Medical Journal of Indonesia

Tackling obesity in Indonesia: current problems and future directions

Dicky Levenus Tahapary — Wed, 24 Jul 2024 14:33:11 +0700

[No abstract available]

Cutting-edge technology application for prostate disease management in Indonesia: implementation of Healthcare 5.0 towards Indonesia’s Golden Vision 2045

Agus Rizal Ardy Hariandy Hamid — Wed, 24 Jul 2024 14:33:50 +0700

[No abstract available]

Maternal IgG in hemolytic disease of the fetus and newborn-ABO incompatibility

Heri Wibowo, Sheila Nurrahmah, Ria Syafitri Evi Gantini — Mon, 01 Jul 2024 00:00:00 +0700

BACKGROUND Hemolytic disease of the fetus and newborn (HDFN) is a type of anemia in the fetus or newborn, characterized by anemia, jaundice, hyperbilirubinemia, and brain damage. IgG is the only antibody that can cross the placenta. The IgG subtypes have a different ability to destroy red blood cells (RBCs). IgG1 and IgG3 can bind to Fc-phagocyte cell receptors and cause hemolysis, while IgG3 has more ability than IgG1. This study aimed to identify the antibody IgG subtype contributing to clinical manifestation differences in HDFN.

METHODS This study used blood and umbilical cord blood samples from 30 pairs of mother-baby. The samples were grouped into control (not jaundice/normal bilirubin levels) and jaundice/hyperbilirubinemia groups. A self-developed IgG subtype enzyme-linked immunosorbent assay protocol was performed on maternal samples, resulting in optical density. Statistical analysis was performed using SPSS software version 23.

RESULTS Blood type was associated with total bilirubin expression (p = 0.005). IgG1 anti-A, IgG3 anti-A, IgG4 anti-A, IgG1 anti-B, IgG3 anti-B, and IgG4 anti-B significantly affected hyperbilirubinemia in newborns (p = 0.041, 0.013, 0.017, 0.028, 0.001, and 0.007, respectively).

CONCLUSIONS IgG1 and IgG3 were more significant in causing clinical problems. IgG4 suppressed IgG activation, resulting in no destruction of the infant’s RBCs.

Effect of selective androgen receptor modulator RAD140 on prostate and testosterone levels in Wistar strain rats with bilateral orchidectomy

Wed, 24 Jul 2024 15:16:54 +0700

BACKGROUND Selective androgen receptor modulators (SARMs) have been investigated as a potential treatment for hypogonadism, a condition characterized by low testosterone levels in men. The idea is to provide therapeutic benefits similar to traditional testosterone replacement therapy. However, research in this area is still in its early stages, and more extensive studies are needed to establish the efficacy of SARM. This study aimed to determine the impact of SARM RAD140 on testosterone levels, fibromuscular stroma, and prostate mass in rats undergoing bilateral orchidectomy.

METHODS This was an in vivo study using posttest-only control group design in rats (Rattus norvegicus). The positive and negative control groups consisted of rats with and without bilateral orchidectomy, respectively. The treatment groups were rats given SARM RAD140 with and without orchidectomy. Testosterone levels, histopathology, and prostate mass were examined at the end of week 6, and the quantitative data were analyzed using one-way ANOVA.

RESULTS This study found no difference in prostate mass (0.598 [0.05] g versus 0.590 [0.07] g, p = 0.984), fibromuscular stroma ratio (0.483 [0.094] versus 0.463 [0.057], p = 0.984), and testosterone level (0.006 [0.005] ng/dl versus 0.014 [0.004] ng/dl, p = 0.098) compared to positive control with orchidectomy and SARM RAD140 administration 6 weeks after treatment.

CONCLUSIONS There were no differences in testosterone levels, prostate mass, or the ratio of fibromuscular stroma to epithelium area in rats undergoing bilateral orchidectomy and placebo surgery with the administration of SARM RAD140.

