eJournal Kedokteran Indonesia (eJKI) is a general medical journal, published quarterly (April, August, December) by Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia. The official journal title is eJournal Kedokteran Indonesia and the abbreviated title is eJKI. Authors can submit manuscripts to eJKI through the website. All correspondences to the corresponding author will be sent electronically. Last accredited (2019-2023) by Directorate General of Higher Education, Research, and Technology of the Ministry of Education, Culture, Research, and Technology of the Republic of Indonesia with Second Grade (https://sinta.kemdikbud.go.id/journals/detail?page=15&id=1662)
Faculty of Medicine Universitas Indonesia
Pemberantasan Pedikulosis Kapitis Menggunakan Metode Penyisiran Basah
Pediculus humanus capitis adalah ektoparasit yang banyak dijumpai di masyarakat terutama pada anak sekolah dasar. Parasit tersebut tersebar luas, mudah menular dan menyerang seluruh anggota keluarga bahkan dapat menyerang kelompok masyarakat misalnya asrama atau sekolah. Prevalensi pedikulosis lebih tinggi pada anak-anak dan infestasi pada anak perempuan lebih berat serta lebih sering dari anak laki-laki. Gejala utama pedikulosis adalah gatal sehingga pasien sering menggaruk yang memicu infeksi sekunder oleh bakteri dan menimbulkan pioderma, impetigo dan furunkulosis. Diagnosis pasti ditetapkan dengan menemukan nimfa atau tuma dewasa. Pengobatan pedikulosis dilakukan dengan antihistamin untuk mengatasi gatal dan antibiotik untuk infeksi sekunder oleh bakteri. Insektisida yang paling efektif untuk membunuh nimfa dan tuma dewasa adalah permetrin 1% dalam bentuk losio, krim atau sampo yang dioleskan secara merata di kepala kemudian dibiarkan selama 10 menit dan dikeramas. Namun, tidak semua masyarakat mampu membeli permetrin dan ada pula yang alergi terhadap insektisida tersebut. Oleh karena itu, terapi yang aman dan murah adalah secara mekanik menggunakan metode penyisiran basah yaitu membasahi rambut dengan kondisioner atau minyak kelapa kemudian rambut disisir dengan serit setiap 3-4 hari selama 2 minggu.
Copyright (c) 2026 Saleha Sungkar https://creativecommons.org/licenses/by-sa/4.0
Quality of Life Outcomes in Pelvic Organ Prolapse Patients After Total Vaginal Hysterectomy: A Prospective Study Using PFDI-20
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.
Copyright (c) 2026 Mochamad Rizkar Arev Sukarsa, Triana Rahmanita, Anita Rachmawati, Raden Mas Sonny Sasotya, Andi Rinaldi, Eppy Darmadi Achmad, Raden Kania Praharsini, Aria Prasetya Masoem, Aisyah Shofiatun Nisa https://creativecommons.org/licenses/by-sa/4.0
Comparing Clinical Outcomes Between Flexible and Fixed Progestin-Primed Ovarian Stimulation
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.
Copyright (c) 2026 R Muharam, Edward Christopher Yo, Tasya Kartika, Alisha Nurdya Irzanti, Achmad Kemal Harzif, Mila Maidarti, Gita Pratama, Kanadi Sumapraja, Andon Hestiantoro, Budi Wiweko https://creativecommons.org/licenses/by-sa/4.0
Effect of Recombinant Human BMP-2 Combined with Synthetic Bone Graft on Osteocalcin and Alkaline Phosphatase Expression in a Rat Bone Defect Model
Bone regeneration is a natural process; however, large bone defects can impair healing, necessitating interventions such as bone grafting. Autografts are the gold standard, but they have limitations. This study evaluates the effects of bone tissue engineering (BTE) using rh-BMP2 and synthetic bone grafts on bone healing, focusing on osteocalcin (OC) and BMP-2 as biomarkers of osteoblast activity. A randomized posttest-only control group design was employed. Thirty male Wistar rats were divided into five groups: synthetic bone graft, rh-BMP2, combined rh-BMP2 and synthetic graft, positive control (bone defect with no treatment), and negative control (no defect). Alkaline phosphatase (ALP) and OC levels were measured after four weeks. Statistical analysis was conducted using SPSS 29.0. OC levels differed significantly among groups (p < 0.05), with the positive control group exhibiting higher levels than all treatment groups. No significant differences were observed between the negative control group and the two treatment groups, while a difference was noted with the third treatment group. Alkaline phosphatase levels showed no difference between the negative control and other groups; however, the positive control group was higher than two treatment groups (p<0.05). The positive control demonstrated greater osteoblastic activity, while the combination treatment was not superior. BTE with rh-BMP2 and synthetic bone grafts significantly enhances bone healing, making the combination more effective than either treatment alone. This method shows potential for treating large bone defects clinically.
