Medical Journal of Indonesia

Research ethics in COVID-19 pandemic

Rianto Setiabudy — 2020-04-20

[No abstract available]

Hajj health istithaah amid the COVID-19 pandemic

Muchtaruddin Mansyur — 2020-06-30

[No abstract available]

Hajj health management in Indonesia

Eka Jusup Singka — 2020-06-30

[No abstract available]

Optimization of the apolipoprotein B mRNA editing enzyme catalytic polypeptidelike-3G (APOBEC3G) gene to enhance its expression in Escherichia coli

Rizkyana Avissa — 2020-06-30

BACKGROUND Apolipoprotein B mRNA editing enzyme catalytic polypeptide-like-3G (APOBEC3G) can abolish HIV infection by inducing lethal mutations in the HIV genome. The HIV protein virion infectivity factor (Vif) can interact with APOBEC3G protein and cause its degradation. Development of a method that can screen substances inhibiting the APOBEC3G-Vif interaction is necessary for identification of substances that potentially used in anti-HIV drug development. In order to increase expression of recombinant APOBEC3G protein that will be used in APOBEC3G-Vif interaction assay, we developed an optimized APOBEC3G gene for expression in Escherichia coli.

METHODS The gene coding APOBEC3G was codon-optimized in accordance with prokaryotic codon using DNA 2.0 software to avoid bias codons that could inhibit its expression. The APOBEC3G gene was synthesized and sub-cloned into pQE80L plasmid vector. pQE80L containing APOBEC3G was screened by polymerase chain reaction, enzyme restriction, and sequencing to verify its DNA sequence. The recombinant APOBEC3G was expressed in E. coli under isopropyl-β-D-thiogalactoside (IPTG) induction and purified by using nickel-nitrilotriacetic acid (Ni-NTA) resin.

RESULTS The synthetic gene coding APOBEC3G was successfully cloned into the pQE80L vector and could be expressed abundantly in E. coli BL21 in the presence of IPTG.

CONCLUSIONS Recombinant APOBEC3G is robustly expressed in E. coli BL21, and the APOBEC3G protein could be purified by using Ni-NTA. The molecular weight of the recombinant APOBEC3G produced is smaller than the expected value. However, the protein is predicted to be able to interact with Vif because this interaction is determined by a specific domain located on the N-terminal of APOBEC3G.

Zika, chikungunya, and dengue viral infections in human peripheral blood mononuclear cells: cell susceptibility and gene expression

Ahmad Husein Alkaff — 2020-06-30

BACKGROUND Infections of Zika (ZIKV), dengue (DENV), and chikungunya viruses (CHIKV) are presented with similar clinical symptoms; these often lead to misdiagnosis. Viremia levels and host immune responses may contribute to disease severity. This study was aimed to characterize the ability of ZIKV, CHIKV, and DENV to infect human peripheral blood mononuclear cells (PBMCs) and assess the expression of tumor necrosis factor (TNF)-α, interleukin (IL)-10, and interferon gamma-induced protein (IP)- 10 genes in response to the viral infections.

METHODS PBMCs were isolated from healthy donors using gradient centrifugation. Cells were infected with Indonesian isolates of ZIKV, CHIKV, and DENV for 48 hours. Plaque assays were performed to measure viable virus titers, while viral genomic RNA and the gene expression of TNF-α, IL-10, and IP-10 were determined using real-time quantitative reverse transcription-polymerase chain reaction.

RESULTS The susceptibility of PBMCs to ZIKV, CHIKV, and DENV infection was observed, and the viable virus titer and viral genome quantity were found to be significantly higher in ZIKV and CHIKV. All viruses induced the expression of immune-related proteins. The TNF-α gene was upregulated by all viruses to relatively similar levels. IL-10 expression was highest in response to ZIKV, followed by CHIKV. In contrast, IP-10 expression was highly upregulated in DENV-infected cells and only moderately expressed in ZIKV- and CHIKV-infected cells.

CONCLUSIONS ZIKV, CHIKV, and DENV clinical isolates infected PBMCs with different levels of virus infectivity. The gene expression of IL-10 was highly upregulated in ZIKV infection and IP-10 in DENV infection.

Cytotoxic effect of natural cuttlefish bone xenograft: an in vitro and in vivo study

Komang Agung Irianto — 2020-06-30

BACKGROUND Commercialized synthetic bone grafts are commonly used to replace the bone defect. Cuttlefish bone is naturally available and widely studied, but the specific cytotoxicity test has not been conducted. This study aimed to evaluate the cytotoxicity of the xenograft compared to commercial grafts.

