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Accuracy of Fat Mass and Muscle Mass Measured by Bioelectrical Impedance Analysis in Predicting Osteoporosis in Older Adults Riviati, Nur; Ari Dwi Prasetyo; Rizki Bastari; Surya Darma; Erial Bahar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i2.1191

Background: Osteoporosis is a prevalent bone disease characterized by reduced bone mineral density (BMD) and increased fracture risk. This study aimed to evaluate the accuracy of fat mass (FM) and muscle mass measured by bioelectrical impedance analysis (BIA) in predicting osteoporosis in older adults. Methods: A cross-sectional study was conducted on 109 outpatients aged 60 years and older. FM parameters (total fat mass, visceral fat level, and fat mass index [FMI]) and muscle mass parameters (total muscle mass, appendicular skeletal muscle mass [ASM], and appendicular skeletal muscle mass index [ASMI]) were measured using BIA. Osteoporosis was diagnosed based on BMD measurements using dual-energy X-ray absorptiometry (DXA). Receiver operating characteristic (ROC) curves were used to determine cut-off points and assess the accuracy of BIA parameters in predicting osteoporosis. Results: The prevalence of osteoporosis was 52.3% (n=57). The optimal cut-off points for predicting osteoporosis were: total fat mass >36.25%, visceral fat level >12.05, FMI >7.82 kg/m2, total muscle mass <37.82 kg, ASM <16.795 kg, and ASMI <6.895 kg/m2. Among the FM parameters, visceral fat level had the highest accuracy (AUC = 60.9%, sensitivity = 64.9%, specificity = 78.8%) while FMI had the lowest (AUC = 53.5%, sensitivity = 56.1%, specificity = 57.7%). For muscle mass parameters, ASM showed the highest accuracy (AUC = 74.0%, sensitivity = 70.2%, specificity = 76.9%). Conclusion: BIA-derived FM and muscle mass parameters, particularly visceral fat level and ASM can be used to predict osteoporosis in older adults with good accuracy. This non-invasive and accessible method may be useful as a screening tool for osteoporosis, especially in settings where DXA is unavailable.

Predicting Postoperative Mortality in Head Injury Patients: Evaluating the Accuracy of Rotterdam Score Fadhli Aufar Kasyfi; Agung Muda Patih; Erial Bahar
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.118

Introduction: Head injury remains a leading cause of mortality and morbidity globally, necessitating accurate prognostic tools to guide clinical decision-making and inform patient outcomes. Rotterdam Score, a computed tomography (CT)-based scoring system, has shown promise in predicting mortality in head injury patients. This study aimed to evaluate the accuracy of the Rotterdam Score in predicting postoperative mortality in head injury patients undergoing surgery. Methods: A retrospective analysis was conducted on 56 head injury patients who underwent surgery at Dr. Mohammad Hoesin General Hospital, Palembang, between December 2023 and November 2024. Patient demographics, clinical characteristics, and CT scan findings were collected. Rotterdam Score was calculated for each patient, and its accuracy in predicting postoperative mortality was assessed using receiver operating characteristic (ROC) curve analysis. Results: The study cohort comprised 37 (66.1%) males and 19 (33.9%) females, with a mean age of 31.8 ± 21.6 years. Mild head injury was the most common Glasgow Coma Scale (GCS) classification (42.9%). The overall mortality rate was 17.8%. ROC curve analysis revealed an area under the curve (AUC) of 0.953 for the Rotterdam Score, with an optimal cut-off value of 4.5. Rotterdam Score demonstrated a sensitivity of 80%, specificity of 97.8%, positive predictive value (PPV) of 88.8%, and negative predictive value (NPV) of 95.7% in predicting postoperative mortality. Conclusion: The Rotterdam Score is a highly accurate predictor of postoperative mortality in head injury patients undergoing surgery. Its CT-based assessment allows for rapid and objective prognostication, aiding clinicians in risk stratification and treatment planning. Further research with larger and more diverse populations is warranted to validate these findings and establish the generalizability of Rotterdam Score across different healthcare settings.

