Highlight: Brain AVMs are a special concern due to their inherent high risk of bleeding. Gamma Knife radiosurgery (GKRS), as one of the modality treatments, is intended to induce progressive occlusion of an AVM by using high-dose targeted radiation The result of Gamma Knife radiosurgery (GKRS) can be full obliteration, with complications because adverse radiation effects.   ABSTRACT Introduction: Brain arteriovenous malformations (AVMs) are relatively uncommon. Gamma Knife radiosurgery (GKRS) is one of the AVM’s therapeutic interventions, with both advantages and disadvantages. Here, we report the results of two cases of brain AVM after GKRS. Cases: Case 1: Non-contrast head MRI imaging of a 45-year-old man with persistent left-sided headaches revealed a 1.4 x 2.5 x 2.28 cm AVM nidus in the left parasagittal frontal lobe. After a single GKRS with a 25-Gy marginal dose, the MRI contrast showed complete obliteration, with persistent perifocal edema and headache. Case 2: A 25-year-old woman with a history of generalized seizures. The angiograms revealed an AVM nidus with a diameter of 32.58 mm on her right posterior frontal lobe. After a single GKRS with a 22-Gy marginal dose, the MRI contrast showed full obliteration with large edema. The patient had presented with hemiparesis. Conclusion: In these cases, the results after GKRS were full obliteration with complications of edema, headache, and hemiparesis. We also found that complications appear to be associated with adverse radiation effects.

Indonesia does not yet have a curriculum that implements conservation education, several schools have carried out conservation activities but do not yet have guidebooks or written documents related with the programs, so it is necessary to prepare a conservation education guidebook. This study aims to determine the eligibility of a high school conservation education guidebook. This study uses the RD research method with the ADDIE limited to the development stage. The eligibility test of the conservation education guidebook was carried out by validating by five validators with the validation sheet assessment instrument and analyzed using Aiken's content validity and ICC (intraclass correlation coefficient) reliability. The aspects assessed in the validation test are material aspects, presentation, language, and guidebook graphics. The results of Aiken's validity were obtained for the material aspect, namely 0.92 very high categories, presentation aspect, namely 0.87 very high categories, language aspect, namely 0.93 very high categories, and graphic aspect, namely 0.92 very high categories. The average validity of the four aspects is 0.92 in the very high categories. The results of the ICC reliability analysis showed a reliability value of 0.965 and agreement between validators was at a very good criteria index. It can be concluded that the high school conservation education guidebook is eligible to use

Background: Neuropathy diabetic pain are common symptom in patient with diabetic melitus. The combination of vitamin B1, vitamin B6, and vitamin B12 usually used for treatment the pain, the result of previous studies are limited and conflicting.Objective: The aim of the study to measure the convering of intensity of pain in diabetic neuropathy.Method: The method of study using quase experimental design with pre and post treatment patient were selected by conservative sampling method from Bethesda Hospital, Yogyakarta. There are 68 patient diabetic neuropathy to follow in the study. Fact patient received combination of vitamin B1 100 mg, vitamin B6 100 mg, and vitamin B12 5000 mcg once a day for 3 month. Pain intensity measured using visual analog scale (VAS) on the first initial visited after 30th day and 90th day.Results: The 68 patient consist of 27 (39.7%) male and 41 (60.3%) women. The mean age 58.32±6.72 years. The mean duration of Diabetic 4.32±2.86 year. The study showed that the pain intensity lower significantly after received vitamin B (p<0.001). The mean pain intensity in first VAS 43.68±12.32 lower to 20.42±11.24 and in the end of study lower to 12.23±8.39.Conclusion: The combination of vitamin B1, B6, B12 significantly lower pain intensity of patient diabetic neuropathy.