METHODS We performed an in vitro test evaluating the viability of human mesenchymal stem cells (hMSCs) when cultured for 48 hours with the tested materials (cuttlefish bone graft and fabricated PerOssal®). The trypsinized mitochondrial activity of the viable hMSC was assayed based on colorimetry of the formazan color change. The tested material was considered nontoxic if >70% of the hMSCs were viable. The in vivo cytotoxic effect was evaluated by implanting the graft material in the femoral muscle of New Zealand (NZ) white rabbits. Nine rabbits were used in each test (cuttlefish bone, PerOssal®, and NaCl 0.9%). The systemic acute pyrogenic effect was evaluated based on 72 hours body weight changes and rectal temperature changes every 30 min in the first 3 hours and 72 hours post-implantation.

RESULTS The mean percentage of hMSC viability when cultured with cuttlefish bone graft and PerOssal® was comparable (93.47% and 105.37%, respectively, p = 0.240). The in vivo cytotoxicity on NZ rabbit was similar between all tested materials, as shown by the minor changes in body weight (<10% body weight, p = 0.391) and rectal temperature (<0.5°C, p = 0.127).

CONCLUSIONS Cuttlefish bone xenograft and fabricated PerOssal® have a similar non-cytotoxic effects on hMSCs and non-pyrogenic systemic effects on rabbits.

Causes of mortality in a neonatal intensive care unit in Iran: one year data

Milad Azami — 2020-06-30

BACKGROUND Neonatal mortality rate is a major health index. Approximately, 65% of all deaths in the first year of life occur during this 4-week period. The present study was conducted to investigate the mortality rates and causes of death in a neonatal intensive care unit (NICU) in Ahvaz, Iran in a year.

METHODS This cross-sectional study was conducted in the NICU of Sina Hospital in Ahvaz. Medical records were studied, and data from 1,040 newborns admitted to the NICU within one year (March 2016 to March 2017) were collected following a checklist. Of these newborns, 123 died, and their relevant data were collected. Data were analyzed using SPSS, version 20 (SPSS Inc., USA).

RESULTS The mortality rate was 11.82% (123 cases) out of 1,040 newborns admitted to NICU. Most of the newborns (48.8%) died on days 1–7. The causes of death were respiratory distress syndrome (RDS) (34.1%), asphyxia (25.2%), anomalies (10.6%), sepsis (7.3%), intracerebral hemorrhage (8.1%), pulmonary hemorrhage (7.3%), and other causes (6.4%), such as hydrops, severe pneumothorax, severe renal failure, and others.

CONCLUSIONS The mortality rate in the NICU of this center was similar to that in other Iranian provinces. The most common causes of NICU mortality included prematurity and its complications, such as asphyxia and RDS. Thus, a strategic plan for reducing preterm delivery and asphyxia are necessary.

Vitamin D₃ levels in the maternal serum, cord blood, and placenta of preeclamptic pregnant women

Noroyono Wibowo — 2020-06-30

BACKGROUND Preeclampsia is affected by oxidative stress, a free-radical produced as a by-product of endothelial damage, and antioxidant imbalance, such as vitamin D₃. This study was aimed to compare the vitamin D₃ levels in the placenta, cord blood, and maternal serum between patients with and without preeclampsia.

METHODS This cross-sectional study included 86 patients from Cipto Mangunkusumo Hospital and Tangerang District Hospital, in which 47 had preeclampsia (13 early-onset and 16 late-onset preeclampsia cases) and 39 had no preeclampsia. The placenta, cord blood, and maternal serum were taken after labor, then were analyzed according to preeclampsia and non-preeclampsia; furthermore, the preeclampsia group was analyzed in a subgroup of early- and late-onset preeclampsia. This is analyzed with either unpaired t-test, Mann–Whitney U test, or Kruskal–Wallis test.

RESULTS The maternal serum, cord blood, and placental tissue vitamin D₃ levels (16.30 [6.20–49.00], 11.80 [3.50–38.60], and 49.00 [22.00–411.00] ng/ml, respectively) of the preeclampsia group were similar to those of the non-preeclampsia group (13.50 [4.80– 29.20], 11.70 [1.00–28.80], and 43.40 [11.80–153.00] ng/ml, respectively) (p = 0.459, 0.964, and 0.354, respectively). However, the placental tissue vitamin D₃ levels in early-onset preeclampsia (79.00 [36.00–411.00] ng/ml) were higher than those in late-onset preeclampsia (40.00 [22.00–171.00] ng/ml) (p = 0.006).

