Individuals conducting commercial transactions must carefully weigh-in determining factors prior to sales purchases, either related to goods or pricing. After all, matters are secured, the involved parties can advance with a sales purchase agreement.  Nonetheless, a transaction can typically be canceled post an agreement, due to circumspection on part of the seller or buyer, who is allowed to annul his/her initial plan. Islamic Sharia gives rights to transaction cancellation or activation, and this concept is called “Khiyār”. Various mazhab (Islamic schools of jurisprudence) give consent to Khiyār and its enabling guidelines.  An example is in a case of defective products or discrepancy on the merchant's original product description, etc.  However, depending on the individual situations, all mazhab can either have consensus or disagreement on the nature of Khiyār.  This paper emphasizes the debates due to its relevancy in today’s market, which warrants further development into broader consumer protection.  A qualitative methodology is used for comparison between various mazhab relating to Khiyār based on Fiqh literature. a Khiyār becomes a right for both the seller and buyer.  But, depending on each unique condition, it can also be invalidated.

This study discusses conflict resolution through adat in Acehnese society according to Islamic law. Conflict resolution like this is a solution in the midst of the piling up of cases in the judiciary in Indonesia. This study uses the sociology of law theory which sees that law is a tool to control communities who can resolve conflicts, namely adat and cultural values. The data collection techniques used are; interviews and literature review. The results of this study indicate that conflict resolution with adat mechanisms in the perspective of sociology of law sees law as a tool and means to control and develop society. Law is seen as a means of community development in a better direction. In fact, the judiciary formally advocates for peace by deliberation known as mediation, this is done in the midst of piling up cases that must be resolved by law enforcers. Therefore, adat-based conflict resolution has advantages, among others, maintaining brotherhood and eliminating grudges, fast, cheap, promoting a sense of justice and elasticity. This advantage is possible because of the involvement of adat institutions as social elites that have both social and juridical legitimacy. Conflict resolution through adat is in line with the values of Islamic law, especially in the concept of al-urf, namely adat that do not conflict with sharia. The strong relationship between adat and Islam in Aceh has resulted in this pattern of conflict resolution being viable and enduring to this day.

This study discusses the transformation of ijtihad of Indonesian scholars in the formulation of the Compilation of Sharia Economic Law (KHES) using the maslahah perspective as the basis of analysis. KHES is the result of the codification of Islamic economic law in Indonesia that seeks to address the dynamics of the modern economy through a contextual approach to classical Islamic legal sources. Indonesian scholars have an important role in the ijtihad process by adapting sharia values to align with the social, cultural, and economic realities of Indonesian society. Through the maslahah mursalah approach, the transformation of ijtihad not only maintains the principles of justice and maslahah, but also reflects the flexibility of Islamic law in responding to developments in the era. This study found that KHES is the result of synergy between classical fiqh texts and the needs of contemporary economic practice, where maslahah becomes the main instrument to maintain the relevance and acceptability of Islamic law in the national economic realm. Thus, KHES reflects a concrete form of moderate, contextual, and oriented Nusantara Islam to the welfare of the people in the economic field.

This paper concerns with how to build a balance of rights and obligations of husband and wife in fulfilling the economic needs of the family, especially in unusual circumstances. The paper aims to give an overall picture of the authority of the husband and wife regarding the domestic and public rights in the family, as well as to deal with the issue on family economy during the Covid-19 pandemic. The study of this paper used the explorative-qualitative research methods, with data obtained by disseminating questionnaires and studying documents related to the responsibilities carried out by the husband and wife. An initial investigation was conducted by taking into account the provisions stipulated in the formal legality of positive law. The data were then analyzed by utilizing a descriptive phenomenological approach through the interpretation of the data obtained from observation, interview, documentation, and literature review. The findings of this study indicate that men and women have equal rights. The concept of nature show that there is normative justification between husband and wife, stating that the domestic responsibilities are closely related to the shared rights and obligations that are balanced within the family and society, and that both husband and wife have the same rights in taking legal actions. In this new normal era, to strengthen the economically weak family in the community requires joint co-operation between the husband and wife so that they can meet the needs of the family and create a harmonious family.

