Depok is one of the cities with a high number of TB cases in West Java. The implementation of TB surveillance in Depok revealed challenges in meeting TB control indicators. Evaluating the surveillance system is essential to assess the quality of the existing system and identify barriers in TB surveillance implementation. Therefore, this study aims to evaluate TB surveillance system in Depok based on its components and attributes. This study was an assessment that describes the implementation of the TB surveillance system using both quantitative and qualitative approaches. It highlighted the systemic challenges that hindered effective TB control, such as inadequate knowledge of legal aspects, insufficient private-sector engagement, lack ability of data analysis and interpretation, the high percentage of TB officers who had not received the training was partly due to staff turnover, complex data collection, and low utilization of surveillance data for decision-making. To enhance the effectiveness of TB control efforts, this study recommends targeted training for healthcare workers, sufficient budget allocations, and simplified data management systems.
A microorganism growth medium is a material containing nutrients that support the growth and development of microorganisms. This nutrient is called the culture medium, and the growth process is known as culture, which can be enriched by the addition of blood. The aim of the researchers was to examine human blood, sheep's blood and cow's blood as growth media for Staphylococcus aureus bacteria. Is there a difference in the resistance test and growth patterns of Staplococcous aureus bacteria in human blood, sheep's blood and cow's blood media. Growth media in human blood, sheep's blood and cow's blood media. Bacterial growth in human blood media with round-shaped colonies, yellowish white with convex elevation, smooth surface, and medium size on cattle blood with a different type of hemolysis with negative results. smooth, and medium sized on sheep blood media with different types of hemolysis with positive results. Bacterial growth on cow blood media bacterial growth on cow blood media colonies are round, yellowish white with convex elevation, smooth surface, and medium sized on cow blood with hemolysis type which is different from a negative result. conclusion is that the Stapylococcus aureus bacteria has the same inhibitory zone in human blood, sheep blood and cow blood media. There is no difference between human blood, sheep blood and cow blood media. The difference in the type of hemolysis in sheep blood is because it has beta hemolysis type and in human blood, and cow's blood has gamma hemolysis
Background: Asia is one of the regions with the highest prevalence rates of Staphylococcus aureus infection. Green betel leaves (Piper betle L.) have been proven to have antibacterial potential with their active compound content, namely essential oils, phenols, chavicol, flavonoids, alkaloids, saponins, tannins, and steroids so it is necessary to investigate whether betel leaf extract has an effect on Methicillin-Sensitive Staphylococcus aureus (MSSA). The aim of this study is to analyze the effect of green betel leaf extract on the growth of MSSA. Methods: This research is a descriptive experimental study regarding the antibacterial activity test of green betel leaf extract against MSSA. The MSSA bacteria used were bacterial preparations in the Microbiology Laboratory of Faculty of Medicine Airlangga University. Green betel leaf extract was obtained from Batu City in 2023. The antibacterial activity test technique used was the dilution test. Results: In the dilution test, for the growth of MSSA, in tubes with concentrations of 800 mg/mL, 600 mg/mL, 400 mg/mL, 200 mg/mL, and 100 mg/mL appear clear indicates that there is no growth of germs. At a concentration of 50 mg/mL it appears cloudy which indicates the growth of germs. The results obtained for the growth of MSSA on agar plates were at concentrations of 800 mg/mL, 600 mg/mL, 400 mg/mL, and 200 mg/mL, there was no growth of germs. Meanwhile, at concentrations of 100 mg/mL and 50 mg/mL, the growth of MSSA germs was found Conclusions: The conclusion of this research is that the minimum inhibitory concentration (MIC) of green betel leaf extract against MSSA is 100 mg/mL and the minimum bactericidal concentration (MBC) of green betel leaf extract against MSSA is 200 mg/mL. Further research is needed on the antibacterial activity of green betel leaf extract against other bacterial species that are resistant to many drugs.
Background: Low back pain (LBP) is a common complaint that affects many individuals and can significantly reduce quality of life. Water-based exercise has been proposed as an effective therapeutic method to reduce pain and improve physical function in patients with LBP. Methods: A literature review was conducted by searching for relevant studies in reputable medical databases. Inclusion criteria included studies that compared water-based exercise with land exercise in individuals with LBP. Results: Studies show that both water-based exercise and land exercise are effective in reducing low back pain. However, water-based exercise tends to overestimate its effect due to publication bias. Nonetheless, water-based exercise provided a significant reduction in VAS scores. Land exercise showed additional benefits with significant improvements in emotional role and physical function on the SF-36, as well as a decrease in the ODI. Conclusion: Based on a literature review of seven selected articles, waterbased exercises have been shown to be effective in reducing pain in cases of low back pain (LBP). However, its application must consider the technical conditions and medical history of the patient.