Copyright (c) 2026 Panji Sananta, Thomas Erwin Christian Junus Huwae, Ananto Satya Pradana, Alifian Alifian https://creativecommons.org/licenses/by-sa/4.0
Comparison of Diagnostic Accuracy Between Stool Staining and Polymerase Chain Reaction in Diagnosing Intestinal Microsporidiosis
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.
Copyright (c) 2026 Edho Yuwono, Ajib Diptyanusa, Agnes Kurniawan https://creativecommons.org/licenses/by-sa/4.0
Brief Report: Evaluation of Ziehl-Neelsen Slide Restaining with 0.4% Malachite Green for Identifying Cyclospora cayetanensis Oocysts
Cyclospora cayetanensis oocysts are typically identified using Ziehl-Neelsen acid-fast staining. However, slides that have been stored for extended periods often experience color fading, reducing visual clarity and unsuitable for training and educational purposes. This study aimeds to evaluate the effectiveness of re-staining with 0.4% malachite green in enhancing the contrast and visualization of Cyclospora oocysts on faded slides. This study used a quantitative experimental laboratory design. Ten positive slides stored at the Clinical Parasitology Laboratory, Universitas Indonesia, were selected based on the degree of fading and thickness of staining. Each slide was (destained with methanol, then??) restained with 0.4% malachite green for 30 seconds. After drying, the slides were examined under a light microscope, and oocysts were manually counted. Restaining restored the background to a bluish-green color, improving visual contrast and facilitating oocyst identification. Restaining Ziehl-Neelsen slides by adding 0.4% malachite green is a simple and effective method for enhancing visualization and accurate counting of C. cayetanensis oocysts.
Copyright (c) 2025 Sri Wahdini, Raphael Salim, Ika Puspa Sari, Agnes Kurniawan https://creativecommons.org/licenses/by-sa/4.0
Fukoidan Ekstrak Alga Cokelat Dienkapsulasi Nanopartikel sebagai Potensi Terapi Spesifik Aterosklerosis
Aterosklerosis merupakan penyebab utama kematian akibat penyakit kardiovaskular secara global, dengan prevalensi yang terus meningkat di Indonesia akibat tingginya angka hiperkolesterolemia, diabetes melitus, dan hipertensi. Meskipun terapi konvensional seperti statin efektif dalam menurunkan kadar LDL, keterbatasan efikasi jangka panjang dan efek samping yang serius seperti rhabdomyolysis, miopati, dan risiko diabetes tetap menjadi tantangan utama. Literatur ini mengulas potensi fukoidan, polisakarida tersulfat yang berasal dari alga cokelat, sebagai agen terapi inovatif untuk aterosklerosis, terutama ketika dikombinasikan dengan sistem penghantaran berbasis nanopartikel. Tinjauan dilakukan terhadap empat studi eksperimental yang relevan, dengan metode pencarian sistematis menggunakan database Science Direct, Elsevier, Wiley Online Library, dan Google Scholar, serta pemilihan artikel lima tahun terakhir yang membahas penggunaan fukoidan dan sistem nanopartikel pada model aterosklerosis. Hasil analisis menunjukkan bahwa fukoidan memiliki efek antiinflamasi, antioksidan, dan imunomodulator yang kuat, serta afinitas tinggi terhadap P-selectin dan SR-A, menjadikannya ligan ideal untuk penargetan spesifik ke jaringan vaskular yang meradang. Kombinasi fukoidan dengan nanopartikel seperti liposom dan kitosan meningkatkan stabilitas penghantaran, memungkinkan pelepasan obat yang responsif terhadap kondisi mikro lingkungan plak, dan menurunkan ekspresi sitokin proinflamasi seperti TNF-α dan IL-6. Temuan ini menunjukkan bahwa penggunaan fukoidan dalam sistem penghantaran nanopartikel memiliki potensi signifikan dalam terapi presisi aterosklerosis, dengan keuntungan dalam efikasi, spesifisitas, dan keamanan. Kajian ini menyimpulkan bahwa fukoidan berpotensi menjadi alternatif atau pelengkap dari terapi konvensional serta membuka arah baru dalam pengembangan pengobatan aterosklerosis berbasis bioteknologi kelautan.
