Vibriosis is still a major threat in aquaculture generating significant implications in ecology and economy. One of the ethologic agents of vibriosis is Vibrio alginolyticus that infects shrimp and fish aquaculture through biofilm-mediated. The objective of the study was to determine the biopotency of ethanolic extract of waru (Hibiscus tiliaceus) leaves to inhibit biofilm formation of V. alginolyticus in vitro. A microtiter plate biofilm assay (OD570) method was applied in this study. The treatments were the addition of ethanolic leaves extracts of waru (H. tiliaceus) at different concentrations of 2%, 4%, 8%, and 10%. The values of biofilm inhibition activity were measured as optical density data that were statistically analyzed using One Way ANOVA, followed by Tukey’s test and the tests were considered statistically significant at a P ≤ 0.05 on two-tailed. The result of this study showed that Waru leaves extract significantly inhibited the biofilm formation of V. alginolyticus. The best inhibition was shown at 10% concentration of extract signifying the potential application of waru to treat biofilm-mediated diseases in aquaculture.

Highlights: In the setting of AF in patient with AHF, conventional treatment strategies do not convert the rhythm into sinus rhythm. Newly emerged therapies such as catheter ablation, or atrioventricular node ablation with biventricular pacing might be more beneficial rather than the conventional rhythm and rate control strategies Abstract: Atrial fibrillation (AF) is the most common form of arrhythmia. The prevalence of AF in patients with systolic left ventricular dysfunction and CHF is around 35% in the patient population with NYHA II-IV. In this case, we will discuss a case report of a patient with AF with complications of CHF and Bilateral Pleural Effusion. Case Summary. A female patient, 62 years old, came to the emergency room of dr. Soegiri Hospital with complaints of sudden shortness of breath since morning. There were crackles in the right lung field during the auscultation and the chest x-ray shows cardiomegaly with a CTR> 50% with bilateral effusion and atelectasis. On the electrocardiogram examination performed at the ICCU, an irregular rhythm was obtained with an HR of 100x/minute, with p waves that cannot be distinguished, normal QRS waves, and T waves that cannot be assessed. The patient was diagnosed with congestive heart failure (CHF) with rapid atrial fibrillation (AF) accompanied by complications of bilateral pleural effusion with a differential diagnosis of acute decompensated heart failure (ADHF) with pneumonia and acute lung edema (ALO). Discussion. Patients with AF and CHF have a poorer prognosis than patients with a single diagnosis of AF or CHF alone. A rhythm control strategy consisting of antiarrhythmic drugs and electrical cardioversion in stable patients with AF and CHF adds no benefit to a heart rate control strategy.

In Indonesia, in 2006, the prevalence of infections due to MRSA was 23.5%. Physalis minima L. plants are known to have antimicrobial activity because they contain compounds withaferin A, which can induce programmed cell death. This research was to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of Ciplukan (Physalis minima L.) extract in Methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Dilution test with Mueller-Hinton broth medium used for measuring the minimum inhibitory concentration (MIC). Ciplukan  fruit extract was dissolved in distilled water, and poured into a test tube with a certain concentration (0.9 g/mL (90%); 0.3 g/mL (45%); 0.15 g/mL (22.5%); 0.075 g/mL (11.25%) and 0.0375 g/mL (5.625%). After being incubated for 24 hours, the bacteria in the test tube were plated on nutrient agar plates to determine the MBC. The MIC cannot be determined, because the medium in the dilution test tube is disturbed by the color of the extract so that turbidity cannot be observed. From the observations of the minimum bactericidal concentration, MBC of the Ciplukan (Physalis minima  L.) fruit extract against MRSA was in the P1 tube or equivalent to 0.9 g / ml (90%).Keywords             : Physalis minima L., Antimicrobial, Ciplukan, Methicillin-resistant Staphylococcus aureus, Withaferin ACorrespondence   : arifa-m@fk.unair.ac.id

Background: Patients with severe vasodilation accompanied by refractory hypotension despite high doses of vasopressors were associated with a high mortality rate. The Ang-2 for the Treatment of High-Output Shock (ATHOS) 3 trial demonstrated that angiotensin 2 (Ang-2) could effectively increase MAP and blood pressure in vasodilatory shock patients. This systematic review aims to summarize the impact of Ang-2 for the treatment of vasodilatory shock on clinical outcomes, including length of stay, MAP level (before and after), and mortality also Ang-2 dose needed. Methods: A systematic search in PubMed, Sage, ScienceDirect, Scopus and Gray literature was conducted to obtain studies about the use of Ang-2 in vasodilatory shock patients. Results: In all of the studies that we obtained, there were different results regarding mortality in patients with vasodilatory shock with Ang-2. Mortality was significantly lower when Ang-2 was administered to patients with elevated renin. The initial dose of Ang-2 can be started at 10-20 ng/kg/min, but there is no agreement on the maximum dose. Ang-2 may be considered a third-line vasopressor if the targeted MAP has not been achieved after administration of norepinephrine >200 ng/kg/min for more than 6 hours. Although not statistically significant, the use of Ang-2 can reduce the length of stay in the ICU and in the hospital when compared to patients without Ang-2 therapy, in addition to reducing the dose of vasopressor. Conclusion: Overall, the use of Ang-2 has potential to be a regimen for patients with vasodilatory shock. Further study is needed to obtain more data.

Liver cirrhosis is a chronic disease characterized by the presence of fibrosis and regeneration of nodules in the liver, the consequence of which is the development of portal hypertension and liver failure. Usually associated with infectious infectious diseases such as viral hepatitis, alcohol consumption, metabolic syndrome, autoimmune processes, storage diseases, toxic substances and drugs. Major complications include gastrointestinal variceal bleeding, ascites, spontaneous bacterial peritonitis infection, hepatorenal syndrome, hepatic encephalopathy, and hepatocellular carcinoma. A 23-year-old woman comes to the ER, dr. Soegiri Lamongan with complaints of vomiting blood. The patient also complained of black bloody stools. Referred patient from Intan Medika Hospital with the initial complaint of vomiting blood more than 5 times (± equivalent to one medium drinking bottle) four days ago. On examination also found anemic conjunctiva and found splenomegaly. On abdominal ultrasound examination, the liver was shrunken, the edges were obtuse angles, partially irregular, parenchymal echo intensity was heterogeneous, v.hepatica was normal, liver fibrosis staging was 11.81 kPa, no masses or nodules were seen. The conclusion on endoscopic examination was the presence of grade III esophageal varices, congestive gastropathy, and erosive gastritis. Liver cirrhosis is a disease that has various etiologies. Early diagnosis and appropriate treatment in cirrhotic patients with complications is one way to improve patient survival