eJournal Kedokteran Indonesia

Neurosifilis Terverifikasi pada Pasien HIV dengan Keterlibatan Okular Berdasarkan Reaktivitas TPHA dan RPR Cairan Serebrospinal

2025-08-12T10:15:55+07:00

Neurosifilis merupakan manifestasi infeksi Treponema pallidum di sistem saraf pusat, yang dapat terjadi terutama pada kondisi imunosupresi, seperti infeksi human immunodeficiency virus (HIV). Seorang laki-laki berusia 32 tahun datang ke Poli Pokdisus RSCM pada bulan Juni 2024 dengan riwayat HIV dan pernah menghentikan terapi antiretroviral. Pasien mengeluhkan gangguan penglihatan bilateral selama empat bulan, disertai riwayat ulkus genital serta lesi eritematosa di telapak tangan dan kaki. Pemeriksaan laboratorium menunjukkan uji serologi non-treponemal (Rapid Plasma Reagin/RPR), treponemal (Treponema pallidum Haemagglutination Assay/TPHA) serum dan cairan serebrospinal (CSF) memberikan hasil reaktif, pleositosis (47 sel/µL), dan kadar protein CSF (56 mg/dL) meningkat. Temuan ini memenuhi kriteria verified neurosyphilis menurut Centers for Disease Control and Prevention tahun 2022. Reaktivitas TPHA dan RPR masing-masing merupakan pemeriksaan yang sensitif dan spesifik untuk diagnosis neurosifilis. Reaktivitas keduanya sangat mendukung penegakan diagnosis. Uveitis posterior sebagai manifestasi okular yang paling sering pada neurosifilis semakin memperkuat diagnosis ini, dengan HIV sebagai faktor risiko utama. Evaluasi lanjutan meliputi analisis ulang cairan serebrospinal, evaluasi RPR cairan otak, viral load HIV, kadar CD4+, serta fungsi ginjal dan hati. Evaluasi ini penting untuk memantau respons terhadap terapi neurosifilis dan HIV, serta potensi toksisitas antiretroviral. Kasus ini menekankan bahwa neurosifilis harus dipertimbangkan pada pasien HIV dengan keluhan okular. Diagnosis ditegakkan melalui integrasi data klinis, analisis cairan serebrospinal, dan reaktivitas uji serologi.

Foreign Body in Vagina: A Year-Long Retained Toothbrush Cap

2024-10-09T14:44:49+07:00

The presence of a foreign body (corpus alienum) in the vagina is a rare condition that can occur in women of all ages. These objects may be inserted for various reasons, including medical treatment, contraception, sexual gratification, or concealment of illicit substances. Diagnosis is often delayed due to patient denial or embarrassment, which can lead to serious health complications.This report presents the case of a 21-year-old woman who experienced brown-black, foul-smelling vaginal discharge after inserting a toothbrush cap into her vagina and leaving it in place for one year. She first sought medical attention at the Obstetrics and Gynecology Clinic of UNS Hospital on August 20, 2024. She also reported amenorrhea for the past four months. Physical examination revealed that the toothbrush cap was embedded in the vaginal tissue. Surgical removal was performed under spinal anesthesia. During the procedure, hardened vaginal tissue was observed, and histopathological analysis showed suppurative chronic inflammation, granulation tissue formation, and fibrosis. This case of retained corpus alienum in the vagina serves as a valuable learning opportunity in the fields of diagnosis and therapy within urogynecology, highlighting the importance of addressing uncommon yet significant medical conditions.

Management of Pulmonary Tuberculosis in Patient with Schizophrenia

2025-03-13T13:30:34+07:00

Schizophrenia affects human cognition, emotion, perception, and other psychosocial skills which is prone to medical noncompliance. Medication adherence or compliance of people with schizophrenia will not be achieved without a shared understanding between professionals, carers and patients regarding medication efficacy, insight, side effects, medication attitudes, and external factors. Recent study found that 32.8% of tuberculosis patients in Indonesia were also managed for psychotic disorders. Furthermore, the treatment coverage of tuberculosis in Aceh Province in 2022 was far below the national average (74,7%), which only reached 52,6%. Rifampicin, a potent anti-tubercular agent, is known to significantly induce several CYP enzymes. As a result, rifampicin may accelerate metabolism of other drugs, in this case antipsychotics, leading to reduced plasma concentrations and potentially diminishing their therapeutic effects. This article reported a case of newly diagnosed pulmonary tuberculosis of a 41-year-old male with schizophrenia in primary healthcare.