Acta Medica Indonesiana, today is The Indonesian Journal of Internal Medicine, addresses all the concerns of science on Internal Medicine. In this edition, we publish a study conductedby Putra ST.1, a cohort retrospective study on teenager subjects who were breast-fed as infants and the effects on the development of atherosclerosis. This study supported the idea that breastfeeding may have protective effect on the development of atherosclerosis. We publish the study since it included the health issues of teenagers.We also publish a study from Yogyakarta conducted by Hartopo AB, et al. which found that neutrophil to lymphocytes ratio of more than 6.2 is correlated to the increased in-hospital adverse events. The subjects were patients with ST elevation myocardial infark (STEMI). Based on the results of the study, the neutrophil/lymphocyte ratio can be utilized as a predictor of adverse events in patients with STEMI.

Aim: to investigate the role of neutrophil-to-lymphocyte ratio (NLratio) in predicting in-hospital adverse cardiac events in patients with STEMI. Methods: this was a cohort study on patients with STEMI onset ≤24 hour hospitalised in ICCU. NLratio was calculated as absolute neutrophil count divided with lymphocyte count measured by automated blood cell counter on admission.The outcome was in-hospital adverse cardiac events,which were recorded during follow-up. The cut-off value of NLratio to predict outcome was determined by ROC curve analysis. Univariate and multivariable analysis to assess whether high NLratio was independent predictor for in-hospital adverse events were performed. Results: among165 subjects, in-hospital adverse cardiac events occurred in 49 subjects (29%). The cut-off value of NLratio was 6.2. The univariate analysis showed that NLratio >6.2 had an odd ratio of 3.19 (95% CI 1.55-6.55, p=0.002) to develop in-hospital adverse cardiac events. The multivariate analysis showed that NLratio was an independent predictor of in-hospital adverse cardiac events with an odd ratio of 4.10 (95% CI 1.59-10.54, p=0.003). Conclusion: high on-admission NLratio is an independent predictor for in-hospital adverse cardiac events in patients hospitalised for STEMI.Key words: neutrophil-to-lymphocyte ratio, adverse cardiac events, STEMI.

Aim: to assess the use of of angiogenesis, inflammation, platelets count, and metastatic status as predictors for thrombosis risk represented by soluble P-selectin level in nasopharyngeal carcinoma (NPC) patients. Methods: a cross sectional study was conducted on NPC patients at the Hematology and Oncology Clinic of Cipto Mangunkusumo Hospital, Jakarta, during Mei to October 2012. Data regarding angiogenesis (CD105 and VEGFR-2), inflammation (IL-6), platelets count, and metastatic status were assessed at enrollment, as well as soluble P-selectin levels in all eligible patients. Bivariate analysis continued with multiple linear regression analysis were done to identify independent predictors for soluble P-selectin levels. Results: sixty NPC patients were enrolled in the study. There was correlation between platelet counts (r=0.389; p=0.002), IL-6 (r=0.595; p<0.001) and number of metastatic sites (r=0.542; p<0.001) with soluble P-selectin level, and a linear regression analysis showed that these three variables can predict soluble P-selectin levels with adjusted R-square 65%. There was no correlation between VEGFR-2 and CD105 levels with soluble P-selectin levels.Conclusion: platelet counts, IL-6 level, and number of sites of metastasis can be used as predictors of soluble P-selectin level as parameter of thrombosis risk in NPC patients. Key words: nasopharyngeal carcinoma (NPC), thrombosis risk, soluble P-selectin.

Aim: to develop a non-invasive diagnostic test for non-alcoholic steatohepatitis NASH. Methods: this is a cross-sectional study on non-alcoholic fatty liver disease (NAFLD) subjects. Sample was taken by consecutive sampling method. Diagnostic criteria of NAFLD were confirmed by liver biopsy. Clinical variables include metabolic syndrome, aspartate aminotransferase (AST), alanine aminotransferase (ALT), adiponectine, TNF-alfa, insulin, homeostatic model assessment insulin resistance (HOMA-IR) index and liver biopsy. Patients were divided into two groups based on their liver biopsy, group 1: Non-NASH (NAFLD activity score <3) and group 2: NASH (NAFLD activity score of >4). Statistical analyses were performed using Student’s t-test, Mann Whitney U, chi-square, the ROC curve, sensitivity and specificity test. Results: fifty NAFLD patients were recruited, 30 males and 20 females. Among these patients, 12 (24%) had type 2 diabetes, 36 (72%) had metabolic syndrome, the remaining 2 (4%) did not fulfilled metabolic syndrome. Liver biopsy confirmed 21 (42%) non- NASH and 29 (58%) NASH respectively. Level of AST and ALT, plasma level of adiponectine and TNF-alfa were statistically different between two groups. The AST level (>25 U/L) in combination with TNF-a (>3.28 pg/cc) demonstrated a good diagnostic accuracy for NASH (Accuracy 82%, Sensitivity 76%, Specificity 90%, PPV 92%, and NPV 73%). Conclusion: the combined diagnostic tests of AST and TNF-alfa plasma levels demonstrated a good accuracy for the detection of NASH among NAFLD patients. This combination test can be used as a noninvasive method to diagnose NASH.Key words: AST, TNF-a, diagnostic test, NASH.

