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All Journal Sriwijaya Journal of Forensic and Medicolegal Sriwijaya Journal of Otorhinolaryngology
Priscilla Kapoor
Department of Radiology, Mumbai State Hospital, Mumbai, India
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Public Health

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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.
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 Aisyah Andina Rasyid Alessandra Navos Febria Suryani Linda Purnama Mustafa Mahmud