Ahmad Fariz Malvi Zamzam Zein

Intestinal ultrasound (IUS) is a non-invasive tool for monitoring inflammatory bowel disease (IBD), offering high diagnostic accuracy and greater patient convenience than gastrointestinal endoscopy. The present study evaluated the feasibility of a mastery learning approach in Indonesia's inaugural IUS workshop to enhance skill acquisition among physicians. A retrospective study was conducted on 37 physicians who participated in a two-day IUS workshop employing a mastery learning approach that included flipped learning, lectures, a pre-test, hands-on sessions with real-time feedback, and a post-test. Skill acquisition was assessed using standardized checklists for scanning the sigmoid colon and terminal ileum, with pre- and post-test performance evaluated against a minimum passing standard (MPS) established by expert faculties. Data was analyzed using SPSS with appropriate statistical tests to determine learning outcomes and effect sizes. 34 out of 37 participants completed the workshop and skill assessment. Significant improvements were observed in both sigmoid colon and terminal ileum ultrasound scores after training (P < 0.001), with effect sizes of r = 0.89 and r = 0.86, respectively. The MPS was achieved by 67.65% of participants for the sigmoid colon and 50% for the terminal ileum. A mastery learning-based workshop significantly enhanced IUS skill acquisition among internists and gastroenterologists. Based on the MPS criteria, approximately one-third of participants would require additional training for sigmoid colon scanning, while about half would benefit from further training in terminal ileum scanning.

The emergence of Mpox as a significant zoonotic viral threat presents new challenges in gastrointestinal endoscopy. This article outlines the risk of Mpox transmission during gastrointestinal endoscopy, particularly through respiratory droplets and contact with the mucosal surfaces. Gastrointestinal endoscopy may also facilitate transmission by fomites, as the Mpox virus can persist on medical instruments and surfaces for long periods. Nosocomial Mpox transmission is a significant concern in both endemic and non-endemic regions. This highlights the necessity for enhanced infection control measures in gastrointestinal endoscopy, including pre-endoscopic assessment, proper use of personal protective equipment, and rigorous post-procedural disinfection. Additionally, vaccination of healthcare workers frequently exposed to high-risk situations is emphasized. Ongoing surveillance and monitoring of healthcare workers are key components in minimizing the transmission risk. Although no direct cases of Mpox transmission via gastrointestinal endoscopy have been reported, these recommendations mitigate the potential risks associated with such procedures and necessitate strict adherence to infection control protocols. By adhering to these protocols and adapting to current practices, gastrointestinal endoscopy can be safely performed during the Mpox upsurge, ensuring the protection of both patients and healthcare workers.

Background: Diabetes Mellitus (DM) is a chronic disease that requires long-term management and carries the risk of leading to other health conditions, which can result in decrease of quality of life. Aims: To find the quality of life of patients with Type 2 Diabetes Mellitus (T2DM) and the factors affecting it at Waled General Hospital (RSUD Waled), Cirebon, Indonesia. Methods: It was an analytic observational study with a cross-sectional approach. The study took place at RSUD Waled, Cirebon Regency, and used 96 (T2DM) patients as research samples that were chosen with simple random sampling. The source of data was primary through a questionnaire and secondary from the patient’s medical record. The questionnaire used for the quality of life’s variable in this research was WHOQOL-BREF. The analytical statistics used were Spearman’s correlation test for the bivariate analytics, and binary logistics regression for the multivariate analytic. Results: There were 54.2% of T2DM patients that fell into bad quality of life category and 45.8% of T2DM patients had good quality of life. Analytic statistics showed a significant relationship between glycemic control (p = 0.003 and r = 0.304), family support (p = 0.000 and r = 0.502), and self-acceptance with quality of life of T2DM patients (p = 0.000 and r = 0.606). Meanwhile types of therapy, comorbidities, and complication didn’t show a significant correlation with quality of life of T2DM patients. Multivariate analysis showed the most correlated factor for quality of life of patients T2DM was self-acceptance (OR=30). Conclusion: There were some factors that had significant correlation with quality of life of T2DM patients. Self-acceptance was the most correlated factor with quality of life of T2DM patients. Healthcare providers can incorporate educational intervention programs into routine diabetes care, emphasizing patients' psychological health, especially with regard to self-acceptance and family support techniques. In order to improve knowledge, motivation, and efficient self-management, this program may incorporate counselling, education, and the creation of support groups.

