Medical Journal of Indonesia

How artificial intelligence chatbots becomes author’s true friend in medical writing without risking ethical violations

Agus Rizal Ardy Hariandy Hamid — Wed, 08 May 2024 16:30:55 +0700

[No abstract available]

Hand surgery without tourniquet as a model for the development of surgical service innovation for competitive advantage-based service readiness

Theddeus Octavianus Hari Prasetyono — Mon, 04 Mar 2024 00:00:00 +0700

[No abstract available]

Digital image characteristics for enhanced interpretation in child sexual violence case examinations

Yuli Budiningsih, Agus Purwadianto, Aria Yudhistira, Agusalam Budiarso — Fri, 26 Apr 2024 00:00:00 +0700

BACKGROUND Photography is an integrated part of standard forensic examination procedures, acting as a guide and the evidence itself. Despite its potential, no research has yet explored the use of 35mm format cameras (digital single-lens reflex [DSLR]) in sexual violence cases. This study aimed to assess the impact of DSLR camera image characteristics on the interpretation of child sexual abuse cases.

METHODS This cross-sectional study used 55 digital photos selected through a convenience sampling. The samples were interpreted by two independent forensic experts who were not affiliated with this research and were compared with the results of the doctor’s examination from the medical records.

RESULTS The metadata extraction results (EXIF data) indicated that all characteristic values had an abnormal distribution. The digital photos’ characteristics were associated with the use of a 50mm focal length (p = 0.011). A range of lens opening values (aperture = f7.1–f8.0), shutter speed (1/100–1/125 sec), and sensor sensitivity (ISO = 800–1600) were not associated with the experts’ interpretation conformity. Additionally, the conformity index for the overall interpretation by the two forensic experts differed in each area.

CONCLUSIONS Focal length of 50mm was significantly related to interpretation conformity. The exposure triangle settings, including aperture (f7.1–f8.0), shutter speed (1/100–1/125 sec), and ISO (800–1600), can serve as fundamental guidelines for digital camera settings in examining child sexual violence cases.

Erythrocyte and iron profiles in soil-transmitted helminth-infected children in a rural area in Banten, Indonesia

Saleha Sungkar, Ninik Sukartini, Aulia Wirastuti, Dian Wahyu Tanjungsari — Tue, 26 Mar 2024 00:00:00 +0700

BACKGROUND Soil-transmitted helminth (STH) infection, frequently caused by Ascaris lumbricoides, Trichuris trichiura, and hookworms (Ancylostoma duodenale and Necator americanus), often gives rise to malabsorption of nutrients that form hemoglobin (Hb) thereby causing anemia. This study aimed to know the difference in erythrocyte profile in children with and without STH infections.

METHODS This cross-sectional study involved 205 children from two Panimbang Jaya elementary schools in Pandeglang, Banten, Indonesia. Blood and stool samples were collected from a previous study conducted from November 2021 to May 2022. Erythrocyte parameters were Hb concentration, erythrocyte count, mean corpuscular volume (MCV), mean corpuscular Hb (MCH), and red cell distribution width (RDW). The iron profile included serum iron, total iron-biding capacity (TIBC), and ferritin. Worm infestation was detected by direct stool microscopical examination. Statistical analysis was performed using SPSS software version 20.

RESULTS The prevalence of STH infection in Pandeglang was 44.4%, primarily characterized by mild intensity STH infection (79%). The identified STH species were A. lumbricoides, T. trichiura, and combination of both. The median differences between erythrocyte count, MCV, and MCH, and the mean differences of TIBC and serum iron were not statistically significant (p = 0.388, 0.098, and 0.057, and p = 0.304 and 0.455). However, children with STH infection had lower Hb (12.57 versus 12.95 g/dl) and ferritin (19.60 versus 30.57 µg/dl) levels but higher RDW (13.20 versus 13.10%).

CONCLUSIONS A high prevalence of STH infection was identified among schoolchildren, but their erythrocyte profiles were similar regardless of STH infection status.

Clinical and microbiological characteristics of onychomycosis in a tertiary hospital: a cross-sectional study

Fri, 22 Mar 2024 00:00:00 +0700

BACKGROUND Onychomycosis is a common fungal nail infection with a low cure rate. While dermatophytes are the most common causal agent for onychomycosis, the incidence of Candida and nondermatophyte mold (NDM) onychomycosis is increasing. This study aimed to analyze the clinical and microbiological characteristics of patients with onychomycosis.

METHODS Patients who visited the Department of Dermatology and Venereology, Cipto Mangunkusumo Hospital, and were diagnosed with onychomycosis from 2017 to 2022 were included. Diagnosis was established through clinical examination, supported by the result of direct microscopic examination with potassium hydroxide.

