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All Journal Sriwijaya Journal of Forensic and Medicolegal Enigma in Education
Ahmad Erza
Department of Criminal Law, Enigma Institute, Palembang, Indonesia
Humanities Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Mathematics Medicine & Pharmacology Other

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Vitreous Humor Biochemical Markers and Non-Linear Regression for Post-Mortem Interval Estimation in Indonesian Tropical Autopsy Cases Lisha Sandrina; Paula Guelle; Ahmad Erza
Sriwijaya Journal of Forensic and Medicolegal Vol. 4 No. 1 (2026): Sriwijaya Journal of Forensic and Medicolegal
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjfm.v4i1.258

Abstract

Introduction: Accurate post-mortem interval (PMI) estimation remains a critical challenge in tropical forensic pathology, where accelerated biochemical decomposition makes temperate-derived formulae unreliable. This prospective validation study investigated non-linear regression modeling of vitreous humor potassium (K+), hypoxanthine (Hx), and urea nitrogen (BUN) for PMI estimation in Indonesian tropical autopsy cases (January–December 2025). Methods: A total of 85 consecutive forensic autopsy cases were enrolled at the Department of Forensic Medicine, Hospital X, Palembang, Indonesia. PMI was verified by at least two independent sources (mean verification uncertainty ±1.4 hours). Vitreous K+ was measured by ion-selective electrode; Hx by enzymatic colorimetry; BUN by the urease-GLDH method. Logarithmic, quadratic, and square-root non-linear regression models were fitted for each biomarker; model selection was guided by R², adjusted R², and Akaike Information Criterion (AIC). Cross-validation was performed by leave-one-out cross-validation (LOOCV). Results: Vitreous K+ demonstrated the strongest quadratic association with PMI (R² = 0.957, LOOCV-R² = 0.942, RMSE = 0.38 mmol/L). BUN showed a quadratic pattern (R² = 0.837, LOOCV-R² = 0.819, RMSE = 1.75 mg/dL) and Hx a square-root pattern (R² = 0.438, RMSE = 3.83 µmol/L). The combined multivariate non-linear model [PMI = 56.19·ln(K++1) + 1.85·√Hx + 1.86·BUN − 136.08] achieved R² = 0.951, LOOCV-R² = 0.934, and RMSE = 4.75 hours. Variance inflation factors for all predictors were ≤2.8, confirming acceptable multicollinearity. K+ and BUN were independent significant predictors (both p < 0.001); Hx did not reach independent significance (p = 0.095). The combined model is valid for K+ ≥ 4.2 mmol/L. Conclusion: Non-linear regression of vitreous biochemical markers provides accurate, locally validated PMI estimation for Indonesian tropical forensic practice, with a combined model RMSE of 4.75 hours over 1–72 hours post-mortem.
The Power Imbalance Personified: A Mixed-Methods Analysis of Senior-to-Junior Bullying in Indonesia's Medical Residency Programs Alex Putra Pratama; Henry Clifford; Ahmad Erza; Ericca Dominique Perez; Fakhrul Setiobudi; Dedi Affandi; Lestini Wulansari; Fachrudin Sani; Vita Amanda; Zahra Amir
Enigma in Education Vol. 3 No. 1 (2025): Enigma in Education
Publisher : Enigma Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61996/edu.v3i1.92

Abstract

Bullying within medical residency is a pervasive global issue with severe consequences for residents' mental health and patient safety. In Indonesia, where hierarchical structures in medicine are deeply entrenched, senior-to-junior bullying is a significant yet under-investigated problem. This study aimed to analyse the prevalence, forms, and lived experiences of bullying perpetrated by senior residents against their junior counterparts in Indonesian medical residency programs. A sequential explanatory mixed-methods design was employed. In the quantitative phase, an anonymous online survey was distributed to 584 junior medical residents across five major teaching hospitals in Indonesia. The survey included the validated Negative Acts Questionnaire-Revised (NAQ-R) and questions on demographics and specialty. In the qualitative phase, 25 junior residents who reported high levels of bullying were purposively selected for in-depth, semi-structured interviews to explore their experiences. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were subjected to reflexive thematic analysis. Quantitatively, 81.3% (n=475) of junior residents reported experiencing at least one bullying behaviour weekly. The most common forms were work-related, such as excessive workloads and meaningless tasks, and personal humiliation. Year of residency was significantly associated with bullying exposure. Qualitatively, four major themes emerged: (1) ‘The Hierarchy as an Unassailable Mandate for Abuse’; (2) ‘The Pedagogy of Fear: Bullying as a Misguided Educational Tool’; (3) ‘Silent Suffering and the Armour of Complicity’; and (4) ‘The Perpetuating Cycle: Victims on a Trajectory to Becoming Perpetrators’. The qualitative findings revealed that bullying was often rationalised by seniors as a necessary part of medical training. In conclusion, senior-to-junior bullying is alarmingly prevalent and deeply embedded in the culture of Indonesian medical residency programs. It is personified through a profound power imbalance, rationalised as an educational necessity, and sustained by a culture of silence. Urgent, multi-level interventions focusing on systemic change, faculty training, and robust confidential reporting systems are imperative to dismantle this destructive cycle.
Co-Authors Alex Putra Pratama Dedi Affandi Ericca Dominique Perez Fachrudin Sani Fakhrul Setiobudi Henry Clifford Lestini Wulansari Lisha Sandrina Paula Guelle Vita Amanda Zahra Amir