Kecerdasan Buatan dan Kesehatan

2025-07-28T10:13:47+07:00

Defisiensi Mikronutrien Zinc sebagai Faktor Risiko Kejang Demam pada Anak di Asia: Sebuah Meta-Analisis

2025-01-13T11:21:01+07:00

Kejang demam dikaitkan dengan berbagai faktor, termasuk riwayat keluarga, infeksi virus, demam tinggi, dan defisiensi nutrisi. Zinc berperan dalam modulasi kejang dengan mengatur neurotransmiter dan menghambat reseptor NMDA, sehingga mengurangi eksitabilitas neuron. Defisiensi zinc dapat meningkatkan aktivitas reseptor, memicu keluaran epileptiform pada anak dengan demam. Meta-analisis ini menentukan prevalensi defisiensi zinc pada anak dengan kejang demam di Asia. Telaah sistematis dilakukan sesuai PRISMA 2020, menganalisis studi dari Google Scholar, MEDLINE, ProQuest, ScienceDirect, dan Scopus. Protokol terdaftar di PROSPERO (CRD42023473671). Studi observasional analitik berbahasa Inggris (2013–2022) yang melaporkan kadar zinc serum pada anak 6–60 bulan dianalisis. Kriteria eksklusi antara lain: studi deskriptif, laporan kasus, editorial, ulasan, disertasi, publikasi ganda, serta penelitian tanpa full-text, effect size, atau nilai-p. Enam studi dengan 776 anak dianalisis, mayoritas menggunakan desain kasus-kontrol. Meskipun hubungan defisiensi zinc dan kejang demam tidak signifikan (OR=2,87, IK 95%=0,56–14,83, p=0,21), odds ratio menunjukkan peningkatan risiko. Prevalensi defisiensi zinc pada anak dengan kejang demam sebesar 30,7%, menekankan perlunya penelitian lebih lanjut untuk memperjelas hubungan ini dan mendukung intervensi kesehatan masyarakat.

The Role of miRNA as Diagnostic Biomarkers of NSCLC through PCR-based Serum Analysis: Systematic Review

2025-01-13T11:12:18+07:00

Non-small cell lung cancer (NSCLC) is usually detected late, even with various conventional methods. Serum microRNA (miRNA) shows potential as a sensitive and specific biomarker for diagnosing NSCLC. A literature search was conducted on the PubMed, ScienceDirect, and Cochrane databases using specifickeywords. Six studies were selected that met the criteria for NSCLC patients, testing miRNA expression through PCR and comparing it with the conventional biomarker, CEA. Eight potential miRNA biomarkers were identified. MiR-21-5p demonstrated the highest sensitivity (96.7%) and specificity (95%), surpassing the performance of the conventional CEA biomarker (sensitivity 26.4%–83.8%; specificity 53.7%–93.6%). miRNA, particularly miR–21-5p, shows strong potential as a diagnostic biomarker for NSCLC. Despite variability in results across studies, data suggest that miRNA outperforms CEA. Further research is needed to optimize miRNA for clinical diagnosis.

The Development of Causative Patterns of Cleft Lip and Palate in Eastern Indonesia

