Medical Journal of Indonesia

Social responsibility of medical journal: a concern for COVID-19 pandemic

Agus Rizal Ardy Hariandy Hamid — 2020-03-26

[No abstract available]

Visit to Singapore Medical Journal during COVID-19 outbreak: learning “beyond” the expectation

Felix Firyanto Widjaja — 2020-03-26

[No abstract available]

Air pollution impacts on human health and policies to reduce air pollution

M. R. Karliansyah — 2020-03-26

[No abstract available]

Air pollution and human health

Agus Dwi Susanto — 2020-03-26

[No abstract available]

A systematic review of respiratory infection due to air pollution during natural disasters

Erlina Burhan — 2020-03-26

BACKGROUND Wildfire and volcano eruption occurred in Indonesia due to its geographical location, climate change, global warming, and human behavior. Various substances produced an increased risk of experiencing health problems, including respiratory infection. Evidence about the effect of pulmonary infection during natural disasters is still limited. This study was aimed to review and elaborate on previous studies to determine the effect of air pollution exposure during natural disasters and respiratory infection.

METHODS Literature searches were conducted on PubMed, EBSCOhost, and Google Scholar, and was limited to the 10 last years, human studies, and the English language. Inclusion criteria were articles with representation for clinical questions, review articles, population studies, and the full-text article was available. Exclusion criteria were articles that only discussed the exposure to and not the association with the effect of the respiratory infection. The Oxford Center for Evidence-Based Medicine tools appraised six relevant articles.

RESULTS Air pollution during a natural disaster enhances particulate matter to 10–70 μg/m³ and more than 5 times the aerosol optical depth measurement compared with the tolerated air concentration. The air level was consistently related to acute respiratory infection, pneumonia, bronchitis, and bronchiolitis admissions in wildfire smoke and volcanic eruption in this review. Nevertheless, there was a diverse result for upper respiratory infection cases.

CONCLUSIONS Natural disasters increased the level of ambient air pollution that exceeded the levels recommended by the World Health Organization air quality guideline. Air pollution may play an important role in respiratory tract infection, especially among population with high exposure.

A randomized controlled trial of high parenteral protein feeding in septic children: the role of tumor necrosis factor-alpha-308 polymorphism

Gema Nazri Yanni — 2020-03-26

BACKGROUND Septic children cause high protein degradation and inadequate nutritional intake would worsen the outcomes. In addition, there are conflicting results of association between tumor necrosis factor-α (TNFA)-308 polymorphism and poorer outcomes. This study was aimed to investigate the impact of high protein feeding in septic children and to examine the role of the TNFA-308 polymorphism in outcome of sepsis.

METHODS In this randomized controlled trial, septic children were randomly assigned to receive either high protein feeding (amino acid of 4 g/kg of body weight [kgBW]/day) or standard nutrient (amino acid of 2 g/kgBW/day) for three days in the pediatric intensive care unit of four hospitals in Indonesia. The patient’s enrollment was done between April 2016 and May 2017. The primary outcome was the pediatric logistic organ dysfunction (PELOD) score. TNFA-308 polymorphism was investigated using restriction fragment length polymorphism method in both groups. PELOD score was analyzed as mean differences and gene polymorphism was analyzed with mortality in a subgroup.

RESULTS There were 40 children in each group. PELOD score on day-1 (22.4 versus 20.5, p = 0.429), day-2 (20.5 versus 19.8, p = 0.815), and day-3 (18.8 versus 19.8, p = 0.772) were not lower in high protein feeding compared to standard feeding. TNFA-308 polymorphism had no role in mortality of both groups (high protein, p = 0.426; standard, p = 0.456).

CONCLUSIONS From this study, researchers concluded that a high protein intervention did not significantly decrease the PELOD score, length of stay, and duration of ventilator use in both groups.

Prognosis of advanced stage non-small-cell lung cancer patients receiving chemotherapy: adenocarcinoma versus squamous cell carcinoma

Noorwati Soetandyo — 2020-03-26

BACKGROUND In Indonesia, lung cancer is one of the most prevalent solid cancer with the highest mortality rate. However, studies to identify prognostic factors associated with mortality are lacking. Thus, this study was aimed to determine the association of histological subtypes and prognosis of advanced stage non-small-cell lung cancer (NSCLC) patients receiving chemotherapy.

METHODS This study focused on a retrospective cohort consisting of 60 patients with advanced stage NSCLC and treated with chemotherapy. Patients with NSCLC stage IIIB or stage IV, age ≥18 years, and good performance status were recruited. The outcomes were one-year mortality and treatment response. Gender, age, body mass index, staging, and performance status were evaluated. Chi-square and Fisher’s exact tests were used.