Background: Despite the rising burden of end-stage renal disease (ESRD) and the rapid expansion of hemodialysis services, there is limited research exploring how Indonesians seek information about this topic online. Understanding digital health-seeking behavior is crucial for improving public education and access to care. Methods: This study analyzes public interest in hemodialysis in Indonesia over a decade (2014–2024) using Google Trends data. Several hemodialysis-related keywords were examined, including both lay and clinical terms. Search trends were evaluated over time and across provinces, and related search queries were also assessed. Results: The results show a steady increase in search volume for hemodialysis-related terms, with “cuci darah” consistently dominating over clinical terms such as “hemodialisa,” “hemodialisis,” and “hemodialysis.” Regional analysis reveals higher relative search interest in certain provinces, indicating potential geographic disparities in awareness or access to services. Common related search queries, such as “hemodialisa adalah” and “gagal ginjal,” reflect both curiosity about the procedure and broader concerns about kidney health. Conclusion: These findings suggest that online health-seeking behavior in Indonesia is growing, but also highlight gaps in public knowledge. Monitoring digital interest through platforms like Google Trends may serve as a valuable tool to guide targeted public education, optimize kidney health communication strategies, and inform more responsive service planning. Given the persistent public preference for lay terminology, future health campaigns should consider integrating colloquial language such as "cuci darah" to increase resonance and reach. Seasonal spikes in online interest also offer opportunities to strategically time educational initiatives for greater impact.
One of the most common reproductive health issues experienced by women is Fluor Albus (vaginal discharge). In general, women with fluor albus produce excessive mucus accompanied by an unpleasant odor. This study aims to analyze the effect of boiled Red Piper crocatum as a natural antiseptic on the reduction of Fluor Albus symptoms in women of reproductive age in Sidodadi Village, Sukosewu Subdistrict, Bojonegoro Regency. This research employed a pre-experimental design method, utilizing a one-group pre-test and post-test approach. The population consisted of 32 respondents, all of whom were included in the sample using a total sampling technique. Data were analyzed using a paired t-test. The results showed a p-value of 0.000, indicating that p < 0.05, and therefore, the alternative hypothesis (H₁) was accepted. This means that boiled Piper Crocatum significantly reduces Fluor Albus symptoms in women of reproductive age in Sidodadi Village, Sukosewu Subdistrict, Bojonegoro Regency. Conclution of this study Maintaining the normal flora of the vagina can be supported by using boiled Red Piper Crocatum water to reduce pathological vaginal discharge symptoms, due to its clinically proven active compounds.
Background; Azadirachta indica A. Juss (neem) leaves are known to contain various bioactive compounds with potential antioxidant properties. This study aimed to evaluate the antioxidant activity of neem leaf methanol extract through three different in vitro assays DPPH, ABTS, and FRAP while also identifying its secondary metabolite constituents. Methods; Neem leaves were extracted using the Ultrasound-Assisted Extraction (UAE) method with methanol as the solvent in a 1:20 ratio. Phytochemical screening was subsequently performed to identify secondary metabolites. Antioxidant activity was assessed using DPPH, ABTS, and FRAP assays, with absorbance values measured by a microplate reader. IC₅₀ values were determined through non-linear regression analysis of percent inhibition versus sample concentration. Results; Phytochemical analysis confirmed the presence of flavonoids, phenolics, alkaloids, and terpenoids in the methanol extract. The extract exhibited strong antioxidant activity in the DPPH assay, with an IC₅₀ value of 54.91 ppm. In contrast, ABTS and FRAP assays did not demonstrate sufficient antioxidant activity to allow calculation of IC₅₀ or RP₅₀ values, even at concentrations up to 1000 ppm, suggesting limited electron transferbased antioxidant capacity. Conclusion; The methanol extract of A. indica leaves demonstrates considerable antioxidant potential, primarily through the hydrogen atom transfer (HAT) mechanism. Flavonoid and phenolic compounds are likely the major contributors to this activity, supporting the potential of neem leaves as a natural source of antioxidants.
Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint among women of reproductive and perimenopausal age, often indicating a wide range of underlying endometrial pathologies. Histopathological examination of endometrial tissue remains the gold standard for determining its etiology and guiding management. Objective: This study aimed to analyze the histopathological patterns of endometrial biopsies in patients presenting with AUB and to correlate these findings with different age groups. Methods: A cross-sectional study was conducted on women presenting with AUB who underwent endometrial biopsy over a defined study period. The specimens were processed and examined microscopically, and histopathological diagnoses were categorized as proliferative, secretory, hyperplastic, atrophic, or neoplastic changes. Data were analyzed according to age distribution and menstrual status. Results: The majority of AUB cases were observed in the perimenopausal group (41–50 years). The most common histopathological finding was proliferative endometrium, followed by secretory and simple hyperplasia without atypia. Endometrial carcinoma and atypical hyperplasia were more frequent in women above 50 years of age. Atrophic and disordered proliferative patterns were also seen in the postmenopausal group. A significant association was found between age and the type of endometrial pathology (p < 0.05). Conclusion: Histopathological evaluation of endometrial biopsies provides critical insights into the etiology of AUB across age groups. Proliferative and hyperplastic changes dominate in perimenopausal women, while malignant lesions are more common in postmenopausal patients. Routine endometrial sampling in AUB cases, particularly among older women, is essential for early detection of premalignant and malignant conditions.
Background: The global population is aging rapidly, with older adults increasingly affected by chronic conditions such as diabetes mellitus. In Indonesia, diabetes among the elderly poses a significant public health concern, often complicated by under-recognized conditions like diabetic neuropathy. Aim: This study aimed to assess the effectiveness of a community-based intervention focused on targeted health education on diabetic neuropathy among elderly residents in urban area. Methods: A pre- and post-test design was used to assess the intervention's effectiveness. In collaboration with local health cadres and facilities, participants completed identical questionnaires on diabetic neuropathy before and after the health education session to measure improvements in knowledge. Results: A total of 143 elderly participants (median age: 65 years) were enrolled, with 73.4% being female. Post-education test scores showed a statistically significant improvement compared to pre-test scores (p<0.001p<0.001, Wilcoxon test). Of the participants, 22.4% were newly identified as having diabetes, and another 22% fell into the prediabetes range. Despite some variations in learning outcomes, 84.6% showed improved scores, indicating high effectiveness of the health education session. Conclusion: This study demonstrates that a community-based approach combining early diabetes screening and health education significantly improves elderly participants' knowledge about diabetes and diabetic neuropathy.
Background: Wound is a condition in which the integrity of body tissue is disrupted, leading to the activation of a complex biological process known as wound healing. This process aims to restore the protective skin barrier, prevent infection, and minimize fluid loss. It involves sequential phases of hemostasis, inflammation, proliferation, and remodeling. While inflammation is essential for initiating repair, prolonged or excessive inflammation may delay the healing process. Mitragyna speciosa (Korth) is a medicinal plant traditionally used in various cultures and has been reported to exhibit multiple pharmacological properties, including anti-inflammatory, antioxidant, antibacterial, analgesic, and wound-healing activities. Methods: The present systematic review was conducted to identify and synthesize scientific evidence regarding the potential of Mitragyna speciosa extract as a therapeutic agent in wound healing through anti-inflammatory and other biological pathways. Literature searches were performed in ScienceDirect, PubMed, MDPI, DOAJ, and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results :A total of 1,176 studies were screened, and five experimental studies fulfilled the inclusion criteria. The findings consistently demonstrated that Mitragyna speciosa extract suppressed pro-inflammatory mediators such as nitric oxide, reactive oxygen species, tumor necrosis factor-alpha, interleukin-6, and enzymatic pathways including cyclooxygenase-2 and 5-lipoxygenase. In addition, the extract stimulated cell migration, endothelial migration, and angiogenesis, thereby supporting tissue regeneration. Toxicity profiles suggest that the extract is safe at effective concentrations, although responses remain dose-dependent. Conclusions: Overall, Mitragyna speciosa shows promise as a plant-based therapeutic option for wound healing. Nevertheless, current evidence is limited and largely derived from in vitro studies, indicating the need for more extensive in vivo and clinical investigations.