Aim: to investigate the effect of breastfeeding duration on vascular characteristics in adolescence. Methods: we conducted a retrospective cohort study on adolescents aged 15-18 years old. Breastfeeding duration was inquired using a questionnaire filled by parents and categorized into 0-<2, 2-<4, 4-<6, 6-<12, and >12 months. Outcomes assessed were flow mediated dilation (FMD), carotid intima media thickness (CIMT), anthropometrics. Analysis was done using linear regression and MANOVA general linear model with cardiovascular risk factors as the dependent variables and breastfeeding duration as the independent variable with further adjustment for confounders. Results: 285 subjects aged 15-18 years were enrolled. Breastfeeding duration of 4-<6 months was associated with thinner CIMT and the effect was more prominent after adjustment for gender and postnatal tobacco exposure (mean difference=24.28 micrometer, p=0.045). No statistically significant association was found with FMD. Conclusion: breastfeeding duration of 4-<6 months is associated with thinner IMT and thus has a protective effect on the development of cardiovascular disease. However the association with FMD in adolescence is less clear.Key words: breastfeeding duration, vascular structure and function, cardiovascular risk.

Aim: to analyse the effects of immunoglobulin (Ig)G and IgM anti-beta-2 glycoprotein-1 (anti-β2GP1) on the expression of tissue factor (TF), thrombomodulin (TM), and plasminogen activator inhibitor-1(PAI-1) of endothelial cells in the messenger RNA level. Methods: laboratory experimental study in human umbilical vein endothelial cells (HUVEC) was done at Cipto Mangunkusumo Hospital/Faculty of Medicine, Universitas Indonesia. Samples are purified IgG anti-β2GP1 from six  antiphospholipid syndrome (APS) patients serum and IgM anti-β2GP1 from six APS patients serum. For controls, purified IgG from six normal human serum (IgM-NHS) and purified IgM from six normal human serum (IgM-NHS) were used. HUVEC were treated with purified IgG anti-β2GP1, IgM anti-β2GP1, IgG-NHS, IgM-NHS for four hours of incubation. We measured TF, TM, and PAI-1 of HUVEC in mRNA relative expression levels (before and after treatment) by real time reverse transcription polymerase chain reaction. Results: the mean value of TF, TM, and PAI-1 mRNA levels in HUVEC after treated with IgG anti-β2GP1 compared to Ig-NHS were 3.14 (0.93)-, 0.31 (0.13)-, 5.33 (2.75)-fold respectively. In other hand, after treated with IgM anti-β2GP1 compared to IgM-NHS, mRNA levels of TF, TM, and PAI-1 were 4.33 (1.98)-, 0.33 (0.22)-, 5.47 (2.64)-fold respectively. Before and after treatment with IgG anti-β2GP1 showed significant differences of TF mRNA levels {1.09 (0.76) versus 3.14 (0.93), p=0.003}, TM mRNA levels {0.91 (0.11) versus 0.31(0.13), p=0.001}, and PAI-1 mRNA levels 0.93 (0.13) versus 5.33 (2.75), p=0.013}. Before and after treatment with IgM anti-β2GP1 showed significant differences of TF mRNA levels {1.03 (0.11) versus 4.33 (1.98), p=0.008}, TM mRNA levels {0.93 (0.08) versus 0.33 (0.22, p=0.003}, and PAI-1 mRNA levels {1.02 (0.10) versus 5.47 (2.64), p=0.01}. Conclusion: IgG anti-β2GP1 and IgM anti-β2GP1 increased TF and PAI-1 mRNA levels. However, IgG anti-β2GP1 and IgM anti-β2GP1 decreased TM mRNA levels. It proved that the mechanism of thrombosis in APS occurs through coagulation activation, reduction of fibrinolysis activity, and reduction of anticoagulant activity.Key words: APS, IgG/ IgM, anti-β2GP1, TF mRNA, TM mRNA, PAI-1 mRNA.

