Introduction  Papillary and follicular thyroid carcinoma are common head and neck cancers. This cancer expresses a thyroid stimulating hormone (TSH) receptor that plays a role as a cancer stimulant substance. This hormone has a diagnostic value in the management of thyroid carcinoma. Objective  The present study aimed to determine the difference in TSH levels between differentiated thyroid carcinoma and benign thyroid enlargement. Methods  The present research design was a case-control study. The subjects were patients with thyroid enlargement who underwent thyroidectomies at the Dr. Sardjito General Hospital, Yogyakarta, Indonesia. Thyroid stimulating hormone levels were measured before the thyroidectomies. The inclusion criteria for the case group were: 1) differentiated thyroid carcinoma, and 2) complete data; while the inclusion criteria for the control group were: 1) benign thyroid enlargement, and 2) complete data. The exclusion criteria for both groups were: 1) patients suffering from thyroid hormone disorders requiring therapy before thyroidectomy surgery, 2) patients receiving thyroid suppression therapy before the thyroidectomy was performed, and 3) patients suffering from severe chronic diseases such as renal insufficiency, and severe liver disease. Results  There were 40 post-thyroidectomy case group patients and 40 post-thyroidectomy control group patients. There were statistically significant differences in TSH levels between the groups with differentiated thyroid carcinoma and benign thyroid enlargement ( p  = 0.001; odds ratio [OR] = 8.42; 95% confidence interval [CI]: 3.19–36.50). Conclusion  Based on these results, it can be concluded that there were significant differences in TSH levels between the groups with differentiated thyroid carcinoma and benign thyroid enlargement.

Introduction Professionalism is the ability to manage ambiguous problems, tolerate uncertainties, and make correct decisions despite limited information to provide optimal medical care to patients. 1 The importance of professionalism in medical education has made it crucial to evaluate professionalism during specialist training and make it part of regular evaluation during the course of medical education. This is particularly important in specialist training programs because of the need for higher competence and the expectation for more responsibility. 2,3 Lack of professionalisms results in medical errors. It is well known that being in the medical profession is stressful and can lead to psychiatric conditions such as anxiety. 4-7 Professionalism is affected by various factors, among which is anxiety. Anxiety can result in doubts in making critical decisions. These doubts will significantly affect both care and professionalism. On the other hand, lack of professionalism will also make doctors anxious about making critical decisions in their provision of medical services. Anxiety is a barrier to good medical service and a risk factor for medical errors. 4 The ear, nose and throat (ENT) training program is known to be full of stressors during the specialist training

Background: The national healthcare insurance (JKN) has been in deficit since 2014-2016; one of the causes is fraud inpatient hospital service. Objective: This study aimed to analyze the validity, reliability and effectiveness of detection system of national healthcare insurance fraud based on computer application in hospital.Methods: Cross-sectional method was used. Fraud data were collected at one episode in the inpatient JKN participant service.Results: Validity was assessed by Fischer exact test. The interpretation was done by hospital internal verification officer and BPJS Kesehatan verification officer. There were only 2 out of 1.106 services claims were different, resulted in p-value 0.01. Reliability was assessed using Human Organization Technology Benefit questionnaire filled by admission administrator officer, BPJS Kesehatan officer and hospital internal verification officer; and then analyzed using Stata® software resulting in Cronbach’s alpha value of 0.8. Effectiveness was assessed by reducing potential fraud, conducted by RSUP dr. Soeradji Tirtonegoro from May until July 2017, which on May 2018 there were 8 findings, June 1 finding, and on July 2018 had no finding.Conclusion: System for detection of national healthcare insurance fraud based on computer application is valid, reliable and effective to be implemented in inpatient service in hospital.

