Udayana University

Brachial Plexus Injury (BPI) is one of the most complex peripheral nerve injuries, causing significant functional impairment of the upper extremities and substantially reducing patients' quality of life. The increasing incidence of BPI, particularly in productive-age individuals due to high-energy trauma such as motorcycle accidents, underscores the urgent need for a comprehensive understanding of its epidemiology, diagnosis, management, and rehabilitation. This study aims to synthesize current scientific evidence on BPI through a systematic literature review. Data were collected from PubMed, Scopus, and Google Scholar using relevant keywords, with inclusion criteria limited to peer-reviewed articles published within the last 10–15 years. Qualitative descriptive analysis was employed to organize findings into key thematic areas. The results indicate that BPI predominantly affects young adult males through high-energy traction injuries, most frequently involving the upper trunk (C5–C6). Accurate diagnosis requires a combination of clinical examination, electromyography, nerve conduction studies, MRI, and CT-myelography to differentiate preganglionic from postganglionic lesions. Surgical reconstruction, including nerve grafting, nerve transfer, and free functional muscle transfer, yields optimal outcomes when performed within 3–6 months post-injury. Multidisciplinary rehabilitation is essential to restore upper limb function and prevent long-term disability. However, significant variation in clinical practice and the absence of standardized global guidelines remain major challenges, particularly in developing countries with limited microsurgical infrastructure and delayed referral systems. In conclusion, an integrated approach encompassing timely diagnosis, individualized surgical reconstruction, and structured rehabilitation is critical to improving functional outcomes in BPI patients globally.

To scale up PrEP, Indonesia launched a pilot program between 2022 and 2023. This study investigates PrEP providers’ knowledge and attitudes to identify barriers and facilitators for future PrEP scale-up in the country. An online survey with convenience sampling was conducted for healthcare workers and community workers at PrEP-providing facilities between May and June 2023. The survey collected data on participants’ knowledge, attitudes, and experiences in offering PrEP as well as basic demographic information. Logistic regressions were conducted to identify factors associated with support for the PrEP program and comfort offering PrEP. 197 participants were recruited, including 63 healthcare workers and 134 community workers. On knowledge, 84.4% knew the correct definition for PrEP, 62.4% knew all target groups, 51.8% knew all eligibility criteria, and 31.0% knew all initiation procedures. Support for the PrEP program was expressed by 70.1% of participants, and 55.2% of experienced participants were comfortable offering PrEP. Community workers were more likely to express support for the PrEP program (aOR 4.00, 95%CI 1.03–15.54) while participants who supported the program in turn were more likely to be comfortable offering PrEP (aOR 4.06, 95%CI 2.24–7.38). The study highlights the importance of fostering positive attitudes toward PrEP for provider comfort in offering it. It also shows the potential for increased empowerment for community workers as the main drivers of the PrEP program. Targeted training and further research are needed to support providers effectively.

Background: Cleome gynandra L. is a leafy medicinal plant widely used in traditional medicine across Asia and Africa. Although its rich phytochemical profile has attracted growing scientific interest, the existing evidence on its pharmacological effects remains fragmented and inconsistent across studies. Objective: This systematic review aims to synthesize and critically evaluate the pharmacological effects of C. gynandra leaf extract reported over the past decade. Methods: A systematic literature search was conducted in PubMed, ScienceDirect, and Medline for articles published between January 2016 and December 2025, following the PRISMA guidelines. Studies reporting the pharmacological activities of C. gynandra leaf extract using in vitro or in vivo approaches were included. Data extraction and quality assessment were performed independently by two reviewers. Results: A total of seven studies met the inclusion criteria. The findings consistently demonstrated that C. gynandra leaf extract possesses antioxidant, antibacterial, anticancer, hepatoprotective, and antimalarial activities, which are largely attributed to its diverse phytochemical constituents, including flavonoids, phenolic compounds, and triterpenoids. However, substantial heterogeneity was observed across studies in terms of extraction methods, experimental designs, dosage regimens, and outcome parameters. All available evidence remains at the preclinical stage, with no clinical trials identified. Conclusion: The current evidence suggests that C. gynandra leaf extract exhibits promising pharmacological potential. Nevertheless, the high degree of methodological variability and the absence of clinical studies preclude definitive conclusions regarding its therapeutic efficacy and safety. Future research should prioritize standardized methodologies, mechanistic investigations, and well-designed clinical trials to validate the medicinal value of this plant.

