, TB relaps Share Link | Plain Format | Corresponding Author (Fiya Natilda)

43	Clinical Practice	ABS-48
Overview of Bacterial Patterns and Their Sensitivity to Antibiotics in Cirebon Permata Hospital Adriana Hendraningrat(a), Rika Nilapsari(b) a,b). Department of Clinical Pathology, Permata Cirebon Hospital adrianahendraningrat[at]gmail.com - rika.nilapsari[at]yahoo.com Abstract The use of broad-spectrum antimicrobials is an option to treat various types of bacteria that may be the cause. This situation tends to increase the number of antibiotic-resistant bacteria. This study aims to look at the distribution of bacteria types, to see patterns of resistance or susceptibility to antimicrobials, and to find out the shift in patterns of bacteria that cause infection and sensitivity at different times at Permata Cirebon Hospital. This type of research is a quantitative descriptive using cross sectional research methods and a retrospective approach using secondary data. Secondary data in the form of resistance culture results in the clinical pathology laboratory at Permata Cirebon Hospital. The sample used in this study was laboratory culture data in 2019 and 2020 as many as 348 samples. Within 2 years (2019-2020) the bacteria were dominated by gram-positive Staphylokokus sp (32%) and followed by gram-negative bacteria, namely Escherecia (23%) and Klebsiella (9.2%). The most common type of specimen was pus (66%). The origin of the sample came from the 3rd floor inpatient (57.4%). The results of the average antibiotic resistance test of the Penicillin group, namely Penicillin (78.1%), Ampicillin (73.6%), and amoxicillin (59.8%) were resistant to the bacteria found but the highest was in the cephalosporin group, namely cephalotin ( 87.7%). There is no shift in bacteria patterns at Permata Cirebon Hospital, only an increase in the number of bacterias from 11 to 20 types in 2020 so that integrated supervision is needed in the use of antibiotics. Keywords: bacteria pattern, culture, resistance Share Link | Plain Format | Corresponding Author (Adriana Hendraningrat)

44	Clinical Practice	ABS-50
Incidence and Characteristics of Pregnant Women who Suffer from Asymptomatic Bacteriuri in Dustira Hospital, Cimahi Eka Noneng Nawangsih, Priatna, Wisnu Yoga Pratama Faculty of Medicine, Universitas Jenderal Achmad Yani Abstract Bacteriuri is the presence of microorganisms in the urine. The diagnosis of asymptomatic bacteriuri is established if there were &#8805-105CFU / ml of bacteria in the urine and there were no clinical symptoms. If untreated, can cause complications in pregnant women such as preterm birth, low birth weight (LBW), and even risk of infant mortality. The purpose of this study was to determine the incidence and characteristics of pregnant women suffering from asymptomatic bacteriuri at Obstetric and Gynecology Polyclinic, Dustira Hospital. This research is a descriptive study using primary data. Subjects in this study were 35 pregnant women who came to check into Obstetric and Gynecology Polyclinic, Dustira Hospital. Samples were taken by purposive sampling. In this study, the incidence of asymptomatic bacteriuria in pregnant women in Dustira Hospital in the period from February to March 2018 was 11.43%. The relatively high proportion of asymptomatic bacteriuria found in second trimester of pregnancy (20%) while in the first trimester of 9.09% and in the third trimester of 7.14%. This is related to physiological changes, increasing hormones and suppression of vesika urinary by the fetus. Based on parity, it was found that there were more asymptomatic bacteriuri in multipara compared to primipara. This is probably caused by the vulnerability of reproductive organs due to physiological changes that often occur. This causes muscle tone in the urinary vesika become weaker and disrupt the process of emptying urine. As a result frequent urinary stasis which is a risk factor for the occurrence of bacteriuri. Keywords: Asymptomatic bacteriuria, pregnant women, Dustira Hospital Share Link | Plain Format | Corresponding Author (Eka Noneng Nawangsih)

