Hendry Irawan

Background: Higher education institutions face information fragmentation and cognitive overload as students struggle to access learning materials scattered across multiple digital platforms. Large Language Models encounter hallucination issues and static knowledge bases, limiting their educational application.Aims: This research aims to design and evaluate a Retrieval Augmented Generation (RAG)-based chatbot system integrated with Learning Management Systems to address information fragmentation in educational environmentsMethods: We employed Design Science Research Methodology (DSRM) to develop the RAG-based chatbot. Technology Acceptance Model (TAM) assessment with 267 undergraduate students and semi-structured interviews with five faculty members evaluate user acceptance and pedagogical perspectives.Results: The RAG chatbot achieved strong initial user acceptance (mean score 4.097). Students valued perceived usefulness over ease of use, with high usage intentions and recommendation willingness. Faculty recognized pedagogical value while emphasizing quality assurance needs.Conclusion: This exploratory study demonstrates technical feasibility and baseline user acceptance for RAG-based chatbots in education, showing promise for addressing information accessibility challenges. Demonstration-based evaluation requires validation through longitudinal field studies.

The management of tongue carcinoma is excision and radical neck dissection followed with reconstruction. This is a case report of a patient with tongue squamous cell carcinoma (SCC) who underwent the procedure with sternocleidomastoid (SCM) flap reconstruction. A 52-year-old woman without smoking history complained tongue ulcer since 3 years ago. Based on the histopathological examination, the patient was diagnosed with T2N2M0 right tongue SCC and underwent wide excision of tumor; right mandibular; neck dissection and were reconstructed with SCM flap. SCC of the tongue requires wide excision and dissection of the neck and mandible if infiltration into the surrounding lymph nodes has been found. The SCM flap reconstruction could be used post-surgery.

Biomedical and Pharmacology Journal (BPJ) is an international, open access, peer reviewed, quarterly research journal.

Background: Malignancy of the thyroid in children was a rare finding and the most pathological finding was papillary thyroid carcinoma. Thyroid carcinoma in children can present with neck lumps or enlarged neck lymph nodes. However, enlarged neck lymph nodes can be a mark of disruption immune system or lymph nodes’ malignancy or metastases from another organ. Case: An eight-year-old girl came to surgical oncology policlinic Prof. Dr. I.G.N.G. Ngoerah general hospital with a tumor on her right neck below the ear lobe and a scar from surgery on her right neck. Previously, she was done surgery on the right neck lump without cytomorphological examination at a regional hospital and it was a papillary thyroid carcinoma. She was referred to Prof. Dr. I.G.N.G. Ngoerah general hospital. She had done total thyroidectomy and right radical neck dissection with sternocleidomastoid muscle removal. The pathological examination was papillary thyroid carcinoma with four metastasis lymph nodes from nine lymph nodes. She had done radioactive iodine and take levothyroxine daily for hormonal suppression. After radioactive iodine therapy, she did not have any malignancy in the surgical field. Conclusion: In children, enlarged neck lymph nodes must be considered as a metastasis lesion of the thyroid. Although thyroid carcinoma is rare in children, we can do fine needle aspiration biopsy to evaluate the origin of enlargement. It can reduce the increase in cancer staging and the risk of metastasis.

Melanonychia striata is caused by the deposition of melanin as a result of melanocyte hyperplasia or increased melanocyte activity. Melanonychia striata has a similar appearance to a malignant lesion, so a proper diagnosis should be made to ensure appropriate management. A 28-year-old man had complained of black discoloration in the middle of the right toenail since a month ago. Previously, the patient frequently experience pain in the nail and redness at the nail tip. The patient had often worn small-size shoes. Physical examination revealed a line of blackish-brown lesions from the proximal to the distal nail plate, with clear boundaries, yellowish on the distal of the nail, and a sign of subsided inflammation on the edges of the nail. Nail extraction with roserplasty-technique and biopsy was conducted. The histopathological result supported the diagnosis of melanonychia striata. Then, the patient was treated with oral analgesic and antibiotic and discharged with no complications. This melanonychia striata case is accompanied by rapid progression and is most likely due to the proliferation of melanocyte cells. The surgical procedure with a partial or total nail extraction should be considered performed to treat the lesion and collect the sample for further examination. Histological examination is a gold standard to differentiate benign and malignant subungual lesions. Periodic follow-up is also necessary to assess the recurrence and general condition of the patient.

