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Open Access Indonesian Journal of Medical Reviews
Published by HM Publisher
ISSN : -     EISSN : 28076257     DOI : https://doi.org/10.37275/oaijmr
Core Subject : Health,
Health Professions Medicine & Pharmacology
Open Access Indonesian Journal of Medical Reviews (OAIJMR) is a bi-monthly, international, peer-review, and open access journal dedicated to various disciplines of medicine, biology and life sciences. The journal publishes all type of review articles, narrative review, meta-analysis, systematic review, mini-reviews and book review.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 200 Documents
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Awake Fiberoptic Intubation for a Giant Multinodular Struma Presenting with Acute Respiratory Failure: A Case Report Abdulrahman Rizky Sulajman; Jeffri Prasetyo Utomo; Buyung Hartiyo Laksono
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.769

Abstract

A giant multinodular struma can cause severe upper airway obstruction, presenting a formidable challenge to anesthesiologists and emergency physicians. Securing the airway is a priority, yet conventional intubation methods carry a high risk of failure and complete airway collapse. Awake Tracheal Intubation (ATI) is a critical technique for managing these anticipated difficult airways, allowing for the maintenance of spontaneous respiration while securing a definitive airway. This report details the emergency management of a patient with near-fatal airway compromise due to a massive goiter. A 51-year-old female presented to the emergency department with severe dyspnea that had worsened over three days. She had a 20-year history of a progressively enlarging neck mass, which was now of a massive size. The patient exhibited signs of acute respiratory failure, including stridor, subcostal retractions, a respiratory rate of 30 breaths/minute, and a decreased level of consciousness. Imaging confirmed a large soft tissue mass causing significant tracheal narrowing from the C4 to C6 vertebral levels. Given the impending airway collapse, an emergency awake fiberoptic intubation was performed. With minimal sedation and continuous oxygenation, a size 6.0 endotracheal tube was successfully placed into the trachea under direct bronchoscopic guidance. The patient’s oxygenation and ventilation improved immediately post-procedure. In conclusion, this case underscores the lifesaving potential of awake fiberoptic intubation in patients with a critically compromised airway from a giant multinodular struma. The ability to maintain spontaneous breathing and provide continuous oxygenation during the procedure is paramount in preventing catastrophic outcomes. This technique should be a core competency for clinicians managing difficult airways in the emergency setting.
Ileal Atresia Mimicking Hirschsprung Disease on Contrast Study: A Case Report and Diagnostic Re-evaluation Anisa Ika Pratiwi; Ibnu Sina Ibrohim
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.770

Abstract

The differentiation between congenital causes of neonatal bowel obstruction, such as ileal atresia and Hirschsprung disease, is paramount for appropriate surgical planning. While clinically similar, their radiological findings can overlap, creating significant diagnostic challenges. Ileal atresia is a congenital anomaly characterized by the incomplete development of the ileum, resulting in intestinal obstruction. The aim of this study is to highlight the limitations of contrast studies in neonatal bowel obstruction and to reinforce the principle that in the face of discordant clinical and radiological evidence. We present the case of a full-term female neonate, born at 39 weeks of gestation, who developed symptoms of green vomiting and delayed bowel movements on her second day of life. An initial colon in loop contrast study at eight days of age was suggestive of short-segment Hirschsprung disease, showing a narrowed rectal lumen and a transition zone in the rectosigmoid region. However, due to persistent signs of distal bowel obstruction, surgical exploration was performed on the ninth day of life. Intraoperatively, the diagnosis was revised to Type 3A ileal atresia located 20 cm from the ileocecal junction, with significant adhesions. The management involved adhesiolysis, resection of the atretic ileal segment, and a primary ileo-ascending anastomosis. The postoperative course was complicated by hypovolemic shock and suspected sepsis neonatorum, which were managed successfully with intensive care support, including intravenous antibiotics and parenteral nutrition. The patient showed significant improvement by the fifth postoperative day and was discharged with normal gastrointestinal function. In conclusion, this case underscores a critical diagnostic pitfall where the 'microcolon of disuse' in distal ileal atresia radiologically mimicked the transition zone of Hirschsprung disease. It highlights that while contrast studies are invaluable, a high index of clinical suspicion and readiness for surgical exploration are essential for accurate diagnosis and timely intervention in complex cases of neonatal bowel obstruction.
Navigating the Triad of Trauma: A Case Report on Managing Concurrent Pulmonary Contusion, Traumatic Brain Injury, and Cervical Fracture in a Geriatric Patient Yasyfie Asykari; Septian Adi Permana; Eko Setijanto
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.771

