Medical Journal of Indonesia

Acknowledgment of Reviewers

Medical Journal of Indonesia — 2025-02-10

Front & Back Matter

Medical Journal of Indonesia — 2025-02-10

Stand-alone middle meningeal artery embolization in chronic subdural hematoma patient presenting cognitive decline: a case report

Yusmahenry Galindra — 2025-02-10

Chronic subdural hematoma (cSDH) is a neurological disorder that commonly occurs in the elderly with high morbidity and mortality. Current treatment for cSDH consists of conservative therapy, surgical evacuation, and endovascular therapy, or a combination of all the methods. Endovascular therapy for cSDH management involving middle meningeal artery embolization (MMAE) has become a promising therapeutic option for clinicians as it offers a minimally invasive, safe, and effective choice with a low recurrence rate. MMAE using particles can also be performed in frail elderly patients who cannot undergo large craniotomy procedures. We presented a case of a subdural hematoma patient with cognitive decline using a therapeutic strategy of stand-alone MMAE, which resulted in cognitive function improvement

Multimodal approach in the diagnosis and management of Eales disease: a case report

Gitalisa Andayani Adriono — 2025-02-10

Eales disease is a rare idiopathic occlusive retinal vasculitis with low prevalence in the general population. Its infrequent occurrence limits diagnostic and treatment guidelines, emphasizing the need for ongoing reports to establish effective protocols. This case report describes a patient presenting with symptoms of bilateral retinal vasculitis. Fundus examination revealed vitreous hemorrhage (VH) and peripheral retinal vasculitis. Laboratory and imaging tests were performed to exclude differential diagnoses, leading to Eales disease as the primary diagnosis. Pars plana vitrectomy, panretinal laser photocoagulation, intravitreal anti-vascular endothelial growth factor, and anti-tuberculosis therapy were administered. Long-term follow-up showed satisfactory outcomes. This report suggested Eales disease to be a diagnosis of consideration for ophthalmologists encountering male patients with recurrent VH. Clinical suspicion, including appropriate laboratory testing and imaging, is essential to developing a holistic approach to diagnosis and management, aiming to prevent progression and achieve optimal visual outcomes.

Intracranial dural arteriovenous fistula presenting like longitudinally extensive transverse myelitis

Nia Yuliatri — 2025-02-10

Intracranial dural arteriovenous fistula (DAVF) that drains into spinal perimedullary veins can generate longitudinally extensive transverse myelitis (LETM)-like lesion, which often represents a significant diagnostic and therapeutic challenge. This is a case report of a 50-year-old male referred with all extremity weaknesses. Despite receiving high-dose intravenous steroids for suspected myelitis, no improvement was recorded. Spinal imaging showed abnormal hyperintensity extending from the T6 vertebral level to the medulla, and a flow void lesion from the cervicomedullary junction up to the L3 level. Angiography confirmed a Cognard type V spinal DAVF, which was treated with transarterial embolization of the feeding vessel. Follow-up angiography showed complete occlusion of the fistula without any backflow. Flow voids are no longer visible on MRI conducted 3 weeks post-procedure. Unfamiliarity with these disorders often leads to delays in diagnosis and treatment. Therefore, it is essential to consider intracranial DAVF as a differential diagnosis for LETM-like lesions.

Role of regulatory T cells and T helper 17 cells in the pathogenesis of hypertension: a review

Hary Sakti Muliawan — 2025-02-10

The discovery of autoantibodies in artery samples from cadavers with hypertension over 50 years ago suggested a potential link between the immune system and hypertension. Since then, research exploring the role of the immune system in hypertension has emerged. Animal studies have demonstrated a strong correlation between regulatory T cells (Tregs) and T helper 17 (Th17) cells in hypertension development, yet studies on human hypertension remain limited. Tregs produce inhibitory cytokines such as interleukin (IL)-10 and transforming growth factor-β to act as anti-inflammatory cells that protect against hypertension. In contrast, Th17 cells, by producing IL-17A, function as pro-inflammatory cells that promote hypertension. Recently, a subset of cells known as IL-17A+FOXP3+Treg cells have been identified, which can produce IL-17 and act as inflammatory cells under certain conditions. Understanding the basic mechanisms by which the immune system influences hypertension could lead to targeted immunotherapies for hypertension in the future. Thus, we highlighted the role of Tregs and Th17 cells in the development of hypertension and their potential as targets for therapy. Our findings confirmed the role of Tregs and Th17 cells in the pathogenesis of hypertension.

Prevalence of calcaneal spur among foot and ankle patients at the Cape Coast Teaching Hospital, Ghana

Emmanuel Fiagbedzi — 2025-02-10

BACKGROUND A calcaneal spur is a bony protrusion that grows from the calcaneus. This study aimed to estimate the prevalence of calcaneal spurs and associated risk variables (age, gender, and type) in patients undergoing foot and ankle X-ray examinations at the Cape Coast Teaching Hospital.

