Medical Journal of Indonesia https://mji.ui.ac.id/journal/index.php/mji <p><a href="http://mji.ui.ac.id/journal/index.php/mji/aboutbrief">ABOUT JOURNAL</a> | <a href="http://scholar.google.com/citations?user=4rXbpKoAAAAJ&amp;hl=en" target="_blank&quot;">CITATIONS</a> | <a href="https://mji.ui.ac.id/journal/index.php/mji/stat">STATISTIC</a> | <a href="/journal/index.php/mji/submit">SUBMISSIONS</a> | <a href="/journal/index.php/mji/indexing">ABSTRACTING &amp; INDEXING</a></p> <hr> <p>This quarterly medical journal is an official scientific journal of the Faculty of Medicine Universitas Indonesia in collaboration with German-Indonesian Medical Association (DIGM).</p> <p>Abstracted and indexed in: <a title="EBSCO host" href="https://www.ebscohost.com/titleLists/a9h-journals.htm" target="_blank" rel="noopener">EBSCO host</a>, <a title="ACI" href="http://www.asean-cites.org/index.php?r=contents%2Findex&amp;id=9" target="_blank" rel="noopener">ASEAN Citation Index</a>, <a title="BASE" 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Journal of Indonesia right of first publication with the work simultaneously licensed under a <a title="CC BY NC" href="http://creativecommons.org/licenses/by-nc/4.0/" target="_self">Creative Commons Attribution-NonCommercial License</a> that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.</span></li> <li class="show">Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.</li> </ol> Citation index analysis: a key or a trap? https://mji.ui.ac.id/journal/index.php/mji/article/view/6117 <p>[No abstract available]</p> Agus Rizal Ardy Hariandy Hamid Copyright (c) 2022 Agus Rizal Ardy Hariandy Hamid http://creativecommons.org/licenses/by-nc/4.0 2022-04-22 2022-04-22 31 1 1 2 10.13181/mji.ed.226117 The journey of policies during the COVID-19 pandemic in Indonesia: a need of evidence-informed policy https://mji.ui.ac.id/journal/index.php/mji/article/view/6199 <p>[No abstract available]</p> Akmal Taher Copyright (c) 2022 Akmal Taher http://creativecommons.org/licenses/by-nc/4.0 2022-04-22 2022-04-22 31 1 3 6 10.13181/mji.com.226199 Effect of immediate electrical stimulation in the distal segment of the nerve with Wallerian degeneration in rats with sciatic nerve injury https://mji.ui.ac.id/journal/index.php/mji/article/view/5870 <p><strong>BACKGROUND </strong>Electrical stimulation in the proximal segment is one of the modalities for peripheral nerve injury, although it is prone to cause excessive axonal sprouting growth in the proximal segment of the nerve. This study aimed to show that immediate electrical stimulation in the distal segment of the sciatic nerve in Wistar rats accelerated Wallerian degeneration by increasing the expression of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-10, and galectin-3/MAC-2 macrophages to avoid sprouting axons excessively in the proximal segment.</p> <p><strong>METHODS </strong>This was an experimental study using male Wistar rats (<em>Rattus norvegicus</em>) with a randomized post-test only control group design. The treatment group received immediate electrical stimulation (20 Hz, 2 mA, for 5 sec) to the distal nerve after sciatic nerve injury, while the control group received no treatment. After 3 days, tissue samples were extracted from the distal segment of the sciatic nerve to examine the level of TNF-α, IL-10, and galectin 3/Mac-2 macrophages using ELISA and from proximal nerves to histologically examine the sprouting axons.</p> <p><strong>RESULTS </strong>Rats in the treatment group had higher TNF-α (52.1 [10.32] <em>versus</em> 40.4 [17.71] pg/100 mg, <em>p</em> = 0.031) and higher IL-10 (918 [167.6] <em>versus</em> 759 [158.9] pg/ml, <em>p</em> = 0.010). Expression of galectin 3/Mac-2 macrophages was similar in both groups (465 [49.5] <em>versus</em> 444 [54.4] pg/100 mg, <em>p</em> = 0.247). The number of sprouting axons was lower in the treatment group (2 [IQR 1–2] <em>versus</em> 2.5 [IQR 2–3], <em>p</em> = 0.003).