Medical Journal of Indonesia

The struggles of regional journals to gain international visibility

Sri Widia Azraki Jusman — 2022-08-31

[No abstract available]

Current condition of social security administrator for health (BPJS Kesehatan) in Indonesia: contextual factors that affected the national health insurance

Ali Ghufron Mukti — 2022-08-26

[No abstract available]

Novel and simple method using cable ties to induce intestinal strangulation in a rat model

Agi Satria Putranto — 2022-06-13

BACKGROUND The pathogenesis of intestinal fibrosis after strangulation in abdominal surgery is not fully understood. Developing an experimental and reliable method is needed to overcome this problem. This study aimed to develop an effective method for intestinal strangulation leading to fibrosis, which might induce intestinal obstruction.

METHODS This study was conducted from 2018 to 2019 at the Department of Pharmacology, Faculty of Medicine, Universitas Indonesia. A total of 24 Sprague Dawley rats were used in this study. Artificial intestinal strangulation using cable ties made of durable plastic, which is generally used to ligate objects, was applied, and rats were further classified into control, 6-hour, and 24-hour strangulation groups. At the end of the study, the rats were sacrificed, intestinal tissues were collected, and histomorphological changes were observed using hematoxylin and eosin stain. Moreover, Masson’s trichome staining was used to assess collagen density.

RESULTS Median collagen density score of the 24-hour strangulation group was higher than the control. A significant difference in collagen density was found between the submucosal layer of the 24-hour strangulation group and the control (45.4 [11.4] versus 32.4 [14.0], p<0.001) and between the mucosa of the 6- and 24-hour strangulation groups and the control (26.9 [17] versus 6.46 [4.3], p = 0.01 and 24.9 [8] versus 6.46 [4.3], p = 0.004, respectively).

CONCLUSIONS The simple use of cable ties adequately promotes intestinal strangulation.

Thromboelastographic method for early decision on anticoagulant therapy in moderate to severe COVID-19 patients

Komang Ayu Ferdiana — 2022-07-14

BACKGROUND Coagulopathy is a serious COVID-19 complication that requires rapid diagnosis and anticoagulation. This study aimed to determine the role of coagulation examination using thromboelastography (TEG) on the decision-making time of anticoagulant therapy in COVID-19 patients and its clinical outcomes.

METHODS A prospective observational study was conducted in Cipto Mangunkusumo Hospital, Indonesia, from October 2020 to March 2021. We consecutively recruited moderate and severe COVID-19 patients in the high and intensive care units. Turnaround time, time to anticoagulant therapy decision, and clinical outcomes (length of stay and 30-day mortality) were compared between those who had a TEG examination in addition to the standard coagulation profile examination (thrombocyte count, PT, APTT, D-dimer, and fibrinogen) and those who had only a standard coagulation profile laboratory examination.

RESULTS Among 100 moderate to severe COVID-19 patients recruited, 50 patients had a TEG examination. The turnaround time of TEG was 45 (15–102) min versus 82 (19–164) min in the standard examination (p<0.001). The time to decision was significantly faster in the TEG group than the standard group (75 [42–133] min versus 184 [92–353] min, p<0.001). The turnaround time was positively correlated with time to decision (r = 0.760, p<0.001). However, TEG did not improve clinical outcomes such as length of stay (10.5 [3–20] versus 9 [2–39] days) and 30-day mortality (66% versus 64%).

CONCLUSIONS The TEG method significantly enables quicker decision-making time for moderate to severe coagulation disorder in COVID-19 patients.

Efficacy and side effects of Blacksoap® as adjuvant therapy of scabies: a randomized control trial

Lidwina Anissa — 2022-07-14

BACKGROUND Blacksoap® is recognized as adjuvant therapy for scabies, but there has been no significant study on its effectiveness. This study aimed to compare the efficacy and safety between Blacksoap® and placebo on standard treatment for pruritus visual analog scale (VAS) and transepidermal water loss (TEWL) scores before and after receiving therapy.

METHODS This single-blind randomized controlled trial was held in a boarding school in West Java in 2018. Subjects were recruited consecutively by random cluster sampling. Both groups received standard permethrin 5% cream therapy. The intervention group (n = 37) obtained Blacksoap®, while the control (n = 41) received baby soap. During the initial assessment, pruritus VAS and TEWL scores were taken. The cure rate, scores of pruritus VAS and TEWL, as well as side effects were assessed and compared during the first and fourth weeks. Data were analyzed using SPSS software version 20 (IBM Corp., USA) by a third party, mostly using non-parametric tests.

RESULTS The cure rate of the intervention group was lower than the control in the first week with 75% versus 81% but higher in the fourth week with 97% versus 92%. There was no significant difference in the scores of pruritus VAS and TEWL, as well as side effects between the two groups.

CONCLUSIONS The efficacy and safety of scabies treatment were similar between Blacksoap® and placebo adjunctive to standard treatment. Blacksoap®, on top of standard scabies treatment, might benefit patients by providing a higher cure rate in 4 weeks without any considerable adverse effects.

Intravenous magnesium sulfate versus intravenous meperidine to prevent shivering during spinal anesthesia

Pryambodho — 2022-07-05

BACKGROUND Shivering is a frequent event during neuraxial anesthesia due to impaired central and peripheral thermoregulation control. Meperidine and MgSO₄ are effective in lowering the shivering threshold. Hence, this study aimed to compare the efficacy of MgSO₄ and meperidine to prevent shivering in patients undergoing spinal anesthesia.