Background: Type 2 diabetes mellitus is a metabolic disorder characterized by elevated blood glucose caused by insulin resistance and impaired insulin production by pancreatic β-cells due to oxidative stress. Kratom (Mitragyna speciosa) has been widely investigated for its antidiabetic, anti-inflammatory, and antioxidant effects, attributed to its alkaloid, flavonoid, phenolic, and saponin contents. This study aimed to evaluate the potential of topical kratom hydrogel as an innovative approach to improving pancreatic histology in type 2 diabetic mice, which has not been previously reported. Methods: Fifteen mice were divided into three groups: untreated diabetic group (DM), diabetic group treated with 5% kratom hydrogel (K5), and diabetic group treated with 15% kratom hydrogel (K15). Treatments were administered for two weeks. Parameters assessed included the percentage of healthy β-cells and acinar cells, as well as histological scoring of islet damage. Data were analyzed using parametric or non-parametric tests according to the normality distribution of each parameter. Results: Administration of 5% kratom hydrogel significantly increased the percentage of healthy β-cells (p<0.05) compared with 15% kratom hydrogel, which unexpectedly showed a lower proportion of healthy cells than the untreated group. Interestingly, the higher dose appeared to exert more toxic effects, whereas the lower dose provided better protective effects. No significant differences were observed in acinar cell parameters or islet damage scores, possibly due to the limited sample size. Conclusion: These findings provide preliminary evidence supporting the systemic therapeutic potential of topical kratom hydrogel, particularly in determining the effective dose and the need for larger sample sizes to obtain more consistent outcomes.
Background: Hansen’s disease (leprosy) continues to be a public health concern in Indonesia, which ranks among the countries with the highest case numbers globally. Despite national control programs, the detection of new cases and disability rates suggests ongoing transmission and delays in diagnosis. A clearer understanding of prevalence, risk determinants, and management approaches is critical to strengthen interventions. Methods: A systematic literature review was performed using PRISMA guidelines. Relevant studies published between 2014 and 2024 were identified from PubMed, Scopus, and Google Scholar. Eligible publications included original research or program evaluations conducted in Indonesia. From 423 records initially screened, 76 full texts were assessed, and 22 articles met the inclusion criteria. Extracted data included prevalence, associated risk factors, and management strategies. Results: The reviewed studies originated from multiple regions such as Java, Sulawesi, Papua, and Maluku. Study designs comprised cross-sectional surveys, case–control studies, cohort analyses, and program evaluations. Prevalence varied substantially, with Papua, Sulawesi, and Maluku reporting the highest burdens. Commonly reported risk factors were poverty, overcrowded housing, malnutrition, genetic predisposition, and persistent social stigma. Household exposure and treatment delay were additional contributors to transmission. Management strategies mainly emphasized multidrug therapy (MDT) adherence, disability prevention, and stigma reduction. Community education and early case detection programs were associated with improved outcomes. However, several barriers remain, including incomplete adherence, inadequate health worker training, and limited psychosocial support. Conclusion: Hansen’s disease in Indonesia remains endemic in several provinces and is shaped by interconnected socioeconomic and biological factors. While MDT has reduced transmission, substantial gaps exist in disability prevention and stigma management. Enhanced surveillance, improved early detection, and stronger integration of community-based and psychosocial strategies are urgently needed to support national and global elimination goals.
Background: Anthrax remains a persistent zoonotic disease in Indonesia, with recurrent outbreaks reported in endemic provinces such as Yogyakarta, Gorontalo, Central Java, and East Nusa Tenggara. Outbreak control is further challenged by the circulation of misinformation, which shapes community perceptions and undermines prevention efforts. Digital epidemiology offers opportunities to complement conventional surveillance by capturing public information-seeking behavior, yet its application in anthrax research in Indonesia remains limited. Methods: This study analyzed temporal and spatial dynamics of public interest in anthrax using Google Trends data from January 2014 to December 2024. Two search terms, antraks (Indonesian) and anthrax (English), were examined to assess monthly patterns, regional distribution, and related search queries. Descriptive analyses were performed to identify peaks of interest, geographic differences, and themes of related and rising queries. Results: Overall search activity was low and stable throughout the 11 years, with distinct peaks corresponding to outbreaks, most notably in July 2023 during the Yogyakarta outbreak. Regional analysis revealed Yogyakarta and Gorontalo as the dominant provinces of search activity. Linguistic patterns showed that antraks was more widely used in western Indonesia, while anthrax was relatively more frequent in eastern provinces. Related queries reflected demand for basic knowledge of symptoms, transmission, and prevention, while rising queries aligned with outbreak-related events. Conclusion: Online search patterns mirror epidemiological risk, cultural context, and digital access. Infodemiology provides timely insights that may enhance outbreak preparedness and risk communication. Integrating digital surveillance with conventional monitoring can support more effective and locally relevant health education strategies for anthrax control in Indonesia.