</p> <p><strong>CONCLUSIONS </strong>Immediate electrical stimulation in the distal segment of the sciatic nerve can accelerate nerve regeneration.</p> Agus Roy Rusly Hariantana Hamid Sri Maliawan Dewa Putu Gde Purwa Samatra Nyoman Mantik Astawa I Made Bakta I Made Jawi Ida Bagus Putra Manuaba I Made Dewa Sukrama David Sontani Perdanakusuma Copyright (c) 2022 Agus Roy Rusly Hariantana Hamid, Sri Maliawan, Dewa Putu Gde Purwa Samatra, Nyoman Mantik Astawa, I Made Bakta, I Made Jawi, Ida Bagus Putra Manuaba, I Made Dewa Sukrama, David Sontani Perdanakusuma http://creativecommons.org/licenses/by-nc/4.0 2022-03-08 2022-03-08 31 1 7 12 10.13181/mji.oa.225870 Zoom fatigue and its risk factors in online learning during the COVID-19 pandemic https://mji.ui.ac.id/journal/index.php/mji/article/view/5703 <p><strong>BACKGROUND </strong>Global nations have enforced strict health protocols because of the COVID-19’s high transmission, infectivity, and mortality. As shown by increased online learning and video conferencing, the employment and education sectors are shifting to home-based activities. Video conferencing as a communication medium has subtly led to zoom fatigue. This study aimed to analyze the risk factors of zoom fatigue for early prevention and treatment.</p> <p><strong>METHODS </strong>This cross-sectional study was conducted on 335 Indonesian university students selected by purposive sampling in July 2021. Data were collected using a demographic questionnaire including online courses duration during the COVID-19 pandemic; Pittsburgh sleep quality index; depression, anxiety and stress scale-21; and zoom &amp; exhaustion fatigue (ZEF) scale through Google Form (Google LLC, USA) distributed via social media and student forums. Association and correlation tests were used, and the model was developed using linear regression.</p> <p><strong>RESULTS </strong>The respondents were aged 21.3 (1.8) years with 12.8 (5.1) months of online courses during the COVID-19 pandemic and a ZEF scale of 2.8 (0.9). Students with higher ZEF had irregular physical exercise, poorer sleep quality, longer video conferencing sessions, longer months of courses during the COVID-19 pandemic, and higher mental illness (i.e., stress, anxiety, and depression). Smoking negatively correlated with fatigue (<em>r</em> = −0.12). The model for ZEF showed good predictability for zoom fatigue (<em>p</em>&lt;0.001, <em>R</em><sup>2</sup> = 0.57).</p> <p><strong>CONCLUSIONS </strong>Daily exposure to video conferencing in educational settings throughout the pandemic has drastically increased zoom fatigue. The stakeholders must act immediately to minimize the risks while providing maximum benefits.</p> Jonathan Salim Sutiono Tandy Jannatin Nisa Arnindita Jacobus Jeno Wibisono Moses Rizky Haryanto Maria Georgina Wibisono Copyright (c) 2022 Jonathan Salim, Sutiono Tandy, Jannatin Nisa Arnindita, Jacobus Jeno Wibisono, Moses Rizky Haryanto, Maria Georgina Wibisono http://creativecommons.org/licenses/by-nc/4.0 2022-01-19 2022-01-19 31 1 13 9 10.13181/mji.oa.225703 Cardiac manifestations and diagnostic imaging in pediatric inflammatory multisystem syndrome temporally associated with COVID-19: a systematic review https://mji.ui.ac.id/journal/index.php/mji/article/view/5754 <p><strong>BACKGROUND</strong> Several studies have reported pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) cases with their cardiac manifestations, but only few studies synthesize the cardiovascular characteristics in children with PIMS-TS. However, detecting cardiac abnormalities is crucial in improving patients' outcomes and reducing mortality. This review aimed to summarize the overall symptoms, laboratory, and workup findings in PIMS-TS patients, focusing on cardiovascular manifestations.