CONCLUSIONS The vitamin D₃ levels between patients with and without preeclampsia were similar. However, the placental tissue vitamin D₃ levels in early-onset preeclampsia were higher than those in late-onset preeclampsia, possibly because of the different pathophysiology between early- and late-onset preeclampsia.

Factors associated with outcome of acute encephalitis in children: a retrospective study of three referral hospitals

Lucyana Alim Santoso — 2020-07-01

BACKGROUND Encephalitis is more frequent in children and has a poor outcome. There was no data on encephalitis in children in Indonesia, so this study was aimed to evaluate clinical presentation and diagnostic examination of children with acute encephalitis, and factors related to outcome.

METHODS This was a retrospective study of medical records between 2014 and 2018 in three referral hospitals in Jakarta and Tangerang. Clinical presentation at admission, cerebrospinal fluid analysis, neuroimaging, and electroencephalography (EEG) were documented. Outcome was determined at hospital discharge and classified as poor for severe neurological abnormalities at discharge or died. Logistic regression was used to evaluate associated factors with the outcome.

RESULTS A total of 190 children were included and most were age >1 year (71%). Most subjects presented with fever (90%) and seizures (87%). Of those who had seizures, 80% experienced generalized seizures. Focal neurological deficit was seen in 90 patients (47%). EEG was positive in 90% subjects (n = 27/30). Probable cases were found in 51% of all subjects. The mortality was 23%. Focal seizures (odds ratio [OR] = 3.305, 95% confidence interval [CI] = 1.122–9.742) and age >1 year (OR = 3.076, 95% CI = 1.388–6.803) were risk factors for a poor outcome.

CONCLUSIONS Acute encephalitis occurred most often in children aged >1 year. Fever and seizures were the most common symptoms. EEG was better than other examinations for confirming diagnosis of encephalitis. Focal seizures and age >1 year were associated with a three-fold increased risk for a poor outcome.

Milk protein consumption improves muscle performance and total antioxidant status in young soccer athletes: a randomized controlled trial

Muhammad Irwan Setiawan — 2020-07-01

BACKGROUND Muscle performance and antioxidant balance are closely related to an athlete achievement. Milk proteins (whey and casein) contain essential and non-essential amino acids, which benefit muscle performance through increased antioxidant levels. This study was aimed to evaluate the effects of milk protein on muscle performance and total antioxidant status (TAS) in soccer athletes.

METHODS A randomized controlled trial was conducted on 20 males 16- to 18-year-old athletes at the Central Java Soccer Club in January 2018. For 28 days, the treatment group received 24 g/d of milk protein and the control group received 24 g/d of maltodextrin. Muscle performance was measured through a 20-m sprint, shuttle run, Illinois run, standing broad jump, sit-ups, push-ups, sit-and-reach test, and one-repetition maximum (1RM) leg extension. TAS was analyzed using the 2,2-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) method.

RESULTS The treatment group had a decreased shuttle run time (-0.16 [0.11] versus 0.08 [0.14] sec), greater increase in sit-ups (6.80 [2.57] versus 1.10 [2.84] times/60 sec), greater increase in push-ups (2.40 [1.78] versus 0.30 [1.77] times/60 sec), and greater increase in 1RM leg extension (32.00 [13.78] versus 3.50 [13.75] kg). After adjustments for age, energy intake, carbohydrates, and pre-interventional performance, these parameters remained significantly improved after the intervention of milk protein. The TAS increase was greater in the treatment group than in the control group (0.36 [0.32] versus -0.12 [0.20] mmol/l) before and after adjustment for age, vitamin C, iron, selenium intake, and TAS pre-treatment.

CONCLUSIONS Milk protein supplementation for 28 days increased muscle performance and TAS.

Neutrophil-to-lymphocyte ratio for predictor of in-hospital mortality in ST-segment elevation myocardial infarction: a meta-analysis

Rodry Mikhael — 2020-07-01

BACKGROUND ST-segment elevation myocardial infarction (STEMI) is the most life-threatening condition of acute coronary syndrome that carries a poor prognosis of in-hospital mortality. Multiple scoring systems have been developed to predict in-hospital mortality and other cardiovascular events. Neutrophil-to-lymphocyte ratio (NLR) is hardly used as a predictor of in-hospital mortality. This study was aimed to determine the predictive value of NLR concerning in-hospital mortality in STEMI patients.