RESULTS Two common histological subtypes, adenocarcinoma (68.3%) and squamous cell carcinoma (31.7%), were observed among all subjects. Four patients (6.7%) died during one-year observation period. Mortality rate was higher in squamous cell carcinoma (10.5%) patients than in adenocarcinoma (4.9%). Underweight patients had higher risk of death (relative risk [RR] = 1.09, 95% confidence interval [CI] = 1.00–1.19) and disease progression (RR = 1.30, 95% CI = 1.12–1.51). In adenocarcinoma, metastasis was a risk for progressive disease (RR = 1.35, 95% CI = 1.09–1.66). In squamous cell carcinoma, men had a lower risk of disease progression (RR = 0.11, 95% CI = 0.03–0.41).

CONCLUSIONS Squamous cell carcinoma had comparable one-year mortality and disease progression rate with adenocarcinoma type in advanced stage NSCLC. However, underweight patients had a higher risk of mortality and disease progression.

Association between axillary lymph node involvement and clinicopathological features of breast cancer among Indonesian women

Dody Novrial — 2020-03-26

BACKGROUND Some clinicopathological features play roles in the spread of breast cancer to axillary lymph node (ALN). However, their roles as predictive factors are not well-established. This study was conducted to determine the correlation between the clinicopathological features of breast cancer and the risk of ALN involvement in Indonesian women.

METHODS This cross-sectional study was conducted in Margono Soekarjo Hospital using archival data from January 2017 to June 2018. All subjects with breast cancer who had undergone modified radical mastectomies without any evidence of distant metastasis were included. Chi-square and Fisher’s exact tests were performed to assess the relationship between ALN involvement and age, menopausal status, laterality, tumor size, tumor stage, histological type, tumor grade, lymphovascular space invasion (LVSI), skin or nipple infiltration, perineural invasion, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 status. The odds ratio of each variable was evaluated using ordinal regression analysis.

RESULTS Stage 3 breast cancer had the worst status of ALN involvement compared with stage 1 (OR = 3.49; 95% CI = 1.51–8.08) and stage 2 (OR = 3.04; 95% CI = 1.32–6.98). Likewise, positive LVSI also had the worst status of ALN involvement compared with negative LVSI (OR = 8.68; 95% CI = 4.23–17.81).

CONCLUSIONS Tumor stage and LVSI could be considered as independent predictive factors of ALN involvement in patients with breast cancer, especially among Indonesian women.

First trimester maternal upper arm circumference correlated to placental size and neonatal anthropometry

Noroyono Wibowo — 2020-03-26

BACKGROUND First maternal nutrition, represented by anthropometrics, is an important factor for fetal growth. This study aimed to determine the correlation between maternal nutritional status of first trimester pregnant women with placental size and neonatal anthropometry.

METHODS A retrospective cohort study (N = 134) was conducted in Jakarta and Riau during August–September 2017. Correlation between first trimester maternal nutritional status, placental size (placental weight and volume), and neonatal anthropometry (birth weight, birth length, head circumference, and abdominal circumference) were examined using Spearman correlation test.

RESULTS High maternal body mass index and upper arm circumference (UAC) are weakly correlated with high birth weight (r = 0.281, p<0.001 and r = 0.271, p<0.001), birth length (r = 0.176, p = 0.022 and r= 0.238, p = 0.002), head circumference (r = 0.251, p = 0.001 and r = 0.297, p<0.001), abdominal circumference (r = 0.227, p = 0.003 and r = 0.226, p = 0.003), placental weight (r = 0.198, p = 0.01 and r = 0.228, p<0.001), and placental volume (r = 0.194, p = 0.01 and r = 0.203, p = 0.008). In addition, high maternal height is also weakly correlated with high birth weight (r = 0.157, p = 0.043) and birth length (r = 0.158, p = 0.041).

CONCLUSIONS UAC can be reliably used to assess the nutritional status of pregnant women and to predict placental and newborn sizes.

Validation of the Indonesian version of the graded chronic pain scale 2.0 in pain-related temporomandibular disorders

Ira Tanti — 2020-03-26

BACKGROUND Pain associated with oral problems is one of the most frequent chronic pain of temporomandibular disorders (TMDs). This study was conducted to analyze the psychometric properties of the Indonesian version of the graded chronic pain scale 2.0 (GCPS-ID) in Indonesian patients with TMDs.