Impact of Prolonged Cardiopulmonary Bypass and Aortic Cross-Clamp Time on Postoperative Ventilator Dependency Following Mitral Valve Replacement Aswin Nugraha; Reizkhi Fitriyana; Erial Bahar
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.126

Introduction: Mitral valve replacement (MVR) is a common procedure for severe mitral valve disease. Prolonged cardiopulmonary bypass (CPB) time and aortic cross-clamp (AOX) time during cardiac surgery are known to be associated with adverse postoperative outcomes, including prolonged mechanical ventilation. Understanding the predictive value of these intraoperative times specifically for ventilator dependency after MVR is crucial for risk stratification and patient management. This study aimed to determine the accuracy of CPB time and AOX time as predictors of postoperative ventilator duration in patients undergoing MVR at a tertiary referral hospital in Palembang, Indonesia. Methods: A retrospective cohort study was conducted using medical records of patients aged ≥ 18 years who underwent MVR between January 2022 and December 2024 at RSUP Dr. Mohammad Hoesin Palembang. Data from 79 patients meeting the inclusion criteria were analyzed. The primary independent variables were CPB time and AOX time (categorized using a 90-minute cut-off). The primary outcome was prolonged mechanical ventilation (defined as >24 hours). Secondary outcomes included ICU length of stay (>4 days) and in-hospital mortality. Statistical analysis involved Chi-square tests and multivariate logistic regression. Results: Prolonged CPB time (≥90 minutes) was observed in 62% of patients, and prolonged AOX time (≥90 minutes) in 45.6%. Both prolonged AOX time (OR 15.167, p=0.01) and prolonged CPB time (OR 8.88, p=0.01) were significantly associated with mechanical ventilation >24 hours. Multivariate analysis confirmed both AOX time (Adjusted OR 8.741, p=0.049) and CPB time (Adjusted OR 5.163, p=0.027) as independent predictors for prolonged ventilation. Significant associations were also found between prolonged AOX/CPB times and ICU stay >4 days (p=0.03 for both). No significant association was found between CPB/AOX times and in-hospital mortality (p=0.968 and p=0.206, respectively). Conclusion: Prolonged CPB time and AOX time are significant independent predictors of postoperative ventilator dependency exceeding 24 hours following MVR in this patient cohort. Minimizing these intraoperative durations may reduce the burden of prolonged mechanical ventilation.

Beyond Clinical Intuition: Quantitative Mortality Prediction in Blunt Thoracic Trauma using the Thoracic Trauma Severity Score (TTSS) Harief Seamaladi; Aswin Nugraha; Erial Bahar
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.127

Introduction: Blunt thoracic trauma is a leading cause of significant morbidity and mortality, particularly in younger populations. Accurate and early prediction of mortality is crucial for guiding clinical management and resource allocation. This study aimed to move beyond subjective clinical assessment by evaluating the accuracy of the Thoracic Trauma Severity Score (TTSS) as an objective, quantitative tool for predicting in-hospital mortality in patients with blunt thoracic trauma in a specific regional trauma center. Methods: A retrospective cohort study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Data from 38 patients admitted with blunt thoracic trauma between January 2023 and January 2025 were analyzed. The TTSS was calculated for each patient based on five parameters: age, number of rib fractures, presence of bilateral rib fractures, extent of pulmonary contusion (assessed by chest X-ray), and the PaO2/FiO2 ratio (from arterial blood gas analysis). The primary outcome was in-hospital mortality. Receiver Operating Characteristic (ROC) curve analysis was used to determine the predictive accuracy of the TTSS, including the Area Under the Curve (AUC), sensitivity, specificity, and optimal cut-off value. Bivariate analysis using the chi-square test was performed. Results: Of the 38 patients, 76.3% (n=29) were male. The mortality rate was 15.8% (n=6). The ROC curve analysis for TTSS in predicting mortality yielded an AUC of 0.727 (95% CI: 0.447–1.000; p = 0.082). At an optimal cut-off value of 10.5, the TTSS demonstrated a sensitivity of 66.6% and a specificity of 71.8% for mortality prediction. Patients with TTSS >7 had a significantly higher proportion of mortality (83% of deaths occurred in this group) compared to those with TTSS $\leq$7. Conclusion: The Thoracic Trauma Severity Score (TTSS) showed fair predictive accuracy for in-hospital mortality in patients with blunt thoracic trauma in this study setting. While demonstrating reasonable sensitivity at a cut-off of 10.5, its specificity was also moderate. The TTSS can serve as a useful quantitative adjunct to clinical judgment, aiding in the early identification of patients at higher risk, though its limitations, particularly the modest specificity and non-significant p-value for AUC in this cohort, warrant cautious interpretation and highlight the need for further validation in larger, multicenter studies.

