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All Journal Scientia Psychiatrica Scientific Journal of Pediatrics Sriwijaya Journal of Obstetrics and Gynecology
Dessy Agustina
Department of Health Sciences, Sei Rambutan Community Health Center, Palembang, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Myo-inositol versus metformin pre-treatment and the follicular-fluid metabolome in PCOS women undergoing IVF: a double-blind randomized trial Syaifudin; Dessy Agustina; Sarah Istiqomah
Sriwijaya Journal of Obstetrics and Gynecology Vol. 4 No. 1 (2026): Sriwijaya Journal of Obstetrics & Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v4i1.299

Abstract

Background: Polycystic ovary syndrome (PCOS) impairs oocyte quality and complicates in vitro fertilization (IVF). Metformin and myo-inositol are widely prescribed insulin sensitizers, yet their comparative effects on the human follicular-fluid (FF) metabolome and IVF outcomes have rarely been examined head-to-head. Objective: To compare myo-inositol and metformin pre-treatment in terms of the FF metabolome and embryologic, clinical, and safety outcomes in women with PCOS undergoing IVF. Methods: In a double-blind, block-randomized (1:1) trial at two tertiary IVF centers in Jakarta and Palembang, Indonesia, 150 women with PCOS (Rotterdam criteria; aged 20–35 years; BMI 18.5–29.9 kg/m²) received myo-inositol 4 g/day (n=75) or metformin 1500 mg/day (n=75) for 12 weeks before and during a GnRH-antagonist protocol. FF was analyzed by LC-MS/MS. Analyses were intention-to-treat and included multivariable logistic regression, ROC analysis, and number needed to treat (NNT). Results: Myo-inositol yielded more MII oocytes (11.6 ± 3.4 vs 10.1 ± 3.6; p=0.010), higher fertilization (72.5% vs 66.8%; p=0.006), and more top-quality embryos (4.3 ± 1.8 vs 3.4 ± 1.7; p=0.002). Clinical pregnancy was 48.0% versus 33.3% (unadjusted p=0.069; adjusted OR 2.18, 95% CI 1.04–4.57; p=0.039; NNT 7). Moderate–severe OHSS (6.7% vs 18.7%; p=0.038; NNT 8) and gastrointestinal events (9.3% vs 34.7%; p<0.001; NNT 4) were lower with myo-inositol. FF myo-inositol, D-chiro-inositol, and antioxidant capacity were higher; FF myo-inositol predicted pregnancy (AUC 0.78). Conclusion: Myo-inositol pre-treatment shifted the FF metabolome toward a pro-developmental antioxidant profile and improved embryologic outcomes and tolerability versus metformin. The clinical-pregnancy signal remains provisional because the trial was underpowered for this endpoint and the unadjusted comparison was not significant; adequately powered live-birth trials are needed.
Predictive Value of Drug-Induced Sleep Endoscopy (DISE) in Pediatric Obstructive Sleep Apnea: A Multicenter Cohort Study in Indonesia Sarah Istiqomah; Annisa Annisa; Dessy Agustina; Abhimanyu Putra; Zainal Abidin Hasan; Johan Wirahadi Putro; Venny Melinda; Nabila Saraswati; Made Swastika
Scientific Journal of Pediatrics Vol. 3 No. 1 (2025): Scientific Journal of Pediatrics
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjped.v2i2.174