Copyright (c) 2025 Mahlil Jibran, Riza Daffa Firdaus, Maryatun Hasan https://creativecommons.org/licenses/by-sa/4.0
The Correlation of Academic Achievement Index and Mental Health of Medical Students
Academic achievement and mental health are critical determinants of success in medical education and future clinical performance. Grade Point Average (GPA) is widely used as an objective indicator of academic achievement and is often assumed to reflect academic stress. However, evidence regarding its association with mental health remains inconsistent, particularly in Indonesian medical education, where psychosocial and institutional factors may play an important role. This study aimed to examine the relationship between GPA and mental health among medical students and to inform student support policies. A cross-sectional study conducted from August to December 2024 involved a sample of 132 fourth-year medical students at Syiah Kuala University, selected through simple random sampling. Academic achievement was assessed using cumulative GPA, while mental health status was evaluated using the General Health Questionnaire (GHQ-28), encompassing somatic symptoms, anxiety, social dysfunction, and depression. The median GPA was 3.30 (range 2.30–3.86), and the median GHQ-28 score was 28 (range 4–74). Mental health problems were prevalent, with 56.1% of students reporting somatic symptoms, 59.8% anxiety and insomnia, 52.3% social dysfunction, and 23.5% depressive symptoms. Correlation analysis showed no significant association between GPA and overall mental health status (p>0.05). These findings suggest that academic performance alone does not adequately capture psychological well-being among medical students. Comprehensive mental health screening and integrated student support systems that address academic stress, personal challenges, and social factors are needed to promote student well-being in medical education.
Copyright (c) 2025 Teuku Muhammad Yus, Hilmee Kuno, Meilya Silvalila, Zulfa Zahra, Muhsin Muhsin https://creativecommons.org/licenses/by-sa/4.0
Implementasi Optimalisasi Strategi Pelayanan Stroke Hiperakut Berbasis Wilayah sebagai Perwujudan Keadilan Sosial dalam Menekan Angka Kecacatan dan Kematian di Indonesia
Copyright (c) 2025 Rakhmad Hidayat https://creativecommons.org/licenses/by-sa/4.0
Perbandingan Perkembangan Karakteristik Seks Sekunder pada Siswa Laki-laki Berdasar Tingkat Paparan Pestisida di SMPN 8 Jember dan SMPN 1 Wuluhan
Pestisida tergolong sebagai endocrine disrupting chemicals dapat mengganggu kerja hormon dan menyebabkan gangguan perkembangan karakteristik seks sekunder pada remaja laki-laki. Penelitian ini dilakukan untuk mengetahui apakah terdapat perbedaan perkembangan karakteristik seks sekunder pada siswa laki-laki akibat paparan pestisida di SMPN 8 Jember dan SMPN 1 Wuluhan. Penelitian ini merupakan penelitian observasional analitik dengan pendekatan cross sectional. Populasi dari penelitian ini adalah siswa laki-laki di dua sekolah dengan jumlah sampel sebesar 60 yang diambil dengan teknik purposive sampling, 30 sampel termasuk kelompok paparan pestisida rendah dan 30 sampel termasuk kelompok paparan pestisida tinggi, dan dilakukan pada September 2024 – February 2025. Penelitian ini menggunakan kuesioner untuk mengumpulkan data mengenai paparan pestisida dan perkembangan karakteristik seks sekunder remaja laki-laki. Analisis data menggunakan uji Mann-Whitney. Hasil penelitian menunjukkan karakteristik sekunder pada siswa sekolah dengan paparan pestisida tinggi yaitu perkembangan genital 60% pada tahap 4, perkembangan rambut pubis 47% pada tahap 4, status pubertas 63% pada tahap midpubertal, sedangkan pada sekolah dengan paparan rendah adalah perkembangan genital 36% pada tahap 4, perkembangan rambut pubis 60% pada tahap 3, status pubertas 53% pada tahap earlypubertal. Kesimpulan dari penelitian ini adalah terdapat perbedaan perkembangan karakteristik seks sekunder pada siswa lakilaki akibat paparan pestisida di SMPN 8 Jember dan SMPN 1 Wuluhan. A Comparative on the Development of Secondary Sexual Characteristics in Male Adolescents Base on the Level of Pesticides Exposure at SMPN 8 Jember and SMPN 1 Wuluhan Abstract Pesticides, as an endocrine-disrupting chemical, can interfere with hormone functions and cause disturbances in the development of secondary sexual characteristics in male adolescents. This study aims to investigate whether there are differences in the development of secondary sexual characteristics in male students due to pesticide exposure at SMPN 8 Jember and SMPN 1 Wuluhan. This cross-sectional study was conducted on 60 male students, 30 in the low pesticide exposure group and 30 in the high pesticide exposure group, at two schools, and in September 2024 – February 2025. The level of pesticide exposure and the development of secondary sexual characteristics in male adolescents were measured using three questionnaires. Mann-Whitney test was used to assess the differences between low and high pesticide exposure groups. The results showed showed that secondary sexual characteristics among students in schools with high pesticide exposure were as follows: genital development was 60% at stage 4, pubic hair development was 47% at stage 4, and pubertal status was 63% in the midpubertal stage. Meanwhile, in schools with low pesticide exposure, genital development was 36% at stage 4, pubic hair development was 60% at stage 3, and pubertal status was 53% in the early pubertal stage. It is concluded that there are differences in the development of secondary sexual characteristics in male students due to pesticide exposure at SMPN 8 Jember and SMPN 1 Wuluhan.
