eJournal Kedokteran Indonesia

Brain Atrophy in Patient with Delirium Tremens

2025-05-09T16:17:44+07:00

Approximately 3-5% of individuals undergoing alcohol cessation or reduction after chronic overuse develop delirium tremens (DT), a severe manifestation of alcohol withdrawal syndrome. Long-term alcohol consumption has been associated with brain atrophy. This case report discusses the findings of an early-onset cerebral atrophy in an alcohol withdrawal patient with DT. A 53-year-old man presented to the emergency unit with nausea and flank pain following the ingestion of a cocktail of alcoholic beverages the day prior. Physical examination showed an elevated blood pressure (223/146 mmHg) with no history of seizure. Within two days, the patient had shown a deterioration of consciousness. He was transferred to the high care unit and referred to the psychiatry department for signs of agitation. Psychiatric assessment revealed that the patient was delirious and experiencing auditory and visual hallucinations. A multi-slice computed tomography scan revealed cerebral atrophy. This case highlights the co-occurrence of brain atrophy and DT, emphasizing the importance of neuroimaging in patients with a history of alcohol use. Early recognition of cerebral changes may facilitate timely intervention, improve management of severe withdrawal, and guide preventive strategies in alcohol use disorder.

Comparison of Diagnostic Accuracy Between Stool Staining and Polymerase Chain Reaction in Diagnosing Intestinal Microsporidiosis

2026-02-03T11:47:30+07:00

Microsporidia are intracellular parasites that cause chronic diarrhea, particularly in immunocompromised individuals, where access to molecular diagnostics remains limited. A 27-year-old man with HIV on antiretroviral therapy presented with a 10-day history of profuse watery diarrhea. Initial stool examinations using modified Ziehl–Neelsen staining were negative, and PCR testing was not available, raising suspicion of intestinal microsporidiosis. The clinical question was whether, in immunocompromised patients with suspected intestinal microsporidiosis, stool smear staining methods are as accurate as PCR in terms of sensitivity and specificity. A structured literature review was conducted using PubMed, Cochrane, and Google Scholar for studies published up to 2025, using keywords including microsporidia, Enterocytozoon, Encephalitozoon, intestinal, diarrhea, diagnosis, detection, staining, and PCR. Eligible studies included those evaluating stool-based staining methods against PCR in immunocompromised patients. Articles were appraised using the STARD 2015 guideline and independently reviewed by two reviewers. Of 70 identified articles, 3 met the inclusion and validity criteria. Modified trichrome (MT) staining showed sensitivity ranging from 38.6% to 90.0% and specificity from 88.9% to 100%. Calcofluor white (CW) showed sensitivity ranging from 70.4% to 96.7% and specificity from 68.4% to 82.4%. Although PCR remains the reference standard, MT staining offers acceptable diagnostic performance and is a practical alternative in settings where molecular testing is not feasible.

Validity and Reliability Test of The Indonesian Version of The Work Stress Scale for Correctional Officers

2025-08-11T13:40:16+07:00

Occupational stress is one of the major issues in occupational health and safety. Correctional officers are one of the occupations with the highest levels of psychological stress and tend to be positive on screening for mental health disorders compared to other professions. The Work Stress Scale for Correctional Officers (WSSCO) is a questionnaire to assess work stress in correctional officers. This study aims to obtain a valid and reliable Indonesian WSSCO questionnaire. The study began with a transcultural adaptation process following WHO recommendations, which included forward translation, expert panel review, backward translation, pre-testing, and cognitive debriefing. Data collection was then conducted using consecutive sampling of 40 correctional officers in Jakarta in May 2025. This was followed by the assessment of content validity, construct validity, and internal consistency reliability. The Indonesian version of the WSSCO questionnaire had good content validity (ICVI = 1 and S-CVI ≥0.90). The Spearman correlation coefficient ranged from 0.331 to 0.853 (p < 0.05), indicating satisfactory construct validity. Internal consistency reliability was high, with a total Cronbach’s α of 0.964 and subscale Cronbach’s α values ranging from 0.778 to 0.936. The Indonesian version of WSSCO is a valid and reliable tool for assessing work stress in correctional officers.

Quality of Life Outcomes in Pelvic Organ Prolapse Patients After Total Vaginal Hysterectomy: A Prospective Study Using PFDI-20

2026-03-03T11:19:24+07:00

Pelvic organ prolapse (POP) is a common gynecological condition that can significantly impair women's quality of life through pelvic, urinary, and bowel symptoms. This study aimed to evaluate changes in Pelvic Floor Distress Inventory-20 (PFDI-20) scores in patients with POP before and three months after undergoing total vaginal hysterectomy (TVH). A prospective, analytical, observational study employing a cohort design was conducted at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, between January and July 2024. Patients diagnosed with POP who underwent total vaginal hysterectomy were included in the study. The PFDI-20 questionnaire was administered preoperatively and three months postoperatively. The instrument consists of three subscales: the Pelvic Organ Prolapse Distress Inventory (POPDI-6), the Colorectal–Anal Distress Inventory (CRADI-8), and the Urinary Distress Inventory (UDI-6). Statistical analyses were performed to compare preoperative and postoperative scores. A total of 30 patients met the inclusion criteria and completed both assessments. The mean age of participants was 61.73 years (range 49–74 years), with a mean parity of 3.97 (range 1–8). Significant reductions in POPDI-6, CRADI-8, UDI-6, and total PFDI-20 scores were observed three months after TVH compared with preoperative values (p = 0.001). Overall, postoperative PFDI-20 scores were markedly lower than preoperative scores, indicating substantial improvement in pelvic floor–related symptoms. These findings suggest that total vaginal hysterectomy provides significant improvement in pelvic floor distress symptoms among women with pelvic organ prolapse.

Comparing Clinical Outcomes Between Flexible and Fixed Progestin-Primed Ovarian Stimulation

2026-02-26T15:00:05+07:00

Controlled ovarian stimulation (COS) is essential in assisted reproductive technology (ART) to obtain multiple oocytes. Gonadotropin-releasing hormone (GnRH) analogues have been used to prevent the premature luteinizing hormone (LH) surges. However, daily injections and high cost cause inconvenience and limit patients’ adherence. Recently, progestin-primed ovarian stimulation (PPOS) has emerged as an alternative. However, the optimal timing of progesterone administration remains unclear. This systematic review aimed to compare clinical outcomes between a fixed regimen that initiates progestin at the beginning of the cycle and a flexible regimen that initiates progestin later in the cycle. A comprehensive literature search was conducted in PubMed, Cochrane, Medline, and Embase Library to identify relevant studies published between January 2018 and April 2024. It was supplemented by manual searches, which identified 3 eligible retrospective cohort studies directly comparing fixed and flexible PPOS protocols. Selected studies were systematically appraised. Two studies in women with diminished ovarian reserve (DOR) found no significant differences between the two regimens, whereas one study in poor ovarian responders (POR) found a higher cumulative live birth rate (CLBR) and lower progesterone use in the flexible group, especially in older, low-prognosis women. Flexible and fixed PPOS regimens show comparable outcomes in DOR patients. Still, preliminary evidence shows potential advantages of the flexible timing in women with advanced age or POR. Therefore, future large-scale prospective studies are needed to validate these findings.