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All Journal Sriwijaya Journal of Forensic and Medicolegal Sriwijaya Journal of Radiology and Imaging Research Sriwijaya Journal of Otorhinolaryngology
Mustafa Mahmud
Department of Thoracic Surgery, CMHC Research Center, Palembang, Indonesia
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Physics Public Health

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Diagnostic Accuracy of Multiparametric MRI-Based Machine-Learning Radiomics for Differentiating Malignant from Benign Soft-Tissue Tumours: A Multi-Institutional Study Rachmat Hidayat; Fatmah Sayeed; Mustafa Mahmud
Sriwijaya Journal of Radiology and Imaging Research Vol. 4 No. 1 (2026): Sriwijaya Journal of Radiology and Imaging Research
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjrir.v4i1.298

Abstract

Introduction: Reliable preoperative discrimination of malignant from benign soft-tissue tumours (STTs) governs biopsy, surgical-margin and neoadjuvant decisions, yet conventional MRI interpretation is experience-dependent and biopsy is invasive and prone to sampling error. We aimed to develop and internally validate a machine-learning radiomics model from multiparametric MRI (mpMRI) for this task across multiple institutions. Methods: In this STARD 2015-compliant retrospective multi-institutional diagnostic-accuracy study, 215 patients (132 benign, 83 malignant) with histopathologically confirmed STTs imaged at three South Sumatran centres (2019–2023) were split 70:30 into training (n=150) and validation (n=65) cohorts. Radiomic features from T1W, T2W fat-suppressed and ADC maps underwent ICC-stability filtering and LASSO selection; SVM, Random Forest and XGBoost classifiers were compared against histopathology (reference standard) and blinded radiologist visual reads. Sensitivity, specificity, predictive values, likelihood ratios (95% CIs), ROC (DeLong), Cohen’s κ and multivariable logistic regression were computed. Results: A 14-feature signature was selected from 945 ICC-stable features. In internal validation, XGBoost achieved AUC 0.92 (95% CI 0.88–0.95), sensitivity 86.7% (70.3–94.7), specificity 91.4% (77.6–97.0), PPV 89.7%, NPV 88.9%, accuracy 89.2%, LR+ 10.1 and LR− 0.15. XGBoost exceeded SVM (AUC 0.84; DeLong p=0.012) and radiologist visual read (AUC 0.78; p<0.001; McNemar p=0.027). Inter-reader κ was 0.78 (0.63–0.94). The radiomics signature (adjusted OR 3.32, p<0.001) and lower ADC (OR 0.21, p<0.001) were independent malignancy predictors. Conclusion: An mpMRI XGBoost radiomics model provides accurate, non-invasive discrimination of malignant from benign STTs with high specificity and a clinically useful positive likelihood ratio, supporting its role as PACS-integrated decision support and as a triage tool in resource-variable settings.
Spatiotemporal Trends and Attributable Risk Factors of Nasopharyngeal Carcinoma in Southeast Asia (1990–2023): An Ecological Analysis of the Global Burden of Disease Study with Projections to 2050 Linda Purnama; Priscilla Kapoor; Mustafa Mahmud; Alessandra Navos
Sriwijaya Journal of Otorhinolaryngology Vol. 3 No. 2 (2025): Sriwijaya Journal of Otorhinolaryngology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjorl.v3i2.306