Copyright (c) 2026 Nadia Nur Fadhila, Muhammad Ihwan Narwanto https://creativecommons.org/licenses/by-sa/4.0
Urethral Mobility Ultrasound: A Comparable Diagnostic Method for Urethral Hypermobility in Indonesian Women with Stress Urinary Incontinence
Urethral hypermobility is the primary mechanism of stress urinary incontinence. In Indonesia, the prevalence of SUI (stress urinary incontinence) is approximately 13% (the other 16% had mixed urinary incontinence). To diagnose urethral hypermobility, the Q-tip test is performed, but it can provoke discomfort. Urethral mobility ultrasonography (UMU) has emerged as a non-invasive, more comfortable alternative, with high accuracy. This study reports the concordance of the evaluations in Indonesian women with SUI, to evaluate the accuracy of UMU compared with the Q-tip test in diagnosing urethral hypermobility among Indonesian women with SUI. A cross-sectional study was conducted at the outpatient clinic of RSUPN Dr Cipto Mangunkusumo and at the Jakarta Urogynecology (JUN) Centre-YPK Mandiri Hospital during the January – December 2024 period. Thirty-six SUI women without symptomatic pelvic organ prolapse (POP) completed the study. Each subject underwent a Q-tip test and ultrasonographic evaluation of urethral mobility. Ultrasonographic assessment of urethral mobility demonstrated high sensitivity (92.6%) but low specificity (33.3%) compared to the Q-tip test. The positive predictive value (PPV) of UMU was 80.6%, while the negative predictive value (NPV) was 60%. The concordance value was 77.8%. 16.67% of patients reported discomfort and pain during the Q-tip test and required medication to manage their symptoms. In those women, the Qtip test was negative but may reflect bias/false negatives, which can affect ultrasound specificity. With 80.6% PPV, 60% NPV, and 77.8% concordance, UMU may serve as a practical alternative to the Q-tip test in daily clinical practice.
Copyright (c) 2025 Gita Nurul Hidayah https://creativecommons.org/licenses/by-sa/4.0
Evaluating Artificial Intelligence in Orthopaedics: A Pilot Study on Accuracy and Reliability in Medical Student Competency Tests
Artificial intelligence (AI) is increasingly recognized as a valuable tool in medical education, yet its effectiveness across platforms remains underexplored. This study evaluated the performance of nine AI models-ChatGPT-4o, ChatGPT Mini, Gemini, Gemini Advanced, Perplexity, Perplexity Pro, Ortho Research Pro, Ortho AI, and Claude- in answering 30 expert-validated multiple-choice questions (MCQs) from the orthopaedics section of the UKMPPD. All models were evaluated concurrently between August and September 2024 using their official web interfaces. Each model was tested five times to assess accuracy and consistency. Statistical analysis was conducted using SPSS version 30.0. Normality and homogeneity were assessed using the Shapiro-Wilk and Levene’s tests. Accuracy differences were analyzed using oneway ANOVA followed by Tukey’s HSD post hoc test (p < 0.05). Reliability was evaluated using the intraclass correlation coefficient (ICC). Gemini demonstrated the highest mean accuracy (89 ± 2.79%), while ChatGPT Mini had the lowest (66 ± 3.33%). Significant differences in accuracy were observed (p < 0.05), with Gemini differing only from ChatGPT Mini and Perplexity. Most models demonstrated excellent reliability (ICC > 0.90), with Ortho Res. Pro among the best (ICC 0.956; 95% CI 0.925–0.977), while the remaining models showed good reliability. Overall, AI models showed strong potential for supporting medical exam preparation, although performance varied across platforms.
