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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.
Failure to Palpate and Failure to Image: Quantifying Standard-of-Care Departure in Fatal Delayed Intracranial Foreign Body Diagnosis, 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 alert at a Glasgow Coma Scale (GCS) of 15 are a rare, lethal and medicolegally exposed failure in Indonesian assault casework, yet the share attributable to specific documentable procedural omissions is unquantified. Methods: This retrospective multi-centre cohort examined 45 confirmed retained intracranial foreign bodies identified from 1,240 mild traumatic brain injury presentations (prevalence 3.63%, 95% CI 2.72–4.82) at three trauma centres in North Sumatra, Indonesia, 2019–2023, per STROBE. Diagnosis beyond 24 hours was the pre-specified outcome. With only aggregate data, inference used Fisher exact tests, exact conditional and Firth-penalised odds ratios with profile penalised-likelihood intervals, Holm multiplicity control, and partial identification of the multivariable model across 4,000 admissible joint arrangements. Results: Diagnosis was delayed in 14 of 45 cases (31.1%, 95% CI 19.5–45.7). Failure to palpate the wound bed carried an exact conditional odds ratio of 29.86 (4.79–281.0; p < 0.001) and computed tomography non-adherence 20.88 (3.57–174.7; p < 0.001). As a bedside marker, palpation failure achieved sensitivity 78.6%, specificity 90.3% and area under the curve 0.844; the attributable fraction was 76.3% (50.8–96.1) with an E-value of 11.18. Adjusted odds ratios were bounded, not estimated, because aggregate marginal data cannot identify a multivariable model. Conclusion: Two zero-cost omissions dominate a fatal diagnostic failure; recording wound-bed palpation and the imaging decision is clinically protective and, under KUHAP Articles 133 and 179 and Law No. 17 of 2023, is what a visum et repertum requires.
Co-Authors Aisyah Andina Rasyid Alessandra Navos Febria Suryani Linda Purnama Mustafa Mahmud