DIAGNOSTIC ACCURACY OF CLINICAL SCORING SYSTEMS (NSS, NDS, AND TCSS) COMPARED TO ELECTROPHYSIOLOGICAL TESTING IN DIABETIC NEUROPATHY AMONG T2DM PATIENTS Muhlisa, Safitri; Theresia Christin; Yulianto Kusnadi; Erial Bahar
Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya Vol. 12 No. 3 (2025): Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Univers
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/jkk.v12i3.689

Diabetic neuropathy is one of the most common chronic complications in diabetes mellitus patients and can significantly impair quality of life. Early diagnosis is essential, but limited availability of diagnostic tools such as electrophysiological testing in many healthcare facilities calls for more practical and efficient alternatives. This study aimed to compare the diagnostic accuracy of three clinical scoring systems—NSS (Neuropathy Symptom Score), NDS (Neuropathy Disability Score), and TCSS (Toronto Clinical Scoring System)—in detecting diabetic neuropathy among Type 2 DM patients at Dr. Mohammad Hoesin Hospital, Palembang. A cross-sectional design was employed, and findings revealed that TCSS had the highest accuracy (90.3%) compared to NDS (85.5%) and NSS (85.4%). TCSS also demonstrated the best balance of sensitivity (95.4%) and specificity (77.8%). All three instruments can serve as effective early screening tools, especially in healthcare settings with limited access to electrophysiological diagnostic facilities.

Establishing an APACHE II Cut-off Score for Predicting Mortality in Post-Thoracotomy Patients: A Single-Center Cohort Analysis Awan Rochaniawan; Ahmat Umar; Erial Bahar
Sriwijaya Journal of Surgery Vol. 8 No. 2 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i2.131

Introduction: Thoracotomy represents a significant physiological challenge with considerable mortality risk. Early, objective risk stratification in the General Intensive Care Unit (GICU) is essential for guiding clinical management. This study sought to evaluate the utility of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score as a prognostic tool in a heterogeneous post-thoracotomy population at a tertiary referral center in Southeast Asia. Methods: A retrospective cohort study was conducted on 33 consecutive patients admitted to the GICU following thoracotomy between January and December 2024. The APACHE II score was calculated using the most deranged physiological values within the first 24 hours of admission. The primary outcome was in-hospital mortality. Statistical analyses included non-parametric tests for group comparisons, Spearman's rank correlation, and Receiver Operating Characteristic (ROC) curve analysis. A novel aspect of this study was the post-hoc stratification of the cohort by the primary surgical indication (malignancy versus non-malignancy) to explore sources of prognostic variability. Results: The overall mortality rate was 27.3% (9 of 33 patients). Non-survivors had a significantly higher median APACHE II score than survivors (23 vs. 8; p < 0.001). A strong, positive correlation was observed between the APACHE II score and mortality (Spearman's ρ = 0.706; p < 0.001). ROC analysis demonstrated excellent discriminatory performance for the overall cohort, with an Area Under the Curve (AUC) of 0.956 (95% CI: 0.891–1.000). A score of ≥12.5 was identified as the optimal cut-off, yielding a sensitivity of 88.9% and specificity of 87.5%. Analysis of the APACHE II components revealed that mortality was primarily driven by derangements in neurological (GCS), renal (Creatinine), and acid-base (pH) parameters. Conclusion: In this preliminary, single-center analysis, the initial 24-hour APACHE II score demonstrated potential as a powerful prognostic marker for in-hospital mortality following thoracotomy. A candidate cut-off score of ≥12.5 successfully identified a high-risk subgroup. However, given the study's significant limitations, including a small and heterogeneous sample, these findings should be interpreted as hypothesis-generating. They underscore the need for larger, prospective studies to validate this cut-off and to develop more refined prognostic models for specific subgroups of post-thoracotomy patients.