Background: Osteoarthritis (OA) is a degenerative disease of the joints that attacks the joint cartilage and is one of the types of arthritis disease commonly found in older people. Knee osteoarthritis is one of the most common types of arthritis. Some treatments that can be performed are non-pharmacological therapies: Low Level Laser Therapy (LLLT), Transcutaneous Electrical Nerve Stimulation (TENS) and Infra Red (IR). Their function are to reduce the severity of pain and therefore reducing disability in knee joint pain patients. Objective of the study: to compare the effectiveness of non-pharmacological treatment of LLLT and combination of TENS IR in patients with knee osteoarthritis at RSI A Yani Hospital Surabaya. Method and Result: A quantitative approach was applied using a twogroup post-test-only experimental design to analyze the influence of independent treatments on pain reduction. The study was conducted from February to August 2024. Participants were selected through purposive sampling based on predefined criteria. Data normality was assessed using the Kolmogorov-Smirnov test. Since the data were not normally distributed, the Mann-Whitney U test was used to determine statistical differences between the two treatment groups. The statistical analysis using the MannWhitney test yielded a p-value of 0.417 (p > 0.05), indicating no significant difference in pain reduction between the LLLT group and the TENS+IR group. Conclusion: The findings suggest that both LLLT and the combined use of TENS and IR are equally effective in managing knee pain in osteoarthritis patients. As neither treatment showed superior outcomes, both can be considered valid non-pharmacological options in OA pain management protocols. Further studies with larger sample sizes and longitudinal assessment are recommended to confirm and expand upon these findings.
Health insurance is one of the major pillars of achieving the Universal Health Coverage, as emphasized in the Sustainable Development Goals (SDGs). However, in Mozambique, although the national health system is confronted by several limitations, uptake of health insurance is not emphasized by stakeholders in the health sector. The study aims to analyze the determinants of health insurance subscription among women of reproductive age in Mozambique. The data were the 2022/23 data for the Demographic and Health Survey (DHS) which covered 9788 women in the 15-49 years age bracket. The data were analysed with Probit regression. The results showed a very low health insurance subscription (1.69%). Additionally, 31.50% of the women with higher education had health insurance. The Probit regression results showed that the probability of insurance subscription among the women was significantly promoted (p<0.05) by access to the internet, reading newspaper, perception of good, moderate and bad health status, ownership of bank account, working, and wealth index, while residence in some regions (Inhambane, Gaza, and Sofala), and religion affiliation (Evangelical/Pentecostal and no religion) reduced it. It was concluded that constraints exist in achieving UHC in Mozambique, there is a need to create media and internet-based advocacy to promote health insurance subscriptions with more focus on the rich, working class, urban dwellers, and educated women. For future research, a qualitative approach could be employed to explore sociocultural and psychological factors influencing women's decision to enroll in health insurance.
Background: Being overweight or obese is one of the factors that cause an increase in blood pressure. The bigger a person's body, the more blood is needed to supply nutrients and oxygen to other tissues and muscles. Bali Province, especially Gianyar Regency, has a relatively high number of hypertension sufferers. The highest estimate of hypertension sufferers is in the working area of the Sukawati I Public Health Center, with a prevalence of 8.55% of the total in Gianyar Regency of 17.35%. This research aims to determine the relationship between body mass index and blood pressure control in hypertensive patients at the Sukawati I Public Health Center, Gianyar Regency. Methods: The research design used was analytic observational with a crosssectional approach. The number of research subjects, namely 83 people, was taken by consecutive sampling technique. Data analysis will be carried out univariately and bivariate using the chi-square test method with a confidence level of 95% (p < 0.05). Results: The results of the univariate analysis showed that the majority of study subjects were aged 51-60 years (60.2%), were female (66.3%), most had normal BMI (66.3%), and 66.3% of subjects with hypertension were classified as have controlled blood control. Based on the results of statistical tests, a value of p = 0.003 (p < 0.05) was obtained, which indicated a significant relationship between body mass index and blood pressure control in hypertensive patients at the Sukawati I Public Health Center, Gianyar Regency. Conclusion: The results of this study indicate that the increasing BMI status of hypertensive patients will tend to have uncontrolled blood pressure.
