Medical Journal of Indonesia

The importance of registry for systematic review and clinical trial

Vivian Soetikno — 2021-06-30

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Analysis of SARS-CoV-2 nucleocapsid protein sequence variations in ASEAN countries

Mochammad Rajasa Mukti Negara — 2021-06-18

BACKGROUND Nucleocapsid (N) protein is one of four structural proteins of SARS-CoV-2 which is known to be more conserved than spike protein and is highly immunogenic. This study aimed to analyze the variation of the SARS-CoV-2 N protein sequences in ASEAN countries, including Indonesia.

METHODS Complete sequences of SARS-CoV-2 N protein from each ASEAN country were obtained from Global Initiative on Sharing All Influenza Data (GISAID), while the reference sequence was obtained from GenBank. All sequences collected from December 2019 to March 2021 were grouped to the clade according to GISAID, and two representative isolates were chosen from each clade for the analysis. The sequences were aligned by MUSCLE, and phylogenetic trees were built using MEGA-X software based on the nucleotide and translated AA sequences.

RESULTS 98 isolates of complete N protein genes from ASEAN countries were analyzed. The nucleotides of all isolates were 97.5% conserved. Of 31 nucleotide changes, 22 led to amino acid (AA) substitutions; thus, the AA sequences were 94.5% conserved. The phylogenetic tree of nucleotide and AA sequences shows similar branches. Nucleotide variations in clade O (C28311T); clade GR (28881–28883 GGG>AAC); and clade GRY (28881–28883 GGG>AAC and C28977T) lead to specific branches corresponding to the clade within both trees.

CONCLUSIONS The N protein sequences of SARS-CoV-2 across ASEAN countries are highly conserved. Most isolates were closely related to the reference sequence originating from China, except the isolates representing clade O, GR, and GRY which formed specific branches in the phylogenetic tree.

A systematic review of intracavernosal injection of mesenchymal stem cells for diabetic erectile dysfunction

Gampo Alam Irdam — 2021-05-19

BACKGROUND As current erectile dysfunction (ED) treatments are limited, other treatment such as stem cells should be explored. Hence, this study aimed to review the sources, method of administration, and therapeutic effect of mesenchymal stem cells (MSCs) for diabetic ED treatment.

METHODS All relevant articles regarding the use of MSCs for diabetic ED were searched in PubMed and Google Scholar databases from December 15, 2019 to January 1, 2020 published in the past 10 years. The keywords were “mesenchymal stem cells” and “diabetic ED”. The selection and critical appraisal of the studies were discussed. Diabetic ED was evaluated for functional and structural outcome. Functional outcome in animal studies was assessed by intracavernosal pressure/mean arterial pressure (ICP/MAP) ratio, meanwhile the structural outcome was done microscopically. In human study, the assessments were done using international index of erectile function score (IIEF-5) to erection hardness score and penile Doppler ultrasonography.

RESULTS There were 10 animal studies and 3 human studies. The studies used MSCs from adipose (n = 6), bone marrow (n = 4), placenta (n = 1), umbilical cord (n = 1), and muscle tissue (n = 1). The MSCs were administrated through intracavernosal injection in all studies. In all animal studies, functional outcome was improved, shown in higher ICP/MAP ratio. Microscopically, there were an increase of cavernosal endothelial cells, vascular endothelial growth factor, nitric oxide synthase, and smooth muscle cells. In human studies, IIEF-5 and erection hardness score were improved. Peak systolic velocity was also higher.

CONCLUSIONS MSCs may be a promising therapy for diabetic ED; however, long-term safety concerns still need further investigations.

Efficacy and safety of platinum chain and gold weight implants for paralytic lagophthalmos: a systematic review

Yunia Irawati — 2021-06-30

BACKGROUND Surgery has been proposed as a treatment of paralytic lagophthalmos. However, no consensus has been reached on the best treatment. This study was aimed to investigate the efficacy and safety between platinum chain and gold weight implants to treat paralytic lagophthalmos.