Abstract

Background: Nasopharyngeal carcinoma (NPC) is an Epstein–Barr virus-associated epithelial malignancy with a strikingly uneven geography concentrated in Southeast Asia and southern China. Its region-specific burden, temporal dynamics and attributable risk factors have not been synthesised in a dedicated spatiotemporal ecological analysis. Objective: To characterise NPC burden, trends and attributable risks across Southeast Asia. Methods: We conducted an ecological analysis of Global Burden of Disease (GBD) estimates. Age-standardised incidence (ASIR), mortality (ASMR) and disability-adjusted life-year (DALY) rates for the GBD Southeast Asia region (1990–2021, GBD 2021) and constituent ASEAN countries (to 2023, GBD 2023) were compiled; temporal trends were summarised by the estimated annual percentage change (EAPC); attributable fractions for tobacco, alcohol and occupational carcinogens were obtained from GBD comparative risk assessment; and age-standardised rates were projected toward 2050. Results: In 2021 the Southeast Asia region recorded the highest NPC mortality of any world region (ASMR 1.60 per 100,000). Age-standardised rates declined (EAPC: incidence −0.39, mortality −0.76, DALYs −0.84% per year), yet absolute incident cases more than doubled (6,209 to 13,661; +120%). National ASIR ranged from 1.3 (Cambodia) to 14.2 (Singapore); Indonesia carried the greatest absolute burden (5,163 cases; 4,306 deaths). Incidence rose in Indonesia (EAPC +0.8), Laos (+0.7) and Viet Nam (+0.6). Alcohol-attributable burden increased most steeply (Southeast Asia EAPC +2.27), against declining tobacco- and occupational-attributable rates. Conclusion: Southeast Asia bears the world's heaviest NPC mortality; falling age-standardised rates mask a rising absolute burden and a growing alcohol-attributable component, underscoring the need for Epstein–Barr virus-informed early detection and region-tailored prevention.
Secondary Cross-Platform Transcriptomic Reanalysis of Laryngeal Squamous Cell Carcinoma Identifies Reproducible Tumor-Associated Programs but No Independently Validated Prognostic Biomarker Rachmat Hidayat; Mustafa Mahmud
Sriwijaya Journal of Otorhinolaryngology Vol. 4 No. 1 (2026): Sriwijaya Journal of Otorhinolaryngology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjorl.v4i1.314

Abstract

Background: Public transcriptomes can reveal reproducible laryngeal squamous cell carcinoma (LSCC) programs, but differential expression alone does not establish prognosis. Objective: To evaluate paired tumor-associated expression changes and test whether any gene met independent prognostic criteria. Methods: Depositor-processed GSE127165 RNA-sequencing data from 57 paired LSCC and adjacent-mucosa specimens were analyzed with patient-blocked limma-trend after predefined filtering of log₂(FPKM + 1) values. Differentially expressed features required Benjamini–Hochberg false-discovery rate (FDR) <0.05 and absolute paired mean difference ≥1. Functional over-representation used g:Profiler. Expression replication used 23 paired TCGA larynx-labeled cases. Prognostic associations were assessed continuously in GSE27020 training (n=59) and validation (n=50) cohorts and 116 TCGA larynx-labeled tumors, with progression-free interval primary and overall survival secondary. Results: Of 11,908 tested features, 230 were upregulated and 205 downregulated. Excluding three quality-control-associated pairs retained 418 primary calls; quantile normalization retained 396. Among 327 measurable discovery features in TCGA, 184 replicated at FDR <0.05 with the same direction; directional concordance was 89.0% and effect correlation was ρ=0.774. Keratinization, extracellular-matrix, adhesion, and inflammatory programs were over-represented. No gene satisfied the operational prognostic criterion. SERPINE1 was exploratory: training HR=2.09, validation HR=1.53, and TCGA progression-free interval HR=1.28; the modified Knapp–Hartung pooled inference was non-significant. Conclusion: LSCC showed reproducible bulk-tissue expression programs, but no single differentially expressed gene qualified as an independently validated prognostic biomarker. These findings support biological prioritization, not clinical decision-making.
Reading the Epigenetic Clock: A Comparative Analysis of DNA Methylation Markers for Age Estimation in Semen, Saliva, and Touch DNA Febria Suryani; Bryan Helsey; Leonardo Simanjuntak; Karina Chandra; Mustafa Mahmud; Lisha Sandrina; Ahmad Erza
Sriwijaya Journal of Forensic and Medicolegal Vol. 3 No. 1 (2025): Sriwijaya Journal of Forensic and Medicolegal
Publisher : Phlox Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjfm.v3i1.233