45	Clinical Practice	ABS-57
THE DIFFERENCE IN THE LEVEL OF ADHERENCE TO THE MEDITERRANEAN DIET TO BMI, WAIST CIRCUMFERENCE, BODY FAT PERCENTAGE, AND MUSCLE MASS IN OBESE PATIENTS Endry Septiadi (a*), Henny Juliastuti (b), Dewi Ratih Handayani (b), Iis Inayati Rakhmat (b), Dinar Mutiara (a), Rangga Trietian Mahadiputra (c), Mochamad Farhan Abhijana (c). (a) Departemen Ilmu Kesehatan Masyarakat, Fakultas Kedokteran Universitas Jenderal Achmad Yani, Cimahi, Jawa Barat, Indonesia *endry.septiadi[at]lecture.unjani.ac.id (b) Departemen Biokimia, Fakultas Kedokteran Universitas Jenderal Achmad Yani, Cimahi, Jawa Barat, Indonesia (c) Program Studi Sarjana Kedokteran, Fakultas Kedokteran Universitas Jenderal Achmad Yani, Cimahi, Jawa Barat, Indonesia Abstract Obesity is a multifactorial disease that occurs when there is an abnormal accumulation of body fat due to an imbalance between energy intake and energy expenditure. The prevalence of Riset Kesehatan Dasar in 2018 showed that 21.8% of the Indonesian population over 18 years is obese. One of the diets recommended by European Association for the Study of Obesity Community for obesity is the Mediterranean diet. This study aims to determine the difference of adherence level in the Mediterranean diet to nutritional status, and muscle mass in obese patients. The method used in this study is analytic observational with prospective cohort observations. Subjects in this study were 37 obese patients who were monitored for diet four times in one month with food frequency questionnaire and checked for BMI, waist circumference, body fat percentage, and muscle mass at the end of the month. BMI and body fat percentage were analyzed using the Anova test while waist circumference and muscle mass data were analyzed using the Kruskal Wallis test. The level of adherence to the Mediterranean diet has been shown to significantly affect BMI (p=0.008), waist circumference (p=0.042), body fat percentage (p=0.014), and muscle mass (p=0.009) in obese patients. This associated with the composition of Mediterranean diet which affects increase in thermogenesis, fat oxidation, anti-inflammatory, and increases satiety for a longer period. The results of this study support the hypothesis that there is the difference of adherence to the Mediterranean diet to nutritional status and muscle mass in obese patients. Keywords: Body fat percentage, Body mass index, Mediterranean diet, Waist circumference, Muscle mass. Share Link | Plain Format | Corresponding Author (Endry Septiadi)

46	Clinical Practice	ABS-58
THE DIFFERENCE IN THE LEVEL OF ADHERENCE TO THE MEDITERRANEAN DIET TO BLOOD PRESSURE IN HYPERTENSIVE PATIENTS Endry Septiadi (a*), Yudith Yunia Kusmala (b), Lukman Tobing (b), Iis Inayati Rakhmat (c), Dewi Ratih Handayani (c), Zacky Muttaqien Putra Nandita (d), Rifky Atha^ullah Nuralif (d) (a) Departemen Ilmu Kesehatan Masyarakat, Fakultas Kedokteran Universitas Jenderal Achmad Yani, Cimahi, Jawa Barat, Indonesia *endry.septiadi[at]lecture.unjani.ac.id (b) Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Jenderal Achmad Yani, Cimahi, Jawa Barat, Indonesia (c) Departemen Biokimia, Fakultas Kedokteran Universitas Jenderal Achmad Yani, Cimahi, Jawa Barat, Indonesia (d) Program Studi Sarjana Kedokteran, Fakultas Kedokteran Universitas Jenderal Achmad Yani, Cimahi, Jawa Barat, Indonesia Abstract World Health Organization indicated that 1.13 billion people have hypertension. The prevalence of hypertension based on Riset Kesehatan Dasar 2018 reached 34.1% in Indonesia, 39.6% in West Java Province, and 41.83% in Cimahi City. One of hypertension management recommended by US Dietary Guideline, American Heart Association, and European Society of Cardiology is the Mediterranean diet. This research aims to determine the differences in the level of adherence to the Mediterranean diet to systolic blood pressure, diastolic blood pressure, and mean arterial pressure in hypertensive patients. The research design used an analytic method with prospective cohort observation of 39 hypertensive patients for one month. Sampling of data used systematic random sampling technique. Research subjects were divided based on adherence to the Mediterranean diet, such as low, medium, and high as measured by the alternate Mediterranean diet score after filling out the food frequency questionnaire four times in one month, then blood pressure was measured at the end of the month. Systolic blood pressure and mean arterial pressure data were analyzed by Anova and Post Hoc Tukey, whereas diastolic blood pressure data was tested by Kruskal Wallis and Mann Whitney. The results showed that there were significant differences in the level of adherence to the Mediterranean diet to systolic blood pressure (p=0.001<0.05), diastolic blood pressure (p=0.029<0.05), and mean arterial pressure (p=0.003<0.05) in hypertensive patients. The compositions of the Mediterranean diet contain high monounsaturated fatty acids and polyunsaturated fatty acids that potentially to lower blood pressure due to antiinflammatory, antioxidant, and cardioprotective effects. Keywords: Adherence, Diastolic, Mean arterial pressure, Mediterranean diet, Systolic Share Link | Plain Format | Corresponding Author (Endry Septiadi)