RESULTS Of 171 patients, 93.6% had onychodystrophy, 65.5% were females, and 62.0% were aged 19–59 years. Most patients had onychodystrophy in more than three nails, affecting fingernails (31.6%) and toenails (34.5%). Interestingly, 84.8% of patients had no history of nail diseases. The median onset of disease was 24.0 (1–1,040) weeks, while the median onychomycosis severity index was 10.0 (2–40). Most cases were caused by Candida albicans (48.3%). Fusarium was the only NDM documented (2.3%). Some patients were resistant to itraconazole (11.4%) and miconazole (4.5%). Overall, 49.1% of the patients were declared not cured.

CONCLUSIONS Candida was the predominant cause of onychomycosis, and onychodystrophy was the dominant feature. Current treatment regimens with systemic or topical antifungal agents did not yield satisfactory results, with more than half of the patients deemed not cured.

Incidence of urethral stricture in patients with urethral trauma: a 10-year experience in an Indonesian tertiary hospital

Paksi Satyagraha, Muhammad Adi Satrio Lazuardi, Taufiq Nur Budaya — Wed, 08 May 2024 00:00:00 +0700

BACKGROUND Urethral injuries are rarely life-threatening but can cause significant morbidity if left untreated. Until now, data on urethral trauma incidence are still limited in Indonesia. This study aimed to report the incidence of traumatic urethral stricture within 10 years of experience in treating urethral trauma.

METHODS This retrospective study used a total sampling method for all patients with urethral trauma who came to the emergency department and agreed to undergo radiological evaluation. Patient data were collected from January 2012 to December 2021. All patients were followed up for 3 months after trauma, and the incidence of urethral stricture was analyzed using the chi-square or Fisher's exact tests as an alternative.

RESULTS The overall incidence of urethral stricture was 48.4%. Of 122 patients, 82.0% had anterior urethral trauma. Grade III American Association for the Surgery of Trauma (43.4%) was the most common urethral trauma. The cause of urethral trauma was iatrogenic, pelvic fracture urethral injury (PFUI), straddle injury, and penile fracture, contributing in 64.8%, 18.0%, 16.4%, and 0.8% of the cases, respectively. Most patients (70.5%) underwent a cystostomy catheterization procedure as initial treatment. Straddle injury, PFUI, and a higher degree of urethral trauma were significantly associated with urethral stricture formation (p<0.05).

CONCLUSIONS Straddle injury, PFUI, and a higher degree of urethral trauma were significantly related to a higher incidence of urethral stricture. Most low-grade and anterior urethral traumas can resolve spontaneously.

Diagnostic value and clinical significance of high-resolution ultrasonography compared to magnetic resonance imaging in diagnosing temporomandibular joint dislocation: a systematic review

Thariqah Salamah, Glancius Nironsta Harefa — Mon, 25 Mar 2024 00:00:00 +0700

BACKGROUND Temporomandibular joint (TMJ) dislocation is uncommon, yet it is associated with a significant negative effect on the patient’s quality of life. Magnetic resonance imaging (MRI), a gold standard for diagnosing TMJ dislocation, is expensive, time-consuming, and cannot be performed on patients with pacemakers and metallic prostheses. On the other hand, high-resolution ultrasonography (HRUS) has low cost, high accessibility, and is less time-consuming. This study aimed to compare the accuracy and reliability of HRUS to MRI in diagnosing TMJ dislocation.

METHODS A comprehensive literature search was conducted using PubMed, Cochrane Library, ScienceDirect, and EBSCOhost databases. Keywords such as temporomandibular joint dislocation, temporomandibular displacement, MRI, and ultrasonography were utilized for the search. The articles obtained were then selected based on the inclusion and exclusion criteria, and the quality assessment was conducted using the QUADAS-2 tool.

RESULTS 5 studies were included in this systematic review. The critical appraisal results showed sensitivity ranging from 74.3–93.7%, specificity from 84.2–100%, positive predictive value from 68.2–100%, negative predictive value from 64.0–98.3%, and accuracy from 77.7–91.7% of HRUS compared to MRI.

CONCLUSIONS HRUS is a reliable method for diagnosing TMJ dislocation. However, MRI is still necessary in selected and more advanced cases.

Efficacy of cilostazol in promoting the maturation of newly created arteriovenous fistula in patients with end-stage renal disease: a systematic review and meta-analysis

Herick Alvenus Willim, Erica Sugandi, Rosa, Alvin Ariyanto Sani, Hengky Khouw — Tue, 16 Apr 2024 00:00:00 +0700

BACKGROUND Arteriovenous fistula (AVF) is considered the gold standard for vascular access in hemodialysis. However, achieving the successful maturation of AVF remains a challenge. Cilostazol, a phosphodiesterase-3 inhibitor, has shown promise in enhancing AVF maturation. This study aimed to assess the clinical efficacy of cilostazol in promoting AVF maturation.

METHODS This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive systematic literature search was performed using PubMed, ScienceDirect, Cochrane Library, ProQuest, and Google Scholar to identify studies investigating the efficacy of cilostazol on the maturation of newly created AVF in patients with end-stage renal disease and published up to August 2023. The intervention group received perioperative cilostazol therapy, while the control group did not receive cilostazol. The outcomes were the maturation rate of AVF and AVF-related complications. Meta-analysis was conducted using Review Manager software version 5.3.