Kegel exercises with a guidebook for stress urinary incontinence treatment

Wed, 24 Jul 2024 14:36:15 +0700

BACKGROUND Stress urinary incontinence (SUI) is uncontrollable urine leakage when intra-abdominal pressure increases. Behavioral therapy with Kegel exercise is currently the best conservative management recommendation for treating SUI patients. This study aimed to investigate the success of supervised Kegel exercises using the Kegel exercises guidebook in women with SUI.

METHODS This quasi-experimental study involved both groups being taught the same regiment of Kegel exercises, but the intervention group was given the Kegel exercises guidebook. After 12 weeks, the compliance, subjective, and objective success rates were evaluated through the patient’s notes, Urinary Distress Inventory-6, Incontinence Impact Questionnaire-7, perineometer, and pad test.

RESULTS Patients with a higher level of education had lower compliance to Kegel exercises (p = 0.01; odds ratio [OR] 0.38; 0.18–0.79). No significant difference was observed in the subjective symptom improvement between the two groups. The intervention group had a significantly higher success rate based on objective success by analyzing the 1-hour pad test results. The intervention group was also more adherent (p<0.001; OR 4.78; 2.51–9.0).

CONCLUSIONS Patients who received the Kegel exercises guidebook were more compliant and more objectively successful than those who did not receive the manuals.

Syndecan-4 levels in bronchoalveolar lavage fluid and serum in non-small cell lung cancer

Wed, 24 Jul 2024 14:37:19 +0700

BACKGROUND Lung cancer has the highest cancer-related mortality rate worldwide. Research has been conducted to improve early detection and markers of predictive value but only focused on the expression of syndecan-4 (SDC4) in serum. Studies in bronchoalveolar lavage (BAL) fluids of non-small cell lung cancer (NSCLC) patients are still limited. This study aimed to evaluate the clinical value of SDC4 in serum and BAL in NSCLC patients.

METHODS Blood serum and BAL fluids were obtained from 44 patients with NSCLC and 41 non-cancer patients as the control. The level of SDC4 was measured. The relationships between SDC4 and clinicopathologic factors were also analyzed.

RESULTS Serum SDC4 levels in NSCLC patients were significantly lower than the control group (p = 0.002). Furthermore, the disease stages and serum SDC4 levels had a negative correlation, which was lower in the advanced stage (IIIb/IV) than in the initial stage (I/II/IIIa) (p = 0.517). The same results were obtained from BAL fluids SDC4 levels, which were significantly lower in the advanced stage (IIIb/IV) than in the early stage (I/II/IIIa) (p = 0.007).

CONCLUSIONS Serum SDC4 levels in NSCLC patients were lower than those of non-cancer patients. They also performed different results in disease stages. SDC4 could be a helpful biomarker in NSCLC.

Association between immune system parameter and clinical characteristics among patients with solid cancer

Rahmat Cahyanur, Alvina Widhani, Nico Iswanto Pantoro, Annisa Tsana Madadika — Wed, 24 Jul 2024 14:38:05 +0700

BACKGROUND Lymphopenia has been reported to be a major predictor of chemotherapy-related toxicity. This study aimed to investigate the correlation between neutrophils, lymphocytes, CD4, and CD8 in solid cancer patients and cancer clinical characteristics.

METHODS This was a cross-sectional study of patients who will undergo chemotherapy at the Hematology and Medical Oncology Clinic, Cipto Mangunkusumo Hospital, from June to September 2023. Clinical characteristics, CD4 and CD8 levels, and neutrophil and lymphocyte counts were assessed at the first visit. A comparative test was carried out on the patients’ average CD4, CD8, neutrophil, and lymphocyte counts.

RESULTS Types of cancer were associated with CD4 levels. Patients with head and neck cancer had lower CD4 levels (411.3 [119.3–1,427.5] cells/mm³) compared with colorectal (514.7 [129.2–861.3] cells/mm³), breast and gynecological (567.5 [180.1–939 cells/mm³), and other cancers (681.4 [175.1–2,056.9] cells/mm³), with p = 0.009. Patients aged ≥40 years had higher CD8 levels than those aged <40 years (376.4 [142.8–1,293.1] cells/mm³ versus 565.3 [185.9–1,944] cells/mm³, p = 0.01). Additionally, lymphocyte count was associated with cancer type, with the lowest number in head and neck cancer (1,380 [280–2,660] μl, p = 0.044).