METHODS This study used all randomized controlled trials or observational studies (prospective or retrospective) using platinum chain and gold weight implants for paralytic lagophthalmos surgery that were published from 1990 to 2020 in the PubMed, Cochrane, and Google Scholar databases. Efficacy was indicated by the reduction of ≥3 in lagophthalmos, and safety was measured based on complications after surgery.

RESULTS The efficacy of platinum chain and gold weight implants were 60–100% and 10–93.6%, respectively. The complications of platinum chain implant were 0–2.9% of extrusion and 0–3.3% of migration. However, gold weight implant had 0–13.3% of migration.

CONCLUSIONS Both platinum chain and gold weight implants have similar efficacy to treat paralytic lagophthalmos. However, gold weight implant has a higher rate of complication.

Delivery routes in pregnancy with COVID-19 and the risk of intrapartum vertical transmission: a meta-analysis

Razmaeda Sarastry — 2021-06-30

BACKGROUND Mode of delivery has become an important highlight in managing pregnancy with coronavirus disease 2019 (COVID-19) due to the possible risk of viral transmission from mother to baby, especially during the peripartum period. This study aimed to review the mode of delivery and the possible risk of vertical transmission related to delivery routes in pregnant women with COVID-19.

METHODS Literature research was conducted using PubMed, Scopus, Embase, and EBSCO database with the following keywords: SARS-CoV-2, COVID-19, pregnancy, vertical transmission, and delivery. The extracted data were as follows: author, country, study design number of cases, maternal age, mode of delivery, and the SARS-CoV-2 status in neonates.

RESULTS Of 11 studies found, vaginal birth was reported in 218 cases (34.53%) and cesarean delivery was reported in 385 women (65.47%). The indication for cesarean delivery was majority due to COVID-19 related condition (53.61%). In total, 8 neonates who confirmed positive for COVID-19 by real-time polymerase chain reaction assay were reported. The pooled odds ratio (95% confidence interval) for SARS-CoV-2-positive neonates in cesarean delivery compared with vaginal birth was 0.622 (0.237–1.633) with p = 0.335.

CONCLUSIONS Cesarean delivery is more common than vaginal delivery in patient with SARS-CoV-2 infection. Any delivery route is not related to possible risk of intrapartum vertical transmission, and cesarean delivery should be carried out based on the obstetric indication.

Accuracy of pediatric advanced life support method for predicting the depth of endotracheal tube in Indonesian children

Andi Ade Wijaya Ramlan — 2021-06-11

BACKGROUND The pediatric advanced life support (PALS) method can predict the depth of endotracheal tube (ETT) in pediatric patients easily, but it has limitations due to variations in the children’s characteristics, especially the racial consideration. This study compared the accuracy of ETT depth prediction based on the PALS methods in Indonesian children.

METHODS Patients aged 0–12 years, who underwent elective surgery with oral intubation, were recruited consecutively based on their ages: 0–24 months and 25 months–12 years for this cross-sectional study in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from June to August 2014. Bland–Altman analysis was used to compare the two measurement methods: PALS method to predict the ETT depth accuracy and auscultation method to confirm the position of the ETT. Furthermore, correlation analysis was done to examine the relationship of age, weight, height, and ETT internal diameter with ETT depth.

RESULTS 50 patients were recruited in each group. Bland–Altman test of ETT depth in the 0–24 months age group showed a 1.18 cm mean difference from confirmation using the auscultation method (limits of agreement −0.71 to 3.08). The 25 months–12 years age group showed a 1.11 cm mean difference with limits of agreement were −0.95 to 3.17 from confirmation using the auscultation method. Age and weight had the strongest correlation value to ETT depth in the 25 months–12 years age group (R² = 62.3%).

CONCLUSIONS The PALS method is inaccurate for predicting ETT depth in Indonesian children aged 0–12 years old compared with the auscultation method.

Treatment delay of cancer patients in Indonesia: a reflection from a national referral hospital

Soehartati Gondhowiardjo — 2021-06-30

BACKGROUND Cancer is a complex disease requiring a multidisciplinary approach in establishing prompt diagnosis and treatment. Treatment in a timely manner is crucial for the outcomes. Hence, this study aimed to provide information on treatment delay including patient and provider delays and its associated factors.