Introduction: Dengue infection is still posed a significant medical challenge for pediatric population in developing countries. However, increased prevalence of overweight and obesity among children in those countries increased the possibility of the coexistence of these conditions. However, their interaction is still under investigated. Therefore, this study was aimed to study the dynamic of sVCAM-1 level as the known predictor of the severity of dengue infection with over nutritional status in children with dengue infection.Method: An analytic observational nested case-control study was conducted in Paediatric Division Sanglah General Hospital, Bali. The children with DHF between 6 months old to 12 years old were included as the case group while control groups consisted of pediatric patients with just Dengue Fever (DF) with the same age range. The diagnosis of dengue was established using 1997 WHO criteria while nutritional status was assessed using WHO curve. The sVCAM-1 was evaluated using ELISA technique.Results: The level of sVCAM-1 was significantly higher in patients with DHF than patients with DF only. The level was also fluctuated more in DHF patients. Likewise, the sVCAM-1 level was also significantly higher in DHF patients with overnutrition compared to normal DHF patients with a more fluctuated pattern over the course of 3 days (starting from day 4 to day 7). Finally, no significant finding was observed in sVCAM-1 level in DSS patients albeit the difference in concentration pattern.Conclusion: Overnutrition is seems to be associated with higher concentration of sVCAM-1 and higher fluctuation of its concentration in children with DHF.

Background: Mental retardation is imperfect condition of mental development which resulted in delay of motoric development, speech and in adaption with the environment. The common symptoms is brain growth disorder, which affects the cranial size and the intelectual function lower than average (<70). Purpose: This study was aimed to determine the difference of cranial size and cephalic index of mentally retarded children compared with normal chilren based on antropometry and cephalometric measurement. Methods: This research was epidemiology analytic observational with case control design. The cranial size and cephalic index measurements were carried out on 168 children in range of age 7-12 years old (84 were moderate mental retarded children and 84 were normal children). Data was statistically analyzed with t-test. results: The size of cranial and cephalic on index on mentally retarded children were smaller than normal children. S-N and G-Op size were shorter than normal children, the results of S-N differences (-4.4), S-Ar (-2.38) and G-Op (-5.5), Eu-Eu (-8.24). The results analysis of linear and angle component cranial base (S-N, S-Ar and

Declining oil production in Indonesia lately has been much discussed by industrial practitioners, especially from the petroleum industry. The decrease is due to the age of old drilling wells with high water cut (> 90%), so it is necessary to pursue a production method that can increase the production of these old wells. The EOR (Enhanced Oil Recovery) method is one way of extracting oil from oil wells that cannot be further retrieved by injecting materials that are not in the reservoir. One ingredient that can be injected is Sodium Ligno Sulfonate (SLS) surfactant derived from lignin. Lignin was obtained from the lignin isolation process from Black Liquor, which in this study came from the pulp and paper mill waste of PT. Indah Kiat, Pekanbaru, Sumatra, Indonesia. This study aims to determine the effect of variations in H2SO4 concentrations (concentrations of 15%, 20%, 25%, 30% w/w) on the yield of lignin isolation results, and to compare the functional groups between dirty lignin, clean lignin, and pure lignin using FT-IR. Based on the research results, it was found that the best lignin is lignin with an H2SO4 concentration of 20%, with the highest yield and the color of lignin produced tends to be similar to pure lignin. In addition, it was found that the peak of the net lignin group had more similarity with commercial lignin compared to crude lignin. Keywords: Lignin, Black Liquor, Enhanced Oil Recovery (EOR), FTIR

Background: Nasal douching or irrigation has been recommended for adjunctive therapy of sinonasal diseases including allergic rhinitis (AR) for many years. Previous study reported large-volume high-pressure device as an effective standard application, but the solutions was remains controversy. This study systematically review the clinical efficacy of nasal irrigation with various solutions for adults with AR from medical literature.Methods: This research systematically asses clinical trial about nasal irrigation with various solutions for adults with AR from medical literature. The sources were PubMed, ProQuest, Scopus, Cochrane Register of Controlled Trials databases, and gray literature from google scholar and RAMA repository limited to English and Bahasa Indonesia language articles, published from January 2017 to July 2022. Only randomized controlled trials involving the human subjects studies will be included. The inclusion criteria research must be related to nasal irrigation for AR, and should be full texted available. Literature management, screening, data extraction will use Rayyan.ai tools. The quality assessment of qualified paper and risk of bias will be assessing independent conducted by 2 reviewer with risk of bias 2. We will use Review Manager (RevMan) [Computer program] Version 5.4. The Cochrane Collaboration, 2020 tools to produce the systematic review and meta-analysis.Results: After completion of the study process, the data analysis and review will be reported. The results will be publicized through a peer-review journal publication. Conclusion:The results of the systematic review will summarize the efficacy of various nasal irrigation for adults with AR, so it can be used as clinician recommendation.

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