RESULTS 5 studies involving 549 patients were included. The intervention group comprised 228 patients, while the control group comprised 321 patients. In the pooled analysis, patients in the intervention group had a significantly higher rate of AVF maturation (odds ratio [OR] = 2.18, 95% confidence interval [CI]: 1.29–3.68, p = 0.003, I² = 47%) and a lower rate of AVF-related complications (OR = 0.46, 95% CI: 0.28–0.77, p = 0.003, I² = 27%) compared to the control.

CONCLUSIONS Cilostazol was associated with a higher rate of AVF maturation and a lower rate of AVF-related complications.

Predictor of recurrent exacerbations in pediatric asthma

Fri, 05 Apr 2024 00:00:00 +0700

BACKGROUND Asthma imposes a heavy morbidity burden during childhood. Severe persistent asthma significantly increases patients’ risk of exacerbations, hospital admissions, and mortality and often substantially impairs their quality of life. This study aimed to identify high-risk patients for exacerbation recurrence using spirometric parameters.

METHODS A prospective cohort study involving patients with asthma aged 6–15 years was conducted at the principal children’s hospital in Mekong Delta, Vietnam, from June 2020 to June 2022. Demographic, clinical, and lung function characteristics of the patients were collected. Spirometry measurement parameters were utilized as predictive factors for the short-term asthma exacerbation recurrence.

RESULTS Among all patients (mean age of 9.5 years old), 10.4% experienced recurrent exacerbations. FEV₁, FVC, FEV₁/FVC, FEF_25–75, FEF_25–75/FVC, and PEF, gradually decreased with increasing exacerbation severity (p<0.01). All patients showed a positive bronchodilator responsiveness (BDR), with a mean value of 16.85 (3.00)%, which was significantly different between the severe and non-severe asthma groups (20.53 [2.83] versus 16.00 [2.35], p<0.001). After adjusting in multivariable logistic regression, a BDR ≥20% was identified as the sole independent factor associated with an increased risk of asthma exacerbation recurrence (aOR 6.95, 95% CI 1.08–44.75, p = 0.041).

CONCLUSIONS A high BDR can serve as a predictor of acute asthma exacerbation recurrence.

Psychosocial impacts of coughing in public places during the COVID-19 pandemic: a cross-sectional study in the western region of Saudi Arabia

Wed, 27 Mar 2024 00:00:00 +0700

BACKGROUND Dry cough is a prevalent symptom of COVID-19. During the pandemic, people may mistake this cough for symptoms associated with other respiratory diseases. This increases the risk of individuals with a cough being falsely judged as having COVID-19. This study aimed to investigate the impact of coughing in public places on adults’ mental and social well-being during the COVID-19 pandemic and to explore the role of demographic factors in the relationship between coughing and psychosocial life in public places in the western region of Saudi Arabia.

METHODS This cross-sectional study was conducted in the western region of Saudi Arabia, targeting healthy adults aged ≥18 years. The participants were randomly selected using a cluster sampling technique. Data were collected through a self-administered validated questionnaire to explore the psychosocial impact of coughing in public places during the COVID-19 pandemic. Additionally, the questionnaire collected demographic information, smoking habits, cough frequency, consumption of cough medications, history of mild respiratory diseases, and family history of chronic respiratory illnesses. The mean and standard deviation were used to calculate continuous variables, and frequency and percentages were used to present categorical variables. We analyzed the relationships between study variables using the analysis of variance test.

RESULTS 288 adults participated in the study, with a 67.2% agreement score. 82.0% of the participants avoided people who coughed in public, while 51.8% felt angry and frustrated when someone coughed in public during the pandemic.

CONCLUSIONS COVID-19 has changed how people react to coughing in public. Mild coughs can be mistaken for COVID-19, leading to avoidance.

Double set up technique as a bailout of diagonal branch coronary perforation: a case report

Wed, 08 May 2024 00:00:00 +0700

Coronary artery perforation is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). A 55-year-old male with a history of implanted stent on the left main ostium to the proximal left circumflex artery (LCX) and distal right coronary artery, and chronic total occlusion (CTO) on ostium left anterior descending (LAD). PCI was performed using a stiff wire to cross the CTO body in LAD. We performed an injection and confirmed the presence of extravasation. We successfully managed to stop the bleeding by placing the tips of floppy wire that were cut into pieces. A drainage pathway was made through thoracotomy for pericardial effusion. Angiography showed persisting extravasation at the wire insertion site. We then made our own covered stent. We implanted on the osteal LAD until proximal LCX. Repeated angiography showed no contrast extravasated from the perforation site, and the patient was stabilized and discharged.

Front & Back Matter

Wed, 08 May 2024 00:00:00 +0700