Background: Hepatic cirrhosis is a terminal manifestation of chronic liver disease. The causes of cirrhosis in the Asia Pacific it was caused by hepatitis B. Older adults are more likely to experience complications, which might be due to abnormalities in the liver. Various complications occurred during the progression from compensated to decompensated, and endoscopic examination showed images of gastroesophageal varices or PHG. Aims: The aim was to determine the characteristics of liver cirrhosis patients and the endoscopy findings at waled hospital from 2020 to 2023. Methods: This research used descriptive observational methods. The sample in this study were patients with liver cirrhosis at Waled hospital from 2020-2023, there were 135 sample who were selected using total sampling techniques. Information was acquired from medical records of 33 patients who met the consideration rules. Results: This study showed that the largest number of patients with liver cirrhosis based on age 45 years old (12.1%), predominantly male (72.7%), with the etiology hepatitis B (69.7%), and all (100%) were in decompensated stage. Endoscopy results revealed that the majority of patients experiences esophageal varices and PHG (54.5%), with grade 3 esophageal varices (81.8%) and mild grade PHG (60.6%) dominating. Conclusion: The majority of patients with liver cirrhosis were 45 years old, predominantly male, with the most common etiology hepatitis B, and all were in the decompensated stage. The most common endoscopy results showed esophageal varices and PHG, with grade 3 esophageal varices and mild grade PHG. Received: 26 September 2024 | Reviewed: 23 October 2024 | Revised: 30 November 2024 | Accepted: 12 December 2024.

Background The coronavirus disease 2019 (COVID-19) pandemic has had significant impacts worldwide, especially among older adults. Frailty is a determinant of susceptibility to morbidity and mortality due to COVID-19 in the elderly. This study aimed to determine frailty status and identify factors associated with the suburban elderly population in Cirebon Regency, Indonesia, after the one-year COVID-19 pandemic. Methods A cross-sectional study of community-dwelling individuals aged ≥ 60 years was conducted in Klangenan, Cirebon Regency, Indonesia, from March to June 2021. A questionnaire was used to determine the baseline characteristics of participants, healthcare access, comorbidity, and frailty status. The Ina-FRAIL scale was used to determine the frailty status (frail/non-frail). The chi-square test and logistic regression analysis were used to determine the association between independent variables and frailty. Results A total of 383 participants were recruited, with a median age of 67 (IQR 64-73) years. The prevalence of frailty in the present study was 10.2%. Multivariate analysis showed that age (OR 2.73; 95%CI 1.21-6.12), multimorbidity (OR 7.86; 95% CI 3.01-20.57) and financial dependence (OR 13.40, 95% CI 5.66-31.73) were significantly associated with frailty. Conclusion One-year COVID-19 pandemic has had a considerable burden on frailty among the suburban elderly population in Indonesia. The factors associated with frailty were age, multimorbidity, and financial dependence.

Aim: This study aims to evaluate the efficacy and safety of endoscopic band ligation (EBL) for bleeding grade III internal hemorrhoids in an evidence-based case report.Method: A search was conducted on PubMed and Cochrane databases based on clinical query, with keywords "endoscopic band ligation AND internal hemorrhoids". The inclusion criteria were meta-analysis, systematic review and randomized clinical trial, and written in English. The critical appraisal was performed for validity, importance, and applicability.Results: Of 18 studies, only 2 studies that suited the criteria. Compared to bipolar electrocoagulation (BPEC), EBL had significantly higher success rate in controlling bleeding and reducing the grade of hemorrhoids. In comparison with band ligation with rigid proctoscope (BL-RP), EBL was associated with higher success rate, lesser treatment sessions, and earlier symptom control. Mild complications and symptomatic recurrence were comparable among EBL, BPEC, and BL-RP.Conclusion: Endoscopic band ligation is effective and safe for bleeding grade III internal hemorrhoids. It is feasible procedure in primary referral hospital.

Background The coronavirus disease 2019 (COVID-19) pandemic has had significant impacts worldwide, especially among older adults. Frailty is a determinant of susceptibility to morbidity and mortality due to COVID-19 in the elderly. This study aimed to determine frailty status and identify factors associated with the suburban elderly population in Cirebon Regency, Indonesia, after the one-year COVID-19 pandemic. Methods A cross-sectional study of community-dwelling individuals aged ≥ 60 years was conducted in Klangenan, Cirebon Regency, Indonesia, from March to June 2021. A questionnaire was used to determine the baseline characteristics of participants, healthcare access, comorbidity, and frailty status. The Ina-FRAIL scale was used to determine the frailty status (frail/non-frail). The chi-square test and logistic regression analysis were used to determine the association between independent variables and frailty. Results A total of 383 participants were recruited, with a median age of 67 (IQR 64-73) years. The prevalence of frailty in the present study was 10.2%. Multivariate analysis showed that age (OR 2.73; 95%CI 1.21-6.12), multimorbidity (OR 7.86; 95% CI 3.01-20.57) and financial dependence (OR 13.40, 95% CI 5.66-31.73) were significantly associated with frailty. Conclusion One-year COVID-19 pandemic has had a considerable burden on frailty among the suburban elderly population in Indonesia. The factors associated with frailty were age, multimorbidity, and financial dependence.