METHODS Cancer patients were recruited conveniently in the outpatient clinic of Department of Radiation Oncology, Cipto Mangunkusumo Hospital, Indonesia between May and August 2015. All patients were asked to fill a questionnaire and interviewed in this cross-sectional study. Treatment delay was explored and categorized into patient delay and provider delay. Patient delay could be happened before (patient-delay-1) or after (patient-delay-2) the patient was diagnosed with cancer. Provider delay could be due to physician, system-diagnosis, and system-treatment delays.

RESULTS Among 294 patients, 86% patient had treatment delay. Patient delay was observed in 153 patients, and 43% of them had a history of alternative treatment. An older age (p = 0.047), lower educational level (p = 0.047), and history of alternative treatment (p<0.001) were associated with patient delay. Meanwhile, 214 patients had provider delay, and 9%, 36%, and 80% of them experienced physician, system-diagnosis, and system-treatment delays, respectively. All types of provider delay were associated with patient delay (p<0.001).

CONCLUSIONS Most of the patient had treatment delay caused by either patient or provider.

Impact of metabolic syndrome on lower urinary tract symptoms in patients with benign prostate hyperplasia

Dyandra Parikesit — 2021-06-30

BACKGROUND Studies evaluating the relationship between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) in men with benign prostate hyperplasia (BPH) are lacking in Indonesia. This study aimed to discover the association of LUTS and MetS in men with BPH.

METHODS Subjects who underwent biopsy were recruited from Cipto Mangunkusumo Hospital, Jakarta, Indonesia from January 2014 to January 2018, but only men who had biopsy-proven BPH were included. Body mass index, waist circumference, fasting blood glucose, triglyceride, high-density lipoprotein, prostate volume (PV), and international prostate symptom score (IPSS) were collected before the biopsy. MetS criteria were based on the National Cholesterol Education Program Adult Treatment Panel III. IPSS was assessed for LUTS and consisted of irritative and obstructive symptoms and quality of life (QoL). Independent t-test or Mann–Whitney test was used to analyze numerical data.

RESULTS Of 227 men with biopsy-proven BPH, 87 (38.3%) were diagnosed with MetS. PV was similar in men with or without MetS (54.4 [20.3–100] versus 49.9 [19.5–100] cm³, p = 0.239). Men with MetS generally had more LUTS (15 [1–30] versus 11 [0–35], p = 0.005), more irritative symptoms (8 [0–20] versus 6 [0–20], p = 0.007), and lower QoL (4 [0–6] versus 3 [0–6], p = 0.018).

CONCLUSIONS BPH patients with MetS had greater LUTS, particularly irritative symptoms and QoL score.

Reliability and validity of the Indonesian version of the World Health Organization quality of life-old (WHOQOL-OLD): a Rasch modeling

Sharon Gondodiputro — 2021-06-30

BACKGROUND The World Health Organization (WHO) has developed the WHOQOL-OLD instrument, specifically measuring the quality of life (QoL) of the elderly, but the Indonesian version of the WHOQOL-OLD has not been available.

METHODS This study was conducted in 2 steps. First, the instrument was translated and pre-tested to 8 elderly respondents from 2 villages in Lembang, West Java, Indonesia. Second, Rasch modeling was used as implemented by the Winstep version 3.73 software to analyze the reliability, validity, value of separation, Wright map analysis, item-fit order, and differential item functioning in elderly respondents (aged ≥60 years old and did not have dementia) from 6 community health centers in Bangka Regency, Bangka Belitung, Indonesia from July to December 2018.

RESULTS Overall, the Indonesian version of the WHOQOL-OLD demonstrated good reliability and validity tests in 175 respondents. The overall value of the person reliability was 0.73 with the Cronbach’s alpha of 0.75, and the value of the item reliability was 0.97. A misconception and bias occurred in the death and dying facet, especially in the demographic categories of age, gender, and marital status.

CONCLUSIONS The Indonesian version of the WHOQOL-OLD module has good psychometric properties to measure the QoL of the Indonesian older population. However, further studies involving various ethnicities, religious groups, and districts in Indonesia should be carried out before the module can be used throughout the country.