The growth of digital marketing has led businesses to increasingly use social media as a promotional tool, particularly through viral marketing strategies. However, highly viral content does not always result in increased consumer purchase intention, indicating the need for supporting factors. This study aims to examine the effect of viral marketing on purchase intention, the effect of viral marketing on brand awareness, the effect of brand awareness on purchase intention, and the mediating role of brand awareness in the relationship between viral marketing and purchase intention at Hanzho Coffee & Eatery in Gianyar Regency. This study adopts a quantitative approach with a causal research design. A total of 100 respondents were selected using purposive sampling. Data were collected through questionnaires using a Likert scale and analyzed using path analysis and the Sobel test. The results show that viral marketing has a positive and significant effect on purchase intention and brand awareness, while Brand awareness also has a positive and significant effect on purchase intention. In addition, brand awareness partially mediates the relationship between viral marketing and purchase intention. These findings indicate that viral marketing strategies are more effective when combined with consistent efforts to strengthen brand awareness in increasing consumer purchase intention.

Background: Patellofemoral pain syndrome remains a highly prevalent running-related injury, characterized by retropatellar pain exacerbated by knee flexion. While multifactorial, biomechanical imbalances and proximal neuromuscular deficits are primary contributors. This systematic review and meta-analysis evaluated the efficacy of targeted neuromuscular training and gait retraining on pain, functional capacity, and biomechanical parameters in runners with patellofemoral pain syndrome. Methods: A systematic search and analysis were conducted, incorporating nine randomized controlled trials. Inclusion criteria focused on adult runners diagnosed with patellofemoral pain syndrome undergoing neuromuscular exercise or gait retraining compared to control or standard care. Primary outcomes included self-reported pain and functional status. Standardized Mean Differences with 95 percent confidence intervals were calculated using an inverse-variance random-effects model. Results: Nine randomized controlled trials involving robust sample sizes were analyzed. The pooled meta-analysis for pain reduction demonstrated a statistically significant large effect size favoring targeted neuromuscular and gait retraining interventions (Standardized Mean Difference = -1.38, 95 percent confidence interval [-1.85, -0.91], p less than 0.001). Functional outcomes also showed significant improvement in the intervention groups (Standardized Mean Difference = 1.51, 95 percent confidence interval [1.02, 2.00], p less than 0.001). Biomechanical analyses indicated significant modulations in hip kinematics, notably reduced peak hip adduction. Conclusion: Targeted neuromuscular training and gait retraining significantly reduced pain and improved lower extremity function in runners. These interventions successfully modulated patellofemoral joint stress through enhanced proximal control and altered strike mechanics.

Background: Drug tourism involves individuals traveling across international borders to access recreational illicit substances. While psychiatric and cardiovascular toxicities of substances like cannabis and methamphetamine are established, quantitative data regarding their impact on ocular microstructures and functional dynamics remain scarce. This study aims to systematically review and meta-analyze the structural and functional ocular alterations induced by these substances. Methods: A systematic review and meta-analysis complying with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were conducted. Electronic databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched from inception to January 2026. Data extraction targeted pupillary dynamics and structural optical coherence tomography measurements. Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tools. A DerSimonian-Laird random-effects model was utilized in Review Manager 5.4 to pool continuous data, calculating Standardized Mean Differences and 95% Confidence Intervals. Heterogeneity was evaluated via the I-squared statistic. Results: Nine primary research articles were included. The mean Newcastle-Ottawa Scale score was 8.1, indicating a low risk of bias. Chronic cannabis users exhibited significantly reduced pupillary constriction velocity (Standardized Mean Difference -0.85, 95% Confidence Interval -1.20 to -0.50, p < 0.001), prolonged reaction latency (Standardized Mean Difference 0.65, 95% Confidence Interval 0.30 to 1.00, p < 0.01), and decreased corneal endothelial cell density (Standardized Mean Difference -0.78, 95% Confidence Interval -1.15 to -0.41, p < 0.001). Methamphetamine abuse was associated with profound global retinal nerve fiber layer thinning (Standardized Mean Difference -1.12, 95% Confidence Interval -1.55 to -0.69, p < 0.001) and reduced minimum rim width (Standardized Mean Difference -0.95, p < 0.001). Conclusion: Recreational cannabis and methamphetamine abuse cause significant, quantifiable ocular morbidity. Methamphetamine induces ischemic neurodegenerative retinal loss, while cannabis disrupts autonomic pupillary pathways and corneal integrity. Comprehensive ophthalmological screening is critical for individuals with substance abuse histories.