Abstract

Background. Predicting an individual's age from biological evidence is a significant advance in forensic intelligence. DNA methylation, a stable epigenetic mark, provides the molecular basis for epigenetic clocks, but their operational reliability requires validation across diverse sample types and populations, particularly for low-template touch DNA. Objective. To develop and validate body-fluid-specific age prediction models from a curated five-CpG panel in semen, saliva and touch DNA, and to compare their accuracy in an Indonesian population. Methods. Following approval from the Ethical Committee of CMHC Indonesia (No. 128/EC/CMHC/2023), 150 healthy Indonesian male volunteers aged 18–65 provided semen, saliva and high-yield standardized touch DNA. Methylation at five CpG sites (ELOVL2, FHL2, TRIM59, KCNQ1DN, C1orf132) was quantified by controlled pyrosequencing after bisulfite conversion with efficiency controls. Body-fluid-specific models were built by multiple linear regression and validated by 10-fold cross-validation. Results. The semen and saliva models were highly accurate, with mean absolute deviations of 3.19 years (R²=0.94) and 3.55 years (R²=0.92). The touch DNA model was less precise but still informative (MAD 5.49 years, R²=0.85). All models satisfied the assumptions of linear regression, with variance inflation factors below 2.5, and 95% prediction intervals were narrowest for semen. Conclusion. The panel is validated for age prediction in a Southeast Asian population. The semen and saliva models are accurate enough for consideration in casework, while the touch DNA model, interpreted cautiously, can generate investigative leads from trace evidence. The findings underline the importance of tissue-specific modeling and provide a methodological blueprint for responsible forensic age estimation.
Comprehension as the Gatekeeper of Valid Surgical Consent: A Cross-Sectional Medicolegal Analysis of 320 High-Risk Indonesian Surgical Patients Mustafa Mahmud; Cinthya Callathea; Yi-Fen Huang; Delia Tamim
Sriwijaya Journal of Forensic and Medicolegal Vol. 3 No. 2 (2025): Sriwijaya Journal of Forensic and Medicolegal
Publisher : Phlox Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjfm.v3i2.249

Abstract

Background. Documented consent without demonstrable comprehension is medicolegally insufficient, yet comprehension-based informed consent (IC) failure in collectivistic surgical populations is largely unquantified. Methods. This study was a cross-sectional assessed IC efficacy among 320 consecutive adults undergoing high-risk elective surgery (ASA physical status III–IV) at Private Hospital X, Palembang, Indonesia, in 2024, reported per STROBE. Six instruments standardised to 0–100 were administered, including the IC Comprehension Score (ICCS) and the five-domain composite IC Efficacy Score (ICE); adequacy was ICE ≥ 70. Exact intervals and permutation tests, effect sizes, areas under the receiver operating characteristic curve recovered from Mann–Whitney U statistics, E-values, fragility indices, standardisation and a partial-identification audit were added. Results. Only 19 of 320 patients (5.9%, 95% CI 3.6–9.1) achieved adequate IC efficacy, below both published comparators reporting an explicit adequacy proportion (exact binomial P < 0.001 versus 14.0% and versus 35.8%); standardisation to lower-education distributions reduced this to 2.74–3.79%, so 5.9% is an upper bound. Adequacy rose monotonically across educational strata from 0.0% to 13.3% (exact Cochran–Armitage z = 3.66, P = 0.0003; tertiary versus secondary education or below, odds ratio 8.27, 95% CI 2.36–29.00; E-value 14.29; fragility index 8). ICCS was the only independent predictor in an exploratory multivariable model with 2.71 events per variable (odds ratio 13.75 per SD, 95% CI 3.32–56.92), an association partly constitutive because comprehension is one ICE domain. Neither family influence nor collectivism predicted adequacy. Conclusion. Comprehension, not cultural collectivism, gates valid surgical consent.
Co-Authors Ahmad Erza Alessandra Navos Bryan Helsey Cinthya Callathea Delia Tamim Fatmah Sayeed Febria Suryani Karina Chandra Leonardo Simanjuntak Linda Purnama Lisha Sandrina Priscilla Kapoor RACHMAT HIDAYAT Yi-Fen Huang