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It further enlarged from 4.5 cm to 10.6 cm in diameter in three months. The urologist performed a total right nephrectomy. selleck The histopathological examination showed XGP with renal abscess. Proteus mirabilis was identified from the pus specimen culture. XGP should be considered in the diagnosis of patients having chronic UTI presented with or without the findings of urinary tract obstruction.Pancreas divisum is an abnormal condition of pancreas duct that occurs from organogenesis. This abnormal condition defined as a failure in fusion between dorsal and ventral part of the pancreas. The incidence reported 4%-14% in general population. Majority patient with pancreas divisum will not present with any sign or symptom, but in some cases may present with signs of pancreatitis. We illustrate a case of 39 years old male with pancreas divisum presenting as acute recurrent pancreatitis. Diagnosis of pancreas divisum was determined through magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Patient treated by sphincterotomy and dilation using Soehendra's dilator catheter. This is the first pancreas divisum case successfully treated and reported in Indonesia.Biliary strictures diagnosis has become a challenge where benign conditions could mimic a malignant process. Recently, SpyGlass DS overcame the limitations by allowing direct visualization of the biliary tree. A 65 years old Indian patient complaints of jaundice with total and direct bilirubin of 23.3 mg/dL and 16.2 mg/dL, respectively. Liver function test, gamma-glutamyltransferase and CA 19-9 were increased. Transabdominal ultrasound and abdominal CT supported dilatation of common bile duct (CBD) with abrupt narrowing showing periductal enhancement at supra pancreatic level and stricture. Endoscopic ultrasound showed intrahepatic CBD stricture with dilated proximal CBD and sludge ball. Endoscopic retrograde cholangiopancreatography showed mid CBD stricture. Although brush cytology results suggested low grade dysplasia and no definite evidence of malignancy, cholangioscopy using SpyGlass DS found nodularity with abnormal vascularity seen in mid of CBD suggesting malignancy, confirmed with histopathology as cholangiocarcinoma. We reported additional value of SpyGlass DS for detecting cholangiocarcinoma in an indeterminate biliary stricture patient.Pancreatic and peripancreatic tuberculosis is a rare abdominal tuberculosis. Diagnosis for pancreatic tuberculosis can be challenging. Conventional imaging tools may show mass or malignancy in the pancreas. Endoscopic ultrasound (EUS) is an excellent tools for evaluating pancreas and peri pancreas region. It also allows us to obtain tissue sample for cytology and histopathology. Here we present a case of peripancreatic tuberculosis lymphadenopathy that mimic pancreatic mass. His symptoms were also nonspecific (weight loss, epigastric pain, and irregular fever). From EUS evaluation we found that there was no mass but multiple lymphadenopathy around the pancreas and then performed FNA. The result of the cytology was granuloma inflammation and caseous necrosis which is compatible with tuberculosis infection. From this case illustration we conclude that EUS is an important diagnostic tool for pancreatic lesion to avoid unnecessary surgery.The COVID-19 pandemic has become a concern for the world community. However, despite abundant attempts taking place, there is currently no definitive therapy for COVID-19 yet. The clinical approaches recently adopted are the provision of antiviral therapy and immunomodulators. One of the immunomodulators that are currently being researched is tocilizumab, an IL-6 receptor antagonist monoclonal antibody. Many case studies and retrospective observational studies have shown that there is a chance that tocilizumab could diminish death rates in COVID-19 patients with severe or critical symptoms. Along with the growing use of tocilizumab in the COVID-19 cases that are emergent in nature, the occurrence of unpredictable adverse effects of the drugs have also been raising. This case report describes a COVID-19 confirmed patient with severe symptoms who was given tocilizumab in addition to standard therapy. The patient developed Herpes Zoster infection which was suspected to be related to the adverse effects of using tocilizumab, which is known for its likelihood to increase the risk of new infections and also probably reactivate latent infections. Tocilizumab use seems to be effective in combating cytokine storm associated with severe COVID-19 infection. The possibility of serious adverse effects in the utilization of tocilizumab, though rare, cannot be excluded. The presence of a latent or chronic infection that can undergo reactivation should be a consideration for appropriate screening or prophylaxis before administering tocilizumab.

Accurate prediction of survival is important for advanced cancer patients to determine medical interventions plan the patient's lives and prepare for their death. The palliative prognostic index (PPI) is most popular scores used worldwide to predict life expectancy in advanced cancer palliative patients. The purpose of this study was to test validity and the performance of PPI in Cipto Mangunkusumo Hospital as a Tertiary Referral Nasional Hospital.

This retrospective cohort study, uses total subject during study with consecutive sampling. Palliative prognostic index was assessed by a palliative care team (PCT). Demographic data were summarized as n (%) and Chi square for categorical variables and median or mean for continuous variables. Overall survival was calculated using the Kaplan-Meier method with hazard ratios. The performance of PPI analyzed using SPSS version 20.0, includes for Receiving Operator Characteristics (ROC) and Hosmer-Lemeshow calibration test.