METHODS Literature search and pooled analysis related to studies on MEDLINE/PubMed, EBSCO, Science Direct, Cochrane, and ProQuest were retrieved. Inclusion criteria were met if they were cohort studies, the subjects were STEMI patient, contained pretreatment NLR cut-off, and considered in-hospital mortality, which is defined as cardiac or all-cause mortality. Quality assessment was conducted using Newcastle-Ottawa scale. Review Manager version 5.3 (The Nordic Cochrane Centre, Copenhagen) was used for meta-analysis.

RESULTS We found 12 studies with a total of 7,251 STEMI subjects with median NLR cut-off value of 5.6. Elevated NLR on admission carries a high risk of in-hospital mortality (odds ratio [OR] = 3.00, 95% confidence interval [CI] = 2.46–3.67). A slightly higher risk of all-cause mortality (OR = 2.74, 95% CI = 1.99–3.77) was observed compared with cardiac-related mortality (OR = 3.20, 95% CI = 2.47–4.14). No significant heterogeneity was observed between these studies (p = 0.46, I² = 0%).

CONCLUSIONS Elevated NLR predicts a higher in-hospital mortality rate of STEMI patients.

MLH1 and MSH2 mismatch repair protein profile using immunohistochemistry in Nepalese colorectal cancer patients

Matrika Bhattarai — 2020-07-01

BACKGROUND Hereditary nonpolyposis colorectal cancer, or Lynch syndrome, caused by germline mutations or genetic defects in mismatch repair (MMR) genes (MLH1, MSH2, PMS2, MSH6, and epithelial cellular adhesion molecule), is an autosomal dominant condition accounting for 2–5% of all colorectal carcinomas (CRCs). Reports on MMR loss in many populations are available; however, there are no reports on the frequency of MMR protein expression in Nepalese cohorts. Therefore, this study was aimed to assess the expression profiles of MLH1 and MSH2 protein by immunohistochemistry (IHC) in Nepalese CRC patients.

METHODS This retrospective study used archived formalin-fixed paraffin-embedded tissue blocks from 43 Nepalese CRC patients. IHC staining was performed using MLH1 and MSH2 antibodies. IHC scoring analysis was assessed using semiquantitative scoring.

RESULTS Of the 43 CRC patients, 8 (18.6%) showed loss of staining for MLH1 antibody, 5 (11.6%) showed loss of staining for MSH2 antibody, and 4 (9.3%) showed loss of staining for both MLH1 and MSH2 antibodies.

CONCLUSIONS IHC is a potential screening method of determining the MMR expression profile of Nepalese CRC patients. IHC can be performed in local clinical laboratories to find MMR protein defects in selected cases prior to expensive molecular tests.

Risk factors for asthma exacerbation among Hajj pilgrims: a case study from DKI Jakarta, Indonesia

Anshari Saifuddin — 2020-07-01

BACKGROUND Hajj pilgrims are prone to asthma exacerbation because of the high transmission rate of respiratory infections, severe environmental factors, and high-intensity activities during the Hajj. Well-controlled asthma status and preventive efforts prior to the Hajj could reduce such exacerbations. This research aimed to determine the risk factors of asthma exacerbation during the Hajj to help establish preventive measures.

METHODS Participants were evaluated at community health centers (puskesmas) through history taking, physical examination, and spirometry. The risk factors examined included a history of exacerbation one year before the Hajj, obesity, comorbidities (e.g., diabetes mellitus, hypertension, coronary heart disease), lung function, smoking, fitness level, and influenza vaccination. Asthma exacerbation while in Saudi Arabia was determined through direct observations by authors and physicians assigned to Hajj pilgrim groups and analysis of data obtained from questionnaires distributed to the pilgrims before their departure. Odds ratios (OR) were calculated using logistic regression.

RESULTS Among 68 pilgrims with asthma, exacerbation occurred in 27 (40%) pilgrims. Risk of asthma exacerbation was significantly increased in the pilgrims with a history of exacerbation one year before the Hajj (OR = 4.27; 95% confidence interval [CI] = 1.156–15.829; p = 0.029) and obesity grade II (OR = 4.02; 95% CI = 1.151–14.097; p = 0.029). Other factors, including smoking, comorbidities, lung function, fitness level, obesity grade I, and influenza vaccination, were not significantly related to exacerbation.