47	Clinical Practice	ABS-62
Clinical And Histhopathological Risk Factors Associated With Regional Lymh Node Metastasis In Papilary Thyroid Carcinoma Fitriardi Sejati, Viator Nadeak, Raden Yohana, Kiki Rizki Departement of Surgery, Jenderal Achmad Yani University, Cimahi, Indonesia Departement of Surgery, Oncology Division, Hasan Sadikin Hospital, Bandung, Indonesia Abstract Abstract Background: Thyroid cancer is a common malignancy of the endocrine system. One of the current challenges is to control the loco regional recurrence. Until today, clinical characteristics and histopathological result as predictive factors that can be used to identify patients for prophylactic radical neck dissection are still unclear. Therefore this study aimed to assess the relationship between clinical characteristics and histopathology result to regional neck lymph node metastases. Methods: This was a cross sectional study, to explain the relationship between clinical characteristic and histopathological result in the incidence of regional neck lymph node metastases. Results: During the study period January 2017 to January 2018, there were 74 patients included in the analysis. The mean age of the patient was 45.31 more and less 13,433 years. There were 47 (63.3%) patients with the age categories of less 20 and more 40 years old 63.3% and 27 (36.5%) with age category 20 to 40 years old. Male patients was accounted for 15 (20.3%) and women 59 (79.7%). The mean size of the tumor was 2.85 around 2.078 cm with size categories less than 5cm 67 (90.5%) and more than 5 cm 7 (9.5%). There were 57 (77.0%) patients with papilary thyroid carcinoma (PTC) and 17 (23.0%) with follicular thyroid carcinoma (FTC). There were 45 (60.8%) and 29 (39.2%) patients with positive and negative regional neck lymph node metastases. Conclusions: The factors that influence the occurrence of lymph metastasis were sex, lymphovascular invasion, capsular invasion and histopathology of papillary thyroid carcinoma. Keywords: Papillary Thyroid Carcinoma, Lymph Nodes Metastasis, Local Recurrence. Keywords: Papillary Thyroid Carcinoma, Lymph Nodes Metastasis, Local Recurrence. Share Link | Plain Format | Corresponding Author (Fitriardi Sejati)

48	Clinical Practice	ABS-64
The Relation Between Knowledge and Iron and Protein Intake to the Incidence of Anemia in Elderly Dinar Mutiara (a*), Susanti Ratunanda (b), Muhammad Fikri Al Gifari (c), Endry Septiadi (d) a) Departemen Ilmu Gizi, Fakultas Kedokteran, Universitas Jenderal Achmad Yani, Cimahi. Indonesia *dinarmutiara3[at]gmail.com b) Departemen Patologi Klinik, Fakultas Kedokteran, Universitas Jenderal Achmad Yani, Cimahi. Indonesia c) Program Studi Sarjana Kedokteran, Fakultas Kedokteran, Universitas Jenderal Achmad Yani, Cimahi. Indonesia d) Departemen Ilmu Gizi, Fakultas Kedokteran, Universitas Jenderal Achmad Yani, Cimahi. Indonesia Abstract Anemia is a condition where hemoglobin decreases, resulting in an insufficient amount of oxygen carried to peripheral tissues. A patient is anemic if hemoglobin concentration is <13 g/dL in men and <12 g/dL in women based on WHO and the Ministry of Health of the Republic of Indonesia. Decline in cognitive function could possibly cause poor knowledge about anemia. Decreased ability to absorb iron can cause. Insufficient protein intake inhibits the process of transporting iron causing anemia. The purpose of this study was to determine the relationship between knowledge and intake of iron and protein on the incidence of anemia in the elderly. This research was conducted using analytical research methods with cross sectional observation. Sample was collected by non-probability sampling, using consecutive sampling method, obtaining 35 samples. The hemoglobin level was checked using hematology photometer, filling out questionnaire and food recall sheet 2 x 24hrs. 45,71% of respondents were anemic, the majority of respondents had poor knowledge about anemia (57.14%), 68.75% of respondents had inadequate iron intake, and 60.00% of respondents had inadequate protein intake. Based on chi-square test, it was found that there was a relationship between knowledge of anemia with p value of 0.008, there is a relation between iron intake to anemia with p value of 0.027, and there is a significant relation between protein intake to anemia with a p value of 0.019. In this study, subjects of research were anemic probably caused by poor knowledge, inadequate iron and protein intake, thus causing anemia. Keywords: Anemia, protein intake, iron intake, knowledge Share Link | Plain Format | Corresponding Author (Muhammad Fikri Al Gifari)