Copyright (c) 2026 Domy Pradana Putra, Farhan Ardiyanta Setyagisna, Heksa Trisnawati https://creativecommons.org/licenses/by-sa/4.0
Laporan Kasus Pilihan Kontrasepsi pada Pasien Diabetes Melitus Tipe 2 dengan Komorbiditas Multisistem
Diabetes melitus tipe 2 meningkatkan risiko morbiditas dan mortalitas pada ibu dan janin selama kehamilan. Pengaturan jarak kehamilan melalui kontrasepsi merupakan langkah penting dalam mempersiapkan kehamilan berikutnya. Seorang perempuan berusia 30 tahun datang ke Rumah Sakit Dr Cipto Mangunkusumo dengan riwayat diabetes melitus tipe 2, nodul di ismus tiroid, kolelitiasis, hipertensi, serta sedang menyusui bayi berusia 1 bulan. Riwayat persalinan sebelumnya adalah bayi makrosomia yang dilahirkan melalui seksio sesarea. Pasien saat ini menggunakan insulin untuk regulasi gula darah dan mendapat terapi ursodeoxycholic acid untuk batu empedu. Metode kontrasepsi yang sesuai pada pasien ini adalah IUD tembaga serta kontrasepsi berbasis progestin saja, seperti IUD hormon, implan, pil, dan suntikan. Pemilihan kontrasepsi pada pasien dengan diabetes melitus tipe 2 dan komorbiditas multisistem harus mempertimbangkan kondisi klinis, keamanan, serta efektivitas metode. IUD tembaga dan kontrasepsi progestin-only merupakan pilihan yang aman dan efektif.
Copyright (c) 2025 Ilham Surya, Dr Kanadi, Mugi Rahayu, Atikah, Dr Tri Juli https://creativecommons.org/licenses/by-sa/4.0
Effect of Hydroxychloroquine Therapy on Hematology and Ocular Manifestations of Systemic Lupus Erythematosus Patients
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that mainly affects women and has various clinical manifestations involving multiple organs. The use of hydroxychloroquine (HCQ) provides some advantages. This study aimed to analyze hematological and ocular effects following short-term HCQ administration in SLE patients. A cross-sectional study was conducted from April to July 2022 at Zainoel Abidin Hospital, Banda Aceh, Indonesia, involving 23 female SLE patients. Blood laboratory parameters were assessed, and an ophthalmologist performed ocular examinations. The study showed an average hemoglobin of 11.6 g/dL. Other blood laboratory results were within normal limits. The mean duration of SLE diagnosis and HCQ use was 21.0 months and 9.7 months, respectively. There was no correlation between HCQ use duration and hematological parameters (hemoglobin, leukocytes, and thrombocytes; p values 0.38, 0.14, and 0.62, respectively). This study showed that only one SLE patient taking HCQ for less than five years had ocular problems. The prevalence of ocular and hematological effects in SLE patients treated with HCQ for less than five years is minimal.
Copyright (c) 2025 Muhsin Muhsin, Mahriani Sylvawani, Vera Abdullah, Enny Nilawati, Muhammad Riswan, Abdullah Abdullah, Maimun Syukri https://creativecommons.org/licenses/by-sa/4.0
Dugaan Malpraktek pada Kasus Cedera Kepala dengan Benda Asing Tertinggal Intrakranial
Cedera kepala merupakan salah satu penyebab kematian tersering akibat trauma, dengan estimasi 500.000 kasus per tahun di Indonesia. Laporan ini bertujuan mengidentifikasi penyebab kematian serta meninjau aspek medikolegal terkait dugaan kelalaian medis. Pemeriksaan luar dan dalam terhadap jenazah menunjukkan adanya fraktur tulang tengkorak serta benda asing yang tertinggal di rongga kranial. Kematian disebabkan oleh perdarahan subaraknoid yang menekan pusat pernapasan hingga terjadi asfiksia. Temuan ini mengarah pada potensi pelanggaran standar profesi medis sebagaimana diatur dalam Pasal 274A UU Nomor 17 Tahun 2023 tentang Kesehatan. Selain itu, Pasal 308 dan Pasal 440 dalam undang-undang tersebut turut mengatur sanksi administratif hingga pidana atas pelanggaran yang berdampak fatal. Selain itu, UU Nomor 29 Tahun 2004 memberi kewenangan kepada Majelis Kehormatan Disiplin Kedokteran Indonesia (MKDKI) untuk melakukan evaluasi dan pemberian sanksi terhadap dugaan pelanggaran disiplin profesi. Laporan ini menegaskan pentingnya kepatuhan terhadap standar pelayanan medis sebagai bentuk perlindungan terhadap pasien sekaligus pencegahan terhadap konsekuensi hukum.