METHODS A retrospective cross-sectional approach and non-probability purposive sampling were used to analyze radiographic reports. A total of 323 radiographic reports from patients undergoing ankle and foot X-ray examinations between July 2020 and July 2023 were selected from 1,690 radiographs and analyzed using Microsoft Excel 2019 and SPSS software version 26.0.

RESULTS The overall prevalence was 34.7% (112/323), with 112 cases indicating calcaneal spurs. Of the patients, 72 (64.3%) were females. Among the cases, 53 (47.3%) were plantar spurs, 40 (35.7%) were dorsal spurs, and 19 (17.0%) exhibited both types. The highest prevalence was found in the 51–60 age group, representing 30 (26.8%) cases. Age was found to have a significant association with calcaneal spur development (p = 0.044).

CONCLUSIONS Both plantar and dorsal calcaneal spurs were significantly associated with age, with the 51–60 age group at higher risk.

Association between vaspin rs2236242 gene polymorphism and atherosclerosis in ischemic stroke patients with diabetes mellitus in the Indonesian population

Rivan Danuaji — 2025-02-10

BACKGROUND Stroke is the third leading cause of morbidity and second in mortality worldwide. Diabetes mellitus (DM) is a risk factor for stroke. Vaspin and single nucleotide polymorphism (SNP) rs2236242 involved DM pathogenesis. This study aimed to explore the correlation between SNP rs2236242, serum vaspin levels, and atherosclerosis in patients with ischemic stroke and DM.

METHODS This study was conducted in Dr. Moewardi Hospital from 2022 to 2023. The case group included patients with ischemic stroke and DM, while the controls were those with ischemic stroke only. Tetra-primer amplification refractory mutation system-polymerase chain reaction was used to determine the genotypes.

RESULTS There were 31 cases and 33 control. SNP rs2236242 showed that odds ratio (OR) (95% confidence interval [CI]) for AA-TT was 0.273 (0.241–0.305) and for TA-TT was 0.315 (0.298–0.341). The OR (95% CI) for allele A to T was 0.789 (0.373−1.669). The mean (standard deviation) serum vaspin level in the case group compared to the control was 1,570 (2,108) ng/ml versus 1,630 (1,428) ng/ml (p = 0.064). Higher vaspin levels were found in T allele of the TT (1,523 [2,269] ng/ml, p = 0.021) and TA (1,760 [1,349] ng/ml, p = 0.004) genotype groups than the A allele of the AA genotype group (0.914 [0.329] ng/ml).

CONCLUSIONS Vaspin gene polymorphism AA genotype or A allele significantly reduces vaspin levels in patients with ischemic stroke with DM.

Natural remedies in burn care: a systematic review and network meta-analysis

Muhammad Azri Ismail — 2025-02-10

BACKGROUND Burn injuries are a global public health issue that impact healing time and cause complications. While silver sulfadiazine (SSD) cream is commonly used for treatment, research indicates that SSD can hinder the wound healing process. Natural alternatives like Aloe vera, honey, and amniotic membranes have shown promise in promoting wound healing. This study aimed to evaluate their efficacy by their wound healing time and infection rate.

METHODS 3 independent reviewers conducted a literature search across 6 databases (Cochrane Central Register of Controlled Trials, PubMed, ScienceDirect, Taylor & Francis, Wiley, and ProQuest). Quality assessment was conducted using the Cochrane Risk of Bias 2 tool, while network meta-analysis was performed using the netmeta package in R. The variable in this study is the average time to burn wound healing and infection occurrence by analyzing MD data or OR of each intervention, with 95% CI to calculate the efficacy.

RESULTS A total of 3,434 patients from 37 studies were included. In the analysis of 26 studies comparing the healing time to SSD, A. vera has the best efficacy (MD: −4.75; 95% CI: −8.67 to −0.86), followed by amniotic membrane (MD: −4.71; 95% CI: −7.45 to −1.97), and honey (MD: −4.25; 95% CI: −6.76 to −1.73). Meanwhile, the occurrence of infection analysis in burn wounds across 24 studies highlighted that honey has the lowest infection rate (OR: 0.09; 95% CI: 0.04 to 0.23) and was the only statistically significant finding when compared to SSD.

CONCLUSIONS Aloe vera and amniotic membrane are effective for wound healing, while honey is particularly effective in preventing wound infection in patients with burn injuries.