CONCLUSIONS Obesity grade II and history of asthma exacerbation one year before the Hajj are strong factors for asthma exacerbation during Hajj pilgrims.

The implementation of health istithaah to the pilgrims with tuberculosis: a cross-sectional study in Jakarta, Indonesia

Ibnu Mas'ud — 2020-07-01

BACKGROUND Based on the regulation of the Indonesian Ministry of Health No. 15 of 2016 about health istithaah for the Hajj, patients with tuberculosis (TB) can be categorized into ineligible or temporarily ineligible pilgrims. This study aimed to know the characteristics of pilgrims with TB and determined their level of fitness for fulfilling the health istithaah.

METHODS A cross-sectional study of pilgrims from Jakarta who were receiving TB treatment during the Hajj in 2018 was conducted with consecutive sampling. The secondary data was collected from the Hajj Integrated Computer Health System 2018, TB registered form, and six-minute walk test (the fitness level data) conducted by the District Hajj Health Team at district health centers in DKI Jakarta and Pondok Gede before the Hajj embarkation in June–July 2018. The questionnaire to the Indonesian Hajj Health Team during pilgrimage was also included as additional data.

RESULTS Thirty-one pilgrims received TB treatment and completed the intensive phase of TB treatment, but 29 pilgrims had no symptoms. Among them, 2 patients had MDR-TB. Most of them were male aged ≥40 years old. Twelve pilgrims with TB have a sufficient fitness. All pilgrims were able to run the pillars of the Hajj.

CONCLUSIONS Pilgrims with TB, including MDR-TB, who had completed the intensive phase with a negative sputum smear test were declared eligible for the Hajj with assistance.

Improving a long-acting reversible contraception usage by understanding client perspectives

Weni Kusumaningrum — 2020-07-01

BACKGROUND Despite the limited use of long-acting reversible contraception (LARC) in Indonesia, they have proven to be cost-effective in family planning programs. This study was aimed to identify the elements of ideas and views that people hold and their association with the use of LARC (intrauterine devices and implants) as a means of improving its utilization in Nusa Tenggara Barat (NTB) Province, Indonesia.

METHODS Data were derived from the Improving Contraceptive Mix Methods survey of 6,384 respondents in Bima District, Central Lombok, and North Lombok, NTB Province, in 2015. Confirmatory factor analysis was used to identify suitable elements of 19 variables and generate three ideation elements on attitude, knowledge, and interpersonal communication. Subsequently, the association of three ideation elements with LARC use in NTB was examined.

RESULTS Multivariate analysis revealed that LARC use was higher among women with a positive attitude toward LARC and high frequency of interpersonal communication. Women with positive attitudes had 7 times greater odds of using LARC than women with negative attitudes (adjusted odds ratio [aOR] = 7.18; 95% confidence interval [CI] = 6.09–8.55). Women with a high frequency of interpersonal communication were 2.4 times more likely to use LARC than women with low communication frequency (aOR = 2.40; 95% CI = 1.94–2.99).

CONCLUSIONS To increase the use of LARC in NTB, family planning programs should not only focus on improving women’s knowledge but also prioritizing the promotion of positive attitudes toward LARC and facilitating interpersonal communication.

Insights into the association between smoking and obesity: the 2014 Indonesian Family Life Survey

Yusuf Syaeful Nawawi — 2020-07-01

BACKGROUND Various findings on the relationship between smoking and obesity have been demonstrated. This study aimed to investigate the association between smoking behavior and obesity in the Indonesian adult population.

METHODS A cross-sectional analysis was conducted using data from the 2014 Indonesian Family Life Survey. A body mass index of ≥25 kg/m² was employed to define obesity. Smoking behavior was assessed in terms of smoking status and its attributes. The potential confounders of gender, age, education, residential environment, economic status, physical activity, and education level were adjusted using logistic regression.