</p> <p><strong>METHODS</strong> We searched 4 medical databases (PubMed, Science Direct, Medline, and Scielo) and 4 preprint databases (Medrxiv, Research Square, SSRN, and Biorxiv). The literature search was done on November 8, 2021. All case reports, case series, cross-sectional studies, cohort studies, and possible clinical trials published from December 2020 onward that studied PIMS-TS on cardiac manifestation (aged 0–18 years) were included. Studies on multisystem inflammatory syndrome in children, animal studies, and studies without full-text availability were excluded. This review was registered in PROSPERO (CRD42021194468).</p> <p><strong>RESULTS</strong> 59 studies were included with a total of 698 patients. The most common cardiovascular findings were the presence of cardiogenic shock (37%) and hypotension (8.5%). Almost all laboratory values were deranged. Cardiac computed tomography scan mostly showed normal results (56%), followed by cardiomegaly with pericardial effusion (14%). Electrocardiography showed normal findings (46%), ST-segment abnormalities (32%), and abnormal T wave (12%). Echocardiography findings showed left ventricle dysfunction (40.6%), which can be considered most significant, followed by pericardial effusion together with pericarditis (11.4%) and tricuspid regurgitation (6.9%).</p> <p><strong>CONCLUSIONS</strong> This review found various cardiac abnormalities that may develop during PIMS-TS. Due to these findings, we should be more vigilant and not underestimate the consequences in pediatric COVID-19 patients.</p> Gilbert Sterling Octavius Ricardo Tan Teodorus Alfons Pratama Charista Lydia Budiputri Fellisa Meliani Rivaldo Steven Heriyanto Rusli Muljadi Andry Juliansen Copyright (c) 2022 Gilbert Sterling Octavius, Ricardo Tan, Teodorus Alfons Pratama, Charista Lydia Budiputri, Fellisa Meliani, Rivaldo Steven Heriyanto, Rusli Muljadi, Andry Juliansen http://creativecommons.org/licenses/by-nc/4.0 2022-03-08 2022-03-08 31 1 20 37 10.13181/mji.oa.225754 Ethicomedicolegal aspects of the COVID-19 health services in preparing regulations and intermediaries for clinical dispute resolution: a systematic review https://mji.ui.ac.id/journal/index.php/mji/article/view/5718 <p><strong>BACKGROUND</strong> The COVID-19 pandemic has caused many medical, ethical, and medicolegal changes, including constant adjustments in service guidelines. Continuing to revise healthcare regulations and guidelines can potentially cause clinical disputes or medical negligence that require ethical and legal solutions. This study aimed to determine the ethical and medicolegal aspects of the potential factors that cause clinical disputes during the pandemic and provide anticipative solutions to national ethicomedicolegal policies.</p> <p><strong>METHODS</strong> A systematic literature search in PubMed, ScienceDirect, ClinicalKey, and Google Scholar was performed using keywords “clinical dispute,” “ethics,” “medicolegal,” “ethicolegal,” and “COVID-19”. The inclusion criteria were articles that contained information on shortage, justice, ethical distribution in intensive care, the possibility of lawsuits and disputes among stakeholders during the pandemic, and stakeholders’ roles in managing the pandemic. Key evidence was analyzed and synthesized following national ethicomedicolegal policies.</p> <p><strong>RESULTS</strong> We identified 19 articles from the 4 databases. Based on the literature, the main ethicomedicolegal impact of the COVID-19 pandemic appears in 3 aspects: (1) a shortage of fair and ethical intensive care services with fair and ethical distribution efforts, (2) legal protection for medical personnel from legal charges while providing health services during the pandemic, and (3) the government’s role in managing the pandemic together with the stakeholders involved.