Background: Hypertension remains one of the most common health issues in Indonesia. Slow deep breathing maneuver is a non-pharmacological therapy that achieves systolic and diastolic blood pressure lowering effect through sympathetic and parasymphathetic firing rate.Methods: This study was done using cross-sectional design, with consecutive sampling. Sample population was patients with hypertension stage 1 and 2, age range 40-55 years old, who came to Puskesmas Balaraja.Results: Systolic blood pressure lowered from 148.04+5.82 mmHg to 138.15+5.9 mmHg (p<0.05) and diastolic pressure lowered from 85+5.05 mmHg to 78.47+5.46 mmHg (p<0.05). This study showed that there is a relation between the manuever and lowering the systolic and diastolic blood pressure (p=0.000, on T-Test analytical study).Conclusion: Based on the data, the slow deep maneuver can be used as a non-pharmacological therapy for patients with hypertension. Because the effect is acute, it can be considered for hypertension crisis, but further studies are still needed.

Background: Basic life support (BLS) performed by general population improves outcomes in cardiorespiratory collapse. This community-based study aims to measure the general population's eagerness in learning BLS, knowledge regarding early recognition, and use an automated external defibrillator. Methods: This was a cross-sectional community-based study in Jakarta using questionnaire. Numerous questions asked through a questionnaire in order to evaluate the general population's eagerness and knowledge about basic life support. Results: There were 303 respondents in this study. Most respondents stated that knowledge about BLS is important and was eager to learn; however, only 39.6% of respondents have ever done BLS training. 59.4% of respondents have ever looked for information or read about BLS. 63.6% of respondents chose to call an ambulance for the first reaction, while 36,5% of respondents preferred to look for a pulse. Most of the respondents know to check the carotid pulse in the neck. 77.4% of respondents know that chest compression was done on mid-chest. 81.5% of respondents agreed that CPR was preferably done repeatedly in a specific rhythm, but giving one despite the method is better than none. Only 49.5% of respondents wanted to give mouth-to-mouth ventilation. Most respondents thought that they are not allowed to use AED, and only a small proportion had seen AED in public. Conclusion: Most of the respondents agreed that BLS is important. Respondents have satisfying knowledge about how to react while encountering an unconscious person. Most respondents have not seen AED and most likely didn't know how to use it.

In managing patient with congenital congenital aural atresia (CAA), preoperative high resolution computed tomography (HRCT) scan and hearing assessment are important. A grading system based on HRCT findings was first introduced by Jahrsdoefer in order to select appropriate candidates for operation and to predict the postoperative hearing outcome in CAA patients. The score of eight and more was considered as a good prognostic factor for hearing reconstruction surgery. However previously in our center this score was not used as the criteria for surgical procedure. This study was conducted at Center A to evaluate the correlation between pre and postoperative hearing level with HRCT based on a Jahrsdoefer grading system in patients with CAA. All records and HRCT films with CAA from January 1997 until December 2007 at Center A were evaluated. The demographic data, operative records, pre and post operative hearing levels and HRCT findings were analyzed. Hearing level in this study was based on a pure tone average of air-bone gap at 500 Hz, 1 kHz and 2 kHz or hearing level obtained from auditory brainstem response eudiometry. This study was approved by Research Ethics Committee (code number, FF-197-2008). Thirty-two ears were retrospectively evaluated. The postoperative hearing level of 30 dB and less was considered as successful hearing result postoperatively. Of the six ears which underwent canalplasty, three had achieved successful hearing result. However, there was no significant correlation between preoperative hearing level (HL) with HRCT score and postoperative HL with HRCT score at 0.05 significant levels (correlation coefficient = -0.292, P = 0.105 and correlation coefficient = -0.127, P = 0.810) respectively. Hearing evaluation and HRCT temporal bone are two independent evaluations for the patients with CAA before going for hearing reconstructive surgery.

Patient: Female, 21-year-old Final Diagnosis: Chylous ascites Symptoms: Pitting edema • shortness of breath Medication: — Clinical Procedure: Paracentesis • thoracentesis Specialty: Gastroenterology and Hepatology • General and Internal Medicine • Palliative Medicine Objective: Rare disease Background: Chylous ascites is a rare condition, which is defined by accumulation of a milky fluid due to high triglyceride levels. It is most commonly secondary to malignancy, liver cirrhosis, infection, and tuberculosis. Case Report: A 21-year-old woman from rural Indonesia, came to the hospital with chronic dyspnea and a history of repeated paracentesis. Six years ago, she was diagnosed with chronic hepatitis B. For the past 2 years, she had complaints of progressive dyspnea and increased abdominal swelling. On examination, there was dullness on chest percussion and decreased breath sounds. Shifting dullness was positive on abdominal examination. Paracentesis and thoracentesis were performed and showed high triglyceride levels. She underwent an abdominal computed tomography scan and was diagnosed with liver cirrhosis, complicated with chylous ascites and chylothorax. Repeated paracentesis was performed as a therapeutic approach; she had strict diet guidelines, and was prescribed octreotide, furosemide, spironolactone, and albumin. Despite this treatment, two years later, she developed an umbilical hernia complicated with ulceration. Hernia repair was not possible due to her comorbidities. She was indicated for a transjugular intrahepatic portosystemic shunt (TIPS) for the refractory chylous ascites. However, this could not be performed as the patient could not afford this expensive procedure, which was not covered by insurance. Conclusions: Management of refractory chylous ascites is challenging, especially in underdeveloped countries due to socioeconomic problems and limited health care facilities. Although TIPS is indicated in refractory chylous ascites, repeated paracentesis can be useful as an alternative method.

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