Copyright (c) 2026 Asan Petrus Sembiring, Nia Maimuria, Shabira Dea Putri https://creativecommons.org/licenses/by-sa/4.0
Pain Management in Elderly with Herniated Disc: Exploring NSAID Options for Non-Surgical Treatment
As global populations age, the demand for orthopedic surgery continues to rise, with low back pain (LBP)— particularly due to herniated nucleus pulposus (HNP)—among the most common reasons for consultation and surgical intervention. However, surgical decisions in elderly patients are often complex due to clinical risks and comorbidities. This review examines the role of pharmacologic therapy as a first-line conservative treatment for HNP in older adults, focusing on the efficacy and safety of nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, opioids, antidepressants, anticonvulsants, and corticosteroid injections. NSAIDs such as ibuprofen, diclofenac, and etodolac are effective but pose risks of gastrointestinal, cardiovascular, and renal complications. Alternatives like paracetamol and metamizole offer better gastrointestinal tolerance, while tramadol is a preferred opioid because it carries a lower risk of dependence. Non-pharmacological interventions—including physical therapy, acupuncture, moxibustion, and minimally invasive procedures like ozone chemonucleolysis—are also discussed as valuable adjuncts. While conservative management often results in significant symptom relief, prolonged reliance without timely surgical evaluation may lead to suboptimal outcomes. Therefore, a personalised, evidence-based approach that carefully balances risks and benefits is essential to optimise outcomes and minimise adverse effects in elderly patients with HNP.
Copyright (c) 2025 Alfath Bagus Pratama, Luthfi Umam Hakim Nasution, Baharudin Yusuf Pane, Muhammad Agung Perdana, Moammer Saddam Syahputra Siregar, Samuel Manutur Simanjuntak https://creativecommons.org/licenses/by-sa/4.0
Neurosifilis Terverifikasi pada Pasien HIV dengan Keterlibatan Okular Berdasarkan Reaktivitas TPHA dan RPR Cairan Serebrospinal
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.
Copyright (c) 2025 Yan Mardian, Dewi Wulandari https://creativecommons.org/licenses/by-nc/4.0
Validity and Reliability Test of The Indonesian Version of The Work Stress Scale for Correctional Officers
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.
Copyright (c) 2026 Agus Sugiharto, Indry Octavia Trisnawati, Dewi Sumaryani Soemarko, Suryo Wibowo, Indah Suci Widyahening https://creativecommons.org/licenses/by-sa/4.0
Correlation of Hematological Profiles and Parasite Density of Malaria Patients from Low Endemic Areas in North Sulawesi, Indonesia
North Sulawesi province is an area with low malaria endemicity. Variations in hematological profiles of malaria patients can serve as indicators for malaria diagnosis. This study aimed to determine correlation of hematological profile and parasite density of malaria patients. The cross-sectional study utilized medical record data from Kandou Hospital, Budi Mulia Hospital, and Tuda Hospital in North Sulawesi Province. The study was conducted from October 2022 to June 2023. In the current study, a total of 65 patient medical records were analyzed. Among them, 28 patients (43.1%) were infected with Plasmodium falciparum, and 37 patients (56.9%) were infected with P. vivax, with 20% of cases belonged to age group of <12 years. Hematological profiles showed moderate to severe thrombocytopenia in falciparum malaria cases and mild to severe thrombocytopenia in vivax malaria cases, while normal leukocyte count was observed in the majority of cases in both groups. Sex (p=0.014) and thrombocytopenia (p=0.034) showed a statistically significant association with malaria infections in this study. Anemia, thrombocytopenia and leukocyte counts did not show a statistically significant association with the degree of parasitemia in patients with falciparum and vivax malaria (r <0.40; p >0.05). The results of current study can be used as additional predictive variables for patients suspected of having malaria in similar populations.