</p> <p><strong>CONCLUSIONS</strong> Ethicomedicolegal clinical dispute management and its norms require an update, especially when deciding the complexity of COVID-19 service standards. Ethicomedicolegal professionals are needed as intermediaries to manage cases of clinical disputes and to implement fair malpractice criteria in Indonesia.</p> Agus Purwadianto Ade Firmansyah Sugiharto Fitri Ambar Sari Roberia Uud Cahyono Yuli Budiningsih Denys Putra Alim Nadia Ulfah Faddila Copyright (c) 2022 Agus Purwadianto, Ade Firmansyah Sugiharto, Fitri Ambar Sari, Roberia, Uud Cahyono, Yuli Budiningsih, Denys Putra Alim, Nadia Ulfah Faddila http://creativecommons.org/licenses/by-nc/4.0 2022-04-22 2022-04-22 31 1 38 49 10.13181/mji.oa.225718 Procalcitonin prognostic value in predicting mortality among adult patients with sepsis due to Gram-negative bacteria https://mji.ui.ac.id/journal/index.php/mji/article/view/5864 <p><strong>BACKGROUND</strong> Sepsis is a leading cause of mortality and morbidity globally. Gram-negative bacteremia was reported to have a high risk of septic shock and poor prognosis. This study aimed to evaluate the role of procalcitonin in predicting mortality in patients with sepsis due to Gram-negative bacteria.</p> <p><strong>METHODS</strong> This was a retrospective cohort study performed based on medical records and sepsis registry of Tropical and Infectious Disease Division, Department of Internal Medicine, Cipto Mangunkusumo Hospital. The inclusion criteria were patients aged ≥18 years diagnosed with sepsis due to Gram-negative bacteria based on blood culture on admission and hospitalized between March 2017 and October 2020. Data taken from medical records included subjects’ characteristics, laboratory parameters, and 28-day mortality outcomes during hospitalization. Receiver operating characteristic was used to determine the area under the curve (AUC) of procalcitonin and its accuracy.</p> <p><strong>RESULTS</strong> A total of 128 patients were eligible. The cumulative survival of patients with Gram-negative bacteremia was 48.4% (standard error 0.96%). The AUC of procalcitonin to predict mortality was 0.45 (95% confidence interval 0.36–0.54). <em>Escherichia coli</em> was the predominant microorganism in blood culture (n = 38, 29.7%).</p> <p><strong>CONCLUSIONS</strong> Procalcitonin has a poor performance in predicting mortality of patients with sepsis due to Gram-negative bacteria.</p> Bonita Effendi Ceva Wicaksono Pitoyo Robert Sinto Suhendro Suwarto Copyright (c) 2022 Bonita Effendi, Ceva Wicaksono Pitoyo, Robert Sinto, Suhendro Suwarto http://creativecommons.org/licenses/by-nc/4.0 2022-04-22 2022-04-22 31 1 50 5 10.13181/mji.oa.225864 Internet addiction and its association with depression, anxiety, and stress symptoms among allied health students in Malaysia https://mji.ui.ac.id/journal/index.php/mji/article/view/5820 <p><strong>BACKGROUND</strong> Internet addiction (IA) is prone to be experienced by students and has become a major health concern. However, data on IA among allied health students are limited. This study aimed to describe the prevalence of IA and the association between mental health problems and IA among allied health students in Malaysia.</p> <p><strong>METHODS</strong> A cross-sectional study was conducted from July to December 2021 in three government-funded allied health training institutes in Malaysia. A total of 265 allied health students undertaking a diploma in nursing, medical assistant training, physiotherapy, occupational therapy, and diagnostic imaging were recruited using stratified random sampling. The Malay version of the IA test was used to measure IA, while depression, anxiety and stress scale-21 items were used to assess their mental health problems. A general linear model was used to analyze the association between IA scores and mental health problems.