49	Clinical Practice	ABS-69
CAUSES AND MANAGEMENT OF EPISTAXIS Nurbaiti Nazarudin (a*), Iwan Darmawan Ma^mur (b) a) Department of Ear Nose Throat-Head and Neck Surgery Faculty of Medicine Universitas Jenderal Achmad Yani-Rumah Sakit Dustira, Cimahi, Jawa Barat, Indonesia b) Department of Surgery Faculty of Medicine Universitas Jenderal Achmad Yani-Rumah Sakit Dustira, Cimahi, Jawa Barat, Indonesia Abstract Epistaxis (nosebleed) is defined as the bleeding from inside the nose or nasal cavity. It is one of the most common emergencies in Otorhinolaryngology worldwide which often requires admission to the hospital. About 60% of the population has had an epistaxis, and 6% require serious and life-threatening treatment. The purpose of writing this article is to find out the cause and treatment of epistaxis. The causes of epistaxis are varied and both local and systemic factors may contribute. Nosebleeds are caused by the rupture of a blood vessel within the nasal mucosa. Most nosebleeds occur in the anterior part of the nose. Several factors have been shown to correlate strongly with epistaxis. Epistaxis management is usually done in the Emergency Department (ED). The principle of epistaxis management is to improve the general state, find the source of bleeding, stop bleeding, and look for causative factors to prevent repeated bleeding. There is no definite protocol for the management of epistaxis, although various treatment methods are available for the management ranging from compression therapy, the use of vasoconstrictor drugs, cauterization (chemical/electric), anterior nasal packing, posterior nasal packing, to embolisation or arterial ligation. Keywords: causes, epistaxis, management Share Link | Plain Format | Corresponding Author (Nurbaiti Nazarudin)

50	Clinical Practice	ABS-71
THE EFFECT OF TONSILLECTOMY ON CHRONIC TONSILLITIS IN CHILDREN QUALITY OF LIFE BASED ON T-14 QUESTIONNAIRE Nurbaiti Nazarudin (a*), Iwan Darmawan Ma^mur (b), Riza Pramudya Iskandar (c) a) Department of Ear Nose Throat-Head and Neck Surgery Faculty of Medicine Universitas Jenderal Achmad Yani-Rumah Sakit Dustira, Cimahi, Jawa Barat, Indonesia b) Department of Surgery Faculty of Medicine Universitas Jenderal Achmad Yani-Rumah Sakit Dustira, Cimahi, Jawa Barat, Indonesia c) Faculty of Medicine Universitas Jenderal Achmad Yani, Cimahi, Jawa Barat, Indonesia Abstract Tonsillitis is a very common disease in children. Chronicity from tonsillitis can occur due to sufferers often experience acute respiratory infections or acute tonsillitis that is not treated adequately. Treatment for chronic tonsillitis is tonsillectomy. Tonsillectomy can affect changes in a person^s quality of life. This study was aimed to determine the effect of tonsillectomy on chronic tonsillitis in children quality of life at Dustira Hospital Cimahi with a prospective observational study using of the Paediatric throat disorder outcome test (T-14) questionnaire. Data samples were collected by convenience method. This study was undertaken examining 12 paediatric patients undergoing tonsillectomy preoperatively and 2 weeks-1month postoperatively. Data were analyzed by marginal homogeneity and Wilcoxon test. The T-14 questionnaire showed, which affected the quality of life before and after tonsillectomy, daytime sleepiness (p = 0.001), noisy breath sounds (p = 0.001), choking on food (p = 0.001), frequency of earaches (p = 0.001) ), chronic throat infections lasting less than 2 weeks (p = 0.001) and more than 2 weeks (p = 0.001), many phone calls to the doctor (p = 0.001), many visits to the doctor (p = 0.001), and no entered school because of sore throat (p = 0.001). There was a decrease in the scores before and after tonsillectomy with an average difference in scores of 45 (p <0.002). This study found a significant effect between the quality of life before and after tonsillectomy. Tonsillectomy had an effect in children quality of life because following tonsillectomy, patients had a significant improvement. Keywords: children, chronic tonsillitis, tonsillectomy, quality of life, T-14 questionnaire Share Link | Plain Format | Corresponding Author (Nurbaiti Nazarudin)

