Introduction: Penile length is defined as a length from base of penile until the tip of the glans. If the length of penile less than 2.5 standard deviations (SD) on average of its age it characterized as a micropenis. The aim of this study is to describe the penile length and micropenis condition in elementary school student. Method: This is a descriptive study to find out the penile length in elementary school boys. Penile length was measured from symphysis pubic to tip of the glans using a rigid ruler by stretching the penile or stretching penile length (SPL) and identified the micropenis condition. Results: There were 203 boys with age ranging from 6 until 13 years old. Mean penile length on all age groups are slightly above mean - 2.5 SD. Micropenis was found in 52 boys (22.6%), half of them are in 9 to 11 years old groups. Most subjects are Sundanese. Conclusions: The mean penile length in all age groups were shorter than the reference that we used. Majority of the subjects in our study were Sundanese, this finding suggest that Sundanese children has a shorter penile length than a subject used in our reference study. Micropenis case findings in this study turned out to be quite large and surprising.

Introduction: Rhabdomyosarcoma (RMS) is the major soft tissue sarcoma in childhood, correlated with high morbidity and mortality. We defined clinico-epidemiological profiles and prognoses on pediatric RMS patients in Indonesia. Methods: This study was conducted retrospectively by examining all medical records of pediatric RMS patients in Dr. Sardjito Hospital, Yogyakarta, Indonesia, for 5 years from 2011 until 2016. Results: There were 21 RMS patients in this study. The median age of our subjects was 6 years and predominantly under 10 years old (71.4%). There was a greater tendency for the disease in males, with a male to female ratio of 2 : 1. The head and neck region was the primary tumor site (52.4%). The most common histological subtype of tumor was embryonal RMS (85.7%). The most common measured diameter for tumor size was ≤ 5 cm (42.9%). Almost half of the patients received combination therapy, including surgery and chemotherapy (47,6%). Overall survival rate was 71.7%. Conclusion: We concluded that the epidemiological profile and prognostic factors of childhood RMS patients in our center are similar to the world reference data and were clinically associated with the mortality rate of our RMS patients, but the findings were not considered statistically significant.

Introduction: Wilms tumor is the major kidney neoplasm in childhood. Approach to therapy gives a 90% 2-year survival rate. However, the mortality rate in developing countries is relatively still high. Research about the clinicopathological profile of Wilms tumor in Indonesia is very limited. This study aimed to investigate the Wilms tumor patients in an Indonesian setting. Methods: This research was a descriptive observational study using a cross-sectional design. Clinical and pathological data were collected from patients’ medical records in Dr. Sardjito General Hospital, from 2011 to 2016. Results: Twenty-five patients were recruited with 52% female subjects. The mean age at the first diagnosis was 38 months. All patients had unilateral tumors. The tumor size was mostly (67%) equal or more than 10 cm. The most frequent symptom was abdominal mass. Ninety-two percent of patients have favorable histology. Most cases (68%) had triphasic morphology. The most common metastasis site of tumor was the liver, followed by the lung, skeletal bone, and spleen. Eighty-four percent of patients received chemotherapy, 80% received surgery, and 28% received radiotherapy. The gender distribution and the most common metastasis site in this study were different compared to previous studies. Conclusion: The clinicopathological profile of Wilms tumor in Yogyakarta, Indonesia, generally matches with other studies from other countries, except the gender distribution and the most common metastasis site. Further prospective studies regarding the prognosis of the patients are urgently needed.

Introduction: The mortality rate due to omphalocele cases remains high. The presence of other congenital anomalies is believed to be one of the factors causing death in patients with omphalocele. The objective of the study was to determine the influence of other congenital anomalies leading to mortality. Methods: We conducted a retrospective cohort study in the neonatal unit of Sardjito General Hospital from March 2008-April 2019. We collected data on factors including sex, mode of delivery, gestational age, birth weight, associated anomalies, management, neonatal complications, need for surgeries, and mortality from our registry and patients’ medical records. We then classified the infants into the isolated omphalocele and non-isolated omphalocele groups. Univariate and multivariate analyses were performed to determine the association of congenital anomalies and other confounding factors with mortality. Results: We identified 73 omphalocele cases during the study period. The hospital occurrence was 4.3/1000 livebirths. We found 45 cases (61.6%) of omphalocele associated with other congenital anomalies including several syndromes (46.7%) such as Patau syndrome and Beckwith-Wiedemann syndrome, congenital heart defects (42.2%), gastrointestinal anomalies (22.2%), neural tube defects (15.6%), cleft palate (11.1%), and syndactyly (0.07%). There was no difference in mortality (25/45 vs 15/28) between the groups (p=0.87). Interestingly, sepsis, pneumonia and gastrointestinal perforation were significantly associated with the survival of infants with omphalocele, with p-value of 0.05, 0.00, and 0.05, respectively. Conclusion: Certain complications might have an impact on survival, but the presence of other congenital anomalies was not significantly associated with the mortality of omphalocele cases.