</p> <p><strong>RESULTS</strong> The prevalence of IA among allied health students was more than 80%, with 16.2% and 2.3% of them reporting moderate and severe IA, respectively. Higher depression (<em>p</em>&lt;0.001), anxiety (<em>p</em>&lt;0.001), and stress scores (<em>p</em> = 0.002) were associated with higher IA scores.</p> <p><strong>CONCLUSIONS</strong> There were significant associations between mental health problems and IA scores among allied health students. Future studies with rigorous scientific methods are necessary to explore mental health effects on IA. Early intervention is also needed to prevent mental health problems among allied health students to overcome the problem of IA.</p> Nor Subhi Jaafar Idayu Badilla Idris Norfazilah Ahmad Rozita Hod Baidi Baddiri Rafidah Hod Copyright (c) 2022 Nor Subhi Jaafar, Idayu Badilla Idris, Norfazilah Ahmad, Rozita Hod, Baidi Baddiri, Rafidah Hod http://creativecommons.org/licenses/by-nc/4.0 2022-04-22 2022-04-22 31 1 56 61 10.13181/mji.oa.225820 Association of P-glycoprotein expression and response to anthracycline-based neoadjuvant chemotherapy in locally advanced breast cancer https://mji.ui.ac.id/journal/index.php/mji/article/view/5863 <p><strong>BACKGROUND</strong> Neoadjuvant chemotherapy (NACT) has been shown to improve the overall survival of locally advanced breast cancer (LABC) patients with pathological complete response. However, the efficacy may be reduced due to chemoresistance mediated by P-glycoprotein (Pgp). This study aimed to explore the association between Pgp expression and patients’ response to NACT.</p> <p><strong>METHODS</strong> A prospective cohort study was carried out from May 2018 to October 2019 at Cipto Mangunkusumo Hospital and Koja Hospital. Treatment-naïve LABC patients were consecutively enrolled in the study. Immunohistochemistry analysis of the biopsy samples was done to semi-quantitatively measure Pgp expression. The clinical response was evaluated after 3 cycles of NACT, while the pathological response was evaluated for subjects who underwent surgery post-NACT.</p> <p><strong>RESULTS</strong> Mean age of the subjects was 46.2 (9.6) years old, and most of the cases were invasive ductal (78%) and luminal B subtype (61%). Pgp was strongly expressed in 21/27 subjects (78%). There were no differences between Pgp-positive and -negative subjects for clinical response (relative risk [RR] 1.1, 95% confidence interval [CI] 0.33–4.01, <em>p</em> = 0.61) and pathological response (RR 1.3, 95% CI 0.8–1.9, <em>p</em> = 0.22). Other clinicopathologic variables were not associated with either clinical or pathological responses.</p> <p><strong>CONCLUSIONS</strong> These results showed that Pgp is expressed in most LABC patients, but its role as a predictive factor could not be established. However, due to the limited subjects and a lack of standardized Pgp measurement, careful consideration must be done when interpreting these results.</p> Erwin Danil Yulian Filipus Dasawala Nurjati Chairani Siregar Copyright (c) 2022 Erwin Danil Yulian, Filipus Dasawala, Nurjati Chairani Siregar http://creativecommons.org/licenses/by-nc/4.0 2022-04-22 2022-04-22 31 1 62 9 10.13181/mji.oa.225863 Management of bladder exstrophy in an adolescent girl: a case report https://mji.ui.ac.id/journal/index.php/mji/article/view/5249 <p>Bladder exstrophy (BE) is a very rare congenital abnormality, especially in girls. We reported a 17-year-old girl with protruded bladder and urinary incontinence. Her vaginal orifice appeared stenotic and shifted anteriorly. She had an incomplete labia minora, short perineum, and anterior