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All Journal Scientia Psychiatrica Sriwijaya Journal of Forensic and Medicolegal Scientific Journal of Pediatrics Sriwijaya Journal of Otorhinolaryngology
Febria Suryani
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience 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.
A Simplified Scoring System for Diagnosing Allergic Rhinitis in Indonesian Primary Care Settings: A Cross-Sectional Study Comparing Accuracy to Specialist Diagnosis Febria Suryani; Irna Nettles; Aisyah Andina Rasyid; Fifia Ardinanti
Sriwijaya Journal of Otorhinolaryngology Vol. 3 No. 1 (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.v2i2.183

Abstract

Introduction: Allergic rhinitis (AR) is a prevalent condition in Indonesia, yet often underdiagnosed and undertreated in primary care settings. Access to specialist otorhinolaryngologists is limited, particularly in rural areas. A simplified, accurate diagnostic tool for primary care physicians (PCPs) could significantly improve early diagnosis and management. This study aimed to develop and validate a simplified scoring system for AR diagnosis in Indonesian primary care, comparing its accuracy to the gold standard of specialist diagnosis. Methods: A cross-sectional study was conducted in five major Indonesian cities (Medan, Palembang, Jakarta, Surabaya, and Makassar) across various primary care clinics. Patients presenting with nasal symptoms suggestive of AR were recruited. Each patient was assessed by a PCP using the newly developed "Indonesian Allergic Rhinitis Score" (IARS) and subsequently by a board-certified otorhinolaryngologist. The IARS included key symptoms and history elements weighted based on existing literature and expert consensus. The otorhinolaryngologist's diagnosis, based on a comprehensive history, physical examination (including nasal endoscopy when indicated), and allergy testing (skin prick test or specific IgE), served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and1 area under the receiver operating characteristic curve (AUC)2 were calculated to evaluate the IARS's diagnostic accuracy. Results: A total of 1500 patients were included in the study (300 from each city). The mean age was 32.4 years (SD = 10.2), with a slight female predominance (58%). The IARS demonstrated a sensitivity of 85.3% (95% CI: 83.1-87.3%), specificity of 79.6% (95% CI: 76.8-82.2%), PPV of 82.5% (95% CI: 80.2-84.6%), and NPV of 83.0% (95% CI: 80.3-85.4%) for diagnosing AR. The AUC was 0.89 (95% CI: 0.87-0.91), indicating good diagnostic accuracy. The most common symptoms reported were nasal congestion (92%), rhinorrhea (88%), sneezing (85%), and itchy nose (79%). Conclusion: The IARS provides a simple, accurate, and readily implementable tool for diagnosing AR in Indonesian primary care settings. Its high sensitivity and acceptable specificity suggest it can effectively identify individuals who require further evaluation and management for AR, improving access to care and potentially reducing the burden of undiagnosed allergic disease.
Forensic DNA Phenotyping for Predicting Externally Visible Characteristics in Indonesian Populations: A Novel Tool for Criminal Investigations Rinna Azrida; Febria Suryani; Bjorka Alma; Sony Sanjaya; Khairiel Anwar
Sriwijaya Journal of Forensic and Medicolegal Vol. 2 No. 2 (2024): 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.v2i2.190