51	Clinical Practice	ABS-75
The Effect of Topical Curcumin Gel on The Epidermal Thickness 2-4 Dinitrochlorobenzene induced Albino mice (Histopathological Analysis) Rina Munirah Bulqini (a*), Lina Damayanti (a) (a*) Department of Dermatology and Venereology, Faculty of Medicine Universitas Jenderal Achmad Yani Jl.Terusan Jenderal Sudirman, Cimahi, Indonesia *rinamunirah[at]gmail.com Abstract Introduction:1-chloro-2,4-dinitrochlorobenzene (DNCB) is an inflammatory inductor with epidermal damage as the main manifestation. Curcumin influences inflammatory signaling pathways and is a potential chemotherapeutic agent. Topical preparation can increase penetration into the skin which makes it a suitable vehicle to maximize the anti-inflammatory property of curcumin, especially through inhibition of phosphorylase kinase enzyme. Objective: To determine the effect of topical application of Curcumin extract gel with various concentrations on the epidermal thickness DNCB-induced albino mice. Methods: Mice were divided into six groups: control (no treatment was given), DNCB induction, DNCB and base gel, and three treatment groups in which in addition to DNCB induction, Curcumin extract gel 2%, 4%, and 8% were applied to the back of mice. After 72 hours, histopathological examination was performed to assess epidermal thickness. Results: From a total of 30 mice, no significant difference in epidermal thickness between the control and treatment groups was found (p>0.05). Conclusion: There was no significant difference in the average thickness of the epidermis between the group of mice that were given the Curcumin extract gel application and the group that was not given the Curcumin extract gel. Keywords: curcumin, gel, inflammation, topical, 2,4 dinitrochlorobenzene Share Link | Plain Format | Corresponding Author (Rina Munirah Bulqini)

52	Clinical Practice	ABS-81
BIPOLAR DISORDER - DIFFICULTIES IN MANAGING EMOTIONAL UPS AND DOWN IN AN ENTERTAINER LIFE : A CASE REPORT Arlisa Wulandari, Meily Dini Kusuma, Rachmaditya Pancarani Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi Abstract Bipolar disorder is an chronic and recurrent disorder, a brain disorder that causes changes in a person^s mood, energy, and ability to function. Patients have an increased mood and activity (mania, hypomania or ^ups^ periode) and declining mood and activity (depressive or ^downs^ periode) in their life. Symptoms of bipolar disorder manic episode include sensitive feelings, lack of rest, shot up self-esteem, and depressive episode include loss of interest, sleep more or less than usual, anxiety, feeling of worthlessness, and lack of concentration. Bipolar disorder is a severe mental disorder with prevalence of 1%-2% and is the 5th cause disability. Bipolar disorder is caused by genetic, environmental factors or social. Social capital can be also viewed as the features of family, the community, school, and work. This report discusses the case of a now manic episodes of bipolar disorder that occurs in a woman aged 25 years old who work as a public figure, announcer and other entertainment activity. Patient have been hospitalized several times and received different kind of pharmacotherapy and psychotherapy but still having difficulties in managing the ups and downs of her emotion. A lot of individual factors must be considered in managing patients with bipolar disorder. Keywords: bipolar disorder, entertainer, ups and downs emotion Share Link | Plain Format | Corresponding Author (Rachmaditya Pancarani)

53	Clinical Practice	ABS-82
2. Developing self-aware mindfulness to manage mood disorder in the adolescent A Case Report Of 22 years male with Suicide Attempt On Major Depressive With Psychotic Symptoms Kiki Puspitasari (a*) Putri Rahmani (b) Syifa Shafira (b) Program Studi Sarjana Kedokteran, Fakultas Kedokteran, Universitas Jenderal Achmad Yani, Cimahi. Indonesia Abstract Severe depressive episodes with psychotic symptoms are a form of major depression accompanied by typical psychotic symptoms such as delusions or nihilistic, non-bizarre delusions, somatic, poverty, worthlessness, or delusional beliefs about guilt and being punished, and sometimes appear hallucination. A 22-year-old male presented to the inpatient psychiatric unit with suicide attempt. The patient reported experiencing a lack of energy, difficulty falling asleep, lack of motivation, and feeling overwhelmed about his work and experiencing auditoric hallucination. The insight level was 5. Multiaxial diagnosis are axis I: major depressive episode with psychotic symptoms- axis II and III: currently not found- axis IV: problems with work- axis V: GAF 20-11. Patient treated with pharmacotherapy group Selective Serotonin Reuptake Inhibitor (SSRI) and First-generation antipsychotics which combined with supportive psychotherapy. Keywords: Major Depression, Suicide attempt, Self-awareness, Psychotic Share Link | Plain Format | Corresponding Author (putri rahmani)

54	Clinical Practice	ABS-83
Rehabilitation of Walking Problem after Chopart^s Amputation for Diabetic Foot : A Case Report Marina A. Moeliono, Farida Arisanti, Deta Tanuwidjadja, Arief Zamir a) Physical Medicine and Rehabilitation Department Faculty of Medicine Padjadjaran University Dr. Hasan Sadikin Central Hospital, Bandung b) PPDS-1, Faculty of Medicine Padjadjaran University, Physical Medicine and Rehabilitation Department, Dr. Hasan Sadikin Central Hospital, Bandung Abstract Abstract Rehabilitation Phase of Chopart Amputee can be challenging. Post operative complication can disturb every day^s live activity, among which is disturbance in his gait. We report a case about rehabilitation of post left choppart amputee due to diabetic foot. It was a 44 years old patient, with diabetes mellitus type 2 since 11 years ago. He was followed with diabetic arteriopathy and infected gangrene of the left foot and had a Chopart^s amputation 5 years ago. He was than reffered to our Physical Medicine and Rehabilitation departement for his gait disturbance. The examination found diabetic ulcus on posterior side of his calcaneal, and we also find an equinus deformity. We plan to give him functional prosthesis to help with his ambulation so he can get back to work and help achieve better long-term outcome. Keywords: Rehabilitation- Chopart- diabetic foot- deformity- walking- prosthesis Share Link | Plain Format | Corresponding Author (Arief Zamir)