CONCLUSIONS CD4 levels and lymphocyte counts were associated with the cancer type, whereas CD8 levels were influenced by age.

Transition of DNA-HPV over time in HPV-infected women: a 7-year cohort study

Tue, 02 Jul 2024 00:00:00 +0700

BACKGROUND Approximately 99% of cervical cancer cases worldwide are associated with one of the high-risk human papillomavirus (HPV) types. This study aimed to determine the transition rate of DNA-HPV over time in women aged 18–69 years with HPV infection in Can Tho City, Vietnam, from 2013 to 2020.

METHODS The 2-phase cohort study was conducted on 213 women between 2013 and 2020. Phase 1 involved a retrospective cohort study (2013–2018), and phase 2 included a prospective cohort study (2018–2020). HPV testing was performed using real-time polymerase chain reaction on cervical fluid. McNemar’s test was employed to compare differences in HPV transition between 2013 and 2020.

RESULTS From 2013 to 2018, the transition, clearance, and non-transition rates were 17.1%, 65.8%, and 66.2%, respectively, revealing a significant difference in the number of HPV cases during this period (p = 0.007). From 2018 to 2020, the transition, clearance, and non-transition rates were 9.8%, 44.9%, and 82.2%, respectively. Overall, the DNA-HPV changes from 2013 to 2020 indicated rates of 14.3% for transition, 68.5% for clearance, and 67.1% for non-transition. A significant difference in HPV cases was found between 2013 and 2020 (p = 0.001).

CONCLUSIONS The longer duration resulted in a more significant difference in the DNA-HPV transition among HPV-infected women.

Diabetic foot score: a predictive model for leg amputation in patients with diabetic foot disease

Wed, 24 Jul 2024 14:40:16 +0700

BACKGROUND Patients with diabetes mellitus are at a higher risk for peripheral artery disease (PAD) and diabetic foot disease (DFD), which can ultimately result in leg amputation. This study aimed to develop a novel scoring system to predict the risk of leg amputation using widely available modalities, including demographic characteristics and various laboratory data.

METHODS This study was conducted at Dr. Soetomo General Hospital and analyzed risk factors for leg amputation in 99 patients with DFD who underwent leg amputation compared with 80 control patients. This study presented a predictive model for leg amputation in patients with DFD, using odds ratio (OR) analysis and logistic regression approach with confidence intervals (CIs) set at 95%. The data analysis was conducted using SPSS software version 25.0.

RESULTS PAD (OR 6.52, 95% CI = 2.19–19.37, p = 0.001), high low-density lipoprotein cholesterol (OR 5.97, 95% CI = 2.31–15.43, p<0.001), type of DFD (OR 4.58, 95% CI = 2.14–9.79, p<0.001), poor glycemic control (OR 4.48, 95% CI = 1.78–11.28, p = 0.001), and neutrophil-to-lymphocyte ratio level (OR 1.04, 95% CI = 1.00–1.07, p = 0.025) were the independent predictors for leg amputation. The predictive model, developed using multivariate analysis with an area under the curve of 89%, optimum threshold of 0.5 (score 6), sensitivity of 84.8%, and specificity of 78.8%, indicating a promising approach for predicting leg amputation outcomes.

CONCLUSIONS The newly developed diabetic foot score may assist in making decisions regarding therapeutic options for patients with DFD.

Changes in body weight and healthy lifestyle perception of Indonesian adults during COVID-19 pandemic

Sorra Milwayani Septiyana, Arif Sabta Aji, Yhona Paratmanitya — Mon, 01 Jul 2024 00:00:00 +0700

BACKGROUND Social restrictions during the COVID-19 pandemic have impacted eating patterns and psychological status, leading to changes in body weight and perceptions of a healthy lifestyle in society. This study aimed to investigate the effect of social restrictions on weight changes and perceptions of a healthy lifestyle in adults during the COVID-19 pandemic in Indonesia.