160 patients were included in the PPI strmance in predicting the survival of advanced cancer patients and may be used to help clinicians in palliative care consultation.

miRNA 21 exhibits an increased expression in breast cancer (BC). However, its relationship with the 1-year survival of breast cancer patients is still disputable and under serious discussion.

Cohort prospective study involving 49 breast cancer patients was done, comprising 26 in early stage and 23 in end-stage. We evaluated miRNA-21 values and observed its association with mortality within 1 year.

In general, there was a correlation between the increase in miRNA-21 levels and the mortality rate of breast cancer patients (r = 0.651; p <0.05). In the early stages, the increase in miRNA-21 values was not associated with breast cancer mortality (r= 0.25; p=0.218), but in the later stages, we found that the increase in miRNA-21 had a correlation with mortality (r=0.866; p=<0, 05). In advanced stage, high level of miRNA-21 had high asscociation with mortality rate (HR 17,27 95%CI 7,37-40,69).

The increase in miRNA-21 values is associated with the 1-year survival of breast cancer patients.

The increase in miRNA-21 values is associated with the 1-year survival of breast cancer patients.

Elderly people who have poor social relationships have a higher risk of death than those who have strong social networks. Loneliness and social isolation are associated with an increased risk of coronary heart disease and stroke. Physical activity can reduce social isolation, diverting feelings of loneliness by socializing with other people and expanding social networks by participating in the community. This study aimed to determine the effect of physical activity on social isolation in the elderly.

A Cross-sectional study was conducted to 181 respondents. The data is collected through interviewing respondents with the International Physical Activity Questionnaire (IPAQ) and social isolation questionnaires. The data was then analyzed descriptively and calculated using Fisher's exact test.

Ardirejo and Panggungrejo villages, Kepanjen District, Malang Regency.

Based on the Fisher's exact between physical activity and social isolation results were obtained p-value 0.000 (PR = 23.407; 95% CI = 3,117-175,800).

There is a significant relationship between physical activity and social isolation in the elderly in the community.

There is a significant relationship between physical activity and social isolation in the elderly in the community.

The emergence of drug-resistant pathogens (DRP) in recent years possibly contributes to the common problems associated with community-acquired pneumonia. However, to predict the risk of the ailment, the DRIP score is mainly applied, although no validation study has been reported in Indonesia. Therefore, the score prediction accuracy in the population, patient characteristics and germ patterns appears indefinite, particularly for Cipto Mangunkusumo Hospital, Jakarta. The purpose of this study is to determine the DRIP performance as an instrument in predicting infections due to drug-resistant pathogens (DRP) in community-acquired pneumonia at Cipto Mangunkusumo Hospital.

This research employed a cross-sectional design, where the subjects were community-acquired pneumonia patients treated between January 2019 and June 2020. In addition, adequate medical records of the participants were obtained. The condition is defined as DRP when the sputum culture results show resistance to non-pseudomonal β-lactam antibiotics, macrolides, and respiratory fluoroquinolones. Furthermore, the score performance was analyzed by determining the calibration and discrimination values, using the Hosmer-Lemeshow test and AUROC, respectively.

A total of 254 subjects were known to have satisfied the selection criteria. These participants were categorized into DRP and non-DRP groups, with 103 (40.6%) and 151 (59.4%) patients, correspondingly. The DRIP calibration analysis using the Hosmer-Lemeshow test obtained p-value = 0.001 (p <0.05), while an AUC value of 0.759 (CI 95%, 0.702-0.810) was derived from the ROC curve. However, at a score of ≥ 4, the DRIP showed sensitivity, specificity, positive and negative predictive values of 70.9, 92.7, 86.9, and 82.3%, respectively.

The DRIP score demonstrated a significant performance in predicting infections due to DRP in community-acquired pneumonia.

The DRIP score demonstrated a significant performance in predicting infections due to DRP in community-acquired pneumonia.

Many studies identified the risk factors and prognostic factors related to in-hospital COVID-19 mortality using sophisticated laboratory tests. Cost and the availability of supporting blood tests may be problematic in resource-limited settings. This multicenter cohort study was conducted to assess the factors associated with mortality of COVID-19 patients aged 18 years and older, based on history taking, physical examination, and simple blood tests to be used in resource-limited settings.

The study was conducted between July 2020 and January 2021 in five COVID-19 referral hospitals in Indonesia. Among 1048 confirmed cases of COVID-19, 160 (15%) died during hospitalization.

Multivariate analysis showed eight predictors of in-hospital mortality, namely increased age, chronic kidney disease, chronic obstructive pulmonary disease, fatigue, dyspnea, altered mental status, neutrophil-lymphocyte ratio (NLR) ≥ 5.8, and severe-critical condition. This scoring system had an Area-under-the-curve (AUC) of 84.7%. With cut-off score of 6, the sensitivity was 76.