Radiological and histological assessment of a novel interlocking three-dimensional miniplate for mandibular angle fractures: an animal study

Prasetyanugraheni Kreshanti — 2025-02-10

BACKGROUND Open reduction and internal fixation are considered the gold standard for managing mandibular fractures, as they effectively restore anatomical structure and functionality. Three-dimensional (3D) miniplates were developed to obtain a geometrically stable structure. However, the rigid structure of 3D miniplate may cause screw holes to be located within the fracture lines or directly above important anatomical structures. Hence, we have developed customizable interlocking 3D miniplates that allow for modifications in the configuration of the horizontal miniplates and vertical cross-struts to meet specific requirements.

METHODS This study included 24 goats divided into 2 groups: interlocking 3D miniplate and standard plate. Each group was further divided into subgroups sacrificed on Days 5, 28, and 56. Radiological assessments were performed to evaluate bone, muscle, peri-implant bone, and peri-implant muscle density. Histological assessments were performed using Masson's trichome (MT) for bone healing evaluation and hematoxylin and eosin (H&E) staining for biocompatibility.

RESULTS Radiological assessment indicated an increase in density across all measured parameters from Day 5 to 56. Histological evaluation from MT staining showed a significantly higher fibrocartilage in the interlocking 3D miniplate group (6.109%, IQR 1.453–10.828) compared to standard plate (1.311%, IQR 0.636–2.553; p = 0.001). Furthermore, H&E staining showed significantly higher inflammatory cell counts in the standard group on Days 28 and 56 compared to the interlocking 3D miniplate group (p = 0.027).

CONCLUSIONS This study concluded that the interlocking 3D miniplate showed better bone healing properties and biocompatibility than the standard plate.

Genotypic pattern of fluoroquinolone resistance among extended-spectrum beta-lactamase-producing Escherichia coli

Tati Febrianti — 2025-02-10

BACKGROUND Fluoroquinolone (FQ) is one of the therapeutic options for treating extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-Ec) infection, but its use could increase the resistance level of ESBL-Ec. This study aimed to analyze the resistant genes responsible for ESBL production and FQ resistance among the ESBL-Ec isolated from healthy humans and communal wastewater.

METHODS This was an observational study using stored isolates and laboratory data. Genome sequencing was done on 43 E. coli DNA isolates before resistance genes, mutations, and high-risk clones were examined through bioinformatic data analysis.

RESULTS The analysis of 39 ESBL-Ec isolates showed ESBL genes, including bla_CTX-M-55 (56%), bla_CTX-M-15 (31%), and bla_CTX-M-27 (8%). ESBL-Ec isolates exhibited mutations in gyrA (54%), gyrB (0%), parC (28%), and parE (10%). Plasmid-mediated quinolone resistance genes detected included qnrS1 (54%), qnrS13 (13%), qnrB2 (3%), aac(6’)-Ib-cr5 (3%), qepA (0%), and oqxAB (0%). ESBL and FQ resistance genes were simultaneously detected in 33 ESBL-Ec isolates, with high-risk clones identified as ST155, ST10, ST23, ST38, ST131, and ST69 Cplx.

CONCLUSIONS ESBL and FQ resistance genes were simultaneously detected in ESBL-Ec isolated from healthy humans and communal wastewater.

Developing an online reproductive health module on sexually transmitted infections for Indonesian adolescents: a qualitative mixed methods study

Hanny Nilasari — 2025-02-10

BACKGROUND A notable rise in sexually transmitted infection (STI) cases among youth correlates with a lack of reproductive health awareness, affecting nearly 80% of Indonesian adolescents. Additionally, sociocultural taboo acts as a challenge to reproductive health implementation in Indonesia. Therefore, this study aimed to develop an online reproductive health module focused on STIs for Indonesian adolescents.

METHODS This research was a mixed methods approach, integrating quantitative study using univariate analysis (survey and questionnaire) and qualitative study using the Delphi method (open discussion and focus group discussion). The study was conducted between March 2 and July 28, 2022. We began by conceptualizing a literature-based module, an online survey, and virtual discussions involving students, teachers, and parents. Then, we consulted with clinical psychologists and dermatovenereologists. Additionally, students completed an assessment to establish a baseline of their knowledge, attitudes, and behaviors (KAB) regarding reproductive health and STIs.

RESULTS Of 327 high school students across Jakarta, analysis of the 129 completed KAB surveys showed that only 56.6% and 65.1% attained acceptable scores (>65) for knowledge and behavior, respectively, with 24.8% being at risk for STIs. Key recommendations included incorporating multimedia elements, ensuring clarity and simplicity in language, adopting non-judgmental tone, providing comprehensive explanations of STIs and their long-term impact, and supporting learning with face-to-face sessions and ongoing access to concise, cost-effective educational resources.

CONCLUSIONS Adolescents need a comprehensive, interactive, instructive, accessible, non-discriminatory reproductive module that strengthens the self-concept that upholds Indonesian values and norms.