Abstract

The management of geriatric patients with multiple severe injuries presents a formidable clinical challenge due to reduced physiological reserve and the complex interplay of competing therapeutic goals. This report details the case of a geriatric patient suffering from the triad of pulmonary contusion (PC), moderate traumatic brain injury (TBI), and an unstable cervical spine fracture, highlighting the intricate balance required in neuroprotective and lung-protective ventilatory strategies. A 68-year-old male was admitted following a 10-meter fall, sustaining a moderate TBI with a temporoparietal subdural hemorrhage, a complete C3 vertebral fracture, and significant bilateral pulmonary contusions. His hospital course was marked by acute respiratory distress and neurological deterioration, with a Glasgow Coma Scale (GCS) score of E3V4M5 and hypoxemia requiring intubation and mechanical ventilation in the intensive care unit (ICU). Management focused on the cautious application of positive end-expiratory pressure (PEEP) to improve oxygenation without exacerbating intracranial pressure (ICP), alongside strict cervical spine immobilization and neuro-monitoring. After eight days of complex critical care, the patient’s prolonged need for mechanical ventilation and significant sputum retention necessitated a percutaneous dilational tracheostomy (PDT) to facilitate respiratory weaning and improve pulmonary toilet. In conclusion, this case underscores the profound difficulty of managing concurrent lung and brain injuries in the context of cervical instability. The successful navigation of this trauma triad hinged on a highly individualized, multidisciplinary approach, with judicious ventilator management and timely procedural intervention like PDT being pivotal. It affirms the need for integrated care protocols that can dynamically balance competing organ-system priorities in complex geriatric trauma.
Comparative Diagnostic Accuracy of CT and Ultrasonography for Bowel Obstruction: A Systematic Review and Meta-Analysis Moch Nurul Jadid; Dono Marsetio Wibiseno
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.772

Abstract

The prompt and accurate diagnosis of bowel obstruction is a critical challenge. This systematic review and meta-analysis aimed to determine and compare the pooled diagnostic accuracy of computed tomography (CT) and ultrasonography (USG) for detecting bowel obstruction in adult patients. Following PRISMA-DTA guidelines, we systematically searched PubMed, ScienceDirect, and SagePub for primary diagnostic accuracy studies published between 2014 and 2024 that evaluated CT and/or USG against a reference standard (surgical findings or clinical follow-up). Two reviewers independently screened studies, extracted data, and assessed bias using the QUADAS-2 tool. Bivariate random-effects models were used to calculate pooled sensitivity and specificity. Our search yielded 15 studies comprising 2,876 patients. For the diagnosis of bowel obstruction, CT had a pooled sensitivity of 95.2% (95% CI: 92.8%–96.9%) and a pooled specificity of 96.1% (95% CI: 93.5%–97.7%). For USG, the pooled sensitivity was 91.5% (95% CI: 88.4%–93.8%), and the pooled specificity was 94.3% (95% CI: 91.2%–96.4%). The area under the summary receiver operating characteristic curve confirmed superior overall diagnostic performance for CT (0.98) compared to USG (0.95). In conclusion, CT demonstrates a slightly higher diagnostic accuracy than USG for bowel obstruction in adults. It should be considered the preferred modality for definitive evaluation, particularly for identifying etiology and complications. However, USG remains an excellent and highly accurate alternative, especially as a first-line, point-of-care tool in emergency settings, in pregnant patients, or where CT is contraindicated. The choice of modality should be guided by the specific clinical context.
The Protective Paradox of Operative Delivery: A Case-Control Analysis of Maternal and Neonatal Risk Factors for Asphyxia in a Balinese Hospital Ida Ayu Sintya Pratiwi; I Wayan Dharma Artana
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.773