Abstract

Introduction: Forensic DNA phenotyping (FDP) is an emerging field that utilizes genetic information to predict an individual's externally visible characteristics (EVCs). While its application has shown promise in aiding criminal investigations globally, its utility within the diverse Indonesian population remains largely unexplored. This study aimed to investigate the potential of FDP for predicting EVCs in a representative sample of the Indonesian population, evaluating its accuracy and implications as a novel tool for criminal investigations in this unique context. Methods: This study involved the analysis of anonymized DNA samples from 1000 individuals self-identified as belonging to various ethnic groups across Indonesia. A panel of single nucleotide polymorphisms (SNPs) known to be associated with EVCs including hair color, eye color, skin pigmentation, and biogeographic ancestry (BGA) was selected based on existing literature. Genotyping data was generated to reflect the genetic diversity observed in Indonesian populations. Statistical analyses were performed to assess the predictive power of the SNP panel for each EVC and to evaluate the correlation between predicted phenotypes and self-reported characteristics. Results: The results demonstrated a moderate to high predictive accuracy for several EVCs within the Indonesian population. Skin pigmentation showed the highest predictability, followed by eye color and hair color. BGA prediction effectively clustered individuals based on their genetic profiles, aligning with the known population structure of Indonesia. Significant variations in allele frequencies for EVC-associated SNPs were observed across different ethnic groups, highlighting the importance of population-specific data. Conclusion: This study provides preliminary evidence suggesting that forensic DNA phenotyping holds significant potential as a novel tool for criminal investigations in Indonesia. The ability to predict EVCs from DNA could provide valuable leads in cases where traditional DNA profiling yields no matches. However, further research with real Indonesian population data is crucial to validate these findings and to develop robust, population-specific FDP models. Ethical and legal considerations surrounding the use of this technology in the Indonesian context must also be carefully addressed.
Preventing Cognitive Decline in Late-Life Depression: A Longitudinal Study on the Efficacy of Omega-3 Fatty Acid Supplementation in Older Adults in Palembang, Indonesia Sony Sanjaya; Febria Suryani; Pham Uyen; Maria Rodriguez; Muhammad Yoshandi
Scientia Psychiatrica Vol. 6 No. 4 (2025): Scientia Psychiatrica
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/scipsy.v6i2.190

Abstract

Introduction: Late-life depression (LLD) is a prevalent condition in older adults and a significant risk factor for cognitive decline and dementia. In Indonesia, with its aging population and specific dietary patterns, understanding interventions for LLD-associated cognitive impairment is crucial. Omega-3 polyunsaturated fatty acids (PUFAs) offer potential neuroprotective benefits. This study aimed to assess the efficacy of long-term omega-3 PUFA supplementation in mitigating cognitive decline among older adults with LLD in Palembang, Indonesia. Methods: This 24-month, randomized, double-blind, placebo-controlled trial was conducted in Palembang. Three hundred sixty older adults (aged ≥60 years) with a current DSM-5 diagnosis of Major Depressive Disorder (MDD) and subjective cognitive complaints were randomized (1:1) to receive either daily oral supplementation of 2.2 grams of omega-3 PUFAs (containing 1320 mg eicosapentaenoic acid [EPA] and 880 mg docosahexaenoic acid [DHA]) or a matched placebo (corn oil). The primary outcome was the change in the Indonesian version of the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog-INA) score over 24 months. Secondary outcomes included changes in the Montreal Cognitive Assessment-Indonesian version (MoCA-INA), Geriatric Depression Scale (GDS-30), Instrumental Activities of Daily Living (IADL), serum Brain-Derived Neurotrophic Factor (BDNF), and high-sensitivity C-Reactive Protein (hs-CRP). Results: Over 24 months, the omega-3 group exhibited significantly less decline on the ADAS-Cog-INA compared to the placebo group (mean difference: -2.1 points; 95% CI: -3.8 to -0.4; p=0.018). Statistically significant benefits for the omega-3 group were also observed in MoCA-INA scores (mean difference: 1.5 points; p=0.025) and GDS-30 scores (mean difference: -2.5 points; p=0.011). BDNF levels increased significantly in the omega-3 group relative to placebo (p=0.008), while hs-CRP levels showed a non-significant trend towards reduction (p=0.072). Conclusion: Long-term supplementation with 2.2 g/day of EPA-rich omega-3 PUFAs resulted in a modest but statistically significant attenuation of cognitive decline and improvement in depressive symptoms in older adults with LLD in Palembang. These findings suggest that omega-3 PUFAs could be a valuable adjunctive therapeutic strategy in this specific Southeast Asian population.
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.
Co-Authors Ahmad Erza Aisyah Andina Rasyid Bjorka Alma Bryan Helsey Desiree Montesinos Fifia Ardinanti Irna Nettles Karina Chandra Khairiel Anwar Leonardo Simanjuntak Linda Purnama Lisha Sandrina Maria Rodriguez Muhammad Yoshandi Mustafa Mahmud Pham Uyen Rinna Azrida Sony Sanjaya Vania Delma