displacement of the anus. The pelvic radiography showed a pubic diastasis with a manta ray sign, and the ultrasonography examination showed a bicornuate uterus. She had undergone a functional reconstruction surgery with cystectomy, ileal conduit, appendectomy, and vaginoplasty along with the advancement of abdominal flap reconstruction with multiple Z-plasty. Functionally, she was able to urinate through the ileal conduit comfortably, had a regular menstrual cycle with minimal pain, had a wider vaginal canal, and had a smooth blood flow. Aesthetically, she had a good lower abdomen appearance, remained dry, and had an odorless urine. In clinical practice, this rare case report can provide additional knowledge and management of the same cases with effective results.</p> Ni Made Putri Suastari Ni Nyoman Margiani Kadek Budi Santosa Dewa Gde Mahiswara Firman Parulian Sitanggang I Wayan Yudiana Copyright (c) 2021 Ni Made Putri Suastari, Ni Nyoman Margiani, Kadek Budi Santosa, Dewa Gde Mahiswara, Firman Parulian Sitanggang, I Wayan Yudiana http://creativecommons.org/licenses/by-nc/4.0 2021-08-03 2021-08-03 31 1 70 4 10.13181/mji.cr.215249 Preseptal cellulitis and cerebral venous sinus thrombosis complication in a patient with diabetes mellitus https://mji.ui.ac.id/journal/index.php/mji/article/view/5568 <p>This was a rare case of preseptal cellulitis with an unexpected complication by cerebral venous sinus thrombosis. A 73-year-old woman with poorly controlled diabetes mellitus presented with a week history of swelling and redness on the left upper eyelid and right forehead, associated with poor oral intake, lethargy, and fever. She was generally lethargic with poor verbal response. She had cellulitis of the left upper eyelid and right forehead with the left upper eyelid necrosis. Computed tomography venography of the brain revealed thrombosis of the right transverse sinus, right sigmoid sinus, and right internal jugular vein. She later developed left upper eyelid and right forehead abscesses. Incision, drainage, and wound debridement were performed. She was treated with intravenous antibiotics and anticoagulant. After 1 week of treatment, the preseptal and forehead cellulitis had resolved. However, she passed away due to aspiration pneumonia with respiratory failure on day-13 of hospitalization.</p> Sylves Patrick Huwaina Abdul Satar Wan Hazabbah Wan Hitam Copyright (c) 2022 Sylves Patrick, Huwaina Abdul Satar, Wan Hazabbah Wan Hitam http://creativecommons.org/licenses/by-nc/4.0 2022-04-22 2022-04-22 31 1 75 9 10.13181/mji.cr.225568 Omicron surge and the future of COVID-19 vaccinations https://mji.ui.ac.id/journal/index.php/mji/article/view/6066 <p>The global surge of Omicron has caused significant concern. Omicron has caused new wave of infections in nations with adequate vaccine coverage. Omicron has around 30 mutations that are similar to the previous variant of concerns, possibly decreasing vaccine effectiveness (VE). Hence, the emergence of Omicron is predicted to be a significant public health challenge and may alter the future of COVID-19 vaccinations. Furthermore, other issues may affect vaccine policy in the future such as the never-ending vaccine inequity, waning immunity of current COVID-19 vaccines, decreasing VE against new emerging strains, and new findings regarding hybrid immunity. This literature review aimed to explore the possible steps forward using the most updated knowledge on COVID-19 vaccines and Omicron.</p> Erlina Burhan Rizky Abi Rachmadi Copyright (c) 2022 Erlina Burhan, Rizky Abi Rachmadi http://creativecommons.org/licenses/by-nc/4.0 2022-04-22 2022-04-22 31 1 80 4 10.13181/mji.bc.226066 Front & Back Matter https://mji.ui.ac.id/journal/index.php/mji/article/view/6233 Medical Journal of Indonesia Copyright (c) 2022-04-26 2022-04-26 31 1