Introduction: As the main cause of typhoid, Salmonella spp., especially Salmonella typhi contribute to the incidence of community-acquired bloodstream infections in developing countries. Annually, there are around 20 million cases of typhoid fever and more than 150,000 deaths reported. However, several studies suggest Salmonella spp. have become resistant to some antimicrobials. This resistance to antibiotics may be caused by inappropriate antimicrobial prescriptions. Methods: This research was a descriptive observational study. Data of clinical isolates of Salmonella spp. from blood cultures and results of antimicrobial sensitivity tests were obtained from the Clinical Laboratory Installation of Dr. Sardjito General Hospital. The data were then processed and analyzed using descriptive statistics and proportion tests. Results: We obtained 14 isolates of Salmonella spp. and 11 isolates of Salmonella typhi. All of the Salmonella spp. isolates were resistant to cefazolin, but 100% of isolates were sensitive to aztreonam, ceftazidime, ciprofloxacin, etc. All of the Salmonella typhi isolates were resistant to tetracycline and cefazolin, but 100% of isolates were sensitive to aztreonam, ceftazidime, ciprofloxacin, etc. The number of inappropriate definitive antimicrobial prescriptions due to Salmonella spp. and Salmonella typhi infections at Dr. Sardjito General Hospital was 47.36% (p=0.0015;95%CI:0.2846-0.6614). The proportion of cephalosporin used as empiric therapy for bloodstream infection was 68% (95%CI:0.52-0.83). Conclusions: Significant number of inappropriate antimicrobial prescriptions in definitive treatment of bloodstream infections caused by Salmonella typhi and Salmonella spp. were found at Dr. Sardjito General Hospital in 2018. More efforts are needed to properly prescribe antimicrobials and prevent increases in antibiotic resistance microbes.

Introduction: Tuberculosis (TB) is the cause of significant health and death problems worldwide. Indonesia is known as the second highest country with TB burden in the world after India. The incident of TB is further increasing in diabetes mellitus patients. Diabetes mellitus disrupts the body’s immune function; thus, patients are more susceptible to infection, including TB. The purpose of this study was to determine the prevalence of diabetes mellitus history (DM) among newly diagnosed TB patients in Surabaya. Methods: 160 patients were grouped into two groups; the first group (67 patients) was positive for TB and diabetes mellitus, and the second group (93 patients) was positive for TB only. Data were collected from TB patients based on acid-fast bacilli stain (AFB) and positive Xpert MTB/RIFF. Blood glucose level was collected from 2hrPPG, and glycated hemoglobin (HbA1c). Results: The prevalence of TB related with DM history was 42% from 55 ± 9.52 years old. Patients with TB-DM showed poor glucose blood level, their 2hrPPG was 301.43 ± 126.80 mg/dl, and the HbA1c result (> 6.5%) was 82%. The rifampicin resistant level result was not significantly different between TB and TB-DM (4.4% and 3% respectively). Conclusions: Our results highlight the incidence of DM history in TB positive patient that was hospitalized in Hajj Hospital. Therefore, it is important to monitor the prevalence of DM in TB newly diagnosed cases to assist practitioner to choose better treatment while considering the risk of DM interference.

Introduction: Urbanisation is a key determinant of population health. Malaysia’s exemplary economic growth in the early 1990s and the consequent development and urbanisation led to significant changes in health, lifestyle and quality of life. Rising expectations, changing demographics and nutrition and disease transitions were challenges synonymous to an increasingly urban Malaysia. As the Government targets optimal population health, this paper aims to explore one of the many challenges of urbanisation, namely the prevalence of non-communicable diseases or NCDs. For the purpose of this paper, NCD is proxied by Diabetes Mellitus. Methods: This study is based the 2015 National Health and Morbidity Survey, which is a cross-sectional population-based survey, involving 30,000 respondents. Given the binomial nature of the survey variables, the multinomial Probit model was employed using the STATA statistical software. Results: Generally, age, gender and race are significant in determining health outcomes. Socioeconomically, all three variables of income, education and employment are significant. For lifestyle factors, findings show that only the weight and physically active status have a role in determining health outcomes. Finally, the urban variable is also positive and significant. Conclusion: Findings show that the prevalence of Diabetes Mellitus, is rising along with urbanisation and that there is a health penalty for the urban population and also for those who do not embrace healthy lifestyles. Additionally, other factors are equally important as urban health determinants, encompassing both the demographic and socioeconomic factors.