55	COVID-19	ABS-15
COVID-19 Incidence and Severity in Pregnant Women at Cimahi Referral Hospital Ifa Siti Fasihah (a*), Asti Kristianti (b), Raissa Anandhianya Dikna (c), Jeffry Iman Gurnadi (a) a) Departmen Ilmu Obstetri Ginekologi, Fakultas Kedokteran, Universitas Jenderal Achmad Yani, Cimahi. Indonesia *ifa807[at]gmail.com b) Departemen Ilmu Telinga Hidung Tenggorok Bedah Kepala Leher, Fakultas Kedokteran, Universitas Jenderal Achmad Yani, Cimahi. Indonesia c) Program Studi Sarjana Kedokteran, Fakultas Kedokteran, Universitas Jenderal Achmad Yani, Cimahi. Indonesia Abstract Coronavirus disease (COVID-19) is a highly infectious and pathogenic disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which is causing a worldwide pandemic. The severity of COVID-19 consists of asymptomatic, mild, moderate, severe, and critical. COVID-19 can attack anyone, including pregnant women. This study aims to determine the characteristics of pregnant women with confirmed COVID-19 based on maternal age, parity, gestational age, comorbid factors, clinical symptoms, and severity at Dustira Hospital and Cibabat Hospital, which are the referral hospitals in Cimahi. This study used a descriptive method which was taken by total sampling using the secondary data in medical records of pregnant women who have confirmed COVID-19 at Dustira Hospital and Cibabat Hospital. The result from this study, 129 pregnant women were confirmed to have COVID-19 at Dustira Hospital and Cibabat Hospital. The characteristics based on maternal age, most of them were 20-35 years (79.07%), multiparous (62.02%), entering the third trimester (82.95%), the most common comorbid factor was hypertension (14.73%), the most common clinical symptom was cough (86.8%) and based on severity, most of them have moderate symptom (73.64%). There are differences about the severity with previous studies which can be caused by hospital differences. There is an incomplete pathogenesis and pathophysiology of COVID-19 related to pregnancy, so the further research on COVID-19 in pregnancy is needed. Keywords: COVID-19, pregnancy, severity Share Link | Plain Format | Corresponding Author (Raissa Anandhianya Dikna)

56	COVID-19	ABS-19
POTENCY OF RECOMBINANT SOLUBLE ANGIOTENSINCONVERTING-ENZYME 2 (sACE2) FOR COVID 19 THERAPY Sayu Putu Yuni Paryati (a*), Khomaini Hasan (b), Hidayatul Rachman (c), Ike Hikmawati (d), Ris Kristiana (e) a) Department of Microbiology, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, West Java, Indonesia * yuni.paryati[at]lecture.unjani.ac.id b) Department of Biochemistry, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, West Java, Indonesia c) Department of Pharmacology, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, West Java, Indonesia d) Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, West Java, Indonesia e) Department of Pathology and Anatomy, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, West Java, Indonesia Abstract Coronavirus Disease 2019 (COVID-19) is an infectious disease, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Since it was declared by the World Health Organization (WHO) as a pandemic on March 11, 2020, COVID-19 cases have received great attention due to its high level of infectivity. The SARS-CoV-2 virus enters the host cell by binding to the Angiotensinconverting-Enzyme 2 (ACE2) receptor which is widely expressed in the lower respiratory tract. The ACE2 enzyme bound to the host cell membrane functions as a SARS-CoV-2 receptor, allowing virus entry into the host cell by binding to the S1 domain of the viral glycoprotein S. ACE2 also exists in the circulating soluble form (sACE2), and is usually present in plasma at low concentrations. This sACE2 enzyme also has the ability to bind to the S1 glycoprotein domain, but due to its soluble nature, the SARS-CoV-2 virus will not enter the host cell. This study aims to prepare and conduct a study on anti-protein S-based therapy, in particular the potential of sACE2 as a candidate for COVID-19 therapy. At the previous studies, the design, optimization, and synthesis of the ACE-2 gene have been developed, and in this study, a study of the potential of recombinant sACE2 was carried out by looking at the ability of sACE2 gene expression in selected superior Escherichia coli hosts. The results of culture of sACE2 in E. coli indicated that sACE2 was well expressed and showed the same characterization results as native sACE2 with a molecular weight of about 11.62 kDa. Thus, it is hoped that sACE2 has the potential to be produced in large quantities and can be used as a candidate for COVID-19 therapy. As a follow-up, it is necessary to conduct research to determine the potency of sACE2 in vitro and in vivo. Keywords: Angiotensinconverting-Enzyme 2, sACE2, COVID-19, SARS-CoV-2 Share Link | Plain Format | Corresponding Author (Sayu Putu Yuni Paryati)