A case report of acute Marchiafava-Bignami disease: a rare clinical entity in chronic alcoholism

Mohd Arif Abdul Malik Khiew — 2021-02-05

Marchiafava‑Bignami disease (MBD) is a rare neurological disease often associated with a chronic consumption of alcohol and malnutrition, which is characterized by a demyelination and necrosis of the corpus callosum. We present a case of a 21-year-old male with chronic alcoholism who presented with an acute altered sensorium and seizure, which were initially treated as meningoencephalitis. His persistent poor Glasgow coma scale score and ideomotor recovery with encephalitic changes on his electroencephalogram prompted urgent magnetic resonance imaging (MRI) of his brain, which revealed extensive symmetrical hyperintensities in the corpus callosum. The diagnosis of MBD was made because of the typical MRI findings and after the exclusion of other possible diagnosis. The patient was promptly treated with a parenteral thiamine and showed a good recovery at 3 months follow-up. This case highlights the importance of diagnosing and recognizing MBD in a patient with chronic alcoholism as prompt treatment could prevent irreversible damage, which could carry high morbidity.

Neurological manifestations of COVID-19: a clinical approach

Ni Made Susilawathi — 2021-05-03

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2 which attacks the respiratory tract and has been declared a global pandemic by the World Health Organization. The disease has a very wide clinical spectrum which can be manifested as asymptomatic to critical conditions. SARS-CoV-2 shows a neurotropism proven by its identification in the cerebrospinal fluid and brain vascular endothelial. The complete mechanism of how the virus invades the human nervous system is yet to be identified. Thus, every neurologist needs to follow the progressivity of COVID-19 symptoms involving the nervous system.

Gastrointestinal disorders in COVID-19 patients: a great imitator

Ari Fahrial Syam — 2021-01-20

Up to this point, the coronavirus disease 2019 (COVID-19) pandemic is still ongoing. Some studies with a large number of cases have reported its clinical manifestations, concluding that the disease is a great imitator. Patients may present with symptoms other than the main symptoms of respiratory tract infections, such as diarrhea, abdominal pain, nausea, or vomiting, which may sometimes cause a delayed treatment in managing COVID-19 patients. Reports of various hospitals have also demonstrated gastrointestinal complaints as a clinical manifestation in those patients. The patients may come with gastrointestinal symptoms as their early clinical manifestation, or the gastrointestinal symptoms may be found in hospitalized COVID-19 patients, which indeed can be explained since the SARS-CoV-2, an etiologic agent of COVID-19 infection, can obviously be found along the gastrointestinal tract. Hence, the virus can be found in fecal and anal, and therefore, rectal swabs can be used as a diagnostic tool for COVID-19 infection.

High visibility of outdoor tobacco advertisements around health facilities in East Java, Indonesia: a geospatial analysis

Hario Megatsari — 2021-04-28

BACKGROUND Indonesian tobacco control initiatives are minimal despite having the second-highest adult male smoking prevalence in the world, with less than 10% of districts/cities banning outdoor tobacco advertisements. This research aimed to provide evidence on the presence of outdoor tobacco advertisements near health facilities in Surabaya where there is no outdoor advertising ban.

METHODS Data collection was carried out in Surabaya from October to November 2018. Data of government (public) and private health facilities were obtained from the city health office. Two spatial data analyses were carried out: a buffer analysis near the healthcare facilities and an advertisement hotspot analysis using ArcMap 10.6.

RESULTS From 308 tobacco advertisements that were identified, there were billboards (63%), banners (31%), and videoboards (7%). Of 142 public and 1,242 private health facilities in Surabaya, 26% and 31% had advertisements within 300 m and 63% and 70% were within advertisement hotspots, respectively. Furthermore, 5% of advertisements were within 300 m from public health facilities and 21% of them were within 300 m from private health facilities.

CONCLUSIONS Outdoor tobacco advertisements were widespread throughout the city, prominently around public and private health facilities.

Front & Back Matter

Medical Journal of Indonesia — 2021-07-01