METHODS The English version of the GCPS version 2.0 was translated and back-translated according to international guidelines. This study conducted from June to December 2016 at the Dental Hospital, Faculty of Dentistry, Universitas Indonesia, and the participants were 202 TMDs patients who had never undergone temporomandibular joint surgery or suffered facial pain for more than 6 months. The evaluation of the GCPS-ID included the internal consistency test, test-retest reliability, and construct validity tests.

RESULTS The GCPS-ID had a high internal consistency (Cronbach’s alpha = 0.896). The intraclass correlation coefficient of the pain intensity and the disability score were 0.789 and 0.706, respectively. The convergent validity demonstrated a moderately positive correlation between the GCPS-ID and the Indonesian version of oral health impact profile for TMD for pain (r = 0.595; p<0.001) and disability (r = 0.488; p<0.001). The discriminant validity between GCPS-ID and the subjective patient’s quality of life revealed a weak positive correlation (r = 0.195; p = 0.191).

CONCLUSIONS GCPS-ID is a reliable and valid assessment tool for evaluating TMD pain in Indonesia.

Wilms’ tumor 1 protein expression in embryonal and alveolar rhabdomyosarcoma and its association with clinical prognostic factors: a cross-sectional study

Aina Angelina — 2020-03-26

BACKGROUND Embryonal rhabdomyosarcoma (ERMS) and alveolar rhabdomyosarcoma (ARMS) are the two major histological types commonly found in the pediatric population, which have different morphology and genetic profile. Wilms’ tumor 1 (WT1) is an antigen highly expressed in solid tumors, including rhabdomyosarcoma, and a potential immunotherapy target. Only a few studies have attempted to determine WT1 expression in rhabdomyosarcoma. This study was conducted to demonstrate WT1 expression in ERMS, ARMS and associate it with established prognostic factors.

METHODS A cross-sectional study was conducted at the Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta using archival data from January 2011 to December 2017. 30 from 102 ERMS cases and 16 from 28 ARMS cases were included in this study. Data of age, tumor size, and location were collected. All cases were stained by WT1 immunohistochemistry. The expression was assessed semiquantitatively using histoscore (H-score) formula. An independent t-test was used to compare WT1 expression between ERMS and ARMS. Correlation analysis was used to evaluate the relationship between WT1 expression and prognostic factors.

RESULTS All ERMS and ARMS cases expressed WT1 in diffuse, moderate to strong staining. ERMS show higher WT1 expression than ARMS (H-score 179.9 versus 149.5) (p = 0.014). Strong WT1 expression mostly found in patient age <20 years and non favourable location. Moderate WT1 expression mostly found in cases with tumor size >5 cm.

CONCLUSIONS WT1 expression was higher in ERMS cases than in ARMS cases, which the expressions were similar in different age, tumor size, and location groups.

Periodic acid-Schiff and alcian blue immunohistochemistry to detect mucin in mucinous breast carcinoma

Primariadewi Rustamadji — 2020-03-26

BACKGROUND Detection of mucins has been shown to correlate with several clinicopathological characteristics in patients. Currently, periodic acid-Schiff (PAS) and alcian blue staining methods are the histochemistry staining techniques that are frequently used to detect mucin. This study was aimed to evaluate PAS and alcian blue staining in differentiating mucin characteristics between invasive carcinoma of no special type (ICNST) with mucinous degeneration and mucinous carcinoma.

METHODS This cross-sectional study of 33 cases included biopsies of mucinous breast carcinoma and ICNST with mucin degeneration that were histologically verified using hematoxylin and eosin (H&E) staining. The PAS and alcian blue staining were conducted in the Laboratory of Histochemistry, Department of Anatomical Pathology, Cipto Mangunkusumo Hospital. Data were recorded using SPSS software, version 21 (IBM Corp, USA).

RESULTS There were 17 cases of ICNST with mucinous degeneration and 16 cases of mucinous carcinoma with age varied from 27 to 75 years. PAS had sensitivity of 87.5% and specificity of 41.2%. Alcian blue had sensitivity of 43.8% and specificity of 82.4%.

CONCLUSIONS PAS staining method is better than the alcian blue staining method in distinguishing between ICNST with mucinous degeneration and mucinous carcinoma. In the limited setting laboratory, PAS staining alone can be considered to detect mucin.

Health consequences of thick forest fire smoke to healthy residents in Riau, Indonesia: a cross-sectional study

Jamal Zaini — 2020-03-26

BACKGROUND Indonesia forest fire in 2015 emitted a huge amount of pollutants into the air. This study was aimed to assess the health consequences of forest fire smoke in healthy residents in Riau during forest fire disaster in 2015.