RESULTS Study subjects were 28,949 adults aged ≥20 years. Current smoking was a protective factor of obesity (adjusted odds ratio [aOR] = 0.53; 95% confidence interval [CI] = 0.48–0.58), whereas previous smoking habit showed no association with obesity (aOR = 0.96; 95% CI = 0.84–1.09). The risk of current smokers having obesity was lower than that of nonsmokers as smoking duration increased (aOR = 0.46–0.63). By contrast, the risk of obesity was relatively higher among former smokers than current smokers as the duration of quitting increased (aOR = 1.46–2.20). Heavy smokers had a higher risk of obesity than light smokers among former (aOR = 1.85; 95% CI = 1.27– 2.67) and current smokers (aOR = 1.38; 95% CI = 1.23–1.65).

CONCLUSIONS Overall, smoking negatively affected obesity among the Indonesian adult population. By contrast, quitting smoking was associated with an increased risk of obesity. Thus, weight management along with smoking cessation intervention should be prescribed.

A case series of eight scoliosis patients undergone pedicle screw placement with freehand technique: study for safety and accuracy

Komang Agung Irianto — 2020-07-01

BACKGROUND Pedicle screws and rods are routinely inserted in the vertebrae thoracic to lumbar in scoliosis reconstruction surgery to gain deformity correction and fusion. Intraoperative imaging is often needed to ensure accuracy, but surgical time will be longer and there will be more radiation exposure. Meanwhile, freehand technique is accepted as safe. This study was aimed to evaluate the accuracy of screw insertion in the freehand technique used in adolescent scoliosis surgery.

METHODS This case series evaluated a total of 127 pedicle screws inserted using the freehand technique in 8 out of 28 adolescent scoliosis patients from 2011 to 2016 whom agreed for computed tomography (CT) scan follow-up from 2011 to 2016 in Dr. Seotomo Hospital, Surabaya. The accuracy and safety of the freehand technique were evaluated postoperatively in each patient using a CT scan. A successful screw was considered accurate if it was within the vertebral body and inside the safety zone within the limit of 2–4 mm to the medial or lateral side of the vertebral body.

RESULTS Of the 127 screws inserted, 106 (83.5%) were accurately placed, and 110 (86.6%) were within the safe zone. According to the level of the spine, in the upper and middle thoracic spine, the inserted screws were accurate in 69.4% and 74.9% within the safety zone, whereas in the lower thoracic and lumbar spine, 94.0% and 95.0% within the safety zone.

CONCLUSIONS The freehand technique in scoliosis reconstructive surgery performed by experienced surgeons is accurate and safe.

Percutaneous atrial septal defect closure using transesophageal echocardiography without fluoroscopy in a pregnant woman: a case report

Radityo Prakoso — 2020-06-30

Transcatheter closure is the treatment of choice for atrial septal defect (ASD); it has good efficacy and minimal complications. However, this approach in a pregnant woman is limited due to the risk of radiation exposure. A novel fluoroscopy-free technique has been introduced to reduce x-ray exposure. This case reported the experience of an ASD transcatheter closure in a pregnant woman without fluoroscopy guidance. To the best of our knowledge, this is the first successful fluoroscopy-free technique for transcatheter closure in Indonesia. The case is a 26-year-old primigravida at 26 weeks’ gestational age with secundum ASD and pulmonary hypertension. Transcatheter closure was successfully performed with a Cera ASD occluder (Lifetech Scientific Corporation) no. 28 mm guided by transesophageal echocardiography. During the procedure, transient supraventricular tachycardia was developed. There were no other major or minor periprocedural complications. ASD transcatheter closure in a pregnant woman without fluoroscopy is feasible, safe, and effective.

Cybersex addiction: an overview of the development and treatment of a newly emerging disorder

I Gusti Ngurah Agastya — 2020-06-30

Cybersex addiction is a non-substance related addiction that involves online sexual activity on the internet. Nowadays, various kinds of things related to sex or pornography are easily accessible through internet media. In Indonesia, sexuality is usually assumed taboo but most young people have been exposed to pornography. It can lead to an addiction with many negative effects on users, such as relationships, money, and psychiatric problems like major depression and anxiety disorders. A few instruments may be used to detect cybersex behavior. This review was aimed to provide a comprehensive discussion about cybersex addiction in Indonesian society and the importance of its screening for this condition to enable its early detection and subsequent management.

Erratum: The use of high-resolution melting techniques for mutation screening of diseases caused by trinucleotide repeats expansion, with emphasis on the AR gene

Achmad Zulfa Juniarto — 2020-07-02

[This corrects the article DOI: 10.13181/mji.v28i2.3008]

Front & Back Matter

Medical Journal of Indonesia — 2020-07-02