External Validation of the RASH Score in Surgically Managed Acute Subdural Hematoma: A Critical Appraisal of Prognostic Accuracy and Surgical Factors in a Southeast Asian Cohort Irwansyah; Trijoso Permono; Dwiandi Susilo; Erial Bahar
Sriwijaya Journal of Surgery Vol. 8 No. 2 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i2.134

Introduction: Acute subdural hematoma (ASDH) is a lethal form of traumatic brain injury (TBI) with high mortality. The Richmond Acute Subdural Hematoma (RASH) score is a simple prognostic tool, but its validity in diverse populations is untested. This study aimed to perform the first external validation of the RASH score in an Indonesian cohort and critically appraise its performance alongside key surgical factors. Methods: We conducted a retrospective, single-center, diagnostic accuracy study of 67 adult patients who underwent surgery for traumatic ASDH between January 2022 and December 2024 at a tertiary neurosurgical center in Palembang, Indonesia. The RASH score was calculated from admission data. We additionally analyzed the type of surgery (craniotomy vs. decompressive craniectomy) and time from injury to operation. The primary outcome was in-hospital mortality. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the RASH score's predictive performance. Results: The overall in-hospital mortality rate was 20.9% (n=14). The RASH score demonstrated excellent discrimination for mortality, with an Area Under the ROC Curve (AUC) of 0.824 (95% CI: 0.715–0.933; p<0.001). A score of 5 or greater was identified as the optimal cut-off, yielding a sensitivity of 78.6% and specificity of 77.4%. This threshold provided a high Negative Predictive Value (NPV) of 93.2% but a modest Positive Predictive Value (PPV) of 47.8%. In bivariate analysis, decompressive craniectomy and longer time to surgery were significantly associated with mortality. Conclusion: The RASH score is a simple and robust tool for risk stratification in this selected surgical population. Its high NPV is valuable for identifying patients with a higher likelihood of survival. However, its utility must be interpreted cautiously due to the significant selection bias inherent in studying only operable patients. The score should serve as an adjunct to, not a replacement for, comprehensive clinical judgment.

Relationship between CD-8 Expression to Treatment Response in Nasopharyngeal Carcinoma Patient After Neoadjuvant Chemotherapy in Dr. Mohammad Hoesin Hospital Palembang Utama, Denny Satria; Eriza; Belly Sutopo Wijaya; Erial Bahar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 4 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i4.455

Background. Nasopharyngeal carcinoma (NPC) is the most common malignancy in head and neck in Indonesia with 19,943 new cases in 2020 resulting 13,399 deaths. Lymphocytes are cells that play a role in the anti-cancer immune response, especially CD-8 T-cells. Neoadjuvant chemotherapy is chemotherapy given before radiotherapy that aims to kill primary tumors and micrometastasis tumors. This study aims to find out the relationship of CD-8 expression to treatment response in NPC undergoing neoadjuvant chemotherapy at Dr. Mohammad Hoesin Hospital Palembang. Methods. This study is an analytical observational research study on a retrospective cohort basis. Data collection from medical records using total sampling in 15 patients pilot study of NPC patients undergoing neoadjuvant chemotherapy and conducted CD-8 examination at ORLHNS polyclinic Dr. Mohammad Hoesin Hospital Palembang from December 2018 to December 2019 that met the criteria of inclusion and exclusion. Results. From 15 samples, the average CD-8 test result before neoadjuvant chemotherapy was 24.54 ng/μL and after neoadjuvant chemotherapy was 193.56 ng/μL. There was a tendency to increase the average CD-8 from before to after completion of neoadjuvan chemotherapy with a statistically significant difference of p =0.001. ROC analysis found CD-8 cut off points is 23.76 ng/μL with an area below the curve is 0.667. There were no significant relationships between CD-8 to performance status and treatment response with p values of 0.289 and 0.219, respectively. Conclusions. There was a significant change between CD-8 before neoadjuvant chemotherapy and after neoadjuvant chemotherapy with increased CD-8 tendencies and trends from before to after 6 series neoadjuvant chemotherapy with CD-8 cut off points is 23.76 ng/μL. In this study there has not been a significant relationships between CD-8 to performance status and treatment response in NPC patients undergoing neoadjuvant chemotherapy.