Background: Breast cancer is still a global public health problem, especially in women and is the second leading cause of death after lung cancer. Indonesia is a country with a high incidence of breast among women. Methods: This study used a retrospective study of breast cancer patients registered at Division of Surgical Oncology in Indonesia. Information about demographic, clinical and pathological characteristics of patients for a period of 5 years (2014 to 2020) were collected and described. Results: Information for 1260 cases of breast cancer who underwent IHC examination with an average age of 53.73 years of patients, with the most age above 50 years (63.6%) were collected. On IHC examination, 58.6% positive estrogen receptors were found, positive progesterone receptors were 55.4%, Her2 was positive 37.7% and high Ki67 protein was 56.9%. The most common breast cancer subtypes were luminal B (43.2%), followed by luminal A (21.7%), TNBC (18.1%), and Her2 (17%), with the highest stages being IIIB (31.7%).Conclusions: The breast cancer was presented at higher stage, with more cases with estrogen or progesterone receptors are positive with low frequency of Her2 positivity and high in Ki67 protein expression.

Sentinel lymph node biopsy (SLNB) has become the standard staging technique in the surgical treatment of breast cancer, replacing the older method of dissecting lymph nodes of the axilla. Several advantages like lowering of the morbidities that accompany the technique and being less invasive have given rise to a promising effect on life aspects of patients suffering from this morbidity. The procedure has evolved over the last few decades, but further studies are still needed to make improvements. Several aspects of the evolution of SLNB, such as the incorporation of the management in early cancer, the technique of lymphatic mapping, the accuracy of the technique, and its utility and evaluation in clinical response after neoadjuvant chemotherapy are discussed in this review.

BACKGROUND: Maxillofacial fracture is one of the major trauma; the cases were increasing because of the high number of motorcycles in Bali. The goal of the treatment is proper positioning of the occlusion, and it depends on rapid diagnosis and proper treatment. AIM: This study aims to know the characteristics of the maxillofacial fracture patients in Sanglah General Hospital Denpasar Bali. METHODS: A retrospective study, based on medical record were concluded, samples taken in Sanglah General Hospital from January to June 2015. Total recorded patient were 35 patients. The data obtained include age, gender, type of the fractures, and operation management. RESULTS: The injury was more common in male compared to female (80% vs 20%). Age 20 to 40 years old were more common (48.57%), followed by the child to adolescent (aged 0 to 20 years old) were 31.43%, and adult to elderly (aged 40 to 60 years old) was 20%. The mandibular fracture was most common (51.43%), other fractures such as a zygomatic fracture (31.43%) and maxillary fracture (17.14%). Internal fixation was the gold standard of the treatment (65.71%), and the other was an arch bar (34.29%). CONCLUSION: Diagnosing the right injury to the facial bone is a key step in determining a treatment plan. Rapid diagnosis and proper treatment lead to good occlusion, both internal fixation and arch bar were an effective treatment. The importance of dealing with almost all maxillofacial fracture problems in the first surgery.

Background: Noncirrhotic portal hypertension (NCPH) is a condition when a high hepatic venous pressure gradient with preserved liver functions and the absence of parenchymal dysfunction. NCPH with portal vein thrombosis (PVT) is a rare condition. Surgery aims to reduce portal vein flow and alter portal vein circulation. Case: A male, 59 years old, complained of blackish stool in the last 2 weeks and enlarged abdomen. Physical examination revealed anemia and melena with splenomegaly and ascites. Laboratory findings were anemia, normal hepatobiliary function, and no liver infection. Abdominal Doppler ultrasonography and contrast-enhanced abdominal computed tomography scan revealed ascites, splenomegaly, noncirrhotic liver, dilatation of portal vein, low portal vein peak velocity, and PVT. Esophagogastroduodenoscopy revealed esophageal varices grade 3 with a positive red color sign and cardia stomach varices. We performed a modified Sugiura technique through the left subcostal incision and proximal splenorenal shunt. The procedures of the modified Sugiura technique are splenectomy, devascularization, transection, and end-to-end anastomosis of the lower esophagus above the gastroesophageal junction, devascularization of the upper 2/3 of the lesser and greater curvatures of the stomach, and pyloroplasty. Portal circulation alteration used the proximal splenorenal shunt with end-to-side anastomosis of the splenic vein to left renal vein. At the one-year follow-up after surgery, his physical condition was better and there was no sign of complications. Conclusion: Devascularization procedure using a modified Sugiura technique is useful to treat and avoid rupture of esophageal varices. Portal circulation alteration using the proximal splenorenal shunt is a good choice. The treatment in NCPH utilizing the combination of modified Sugiura technique and the proximal splenorenal shunt is proper without complication.