* Background The coronavirus disease 2019 (COVID-19) pandemic has had significant impacts worldwide, especially among older adults. Frailty is a determinant of susceptibility to morbidity and mortality due to COVID-19 in the elderly. This study aimed to determine frailty status and identify factors associated with the suburban elderly population in Cirebon Regency, Indonesia, after the one-year COVID-19 pandemic. Methods A cross-sectional study of community-dwelling individuals aged ≥ 60 years was conducted in Klangenan, Cirebon Regency, Indonesia, from March to June 2021. A questionnaire was used to determine the baseline characteristics of participants, healthcare access, comorbidity, and frailty status. The Ina-FRAIL scale was used to determine the frailty status (frail/non-frail). The chi-square test and logistic regression analysis were used to determine the association between independent variables and frailty. Results A total of 383 participants were recruited, with a median age of 67 (64-73) years. The prevalence of frailty in the present study was 10.2%. Multivariate analysis showed that age (OR 2.72; 95%CI 1.21-6.12), multimorbidity (OR 7.86; 95% CI 3.00-20.57) and financial dependence (OR 13.39, 95% CI 5.66-31.73) were significantly associated with frailty. Conclusion One-year COVID-19 pandemic has had a considerable impact on frailty among the suburban elderly population in Indonesia. The factors associated with frailty were age, multimorbidity, and financial dependence.

Introduction: This study aims to assess the association between mean platelet volume (MPV) and poor outcome in patients with COVID-19. Methods: We performed a comprehensive literature search using the PubMed, Embase and Scopus databases with keywords “2019-nCoV” OR “SARS-CoV-2” OR “COVID-19” AND “mean platelet volume” OR “MPV” on 8 July 2021. The primary outcome was composite poor outcome, defined as severe COVID-19 or mortality. The pooled effect estimate was reported as mean differences in terms of MPV between the group with and without outcome. Results: There were 17 studies which consist of 4549 patients with COVID-19 were included in this study. The incidence of poor outcome was 25% (20%–30%). Mean MPV was found to be higher in the poor outcome group in compare to no poor outcome group (10.3 ± 1.9 fL vs 9.9 ± 1.7 fL). The mean MPV difference between both group was 0.47 fL [95% CI 0.27, 0.67], p < 0.001; I²: 62.91%, p < 0.001). In the sub-group analysis, patients with severe COVID-19 had higher MPV (mean difference 0.54 fL [95% CI 0.28, 0.80], p < 0.001; I²: 54.84%, p = 0.014). Furthermore, MPV was also higher in the mortality group (mean difference 0.54 fL [95% CI 0.29, 0.80], p = 0.020; I²: 71.11%, p = 0.004). Meta-regression analysis showed that the association between MPV and poor outcome was not affected by age ( p = 0.789), gender ( p = 0.167), platelets ( p = 0.056), white blood cells ( p = 0.639), and lymphocytes ( p = 0.733). Conclusion: This meta-analysis indicated that increased MPV was associated with severity and mortality in patients with COVID-19. Further research is needed to determine the optimum cut-off point.

Background. Porocarcinoma is a rare cancer of the developing sweat glands. It often occurs in older adults and frequently affects the head, neck, and extremities. We report a rare case of metastatic porocarcinoma with intriguing approach of the diagnosis and management due to limited resource setting. Case Report. A 60-year-old man with a history of type 2 diabetes mellitus presented with nodules on the left foot with no palpable lymph node. A chest radiograph revealed multiple coin lesions and histopathological findings were suggestive for porocarcinoma. We assessed the case as a metastatic porocarcinoma in a patient with uncontrolled type 2 diabetes mellitus. Surgery was performed in the initial phase of treatment, consisting of below-knee amputation. The patient refused the planned chemotherapy in the referral hospital and then underwent other modalities of palliative care. He passed away eleven months after the initial diagnosis. Conclusions. Metastatic porocarcinoma is a rare oncological case with a challenging approach of the diagnosis and management. High awareness of clinical clues in rare cancer is needed for early diagnosis and prompt treatment, especially in limited resource settings.