Pseudomonas aeruginosa is the main cause of nosocomial infection which is responsible for 10% of hospital-acquired infection. Pseudomonas aeruginosa tends to mutate and displays potential for development of antibiotic resistance. Approximately, 10% of global bacterial isolates are found as (6 g/ml; 3 g/ml; 1.5 g/ml; 0.75 g/ml, 0.375 g/ml; and 0.1875 g/ml

Highlights Concurrent giant bladder stones and bladder squamous cell carcinoma (SCC) is rare. Recurrent urinary tract infections should be suspected as bladder stones. The giant size of bladder stone makes open surgery the only therapeutic modality. Chronic inflammation due to bladder stones may contribute to the development of SCC. In a limited situation, bladder preservative therapy may be considered for MIBC.

Background: The knee joint is a weight-bearing support joint that often affected by osteoarthritis. Knee joint osteoarthritis is characterized by pain in a movement that disappears when resting, joint stiffness especially after prolonged resting or waking up, crepitations, and can be accompanied by synovitis with or without joint fluid effusion. If the patient was passive, did not do exercises, muscle atrophy can occur, which will worsen the stability and function of the joint. Other consequences that can disrupt daily activities to the most severe feature, such as an inability to walk.  Objective: To discuss the role of core stability exercise for pain reduction in osteoarthritis. Method: This type of study is a literature review. Result: The goals of core stability exercise include: increasing muscle strength, improving posture, reducing pain, increasing ability, and functional mobility in patients. The provision of core stability exercise has a relationship between core stability with hip, knee, and ankle. This is because all parts of the body are connected to each other, both directly and indirectly. If the core muscle is strong, the muscles of the hip, knee, and ankle will also be strong. Conclusion: Core stability exercise is potential in the management of knee osteoarthritisKeywords:            core stability exercise, joint, knee, osteoarthritis

A preliminary study showed that most health workers in primary health care (PHC) claimed that they need a refreshing course because of their lack of updated knowledge and skill. This study enrolled 27 primary healthcare workers recruited from the PHC. The intervention used were classic lectures and workshops. The knowledge was evaluated using a paper-based test and practice, while the skill was evaluated using a practice test. Multiple questions (pre-test and post-test) based on current emergency management for pediatric were used for paper-based evaluation. Semi-structured interviews were conducted to confirm the subject's perspective on the intervention. A paired t-test was used for evaluating the pre- and post-test results, which was confirmed by a triangulation approach. There was a significant difference between the pre- and post-test results (p<0.001), and 8 of 10 subjects can demonstrate the procedure learned correctly after the intervention. A total of 14 interviewed subjects stated great effectiveness of the intervention, with several limitations on applicability in daily clinical practice. Classic lecture and workshop as an intervention in health education effectively increase health workers' knowledge and skill in PHC. This study might help other rural areas PHC apply the same method so the professionalism and quality of health workers in PHC providers can be maintained.Keywords                : primary health care, classic lecture; workshop; knowledge; skillCorrespondence     : rickyindraalfaray@gmail.com

Objective: In this report, we describe the case of urethral injuries after circumcision. Case(s) Presentation: A 5-year-old male came to the urology clinic complaining of urine seeping through the gauze-covered wound. The patient had undergone circumcision. Before the procedure, the patient could generally urinate through the external urethral orifice. His parent realized that the urine was flowing out through the circumcision scar instead of the external orifice. Even though the wound was open and wet, he felt painless when urinating. After cleaning the wound, it appeared that there was a sizeable chromic catgut thread knotted on the right corpus cavernosum. The pendular urethra was cut widely; therefore, the urine came out of this spot. A six French Foley catheter was inserted over the external urethral orifice, the cut urethra towards the bladder. The injured urethra was expected to be attached to simplify the next six-month operation by inserting this urinary catheter. Discussion: Urethral injury post circumcision is rarely reported, but this complication is dangerous due to its morbidity and long-term impact. The paradigm shift from two-stage repair to one-stage repair has developed. Mathieu’s modified technique and the Snodgrass technique are recommended. Conclusion: Urethral injury during circumcision can be devastating. The repair technique for urethral trauma depends on the involvement and condition of the surrounding soft tissue, also the size of the tissue damage.