2025-04-22T14:50:53+07:00

Cleft lip or cleft palate (CL/P) is a congenital disorder involving genetic and environmental factors. Eastern Indonesia is a region with the fourth-highest incidence of CL/P in Indonesia. Low socioeconomic conditions in this region are thought to contribute to the high prevalence of CL/P, both directly and through maternal health and environmental factors. This study aims to identify and analyze the evolving patterns of causative factors for cleft lip and/or palate (CL/P) in Eastern Indonesia. Conducted between February and October 2024, the research employs a cross-sectional design integrated with a path analysis approach to explore the complex interplay between environmental exposures and genetic predispositions contributing to CL/P in the region. Purposive sampling was used to interview families of CL/P patients to gather samples; the number of respondents was chosen based on the predetermined inclusion criteria. The data obtained were then analyzed using path analysis to examine the relationship between environmental and genetic factors, utilizing the SmartPLS 4.0 software. This study showed that social factors significantly affected CL/P with a t-statistic value of 0.043. Meanwhile, neither economic nor genetic factors had a significant effect. This result may be attributed to limited awareness among families regarding genetic influences, such as those identified through pedigree tracing in individuals with CL/P. Furthermore, as public knowledge has improved, the incidence of consanguineous marriages in Eastern Indonesia has declined, which is one factor that influences CL/P from a genetic perspective. This study highlights the importance of social and economic interventions in reducing the incidence of CL/P. It emphasizes the need for further research employing a genetic analysis approach to obtain more comprehensive results.

Intraoperative Burden of Open Cervical Spine Surgery: A Cross-Sectional Analysis of Complex Cases

2025-07-23T13:34:33+07:00

Open cervical spine surgery is commonly performed for complex spinal conditions requiring instrumentation or multilevel intervention. Although minimally invasive spine surgery (MISS) offers potential benefits in reducing tissue trauma, its applicability in complex cervical procedures is still unclear. This study aimed to evaluate the intraoperative burden and clinical outcomes of open cervical spine surgery in complex cases. A five-year cross-sectional analysis was conducted, including 48 patients undergoing cervical spine surgery. Data collected included operative time, estimated intraoperative blood loss (EIOBL), postoperative hemoglobin and leukocyte changes, and length of stay (LOS). Patients were stratified by the use of instrumentation and extent of surgery (≥3 versus <3 vertebral levels). The mean operative time was 256 ± 95 minutes, with a mean EIOBL of 252 ± 223 mL. Surgery involving ≥3 vertebral levels was significantly associated with longer operative time (p = 0.012), but not with increased EIOBL, laboratory changes, or LOS. Instrumentation, used in 71% of cases, was associated with increased operative time and blood loss, although these differences were not statistically significant. In conclusion, open cervical spine surgery in complex settings increases operative time but does not significantly impact perioperative morbidity. Surgical complexity likely contributes more to intraoperative burden than surgical approach.

Uji Kesahihan Konstruks dan Keandalan Alat Ukur Skala Pemulihan Pasien Skizofrenia

2025-04-24T15:54:42+07:00

Skizofrenia merupakan gangguan mental yang kompleks dan berat, ditandai dengan perjalanan penyakit yang kronis serta gejala yang beragam. Kondisi ini menimbulkan tantangan signifikan bagi individu, karena memengaruhi berbagai aspek kehidupan seperti hubungan sosial, pekerjaan, dan pencapaian tujuan hidup. Di Indonesia, telah dikembangkan alat ukur penilaian pemulihan yang relevan dengan nilai budaya lokal, yaitu skala pemulihan pasien skizofrenia (SPPS) yang saat ini telah melalui tahap uji kesahihan isi. Oleh karena itu, diperlukan penelitian untuk mengevaluasi kesahihan konstruk dan keandalannya. Penelitian ini bertujuan untuk menguji validitas konstruk dan keandalan kuesioner SPPS. Penelitian menggunakan desain penelitian potong-lintang yang dilakukan di dua rumah sakit, yaitu Rumah Sakit dr. Cipto Mangunkusumo (Jakarta) dan Rumah Sakit dr. H. Marzoeki Mahdi (Bogor, Jawa Barat). Subjek penelitian sebanyak 200 pasien dengan diagnosis skizofrenia yang memenuhi kriteria inklusi, direkrut menggunakan teknik consecutive sampling pada September-November 2023. Analisis data dilakukan melalui uji kesahihan konstruk menggunakan analisis faktor eksploratori (EFA) dan analisis faktor konfirmator (CFA), serta uji keandalan menggunakan Cronbach’s alpha. Hasil EFA menunjukkan bahwa terdapat 28 butir pernyataan yang terdiri dari enam dimensi dengan kesahihan konstruks yang baik (chi-square p=0,053; root mean square error of approximation=0,036) dengan nilai loading factor berkisar 0,60-0,91. Nilai keandalan dinilai sedang dengan Cronbach alpha 0,959. Disimpulkan bahwa alat ukur SPPS dinilai sahih dan handal untuk menilai kondisi pemulihan pada pasien dengan spektrum skizofrenia.