Relationship between CD-8 Expression to Treatment Response in Nasopharyngeal Carcinoma Patient After Neoadjuvant Chemotherapy in Dr. Mohammad Hoesin Hospital Palembang Utama, Denny Satria; Eriza; Belly Sutopo Wijaya; Erial Bahar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 4 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i4.455

Background. Nasopharyngeal carcinoma (NPC) is the most common malignancy in head and neck in Indonesia with 19,943 new cases in 2020 resulting 13,399 deaths. Lymphocytes are cells that play a role in the anti-cancer immune response, especially CD-8 T-cells. Neoadjuvant chemotherapy is chemotherapy given before radiotherapy that aims to kill primary tumors and micrometastasis tumors. This study aims to find out the relationship of CD-8 expression to treatment response in NPC undergoing neoadjuvant chemotherapy at Dr. Mohammad Hoesin Hospital Palembang. Methods. This study is an analytical observational research study on a retrospective cohort basis. Data collection from medical records using total sampling in 15 patients pilot study of NPC patients undergoing neoadjuvant chemotherapy and conducted CD-8 examination at ORLHNS polyclinic Dr. Mohammad Hoesin Hospital Palembang from December 2018 to December 2019 that met the criteria of inclusion and exclusion. Results. From 15 samples, the average CD-8 test result before neoadjuvant chemotherapy was 24.54 ng/μL and after neoadjuvant chemotherapy was 193.56 ng/μL. There was a tendency to increase the average CD-8 from before to after completion of neoadjuvan chemotherapy with a statistically significant difference of p =0.001. ROC analysis found CD-8 cut off points is 23.76 ng/μL with an area below the curve is 0.667. There were no significant relationships between CD-8 to performance status and treatment response with p values of 0.289 and 0.219, respectively. Conclusions. There was a significant change between CD-8 before neoadjuvant chemotherapy and after neoadjuvant chemotherapy with increased CD-8 tendencies and trends from before to after 6 series neoadjuvant chemotherapy with CD-8 cut off points is 23.76 ng/μL. In this study there has not been a significant relationships between CD-8 to performance status and treatment response in NPC patients undergoing neoadjuvant chemotherapy.

The Relationship between Maxillofacial Injury Severity Score (MFISS) and Outcomes of Maxillofacial Trauma Patients at Dr. Mohammad Hoesin General Hospital (RSMH) Palembang, Indonesia Valendra, Deo; Iqmal Perlianta; Erial Bahar
Sriwijaya Journal of Surgery Vol. 6 No. 2 (2023): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v6i2.92

Introduction: Maxillofacial trauma is an important public health problem, and understanding the relationship between injury severity and patient outcomes is critical for effective management. This study aimed to determine the relationship between the maxillofacial injury severity score (MFISS) and the outcomes of maxillofacial trauma patients at Dr. Mohammad Hoesin General Hospital, Palembang. Methods: An analytical observational study was conducted involving 121 maxillofacial trauma patients from April to May 2023. Data regarding patient characteristics, MFISS scores, type of management, length of stay, and mortality were collected and analyzed using statistical tests. Results: The majority of maxillofacial trauma patients were male (74.4%) and aged over 18 years (63.6%). Traffic accidents are the main cause of trauma (84.3%). The distribution of MFISS scores showed that 75% of patients had mild scores, 18.2% had moderate scores, and 5.8% had severe scores. Most patients underwent surgical management, with the majority having a length of stay of ≤7 days. The mortality rate was 2.5%. There was no significant relationship between the MFISS score and type of management (p > 0.05). However, there was a significant difference in the length of stay based on the MFISS score (p = 0.000). Patients with severe MFISS scores had significantly longer lengths of stay compared with patients with mild or moderate scores. In addition, there was a significant relationship between MFISS score and mortality (p = 0.000). Patients with severe MFISS scores had a higher risk of death compared with patients with mild to moderate scores. Conclusion: The MFISS score is associated with length of stay and mortality in maxillofacial trauma patients. However, there was no significant relationship between the MFISS score and the type of management.

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