Copyright (c) 2025 Evy Beatrix Senduk, Josef Sem Berth Tuda, Agnes Kurniawan, Ajib Diptyanusa https://creativecommons.org/licenses/by-sa/4.0
Open Disclosure Practices of Patient Safety Incidents in Indonesian Hospitals
Open disclosure of patient safety incidents in Indonesian hospitals is essential to improve transparency, foster trust, and enhance the quality of healthcare services. This study aims to analyze attitudes and barriers to the open disclosure of patient safety incidents in Indonesian hospitals. A descriptive quantitative research method was applied, involving 265 healthcare workers with at least 1 year of hospital experience at an Indonesian Hospital. Data collection was conducted via an online questionnaire over 2 weeks, recruited through convenience sampling, and analyzed descriptively. The findings reveal that most respondents believe that patients should be informed about safety incidents that affect them. Additionally, the majority of respondents agreed that ethically disclosing patient safety incidents is very important. However, the study results also indicate barriers to open disclosure, as many respondents believe that only serious patient safety incidents should be disclosed to patients. This perception is primarily driven by fears of losing their reputation, fear of penalties, and the belief that open disclosure may increase the risk of lawsuits. The results highlight the need for goverments' policies to address the identified barriers and to support the implementation of open disclosure in hospitals by strengthening institutional support and providing training programs to enhance patient safety culture in Indonesia.
Copyright (c) 2025 Inge Dhamanti, Taufik Rachman, Rizka Kusuma Wardahni https://creativecommons.org/licenses/by-sa/4.0
Cartilaginous Choristoma of the External Auditory Canal
Choristoma, a subtype of heterotopia, represents the presence of histologically normal tissue at an embryologically aberrant site. The finding of a heterotopic cartilaginous mass within the bony external auditory canal is an uncommon occurrence. We report a case of cartilaginous choristoma in a 5-year-old male patient. Otoscopic examination demonstrated a round, white, firm mass located on the anterior wall of the external auditory canal, covered by normal-appearing epithelium. Palpation using a ball-probe revealed firm and non-tender lesions, raising suspicion for osseous or cartilaginous masses rather than soft tissue tumors. The mass was surgically excised through a transcanal approach. Histologically, the mass was composed of mature cartilage without any neoplastic characteristics. This case emphasizes the necessity of considering choristoma in the differential diagnosis of a white mass seen lateral to an intact tympanic membrane.
Copyright (c) 2025 Angga Kusuma, Theresia Hening Dwi Ambarwat, Fiane de Fretes https://creativecommons.org/licenses/by-sa/4.0
Diagnostic Test of The Hematologic Scoring System in Neonatal Sepsis
Neonatal sepsis remains a major challenge in neonatal care, particularly because early detection and clinical severity categorization are not always effectively achieved. The hematologic scoring system (HSS) has been proposed as a useful tool for assessing the presence or absence of infection. This study aimed to compare the HSS with blood culture in diagnosing neonatal sepsis. A cross-sectional study was conducted at Ulin Hospital, Banjarmasin, in September 2019, involving 43 neonates aged 0–30 days with clinical or suspected neonatal sepsis. Neonatal sepsis was assessed using HSS, supported by a hematology analyzer. The Leishman-stained peripheral blood smear was evaluated according to Rodwell’s hematological criteria. Diagnostic performance was evaluated by calculating sensitivity, specificity, positive predictive value, and negative predictive value using blood culture as the reference standard. The chi-square test was used to assess the association between HSS and blood culture results. The HSS results did not associate with blood culture results in patients (p = 0.850). The HSS demonstrated a sensitivity of 59.09%, a specificity of 38.10%, a positive predictive value of 50%, and a negative predictive value of 47.06%. The HSS showed limited diagnostic performance and should not replace blood culture. However, it may be considered as an adjunctive tool in the initial assessment of neonatal sepsis.
Copyright (c) 2026 Dewi Indah Noviana Pratiwi, Dastin Andre, Pandji Winata Nurikhwan https://creativecommons.org/licenses/by-sa/4.0
Copyright (c) 2025 Tjandra Yoga Aditama https://creativecommons.org/licenses/by-nc/4.0
Impact of Surgical Complexity and Instrumentation on Perioperative Outcomes in Cervical Spine Surgery
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. This retrospective study evaluated the clinical characteristics and surgical outcomes of patients who underwent cervical spine surgery at Dr. Cipto Mangunkusumo National General Hospital, Jakarta, during the period from August 2021 to August 2023. 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.
Copyright (c) 2025 Mohamad Saekhu, Ria Amelia, Azhar Farisyabdi Kurniawan, Renindra Ananda Aman, Syaiful Ichwan, Setyo Widi Nugroho https://creativecommons.org/licenses/by-nc/4.0
Efektivitas Pemberian Secretome secara Intravena Dibandingkan dengan Intratrakeal terhadap Paru-paru Tikus Sprague Dawley yang Terpapar Asap Rokok Kretek
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.