METHODS This cross-sectional study was performed in healthy residents who lived in Pekanbaru, Riau Province, Sumatera, for at least 6 months during forest fire disaster in 2015, and data were taken in October 2015. Questionnaires consisting of respiratory and non-respiratory symptoms were collected. Lung function was assessed by spirometry (MIR II Spirolab™ spirometer, Medical International Research, Italy) and exhaled carbon monoxide (CO) was assessed using piCO+ Smokerlyzer®. Heart rate at rest and oxygen saturation in the room air were measured using Onyx 9591 Pulse Oximeter®.

RESULTS A total of 89 subjects were mostly female (75.3%), housewife (37.7%), nonsmoker (86.5%) with mean age of 38.9 years old. The non-respiratory and respiratory symptoms were reported in 84.7% and 71.4% subjects, respectively. Lung function was impaired in 72.6% subjects, mostly with mild obstruction and mild restriction. Exhaled CO was highly detected over normal values (mean [standard deviation] = 32.6 [9.97] ppm) with predicted carboxyhemoglobin (COHb) of 5.74 (1.56).

CONCLUSIONS Forest fire smoke exposure increased the respiratory and nonrespiratory symptoms among healthy individuals, which showed impairment in lung function, exhaled CO, and predicted COHb. Long term health effects on healthy individuals exposed to forest fire smoke warrant further evaluation.

Risk factor for Mycobacterium leprae detection in household contacts with leprosy patients: a study in Papua, East Indonesia

Hana Krismawati — 2020-03-26

BACKGROUND In the era of leprosy eradication, Jayapura is still one of the biggest leprosy pockets in Papua, Indonesia. The trend for leprosy case detection rate has remained relatively stable over recent years. This study was aimed to detect Mycobacterium leprae in household contacts and to evaluate the associated factors with the detection.

METHODS This cross-sectional study recruited household contacts of leprosy patients who were diagnosed consecutively from March to August 2015 in Hamadi Point of Care, Jayapura. The leprosy patients were diagnosed using polymerase chain reaction (PCR). For each leprosy patient, up to four household contacts that had no symptom were included. Every household contact received screening through DNA detection of M. leprae extracted from nasal swab specimens and examined using PCR. Factors for bacteria detection included intensity, time duration and number of contacts living together in the same house, and random blood glucose levels were evaluated. Bivariate analysis was used to associate them with M. leprae detection in household contacts.

RESULTS From 107 household contacts of 35 patients who had leprosy, M. leprae was detected in 19.6%. Household contacts with leprosy patients for >1 year was a risk factor for detection (OR = 12.45; 95% CI = 1.595–97.20; p = 0.002). Blood glucose (p = 0.444), ethnic (p = 0.456), sleeping proximity to leprosy case (p = 0.468) and relatives (p = 0.518) give no effect to M. leprae detection in household contacts.

CONCLUSIONS Among the various risk factors studied, duration of living together with the patient significantly increased the risk of M. leprae transmission.

Eating behavior affects cardio-metabolic risk in high school teenagers in a developing country

Rita Suhadi — 2020-03-26

BACKGROUND Modernization negatively changes lifestyle, characterized by excessive eating and reduced energy consumption, and concurrently increases the cardiometabolic risk. This study was aimed to evaluate the association between eating behavior and cardio-metabolic risk factors including body mass index (BMI) in percentile, blood pressure (BP) in percentile, waist circumference, and heart rate in total subjects and gender sub-groups.

METHODS This analytical cross-sectional study was done from July to November 2018. High schools in four provinces of Indonesia and students were selected using purposive sampling. Subjects’ profiles were collected from interview and cardio-metabolic parameters were measured at the study sites. Data were analyzed with chi-square and independent t-test.

RESULTS Subjects who were overweight/obese and had high BP accounted for 27.1% and 9.3–12.0% of the total subjects (n = 768), respectively. Subjects who having breakfast tended to have lower BMI (p = 0.006), and the lower consumption of western meals had lower heart rate (p = 0.02). Male subjects had more meal frequency and had less quantity of snacks than female subjects (p<0.001). Male subjects with routine intake of vegetables had low heart rate (p = 0.03). Female subjects with routine breakfast had better BMI (p<0.001), and lower diastolic BP (p = 0.004) and waist circumference (p = 0.02), whereas those who consumed Western meals had higher heart rate (p = 0.046) and waist circumference (p = 0.001).

CONCLUSIONS Eating behaviors are likely to affect cardio-metabolic risk factors, and the effects vary within gender groups.