This study examines the institutional role of the Legislative Secretariat in facilitating recess-based representation within the local democratic system in Bali, Indonesia. In Indonesia’s decentralized governance framework, legislative recess activities function as an important mechanism through which members of the Regional House of Representatives reconnect with their constituencies to absorb public aspirations and communicate policy developments. While existing studies on local political representation primarily emphasize elected representatives and electoral dynamics, the administrative institutions that support these interactions remain underexplored. This study addresses this gap by analyzing how the Session and Legislative Function Facilitation Division within the Bali Provincial Legislative Secretariat supports the planning, implementation, and reporting of recess activities, and how such administrative support contributes to the transmission of community aspirations into local policymaking processes. Using a qualitative descriptive approach, data were collected through in-depth interviews with legislative secretariat officials and staff, direct observation of administrative procedures, and document analysis of recess reports and institutional regulations. The findings indicate that the Secretariat plays a crucial mediating role across three stages: planning, implementation, and evaluation and reporting. Administrative coordination, technical guidance, and verification processes ensure that public aspirations gathered during recess activities are systematically documented and incorporated into policy deliberations. The study highlights the importance of bureaucratic capacity in strengthening democratic representation and effective state–society relations at the local level.

Rapid identification of acute leukemia is essential for its management. In resource-limited settings, simple, fast, and non-invasive initial screening methods are crucial for early detection. Cell population data (CPD) obtained from an automated hematology analyzer provides a new approach to identify acute leukemia quickly. Determine the ability of the width of dispersion of neutrophil fluorescence (NE-WY) and the width of dispersion of monocyte fluorescence (MO-WY), in rapidly identifying acute leukemia. The research was performed at Ngoerah Hospital Bali, focusing on patients recently diagnosed with acute leukemia. NE-WY and MO-WY values were measured using the Sysmex XN-3000 device. The study included healthy controls who had a medical check-up, and reactive controls, specifically patients with infections or inflammatory conditions. Patients who relapsed or previously received chemotherapy were excluded. A total of 228 subjects were involved in this study: 78 acute leukemia patients, 80 healthy controls, and 70 reactive controls. Distinguishing leukemia from healthy controls, the NE-WY cut-off value was 689, with sensitivity; 92.3%, specificity; 100% (p <0.001). While distinguishing from reactive controls, the cut-off value of NE-WY 857.5 was obtained, with sensitivity; 70.5%, specificity; 82.9% (p <0.001). In distinguishing leukemia from healthy controls, the cut-off value MO-WY 804 was obtained, with sensitivity; 52.6%, specificity; 96.3% (p <0.001). While distinguishing from reactive controls, the cut-off value of MO-WY 901 was obtained, with sensitivity; 46.1%, specificity; 85.7% (p = 0.299). NE-WY values indicated superior sensitivity and specificity compared to MO-WY in the early detection of acute leukemia.

Purpose: This study aims to identify the main indicators, influencing variables, analytical techniques, and regional trends of sustainability performance in the hospitality industry. Methodology: This study adopts a Systematic Literature Review (SLR) method using the Scopus database as the primary source. Articles were searched through Boolean keyword techniques, screened with PRISMA guidelines, and analysed using descriptive synthesis to map indicators, variables, and methods applied in prior studies. Results/Findings: The review shows that environmental, economic, and social performance remain the most dominant indicators, whereas cultural sustainability is rarely addressed. Green Human Resource Management (GHRM), Corporate Social Responsibility (CSR), and environmental management are the most studied variables. In contrast, green intellectual capital and spiritual capital have not been examined in the hospitality sector, although they show potential relevance. SEM-PLS is identified as the most frequently applied analytical tool, and most studies are concentrated in developing countries. Conclusions: The findings emphasize the need for further research into cultural sustainability and the inclusion of intellectual and spiritual capital in hospitality sustainability practices. The dominance of environmental, economic, and social factors suggests that a broader, more integrated approach is necessary. Limitations: This review is limited to English-language articles indexed in Scopus and excludes non-English or unpublished studies. Contributions: This study makes both theoretical and practical contributions. Theoretically, it expands sustainability research in hospitality by integrating knowledge-based and value-based resources. Practically, it guides hotel managers and policymakers, especially in culturally rich destinations, to incorporate cultural heritage, intellectual capital, and spiritual values into sustainability practices.