Profile and Risk Factors of Children with Isolated Ventricular Septal Defect in dr. Cipto Mangunkusumo Hospital

2025-06-18T08:46:13+07:00

Ventricular septal defect (VSD) is the most prevalent congenital heart disease (CHD). While various risk factors for isolated VSD exist, the specific risk factors and patient profiles for isolated VSD cases at dr. Cipto Mangunkusumo Hospital (CMH) remains undisclosed. Thus, this study aims to investigate this information. Data were obtained from medical records and or patients’ parent interviews. The data were then analyzed using the Statistical Package for Social Sciences (SPSS) version 20 for Windows. The chi-square and Fisher's exact tests were used to investigate the association of the variables. This case-control study investigated 40 isolated VSD patients and 40 control patients, aged 1 month to 18 years, at CMH in 2020. For the risk factors, the presence of a genetic syndrome such as Down syndrome [OR 2.143 (CI 95% 1.682–2.729), p=0.02] was confirmed from 40 VSD patients as the only risk factor of isolated VSD in this population. However, several other parameters including socio-economic status (p=0.491), maternal age when pregnant (p=0.745), paternal smoking (p=0.370), maternal gestational diabetes (p=0.494), maternal smoking history during pregnancy (p=1), and maternal alcohol intake history during pregnancy (p=1) did not correlate with isolated VSD in this population. Children with Down syndrome are at risk of isolated VSD, compared to children without a genetic syndrome.

Characteristics of Pediatric Ocular Injury in a Tertiary Healthcare Facility in West Borneo

2025-04-24T15:43:57+07:00

Sudden vision loss in the pediatric population caused by ocular injury significantly reduces their quality of life. This study aims to describe the demographics, clinical manifestations, causes of injury, and management of ocular injury in the pediatric population. A retrospective review was conducted on pediatric ocular injury cases presented to Dr. Soedarso General Hospital in West Borneo, which were recorded from January 2020 to December 2024. Demographic data, types of injury, causes of injury, and management approach were extracted for the study. The ocular injury was classified according to Birmingham Eye Trauma Terminology. A total of 25 patients were included in the study, which consisted of 18 males and 7 females with a mean age of 8.08+4.15 years (3-16 years old). Almost all cases occurred unilaterally (n=24), with open globe injuries being the most common type (n=18). The surrounding environment and organic materials played significant roles in the occurrence of ocular injury (n=12). Around half of the cases (n=13) were not managed by ophthalmologists within 24 hours of the injury. Understanding the pattern of pediatric ocular injury may increase awareness of the occurrence of trauma among general practitioners, which may prevent further injuries.

The Expression of LFA-1, MMP-9, and Dicer1 in The Histological Grading of Colorectal Cancer

2025-03-06T13:59:49+07:00

Colorectal cancer (CRC) remains one of the most common cancers in many Asian countries, alongside lung and breast cancer. Tumor dissemination to the organs, particularly the liver, contributed to the mortality of this disease. The β2 subunit of lymphocyte function-associated antigen-1 (LFA-1) was revealed to cause impairments in liver endothelial activation, cytokines release, and tumor cell retention in the liver of CRC in the in vivo study. Epigenetic and matrix metalloproteinase (MMP)-9 are essential for CRC progression and poor prognosis. Tumor differentiation grade correlates with TNM staging, prognostic factors, patient survival, and lymph node metastasis. This study aimed to investigate the expression of the β2 subunit of LFA-1, MMP-9, and Dicer1 in the histological grading of CRC. A total of 38 formalin-fixed paraffin-embedded (FFPE) CRC samples were classified into low-grade, high-grade, and histology variants. Tissue samples were processed for qRT-PCR to examine the β2 subunit of LFA-1 expression and immunohistological staining to evaluate Dicer1 and MMP-9 expression. The results show that the expression of LFA-1 was significantly higher in high-grade compared to low-grade (p<0.05), except for mucinous type adenocarcinoma. In contrast, no significant difference was found in Dicer1 and MMP-9 expressions of all grades of CRC (p>0.05). In addition, no significant correlation (p>0.05) was found between Dicer1 expression and LFA-1 and MMP-9. In conclusion, the expression of LFA-1 is upregulated in high-grade tumors; however, Dicer1 and MMP-9 expressions are not correlated with the histological grade.