Abstract

Introduction: Obstructive sleep apnea (OSA) is a significant pediatric health concern in Indonesia, but diagnostic and treatment pathways are often resource-constrained. Drug-induced sleep endoscopy (DISE) offers a dynamic assessment of upper airway obstruction, but its predictive value for treatment outcomes in Indonesian children remains unclear. This study aimed to evaluate the predictive value of DISE findings for polysomnography (PSG)-determined OSA severity and surgical outcomes in a multicenter cohort of Indonesian children. Methods: A prospective, multicenter cohort study was conducted at three tertiary hospitals in Indonesia. Children aged 2-18 years with suspected OSA underwent DISE and overnight PSG. DISE findings were classified using the VOTE (Velum, Oropharynx, Tongue base, Epiglottis) classification system. The primary outcome was the correlation between DISE findings and the apnea-hypopnea index (AHI) on PSG. Secondary outcomes included the prediction of surgical success (defined as a postoperative AHI < 5 and >50% reduction from baseline) after adenotonsillectomy (T&A). Statistical analyses included Spearman's rank correlation, receiver operating characteristic (ROC) curve analysis, and logistic regression. Results: 250 children (mean age 8.2 ± 3.5 years, 60% male) were included. A significant positive correlation was found between the total VOTE score and AHI (ρ = 0.62, p < 0.001). Tongue base obstruction (VOTE-T) showed the strongest correlation with AHI (ρ = 0.58, p < 0.001). The area under the ROC curve (AUC) for the total VOTE score predicting severe OSA (AHI ≥ 10) was 0.85 (95% CI, 0.79-0.91). In the subgroup of 180 children who underwent T&A, a higher total VOTE score (particularly VOTE-T and VOTE-E scores) was significantly associated with a lower likelihood of surgical success (OR 0.45, 95% CI 0.28-0.72, p = 0.001). Conclusion: DISE, using the VOTE classification, demonstrates good predictive value for OSA severity and surgical outcomes in Indonesian children. Tongue base and epiglottic obstruction are particularly important predictors. DISE can be a valuable tool for guiding treatment decisions in resource-limited settings.
Explainable Temporal Reconciliation for Psychiatric Risk Phenotyping in Synthetic Longitudinal Clinical Notes Dessy Agustina; Sarah Istiqomah
Scientia Psychiatrica Vol. 7 No. 4 (2026): Scientia Psychiatrica
Publisher : HM Publisher in collaboration with CMHC Research Center

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Background. Psychiatric risk changes during hospitalization. Document-level natural language processing can retain historical high-risk language after the current clinical state has changed. Objective. To evaluate an explainable approach that reconciles chronology, source authority, negation, and transition barriers across longitudinal records against a maximum-risk baseline. Methods. This retrospective study used all 180 synthetic inpatient psychiatric chart packets of ClinAuthBench v1. A deterministic pipeline gave priority to the most recent suicide-risk screens, psychiatric progress notes, and social-work transition-barrier notes. The baseline was a maximum-risk-across-record strategy. The primary endpoint was current risk (low versus elevated/uncertain). Secondary endpoints were three-class risk, diagnosis, psychosis, substance use, transition barriers, and lower-level-of-care readiness. We used accuracy, Wilson 95% confidence intervals (CIs), macro-F1, Cohen's κ, paired bootstrap differences, and exact McNemar testing. Results. Gold current risk comprised 72 low, 82 moderate, and 26 high cases. Temporal reconciliation classified 180/180 cases correctly on the binary endpoint, versus 108/180 for the baseline (difference 40.0 percentage points; bootstrap 95% CI 32.8–47.2; exact McNemar p < 0.001). Three-class accuracy was 88.9% (160/180; 95% CI 83.5–92.7), macro-F1 was 0.852, and κ was 0.824, with all errors at the moderate–high boundary. Five structured phenotype endpoints reached 100% accuracy. Conclusion. In this synthetic benchmark, temporal and source-aware reconciliation kept historical high-risk language from dominating current-risk classification. The results show construct-aligned technical validity. They do not show clinical deployment validity, and external validation on real notes with clinician adjudication is required. For every packet the explainable trace retained source, time, screen status, barrier status, and context.
Co-Authors Abhimanyu Putra Annisa Annisa Johan Wirahadi Putro Made Swastika Nabila Saraswati Sarah Istiqomah Sarah Istiqomah Syaifudin Venny Melinda Zainal Abidin Hasan