With a high risk of sudden cardiac mortality, arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare inherited cardiomyopathy characterized by right ventricular dysfunction and ventricular arrhythmias (VA). In this case study, a 35-year-old presented with palpitations and revealed epsilon waves on the right precordial electrocardiogram (ECG) leads which led to the suspicion of ARVC. A 24-hour Holter monitoring revealed frequent ventricular extrasystoles (>500 per 24 hours), a CMRI revealed RV dyskinesia and transmural LGE in the apical RV, and an electrophysiologic study detected spontaneous polymorphic ventricular tachycardia (VT) despite the presence of induction ventricle fibrillation (VF). These results validated the diagnosis of ARVC and indicated that an implantable cardioverter defibrillator was necessary treatment. The ability to identify potential ARVC’s ECG abnormalities, the timing to pursue further studies, and determining necessary treatment execution are critical. The evaluation of cardiac, electrophysiological, and clinical imaging parameters is essential for the risk stratification, diagnosis, and management of patients with ARVC.
This case report details the anesthetic management of a 64-year-old male with dilated cardiomyopathy (DCM) and a significantly reduced ejection fraction, undergoing lower limb amputation for peripheral arterial disease. Managing anesthesia in such patients poses considerable challenges due to the complexities associated with congestive heart failure. The successful administration of general anesthesia in this case can be attributed to a rigorous preoperative assessment and a meticulously devised anesthetic plan. The systematic approach included careful monitoring, fluid management, and the use of specific anesthetic agents that minimize cardiovascular stress, thereby ensuring an uneventful anesthetic course. This report emphasizes the importance of strategic planning and expert execution in the anesthesia management of patients with severe cardiomyopathy undergoing major surgical procedures.
Background: Diabetes mellitus is most common associated with neurological complications, including depressive symptoms, so this study investigated whether mitragyna may provide benefits in reducing depressive symptoms in animal models of diabetes. This study aims to evaluate the effect of mitragyna as a potential antidepressant agent in animal models of diabetes mellitus using the Force Swimming Test (FST). Methods: In this study, diabetes mellitus rats were induced by administering streptozotocin and then divided into four groups: control group (Control), Group Diabetes (DM), Mitragyna treatment group (DM+EMS 15mg) and (DM+EMS 30mg). After the treatment period, the rats were then tested with the FST, which is used to measure immobility behavior which can be used as an indicator of depressive symptoms. Results: The results showed that the treatment group that received mitragyna showed shorter immobility times compared to the control group (P<0.01), indicating an increased active response in facing FST stressors. Conclusion: These results indicate that mitragyna has potential as an antidepressant agent in reducing depressive symptoms in rats models of diabetes mellitus.
Multiple myeloma (MM) is a hematological malignancy commonly associated with bone pain, hypercalcemia, and renal failure. However, its presentation can occasionally mimic other medical conditions, which may delay diagnosis. This case report describes a patient who was initially diagnosed and treated for heart failure but was later found to have MM, highlighting the importance of considering MM in the differential diagnosis of heart failure. A 56-year-old lady presented with recurrent episodes of shortness of breath, orthopnea, paroxysmal nocturnal dypsnea and bilateral lower limb swelling which she had been treated for decompensated heart failure with optimal therapy. She denied any family history of cardiovascular disease personal history of underlying medical condition and was a nonsmoker. This patient was diagnosed with multiple myeloma and probability of concomitant cardiac amyloidosis and commenced on bortezomib, thalidomide and dexamethasone (VTD) regime and standard optimal therapy of heart failure but her condition deteriorated. After a few days of starting chemotherapy, patient demised despite all the resuscitative effort. Multiple myeloma is common hematological malignancy with its distinct clinical features of “CRAB”, however, more attention and alertness should also be exercised by clinicians as to be able to diagnose it early.