Epidemiology of erectile dysfunction in men with diabetes mellitus: a study in a primary health care center in Indonesia

Diana Kusmi Tridiantari — 2020-03-26

BACKGROUND Diabetes mellitus (DM) is one of the factors causing erectile dysfunction (ED) and may affect a person's quality of life. This study was aimed to describe the epidemiology of ED in men with DM in a primary health care.

METHODS The study used a cross-sectional study design conducted from January to March 2017 at the Tlogosari Kulon Health Center, Semarang. There were 122 diabetic men who were all included in the study. The data were collected using interviewerassisted questionnaires. The status of ED was measured by the erectile dysfunction intensity scale adapted to the International Index of Erectile Function.

RESULTS The results showed that the prevalence of diabetic men with ED was 84.4%. Most men with ED had age of ≥46 years (91.0%), experienced work stress (88.5%), had low physical activity (93.1%), had obesity (88.0%) of which 86.3% had central obesity, smoking (84.6%), had DM >5 years (91.2%), and took antihypertensive drugs (90.0%). The fasting blood glucose level of respondents ≥126 mg/dl was 86.0%, and 91.7% had sexual desire disorder. The duration of DM and aging are contributing factors of ED in males with DM, with a p-value of 0.016 and 0.013, respectively.

CONCLUSIONS The prevalence of ED in primary health care is still high, and the determining factors were the duration of DM and aging. Public health centers are advised to undertake health promotion on the prevention of factors that can lead to sexual dysfunction in males with DM.

Streptococcus suis meningitis related to processing and consuming raw pork during Balinese tradition, Mebat

IGM Ardika Aryasa — 2020-03-26

Streptococcus suis is a zoonotic pathogen that can infect humans, especially meningitis. S. suis meningitis has been commonly diagnosed in Bali, which is associated with the consumption of raw pork. We reported case of S. suis meningitis that could have occurred due to the ingestion of undercooked pork during a traditional ceremony, which also involved two more patients with similar symptoms. A 62-year-old male was brought to the emergency unit because of decreased consciousness (Glasgow coma scale 14/15) in the last 8 hours before admission. He also had a headache, high fever, and stiff neck. Examination of cerebrospinal fluid revealed the presence of S. suis infection and was confirmed by polymerase chain reaction. The patient was administered ceftriaxone and showed a clinical improvement on the third day without any hearing problem.

Multifocal recurrence of medulloblastoma: a long follow-up case study

Benny Zulkarnaien — 2020-03-26

Medulloblastoma is the most common malignant brain tumor in pediatric patients. Leptomeningeal dissemination often occurs in the spinal canal and rarely into the supratentorial as an extra-axial lesion. This study followed an 8-year progression of multifocal medulloblastoma recurrence as supratentorial metastasis that mimics an intra-axial mass of the temporal lobe. Pathologic examination of the temporal mass showed densely packed small round blue cells that are distributed in a ribboning pattern with areas of necrosis, rosette formation, and mitosis. Ki-67 immunohistochemical staining of the tumor showed a high proliferation index of 40% and revealed positive results for synaptophysin and negative results for glial fibrillary acidic protein and β-catenin. A long follow-up is essential to diagnose the recurrence and elucidate the progression of medulloblastoma.

Genes predisposing to type 1 diabetes mellitus and pathophysiology: a narrative review

Tajudeen Yahaya — 2020-03-26

The possibility of targeting the causal genes along with the mechanisms of pathogenically complex diseases has led to numerous studies on the genetic etiology of some diseases. In particular, studies have added more genes to the list of type 1 diabetes mellitus (T1DM) suspect genes, necessitating an update for the interest of all stakeholders. Therefore this review articulates T1DM suspect genes and their pathophysiology. Notable electronic databases, including Medline, Scopus, PubMed, and Google-Scholar were searched for relevant information. The search identified over 73 genes suspected in the pathogenesis of T1DM, with human leukocyte antigen, insulin gene, and cytotoxic T lymphocyte-associated antigen 4 accounting for most of the cases. Mutations in these genes, along with environmental factors, may produce a defective immune response in the pancreas, resulting in β-cell autoimmunity, insulin deficiency, and hyperglycemia. The mechanisms leading to these cellular reactions are gene-specific and, if targeted in diabetic individuals, may lead to improved treatment. Medical practitioners are advised to formulate treatment procedures that target these genes in patients with T1DM.

Consumption of growing up milk and stunting among Indonesian toddlers

Irma Hidayana — 2020-03-26

[No abstract available]

Consumption of growing up milk and stunting among Indonesian toddlers: authors’ reply

Damayanti Rusli Sjarif — 2020-03-26

[No abstract available]

Front & Back Matter

Medical Journal of Indonesia — 2020-03-26