METHODS This was a double-blind randomized clinical trial of 100 patients divided into 2 groups. One group had MgSO₄ 30 mg/kg, and the other group had meperidine 0.5 mg/kg intravenously in 100 ml of 0.9% NaCl before undergoing spinal anesthesia. Participants were non-pregnant patients aged 18–65 years and had physical status I or II (based on the American Society of Anesthesiologist). Shivering was considered significant if it occurred in grade 3 or 4. Patient characteristics, shivering degree, tympanic membrane temperature, and side effects were recorded.

RESULTS Shivering occurred 10% in the MgSO₄ group and 19% in the meperidine group, with p = 0.23. Both groups had similar side effects of nausea, vomiting, and hypotension.

CONCLUSIONS MgSO₄ 30 mg/kg was not superior to meperidine 0.5 mg/kg intravenously in preventing shivering in patients undergoing spinal anesthesia.

Kidney function profile before, during, and after Ramadan fasting in healthy elderly: a prospective cohort study

Murdani Abdullah — 2022-08-31

BACKGROUND Kidney function profile is one of the important parameters in determining the health of the elderly. In Indonesia, no study has been conducted on kidney function profile during Ramadan fasting to determine the safety of Ramadan fasting in the elderly. This study aimed to determine the kidney function profile in the elderly who fasted during Ramadan.

METHODS This study used a prospective cohort design. The inclusion criteria were elderly aged >60 years undergoing Ramadan fasting in Jatinegara, Jakarta from April to July 2019. Patients with end-stage renal failure who had an acute infection, hypertension crisis, or refused to participate in the study were excluded. Patients who did not fast for 3 consecutive days were dropped out. The kidney function profile was calculated by the estimated glomerular filtration rate (eGFR) using the CKD-EPI formula 1 week before the first day of Ramadan, 3 weeks after the first day of fasting, and 2 weeks after the last day of fasting. Decreased eGFR was defined as having a minimum of 20% eGFR decline during or after the fasting period. Bivariate analysis was performed using McNemar or Cochran tests.

RESULTS 2 patients had eGFR decline during fasting, and 7 patients had eGFR decline after fasting. The median eGFR before, during, and after fasting were 81.5, 88.7, and 76.8 ml/min/1.73 m², respectively. A total of 1.4% of subjects had decreased eGFR during Ramadan, while 9.1% had decreased eGFR after Ramadan. However, the changes were not statistically significant.

CONCLUSIONS Although most elderly had lower eGFR following Ramadan fasting compared to before and during Ramadan, only individuals with several comorbidities had significant changes of kidney function.

A case report of tuberculous constrictive pericarditis as a sole manifestation of tuberculosis in a male adolescent

Michael Jaya — 2022-06-28

Constrictive pericarditis is a rare type of pericardial disease that can be caused by various factors. Tuberculosis (TB) is one of the most common causes of this abnormality in Indonesia. Interestingly, tuberculous constrictive pericarditis can occur in the absence of acute pericarditis, pulmonary, or extrapulmonary TB. This case described a male adolescent with refractory right-sided heart failure symptoms who developed a rapidly progressive tuberculous constrictive pericarditis. Various imaging modalities, such as echocardiography, chest computed tomography (CT) scan, cardiac magnetic resonance imaging, and incidental PET/CT scan, were used to diagnose the pericardial abnormality. Histopathological findings in pericardial tissues confirmed the diagnosis. Complete surgical pericardiectomy, in conjunction with anti-TB drugs, diuretics, and colchicine, resulted in a significant clinical improvement.

Placenta accreta spectrum disorder in a primigravida with angular pregnancy: a case report

Abarham Martadiansyah — 2022-08-31

Placenta accreta spectrum (PAS) is characterized by abnormal invasion of placental tissue into the underlying uterine muscles and has an incidence of 1/533–1/251. The incidence of complications includes uterine rupture (14–29%), PAS (6–10%), and retained placenta or incomplete placenta removal (4%). Here, we described a rare case of PAS and angular pregnancy, including how to diagnose and manage it preoperatively. A 32-year-old primigravida diagnosed at 24 weeks of gestation with a right angular pregnancy was admitted due to preterm premature rupture of membrane (PPROM) with a singleton fetus. We decided to perform hysterotomy because of the PPROM and intrauterine infection. Intraoperatively, we found PAS in the right angular pregnancy; therefore, we performed uterine conservative management with wedge resection on the right uterine fundus. Intraoperative bleeding was 1,600 cc. Histopathological examination revealed placenta increta. The maternal prognosis was good, while the fetus was poor, with an APGAR score of 1/1/0.

A review of pathobiological mechanisms and potential application of medicinal plants for vascular aging: focus on endothelial cell senescence

Agian Jeffilano Barinda — 2022-08-26

Endothelial cell (EC) senescence plays a pivotal role in aging and is essential for the pathomechanism of aging-related diseases. Drugs targeting cellular senescence, such as senolytic or senomorphic drugs, may prevent aging and age-related diseases, but these bullets remain undeveloped to target EC senescence. Some medicinal plants may have an anti-senescence property but remain undiscovered. Deep learning has become an emerging approach for drug discovery by simply analyzing cellular morphology-based deep learning. This precious tool would be useful for screening the herb candidate in senescent EC rejuvenescence. Of note, several medicinal plants that can be found in Indonesia such as Curcuma longa L., Piper retrofractum, Guazuma ulmifolia Lam, Centella asiatica (L.) Urb., and Garcinia mangostana L. might potentially possess an anti-senescence effect. This review highlighted the importance of targeting EC senescence, the use of deep learning for medicinal plant screening, and some potential anti-senescence plants originating from Indonesia.

Front & Back Matter

Medical Journal of Indonesia — 2022-08-31