METHODS This cross-sectional study was conducted using convenience sampling on 287 Indonesian adults from June to August 2020. The data were collected using a self-administered online questionnaire using Google Forms. Data were analyzed using the chi-square test and logistic regression analysis.

RESULTS There was no effect of social restrictions on weight changes and perceptions of lifestyle in adults (p = 0.900 and 0.748, respectively). However, 112 respondents (78.3%) had positive perceptions or supported adopting a healthy lifestyle under large-scale social restrictions. Multivariable logistic regression demonstrated that adults aged 36–45 years had a 3.6 times higher risk of weight changes than young adults aged 25–35 years (p = 0.004, OR = 3.65, 95% CI = 1.51–8.85).

CONCLUSIONS Social restrictions did not affect weight changes and perceptions of a healthy lifestyle in adults during the COVID-19 pandemic in Indonesia. However, older adults might have a higher risk of body weight changes. Controlling body weight is important to prevent further weight gain and the risk of noncommunicable diseases that can aggravate COVID-19.

Obesity in urban Indonesia: evidence from the 2007 and 2018 Basic Health Research

Ayunina Rizky Ferdina, Prisca Petty Arfines, Ni Ketut Aryastami — Wed, 24 Jul 2024 14:42:22 +0700

BACKGROUND The prevalence of obesity in urbanizing Indonesia is rising, where the double burden of malnutrition poses a significant challenge. This study aimed to examine the prevalence and increment of obesity-related noncommunicable diseases (NCDs) of diabetes and hypertension.

METHODS Secondary data from the latest 2018 Basic Health Research (RISKESDAS) were used to analyze the obesity rate and its associations with lifestyle, sociodemographics, and certain comorbidities among urban Indonesians. This study included non-pregnant adults aged ≥18 years who lived in the urban area and whose blood pressure and glucose levels were measured in the survey. Results were compared to a similar study using data from 2007.

RESULTS The proportion of obesity among Indonesia’s urban population was more than doubled from 23.0% in 2007 to 50.1% in 2018 for obesity and 28.0% to 57.2% for central obesity. Additionally, females, individuals with higher socioeconomic status, and higher education levels exhibited a higher obesity prevalence.

CONCLUSIONS Urban Indonesia has witnessed a dramatic rise in obesity prevalence. Our findings highlighted the urgent need for policymakers to consider the escalating prevalence of NCDs associated with obesity. Strengthening and concretizing health promotion and prevention policies at the community level are crucial to combat this alarming public health challenge.

Flaps or flat: a case report of double free flap survival after a prolonged cardiac arrest

Wed, 24 Jul 2024 14:43:11 +0700

This case addressed patient and free flap survival after cardiac arrest with the contentious use of vasopressors amid concerns about potential vasoconstrictive effects on flap vitality. A 59-year-old male with mucoepidermoid carcinoma underwent post-total maxillectomy and double free flap reconstruction (free fibular flap and anterolateral thigh free flap). Intraoperatively, he experienced cardiac arrest after anastomosis due to hypovolemia or hypoxia, requiring external cardiac massage and vasopressor administration. Despite the initial restoration of circulation, subsequent cardiac arrest ensued, necessitating further resuscitation. Postoperatively, vasopressors were also administered due to hemodynamic instability. Contrary to concerns, both flaps demonstrated sustained vitality, challenging prevailing apprehensions about vasopressor-induced vasoconstriction compromising flap viability. This observation suggests that vasopressors may not significantly threaten flap viability, prompting reconsideration of hesitations and encouraging further investigation. The study advocates for a judicious evaluation of vasopressor administration in free flap procedures, enriching clinical considerations for optimal patient care.

Front & Back Matter

Wed, 24 Jul 2024 00:00:00 +0700