Effect of Low-Dose Chlorpyrifos on Hepatocyte Necrosis and Serum Albumin Levels in Wistar Rats

2025-02-24T16:10:14+07:00

Chlorpyrifos is a broad-spectrum organophosphate pesticide that also causes various health problems. The active metabolite of chlorpyrifos can increase free radicals in the body, especially in the liver and kidneys. The continuous increase in free radicals will cause an imbalance between free radicals and oxidants, triggering oxidative stress. Oxidative stress stimulates mitochondrial dysfunction, resulting in changes in the hepatocyte shape and serum albumin levels. This study aimed to determine the effect of chlorpyrifos on the hepatic histopathology scores and serum albumin levels of Wistar rats. Experimental research was conducted at the Faculty of Medicine, University of Jember in May-December 2024. A total of 12 male Wistar rats were divided into two groups. The control group was given normal saline (+5% Tween 20), and the chlorpyrifos group was given chlorpyrifos + normal saline (+5% Tween 20) orally for 7 days. On the 8th day, all animals were euthanized with ketamine-xylazine, hepatic organs, and blood were taken intracardiac. Preparations were made using HE staining, and serum albumin levels were checked using a photometer. The results showed that hepatic histopathology scores assessed by the Manja Roenigk method and serum albumin levels had significant differences between the groups metabolized. Seven days of chlorpyrifos exposure can increase hepatocyte necrosis and decrease serum albumin levels.

Efektivitas Pemberian Secretome secara Intravena Dibandingkan dengan Intratrakeal terhadap Paru-paru Tikus Sprague Dawley yang Terpapar Asap Rokok Kretek

2025-07-23T11:24:23+07:00

Sistem pernapasan manusia membutuhkan paru-paru untuk memenuhi kebutuhan oksigen tubuh. Namun, gangguan dan kelainan pada paru dapat mengganggu fungsi sistem pernapasan dan dapat membahayakan fungsinya jika tidak ditangani dengan serius. Asap rokok adalah penyebab utama kerusakan paru, yang juga dapat menyebabkan peradangan dan perubahan histologi. Studi ini dilakukan di laboratorium dan menggunakan pengambilan simple random sampling. Penelitian eksperimental ini menggunakan tikus jantan Sprague Dawley yang dipaparkan asap rokok kretek selama 18 hari. Secretome diberikan sebanyak 0,4 ml pada hari ke-5, 10, dan 15 melalui rute intravena dan intratrakeal. Tikus dibagi menjadi empat kelompok: kontrol negatif, kontrol positif (paparan asap tanpa secretome), secretome intravena, dan secretome intratrakeal. Pemeriksaan histopatologi paru dilakukan dengan pewarnaan hematoksilin-eosin untuk menilai perubahan jaringan.Tikus yang menerima secretome secara intratrakeal menunjukkan perbaikan histologis paru yang lebih signifikan dibandingkan kelompok intravena, ditandai dengan penurunan kejadian pneumonia, fibrosis, peribronkiolitis, dan trakeitis. Uji statistik menunjukkan bahwa pemberian intratrakeal memiliki pengaruh terapeutik yang lebih baik dibandingkan intravena (p<0,05 pada sebagian besar parameter). Pemberian secretome secara intratrakeal lebih efektif dalam memperbaiki kerusakan paru-paru akibat paparan asap rokok dibandingkan rute intravena. Temuan ini mendukung penggunaan secretome melalui rute lokal sebagai pendekatan terapeutik yang menjanjikan untuk penyakit paru-paru akibat paparan toksik.