Copyright (c) 2025 Chrispian Mamudi, Ronald, Alvin, Erma, Siufui https://creativecommons.org/licenses/by-nc/4.0
Correlation Between Neutrophil-to-Lymphocyte Ratio (NLR) and Length of Hospital Stay in Pediatric Patients with Dengue Hemorrhagic Fever
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.
Copyright (c) 2025 Desi Oktariana https://creativecommons.org/licenses/by-nc/4.0
Linking the Life Cycle of Sarcoptes scabiei to Diagnosis, Treatment, and Control
Scabies is a neglected tropical disease caused by the mite Sarcoptes scabiei, with an annual incidence of 455 million cases. Despite its significant global burden, it remains underdiagnosed and undertreated, largely due to insufficient consideration of the parasite’s biological behavior. The mite’s life cycle, comprising egg, larval, nymph, and adult stages, plays a pivotal role in determining the success or failure of diagnostic and treatment strategies. Many conventional treatments do not effectively target all life stages, especially the egg stage, resulting in incomplete treatment and frequent reinfection. This literature review aims to critically examine the life cycle of S. scabiei and analyze how each developmental stage can inform more effective diagnostic, therapeutic, and public health responses. Understanding how the biology of the mite intersects with the timing and sensitivity of clinical interventions is essential for optimizing outcomes, highlighting the need for repeat treatments and the development of ovicidal agents or vaccines. By integrating insights from parasitology, immunology, and epidemiology. This review advocates for a multidisciplinary, life cycle–based framework to enhance early detection, improve treatment efficacy, and support sustainable control measures. When aligned with mass drug administration, hygiene promotion, and health education initiatives, such an approach offers synergistic potential to break transmission cycles and manage outbreaks more effectively. Advancing scabies control will ultimately depend on embedding life cycle–informed strategies into both clinical practice and public health programs.
Copyright (c) 2025 Saleha Sungkar https://creativecommons.org/licenses/by-sa/4.0
Insights into Acute Coronary Syndrome: A Study of Patient Characteristics in Dr. Rivai Abdullah Public Hospital
Acute Coronary Syndrome (ACS) remains a leading cause of morbidity and mortality worldwide, with variations in patient characteristics and risk factors across regions. In Indonesia, especially in resource-limited settings, data on the demographic and clinical features of ACS are limited. Such information is crucial for guiding management strategies. This study analyzed secondary data from medical records of 86 ACS patients admitted to Dr. Rivai Abdullah Public Hospital between January and December 2023. This cross-sectional study included new and existing patients with acute coronary syndrome who had complete demographic, clinical, and electrocardiographic data. In contrast, patients with incomplete data or congenital heart disease were excluded. The research was conducted between July and September 2024. Of these patients, 64% were male, and 51.16% were aged 41 to 60 years. Nearly half (46.51%) had only primary education, and 25.58% were farmers or housewives. Hypertension was the most common comorbidity (66.28%), followed by diabetes mellitus (25.58%), obesity (18.60%), and dyslipidemia (5.81%). Electrocardiographic findings showed that 55.81% had ST-elevation myocardial infarction (STEMI), mainly involving the anteroseptal region. Meanwhile, 44.19% had non-ST-elevation myocardial infarction (NSTEMI), with T-wave inversion present in 42.11% of these cases. These results indicate that ACS mainly affects middle-aged males with low education and informal occupations. Hypertension was the leading risk factor, and STEMI was the most common presentation. Targeted prevention and early detection are vital to improving outcomes in this population.
Copyright (c) 2025 Zabrina Zerlinda, Erwin Azmar, Ayeshah Augusta Rosdah https://creativecommons.org/licenses/by-sa/4.0
Profile and Risk Factors of Children with Isolated Ventricular Septal Defect in dr. Cipto Mangunkusumo Hospital
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.
Copyright (c) 2025 Dyanti Prima Putri https://creativecommons.org/licenses/by-nc/4.0
Efektivitas Penggunaan High-Efficiency Particulate Air (HEPA) Filter terhadap Asma pada Pasien Anak
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.
Copyright (c) 2025 Muhammad Sidiq, Astagina Naurah, Ifti K. Ilmi, Chintia D. Maharani, Bayu I. Nugraha https://creativecommons.org/licenses/by-nc/4.0