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All Journal Sriwijaya Journal of Forensic and Medicolegal Scientific Journal of Pediatrics
Febria Suryani
Department of Health Sciences, Emerald Medical Center, Jakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Nursing Public Health

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Non-Invasive Neuromodulation for Drug-Resistant Epilepsy in Children: A Randomized Controlled Trial of Transcranial Magnetic Stimulation (TMS) versus Vagus Nerve Stimulation (VNS) in Jakarta, Indonesia Febria Suryani; Rinna Azrida; Linda Purnama; Vania Delma; Desiree Montesinos
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.v2i2.173

Abstract

Introduction: Drug-resistant epilepsy (DRE) significantly impacts the quality of life in children. While vagus nerve stimulation (VNS) is an established treatment, repetitive transcranial magnetic stimulation (rTMS) offers a non-invasive alternative. This study aimed to compare the efficacy and safety of rTMS versus VNS in a pediatric DRE population in Jakarta, Indonesia. Methods: This was a single-center, randomized, controlled, open-label trial conducted at Private Hospital, Jakarta. Children aged 5-18 years with DRE, defined as failure to achieve seizure freedom despite adequate trials of two appropriate antiepileptic drugs (AEDs), were randomly assigned (1:1) to receive either rTMS or VNS. The primary outcome was the percentage reduction in seizure frequency at 6 months post-intervention compared to baseline. Secondary outcomes included responder rate (≥50% seizure reduction), quality of life (QoL) using the PedsQL, cognitive function (using standardized neuropsychological tests), and adverse events. Results: A total of 60 children were randomized (30 rTMS, 30 VNS). At 6 months, the mean percentage reduction in seizure frequency was significantly greater in the rTMS group (48.5%, SD 15.2%) compared to the VNS group (35.2%, SD 12.8%) (p = 0.001). Responder rates were 63.3% for rTMS and 46.7% for VNS (p = 0.17). PedsQL scores showed a significant improvement in the rTMS group compared to baseline in the psychosocial health summary score (p = 0.005), but not the VNS group (p=0.1). No significant differences were observed in cognitive function between the groups. Adverse events were generally mild and transient in both groups, though VNS was associated with more voice alteration and coughing. Conclusion: rTMS demonstrated superior efficacy in reducing seizure frequency compared to VNS in this Indonesian pediatric DRE population. While VNS is an established method, rTMS may present a non-invasive and potentially more effective therapeutic alternative. Further, larger, multicenter studies are warranted to confirm these findings and explore long-term outcomes.
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: Indonesian Medical Research Organization

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

Abstract

Introduction: The capacity to predict an individual's age from biological evidence constitutes a significant advancement in forensic intelligence. DNA methylation, a stable epigenetic mark, provides a molecular basis for "epigenetic clocks." However, the operational reliability of these clocks necessitates rigorous validation across diverse biological samples and populations, particularly for challenging, low-template touch DNA evidence. Methods: Following approval from the Ethical Committee of CMHC Indonesia (No. 128/EC/CMHC/2023), we recruited 150 healthy Indonesian male volunteers aged 18-65. Semen, saliva, and high-yield standardized touch DNA samples were collected. DNA was extracted, quantified fluorometrically, and subjected to bisulfite conversion with efficiency controls. The methylation levels of a curated five-CpG panel (ELOVL2, FHL2, TRIM59, KCNQ1DN, C1orf132) were quantified using a rigorously controlled pyrosequencing workflow. Body-fluid-specific age prediction models were developed using multiple linear regression, validated with 10-fold cross-validation, and assessed for statistical assumptions including multicollinearity. Results: The models for semen and saliva demonstrated high predictive accuracy, yielding Mean Absolute Deviation (MAD) values of 3.19 years (R²=0.94) and 3.55 years (R²=0.92), respectively. The model developed from high-yield touch DNA was less precise but still highly informative, with a MAD of 5.49 years (R²=0.85). All models satisfied the assumptions of linear regression, with Variance Inflation Factors below 2.5 indicating low multicollinearity. The 95% prediction intervals were narrowest for semen, reflecting its superior precision. Conclusion: This study validates a robust, targeted epigenetic panel for age prediction in a Southeast Asian population. We present highly accurate, tissue-specific models for semen and saliva, suitable for immediate consideration in forensic casework. The touch DNA model, while requiring cautious interpretation, provides a valuable framework for generating investigative leads from trace evidence. Our findings underscore the critical importance of tissue-specific modeling and provide a detailed methodological and statistical blueprint for the responsible implementation of forensic age estimation.
Procedural Failures as Independent Predictors of Delayed Intracranial Foreign Body Diagnosis in Mild Traumatic Brain Injury: A Multivariable Logistic Regression Analysis from North Sumatra, Indonesia Aisyah Andina Rasyid; Priscilla Kapoor; Febria Suryani
Sriwijaya Journal of Forensic and Medicolegal Vol. 3 No. 2 (2025): 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.v3i2.247

Abstract

Introduction: Retained intracranial foreign bodies in patients presenting with a Glasgow Coma Scale (GCS) score of 15 represent a rare but potentially fatal diagnostic pitfall in emergency trauma management, carrying profound medicolegal consequences under Indonesian health legislation. This retrospective multi-centre cohort study identified independent procedural risk factors predicting delayed diagnosis (>24 hours) of intracranial foreign bodies among mild traumatic brain injury (mTBI) patients in North Sumatra, Indonesia. Methods: Medical records from 1,240 mTBI patients (GCS 13–15) presenting to three tertiary trauma centres were reviewed; 45 cases with confirmed intracranial foreign bodies were identified, of whom 14 (31.1%) experienced delayed diagnosis. Results: Bivariate analyses demonstrated that failure to perform digital wound palpation (78.6% vs. 9.7%, p<0.001) and non-adherence to neuroimaging guidelines (71.4% vs. 9.7%, p<0.001) were significantly overrepresented in the delayed group. Multivariable logistic regression, adjusted for age, sex, mechanism of injury, and centre, identified non-adherence to computed tomography guidelines (adjusted odds ratio [aOR] 8.71, 95% CI 3.80–21.45, p<0.001), failure to palpate the wound bed (aOR 6.42, 95% CI 2.15–18.50, p<0.001), and an initial GCS of 15 (aOR 3.15, 95% CI 1.42–7.21, p=0.012) as significant independent predictors. Model calibration was excellent (Hosmer–Lemeshow p=0.711; accuracy 88.4%). Conclusion: A sentinel autopsy case demonstrated the fatal sequence: an undetected stone caused subarachnoid haemorrhage, brainstem compression, and asphyxial death. Strict protocol enforcement for secondary physical survey completion and CT guideline adherence is imperative to prevent fatal outcomes and mitigate medicolegal liability in Indonesian emergency departments.
Co-Authors Ahmad Erza Aisyah Andina Rasyid Bryan Helsey Desiree Montesinos Karina Chandra Leonardo Simanjuntak Linda Purnama Lisha Sandrina Mustafa Mahmud Priscilla Kapoor Rinna Azrida Vania Delma