57	COVID-19	ABS-22
Cardiac Damage in an Adolescent Patient with COVID-19: a Case Report Prihati Pujowaskito (a, b)*, Tamia Setia Tartila (b), Novaro Adeneur Tafriend (b), Fatimah Defina Khamarul Jannah (b), Elsy Mayasari (b) (a) Department of Internal Medicine, Faculty of Medicine, Jenderal Achmad Yani University (b) Department of Cardiology, Gatot Soebroto Army Hospital *pujowaskito[at]yahoo.com Abstract COVID-19 has been found to affect the cardiovascular system leading to myocardial damage. As a chronic sequela, this condition may result in cardiomyopathy. We report a case of an adolescent COVID-19 survivor with dilated cardiomyopathy who had no underlying heart disease. A male patient aged 16 was admitted to our outpatient clinic with a primary symptom of exhaustion and had recently recovered from mild to moderate COVID-19 one month prior to the visit. The patient had no previous history of heart disease. Physical examination showed no abnormalities, but the laboratory results revealed substantially elevated NT-proBNP (7705 pg/mL) and D-dimer (1850 ng/mL). ECG showed normal sinus rhythm with poor R wave progression. Bedside echocardiography revealed all chamber dilatation, eccentric left ventricular hypertrophy, global hypokinetic, moderate mitral regurgitation and reduced ejection fraction (22%). We diagnosed the patient with new-onset dilated cardiomyopathy as a COVID-19 sequela, and we began treatment with an angiotensin II receptor blocker (candesartan), a beta-blocker (bisoprolol), diuretics (furosemide and spironolactone), rivaroxaban, and trimetazidine. The recovery was steady at a three-month follow-up visit. The emergence of new-onset cardiomyopathy in this previously healthy young patient raises the possibility of COVID-19 acting as a sole cause of myocardial injury in the absence of underlying heart disease. To avoid further complications, comprehensive evaluation and effective therapy should be implemented during hospitalization and post-discharge period. To offer final proof, additional tests such as cardiac magnetic resonance imaging and endomyocardial biopsies should be performed. Keywords: Cardiomyopathy, COVID-19, myocardial injury Share Link | Plain Format | Corresponding Author (Prihati Pujowaskito, Sp.JP(K), FIHA, MMRS)

58	COVID-19	ABS-23
Parosmia sebagai Gejala Lanjut Covid-19: Laporan Kasus Yanti Nurrokhmawati Bagian Ilmu Telinga Hidung Tenggorokan - Bedah Kepala dan Leher, Fakultas Kedokteran Universitas Jendral Achmad Yani / Rumah Sakit Dustira, Cimahi, Indonesia Abstract Parosmia atau distorsi fungsi penciuman adalah gangguan penghidu/penciuman yang membuat seseorang merasa membau secara berbeda dari yang seharusnya. Parosmia akhir-akhir ini dikenal sebagai salah satu gejala lanjutan dari Covid-19 atau sering disebut juga sebagai long covid. Prevalensi pasti kejadian parosmia sebagai lanjutan gejala covid-19 masih belum jelas diketahui karena masih sedikitnya pelaporan dan tidak semua penderita datang berobat. Penelitian ini melaporkan 3 kasus parosmia yang datang ke poliklinik THT RS Dustira. Tujuan penelitian ini adalah untuk menilai karakteristik pasien dan hasil dari pengobatan parosmia sebagai gejala lanjutan Covid-19. Dari 3 pasien yang mengalami parosmia, jenis kelamin laki-laki 2 orang dan perempuan 1 orang. Usia pasien 30, 32 dan 40 tahun. Dua orang pasien merupakan perokok. Ketiga pasien didiagnosis Covid-19 3-5 bulan yang lalu dan semua disertai gejala hidung seperti anosmia, hidung beringus dan hidung tersumbat. Dua pasien mengalami dysgeusia. Keluhan yang dirasakan berupa sensasi mencium bau busuk pada satu orang dan dua orang mencium bau karat.Tatalaksana yang diberikan berupa irigasi nasal salin dan latihan penghidu (olfactory training). Respon pengobatan pada ketiga pasien dalam rentang waktu pengobatan 3 bulan berupa hilangnya gejala pada satu orang dan tidak berespon pada 2 orang. Parosmia adalah gejala yang dapat terjadi paska infeksi covid-19. Tatalaksana dengan irigasi nasal salin dan latihan penghidu memberikan perbaikan pada sebagian pasien walaupun dengan respon yang lambat. Keywords: covid-19, long covid, parosmia, penghidu Share Link | Plain Format | Corresponding Author (Yanti Nurrokhmawati)