Correlation Between Neutrophil-to-Lymphocyte Ratio (NLR) and Length of Hospital Stay in Pediatric Patients with Dengue Hemorrhagic Fever

2025-07-15T09:25:13+07:00

Dengue hemorrhagic fever (DHF) is a tropical infectious disease that remains a serious global health concern. During the critical phase of the illness, the neutrophil-to-lymphocyte ratio (NLR) decreases, exacerbating the infection and facilitating dengue virus replication in mononuclear blood cells. A lower NLR value is thought to be associated with a longer duration of hospitalization. This study aims to investigate the correlation between NLR and the length of hospitalization in pediatric patients with DHF at Mohammad Hoesin Hospital, Palembang. This study employed an analytical observational cross-sectional design using secondary data collected from August to December 2023. A total of 67 children met the inclusion criteria. The predominant characteristics included age 5–10 years (52.2%), male (47.8%), female (52.2%), DHF grade II (46.3%), and a history of 5 days of fever (44.8%). Bivariate analysis revealed no correlation between NLR and the length of hospitalization in pediatric DHF patients (p=0.068; r=0.224). To conclude, there is no correlation between the NLR value and the duration of hospitalization in pediatric DHF patients at Mohammad Hoesin Hospital, Palembang.

Post-TURP Urethral Stricture Cases in Jakarta: a Survey-Based Study of Urologists' Clinical Experience

2024-12-18T09:38:53+07:00

Urethral stricture is a common late complication after transurethral resection of the prostate (TURP) procedure, but the incidence is varied. The objective of this study was to explore urologists’ general clinical practices in performing TURP and to identify reported occurrences of post-TURP urethral strictures and associated procedural factors, based on a regional survey of urologists. This cross-sectional study used a self-designed online questionnaire, targeting all registered urologists in Jakarta and several surrounding areas. A total of 73 urologists completed the questionnaire. In Jakarta, the number of post-TURP stricture cases reported by individual urologists ranged from 2 to 10 cases annually. Most urologists performed a low number of TURP procedures (43.8%), with the majority completing the procedure in less than 60 minutes (89%). A German-manufactured resectoscope was predominantly used (87.7%), along with monopolar energy (76.7%), and warm irrigation was generally not employed (94.5%). The postoperative catheter dwelling time was predominantly 3–7 days (78.1%). Most respondents (86.3%) reported having encountered at least one post-TURP urethral stricture during their practice. Most strictures were located in the bulbomembranous urethra (68.5%) and were primarily managed using internal urethrotomy (61.9%). In conclusion, although exact incidence rates were not determined, most urologists in Jakarta reported experience with post-TURP stricture cases. Internal urethrotomy and urethral dilation were the most reported treatment methods, although treatment outcomes remain unclear.

Efektivitas Penggunaan High-Efficiency Particulate Air (HEPA) Filter terhadap Asma pada Pasien Anak

2025-05-21T14:22:28+07:00

Asma termasuk salah satu penyakit kronis yang paling sering dijumpai pada anak-anak, dan kemunculannya dapat dipengaruhi oleh faktor lingkungan, seperti kualitas udara dalam ruangan. Salah satu upaya yang dapat dilakukan untuk mengurangi risiko timbulnya asma pada anak adalah dengan menggunakan penyaring udara high-efficiency particulate air (HEPA), yang berfungsi menyaring partikel PM2.5 guna meningkatkan kualitas udara dalam ruangan. Studi ini membahas sebuah kasus anak dengan riwayat eksaserbasi asma akut yang berulang setelah dimulainya proyek pembangunan di sekitar tempat tinggalnya. Tujuan dari studi ini adalah untuk menilai efektivitas penggunaan filter HEPA dalam mengurangi gejala dan morbiditas asma pada anak-anak. Penelusuran literatur dilakukan melalui database PubMed dan ScienceDirect, kemudian artikel yang ditemukan diseleksi berdasarkan kriteria inklusi dan eksklusi, lalu dievaluasi menggunakan panduan dari Oxford Centre for Evidence-Based Medicine dan alat penilaian kritis. Tiga artikel ranomized-controlled trial terpilih menunjukkan bahwa penggunaan filter HEPA dapat mengurangi gejala asma, memperbaiki kontrol asma, dan menurunkan jumlah kunjungan medis yang tidak terencana. Dari hasil tersebut disimpulkan bahwa filter HEPA berpotensi menjadi strategi tambahan yang efektif untuk meningkatkan kualitas udara serta menekan gejala dan morbiditas asma pada anak, terutama yang tinggal di daerah dengan tingkat polusi udara tinggi.