Aim: to assess physiological and operative severity score for the enumeration of mortality (POSSUM) scoring system and compare it with European system for cardiac operative risk evaluation (EuroSCORE) scores in patients who underwent cardiac surgery from two hospitals in the southwestern region of Iran. Methods: in this retrospective study, total of all 1420 patients who were admitted for elective cardiac surgery at our centers, from 2007 to 2012, were scored using the POSSUM and EuroSCORE systems. Results: the overall mortality rate was 0.87%. Among the risk factors, history of diabetes, smoking, respiratory disease, and myocardial infarction, were significantly affect the mortality rate. Therefore, of these risk factors, only the hemoglobin was significantly correlated with the morbidity rate. The predictive accuracy of mortality equations was 74.5%. The lower predictive accuracy of mortality equations was 67.8% was observed using EuroSCORE. Conclusion: although results are statistically significant, but the analysis have never intended to affect the decision to operate, and this decision must be based on clinical expertise, because of the need to standardize data collection and stratify the risks involved in operations, scoring systems such as POSSUM should be used prospectively. However, if analyzed correctly, POSSUM is a good predictor of mortality in patients undergoing cardiac surgery.Key words: cardiac surgery, physiological and operative severity score for the enumeration of mortality (POSSUM), European system for cardiac operative risk evaluation (EuroSCORE).

Aim: to identify the effect of high-PUFA dietary supplementation on inflammatory status of patients with advanced cervical cancer. Methods: a randomized double-blind clinical trial was conducted in patients with advanced cervical cancer who had undergone external radiation therapy at Department of Radiotherapy, Cipto Mangunkusumo Hospital, Jakarta, between April 2013 and April 2014. The inflammatory status was evaluated based on serum prostaglandin E2 (PGE2) levels using ELISA method. The dietary supplementation was isocaloric, isoprotein and contained PUFA with a ratio of ω-6: ω-3 fatty acid = 1.27:1 and supplementation without PUFA. Data were analyzed with statistical tests, including Shapiro-Wilk test, independent T-test and Mann–Whitney test. Results: there was statistically no significant difference on PGE2 level between treatment and control groups (p=0.127). However, there was clinically significant difference, in which the treatment group had reduced PGE2 level by 8.9%; while the control group had increased level by 28.1%. Conclusion: dietary supplementation enriched with PUFA can reduce inflammatory status in patients with advanced cervical cancer. Reduced PGE2 level will lower the survival of cancer cells; therefore dietary supplementation enriched with PUFA with a ratio of ω-6 : ω-3 fatty acid = 1.27 : 1 along with radiation therapy may improve tumor response to radiation.Key words: cervical cancer, ω-3 PUFA, ω-6 PUFA, PGE2 level.

This is the first report of MRSA infection in Sanglah Hospital. We reviewed eight patients with MRSA infection from microbiologi laboratory records between January and May 2011, than followed by tracing medical records to obtained data of the patients. Five of cases with sepsis, 1 case with osteomyelitis, and the two others with mediastinitis and pneumonia. The patients were kept in private isolated room and barrier-nursing technique was strictly followed. Further action was culturing specimen taken from the patients nose, throat, axilla, and samples taken from the health care workers, with no MRSA colonization were found. Five patients demonstrated good respond to intravenous administration of either vancomycin or linezolide. Three were died due to septic shock before the laboratory culture and antimicrobial susceptibility availabled. All of the strains isolated more than 48 hours after admission and also demonstrated clinical risk factors for hospitalized acquired MRSA (HAMRSA). These strains had  resistance to ß-lactams but remain susceptible to many non ß-lactam antibiotics, as reported in some community acquired MRSA (CA-MRSA) isolates. Future study using molecular typing required to fully understand the magnitude and ongoing evolution of MRSA infections.Key words: MRSA, Antimicrobial susceptibility, treatment

We are reporting a male, 46 years old came to emergency unit with a chief complaint of abdominal tenderness since 1 day prior to admission. No history of abdominal trauma. He often felt abdominal discomfort for the last 5 years. Physical examination revealed decreased consciousness, shock, pale conjungtiva, distended abdomen, with tenderness of the whole abdomen on palpation, and no bowel movement. Laboratory examination found anemia, leucocytosis, normal amilase and lipase. FAST (focus assissted Sonography on trauma) found massive ascites. Patient underwent cito laparotomic exploration that found blood on abdominal cavity, nodular liver, and actively bleeding tumour of liver. During hospitalization, patient recovered and discharged.In the case of acute abdomen, spontaneous ruptured hepatocellular carcinoma (HCC) is one of differential diagnosis, considering high incidence of HCC in South East Asia, especially Indonesia. Confirming diagnosis of generalized peritonitis requires abdominal CT scan and ultrasonography, to rule out ruptured HCC.Key words: hemoperitoneum, ruptured hepatocellular carcinoma