59	COVID-19	ABS-24
Diabetes Mellitus And Covid-19 Patient Severity And Mortality At Dr. Slamet Garut General Hospital Yudith Yunia Kusmala1, Lina Damayanti2, Julianto W1, Salza Billa3 1Internal Medicine Department, Medical Faculty of Jenderal Achmad Yani University, Cimahi. Indonesia 2Dermatologist Department, Medical Faculty of Jenderal Achmad Yani University, Cimahi. Indonesia 3Bachelor Degree of Medicine Program, Medical Faculty of Jenderal Ahmad Yani University, Cimahi. Indonesia Abstract Introduction : Respiratory illness caused by Coronavirus Disease 19 can be attributed to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Diabetes mellitus (DM) may be a contributing factor in the higher mortality and severity of COVID-19 patients, according to researchers. This is an investigation on the link between diabetes mellitus (DM) and COVID-19 patient mortality and severity. Methods: This study examines the association between DM, severity, and death in COVID-19 patients. The subjects in this study were COVID-19 patients treated at Dr.Slamet Garut General Hospital in 2020-2021. The data for this study came from COVID-19 patients^ medical records. Results : According to the research data, 18 patients (30 percent) with COVID-19 and DM were treated in the ICU, and 15 patients with COVID-19 and DM died (25 percent ). The Chi-square test results showed that there was a relationship between COVID-19 patients suffering from DM and COVID-19 patient severity (p=0,020- OR=3,5- 95 percent CI: 1,20 to 10,19) and a relationship between COVID-19 patients suffering from DM and COVID-19 patient mortality (p=0,015- OR= 4,0- 95 percent CI: 1,27 to 12,57). Conclusion- The Chi-Square test revealed a significant connection between diabetes severity and mortality in COVID-19 patiens (p 0.05) in Dr. Slamet Garut General Hospital. It^s believes that early glucose control is critical since higher glucose levels have been linked to increased mortality in COVID-19 diabetic patients, and management of cardiovascular risk factors is critical. Keywords: COVID-19- Diabetes mellitus- Mortality- Severity Share Link | Plain Format | Corresponding Author (Salza Billa)

60	COVID-19	ABS-53
Association between Wearing Mask and the Incidence of COVID-19 within the Community of Cipageran Health Center Region Desy Linasari (a*), Hanifah Tri Octaviani (b), Yanti Nurrokhmawati (c) a) Departemen Ilmu Kesehatan Masyarakat, Fakultas Kedokteran Universitas Jenderal Achmad Yani *desylinasari[at]gmail.com b) Program Studi Kedokteran Umum, Fakultas Kedokteran Universitas Jenderal Achmad Yani c) Departemen Ilmu Penyakit THT-KL, Fakultas Kedokteran Universitas Jenderal Achmad Yani Abstract COVID-19 is a disease caused by Sars-CoV-2 and transmitted through the fluids of an infected person when coughing, sneezing, or talking. Based on the mode of transmission, the Ministry of Health establishes regulations regarding the prevention of COVID-19, by applying 5M protocol, one of which is wearing mask. Cipageran is the village with the highest COVID-19 incidence in Cimahi. This study aims to determine the association between wearing mask and the incidence of COVID-19 Within the community of Cipageran health center region. This is an analytical case-control study, by comparing people who have tested positive for COVID-19 (cases) with people who have never had COVID-19 (controls). The data obtained using a questionnaire. There are 56 cases and 97 controls. The collected data were analyzed using the chi square test, logistic regression test, and Mann Whitney test, it was found that 53.6% of cases is household-acquired. Sometimes wearing a mask (OR: 1.73) have a higher risk of COVID-19 transmission compared with mostly wear masks. There is no association between the type of mask because it depends on the technique, duration of using a mask due to difference activities of the subjects, changing mask every day because reuse mask still has the protective effect than not wearing mask at all, and contact history with with person with confirmed COVID-19 who didn^t wear mask. The public is advised to comply health protocols at home while in self-isolation or if a family member suffers from COVID-19. Keywords: COVID-19- Prevention- Wearing mask Share Link | Plain Format | Corresponding Author (Hanifah Tri Octaviani)

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