Introduction: Determination of learning needs is central for holistic patient education, to sustain behavior changes and to control patient’s risk factor. However, patients often sense that their learning needs are unmet and information provided was too general. Thus, this study aimed to determine the perceived learning needs and their level of importance among Coronary Artery Disease (CAD) patients. Methods: The current investigation is a descriptive, cross-sectional study for which all CAD patients were selected using the cencus method. The data was collected using Cardiac Patients Learning Needs Inventory. The questionnaire was delivered to 140 CAD patients who had their follow-up in a cardiology clinic. The instrument is reliable with a Cronbach’s alpha coefficient of 0.96. The study design followed STROBE cross-sectional design process guideline. Results: Participants’ mean age was 58.96 ± 9.42 years. More than half of the participants were males (62.9%), employed (52.0%) and had attained secondary level education (69.3%). Around two-thirds (60.7%) of the patients perceived to have high learning needs. Gender and highest educational achievement were significantly associated with perceived learning needs. The most significant perceived learning needs were medication information, risk factors for CAD, information on diet, physical activity, anatomy and physiology, and other related information. Conclusion: This study has identified the important domains of learning needs among CAD patients. Findings from the present study will provide important input for future cardiac educational strategies to reduce the rate of hospital readmission and death.

Introduction: Scarcity of data found in regard to association of vitamin D level with bone mineral density (BMD). Our study aimed to determine the correlation of vitamin D with BMD and intact parathyroid hormone (iPTH) among healthy Malay adult. Methods: This cross-sectional study recruited 126 healthy Malay volunteers (aged 21–45 years old) from Kota Bharu, Malaysia. Serum total calcium, albumin, phosphorus, 25-hydroxyvitamin D (25(OH)D), and iPTH were measured. BMD was assessed with dual energy X-ray absorptiometry (DXA) scan over left hip (right hip in case of problem with left hip) and lumbar spine (L1 – L4 vertebrae). Results: The mean serum 25(OH)D was 38.91 ± 14.07 nmol/L. Out of 126 study subjects, 104 subjects (82.5%) had insufficient level of vitamin D (< 50 nmol/L). Mean hip and lumbar BMD were 0.952 ± 0.145 g/cm2 and 1.006 ± 0.133 g/cm2 respectively. According to T-score, 93 subjects (73.8%) had normal T-score of ≥ -1, 33 subjects (26.2%) had osteopenia (T-score -2.5 to -1) and none had osteoporosis (T-score ≤ -2.5). Significant positive correlation between serum 25(OH)D and hip BMD (r = 0.234, p = 0.009) was observed, but no correlation was found between serum 25(OH)D and lumbar BMD. Meanwhile, significant inverse correlation between serum 25(OH)D and iPTH was observed (r = -0.324, p < 0.001). Conclusion: High prevalence of vitamin D insufficiency was observed among healthy Malay population, but majority had normal bone density. Nonetheless, serum 25(OH)D was positively correlated with BMD and inversely correlated with iPTH. Our findings support the role of vitamin D for maintaining bone health.

Introduction: Drug-resistance is a major hindrance to successful treatment of AML. Current predictive biomarkers are mainly genetic aberrations and insufficient in foretelling treatment outcome in all acute myeloid leukaemia (AML) due to its heterogeneous and aggressive nature. Proteins are stable and reliable. Secreted proteins in AML may have predictive or prognostic values for early intervention. Proteomic studies on AML are few and further investigations will benefit in selection of best markers. The aim of the study was to identify differentially expressed plasma proteins in AML with different treatment outcome. Methods: Two-dimensional electrophoresis (2-DE) technique was utilised to identify proteins differentially expressed in chemo-sensitive/chemo-resistant AML. Plasma and peripheral blood mononuclear cell (PBMC) lysate proteome analysis were performed on six chemo-resistant, four chemo-sensitive and six healthy controls and seven chemo-resistant, three chemo-sensitive and six healthy controls, respectively. Each experiment was conducted in duplicate or triplicate. Images were captured and protein spots detected by software. Differentially expressed protein spots were excised from gel and proteins were identified using LC/MS/MS. Proteins spots that were also detected in healthy controls were excluded. Results: Comparing mean % volume of each spot demonstrated significantly enhanced expression of apoliprotein-E (APO-E) and haptoglobin (HP) (p<0.05) in plasma and HNRNP H1 (p=0.049) in cell lysate of chemo-sensitive group. Serotransferrin (STF) from plasma and DNA-PK from cell lysate (p=0.01) were associated with chemo-resistance. Conclusion: This preliminary study identified several potential predictive biomarkers associated with chemo-resistance/chemo-sensitivity to treatment in AML. Further studies with a larger number of samples are required to validate the results.