Dendritic cells are major antigen-presenting cells (APC) that stimulate naïve T cells, which induce adaptive immune responses. Graves’ disease (GD) is an autoimmune disease characterized by the presence of autoantibodies against Thyroid Stimulating Hormone Receptor (TSHR). The autoantibodies bind with TSHR and stimulate thyroid hormone production. Dendritic cells are still the major APC in GD immune response although thyrocytes in GD can also express Major Histocompatibility Class (MHC) class II molecule. Studies about DC in GD have been conducted by isolating intra-thyroid DC or DC in peripheral circulation. Results of DC studies in GD are still controversial. Changes in number and profile of DC are found, which indicate altered immune response activity and defects of regulator T cell (Treg) in GD.Key words: dendritic cells, Graves’ disease

A forty four years old male patient presented with headache and dizziness in our outpatient department. On examination, he had pulse rate of 96 /min, blood pressure of 122/80 mmHg, JVP was not raised. He had clubbing and cyanosis on General physical examination. On auscultation pansystolic murmur was heard all over the chest. His respiratory and abdominal examination was normal. There were no significant findings on electrocardiography and skiagram chest. Echocardiography revealed ventricular septal defect with overriding of aorta, pulmonary artery could not be visualised. On computrized tomography pulmonary angiography revealed Ventricular septal defect with overriding of aorta. The main and  normally confluent right and left pulmonary arteries were not visualized

Aim: to know the relationship between salted fish consumption and nasopharyngeal carcinoma (NPC). Methods: we searched for the articles from PubMed® and ScienceDirect® based on our clinical question. After filtered with our in- and exclusion criteria, we had six articles about this topic, all of them were case-control studies. All articles were then critically appraised for their validity, importance, and applicability. Results: there was no consistent relationship between salted fish consumption and NPC. Worth to note that those studies wo showed the firm relationship were conducted in Southern China, where the incidence of NPC was extremely high and related to specific Chineese-style salted fish consumption. Conclusion: there was an inconsistent relationship between salted fish consumption and NPC.Key words: salted fish, risk factor, nasopharyngeal carcinoma.

Hypertension-related maternal mortality reaches 16% when it is compared to other causes of maternal mortality such as sepsis, bleeding or abortus. Pregnant women with hypertension disorder are at increased risk for experiencing numerous complications including disseminated intravascular coagulation (DIC), cerebral hemorrhage, liver dysfunction and acute renal failure; while to the fetus, it may cause intrauterine growth retardation, prematurity and perinatal mortality. Hypertension in pregnancy should be managed appropriately to reduce maternal and fetal morbidity and mortality rate, i.e. by preventing women from getting the risks of increased blood pressure, preventing disease progression and preventing the development of seizure and considering termination of pregnancy in lifethreatening situation for maternal and fetal health.Key words: blood pressure, hypertension, eclampsia, preeclampsia, pregnant women, gestational.

The use of salicylates (popularly known as aspirin or ASA) is well established for the secondary prevention of cardiovascular disease. However, there are reportedly a numer of patients who suffered repeat cardiovascular events despite being given aspirin “prophylaxis”, and uncertainty prevails on whether or not this is due to an inherent inability of aspirin to sufficiently modify platelet activity or are there other mechanisms involved. Coined as “aspirinresistance”, the condition warrants attention as an ineffective prophylaxis may lead to unexpected morbidity and subsequent disappointment

Frailty syndrome has become one of the geriatric syndromes with an increasing risk of debilitating clinical outcome. Accordingly, thecurrent treatment guidelines have been focusing in viewing frailty syndrome as an important aspect to be considered. The International Diabetes Federation (IDF) classifies the guideline for managing the elderly with type 2 diabetes mellitus based on their functional status, whether it is functionally independent or dependent. Functionally dependent group is further classified as subgroup of frail and/or demented people. Special consideration on older people has also been discussed as a topic on the treatment algorithm for hypertension and dyslipidemia.