Abstract

Neonatal asphyxia constitutes a primary driver of neonatal morbidity and mortality worldwide, with a disproportionate burden in developing nations like Indonesia. The identification of localized, modifiable risk factors is a critical prerequisite for the development of targeted and effective preventive healthcare strategies. This study was designed to meticulously identify the significant maternal, intrapartum, and neonatal risk factors associated with neonatal asphyxia within a tertiary care hospital setting in Bali, Indonesia. We executed a retrospective matched case-control study at a specialized Maternal and Child Hospital in Denpasar, Bali. The study included all neonates diagnosed with asphyxia (cases, n=103) born between January 1st and December 31st, 2023, and 103 randomly selected neonates without asphyxia (controls), also born within the same period. To control for potential confounding, cases and controls were matched by gender and month of birth. An exhaustive review of maternal and neonatal medical records was conducted. The data were analyzed using Chi-square tests for bivariate analysis and a multivariate logistic regression model to isolate the independent predictors of asphyxia. The multivariate analysis identified prematurity as the most profound risk factor for neonatal asphyxia, conferring a more than tenfold increase in risk (Adjusted Odds Ratio [aOR] = 10.33, 95% CI: 4.50-23.71, p<0.001). Significant maternal risk factors included anaemia during pregnancy (aOR = 6.56, 95% CI: 2.36-18.20, p<0.001), maternal age outside the optimal range of 20-35 years (aOR = 3.93, 95% CI: 1.50-10.32, p=0.005), and maternal obesity (aOR = 2.92, 95% CI: 1.20-7.11, p=0.018). Premature rupture of membranes (PROM) was identified as a significant intrapartum risk factor (aOR = 3.16, 95% CI: 1.30-7.72, p=0.011). Notably, delivery by caesarean section or instrumental assistance appeared to be a significant protective factor (aOR = 0.22, 95% CI: 0.08-0.59, p=0.003). In conclusion, prematurity, maternal anaemia, age extremes, maternal obesity, and PROM are confirmed as critical, independent risk factors for neonatal asphyxia in this Balinese population. The striking protective association of operative delivery likely represents a "protective paradox," a statistical artifact arising from confounding by indication, wherein timely and decisive obstetric intervention for high-risk pregnancies successfully mitigates adverse outcomes. Preventive strategies must therefore be multifaceted, prioritizing the public health imperatives of preterm birth prevention and the rigorous clinical management of maternal anaemia and obesity throughout the continuum of antenatal care.
Efficacy and Safety of IL-5 Pathway-Targeting Biologics (Mepolizumab, Reslizumab, Benralizumab) in the Management of Hypereosinophilic Syndromes: A Systematic Review and Meta-Analysis Yuniza; Melani; Ratna Maila Dewi Anggraini; Yenny Dian Andayani
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.780

Abstract

Hypereosinophilic syndromes (HES) are rare disorders defined by persistent eosinophilia and eosinophil-driven organ damage. Interleukin-5 (IL-5) is the central cytokine governing eosinophil maturation and survival, establishing its pathway as a critical therapeutic target. While individual trials of biologics targeting the IL-5 pathway—mepolizumab, reslizumab, and benralizumab—have shown promise, a quantitative synthesis of their class-wide efficacy and safety in HES is needed. This study aimed to meta-analyze the evidence for these agents in managing HES. Following PRISMA guidelines, we systematically searched PubMed, Embase, and Cochrane Library through December 2024 for randomized controlled trials (RCTs) and prospective observational studies of IL-5 pathway biologics in patients with HES. Primary outcomes were the proportion of patients achieving hematologic response and the annualized rate of clinical exacerbations. Key secondary outcomes included oral corticosteroid (OCS) dose reduction and adverse events (AEs). Data were pooled using a random-effects model, with extensive, pre-planned subgroup and sensitivity analyses to explore heterogeneity. Seven studies (3 RCTs, 4 observational) involving 388 patients were included. Patients receiving IL-5 pathway biologics had significantly higher odds of achieving hematologic response (Odds Ratio [OR] 9.85; 95% Confidence Interval [CI] 5.12-18.96; p<0.0001), a finding robust to sensitivity analyses of different response definitions. The annualized exacerbation rate was reduced by 64% (Rate Ratio 0.36; 95% CI 0.25-0.52; p<0.0001). The intervention led to a mean daily OCS reduction of 12.5 mg (95% CI -15.8 to -9.2 mg; p<0.0001). Subgroup analysis revealed this effect was more pronounced in observational studies than in RCTs. The overall risk of AEs was not significantly increased. This meta-analysis provides robust evidence that biologics targeting the IL-5 pathway are highly effective and generally safe for managing PDGFRA-negative HES. They induce high rates of hematologic remission, substantially reduce clinical exacerbations, and facilitate a significant corticosteroid-sparing effect. These findings strongly support their role as a foundational component of modern HES therapy, though long-term safety and efficacy within distinct HES subtypes warrant further investigation.
Salvage Total Laryngectomy with Bilateral Deltopectoral Flap Reconstruction for Metastatic (Stage IVC) Laryngeal Carcinoma: A Case Report Steven Yohanis Latupeirissa; I Wayan Lolik Lesmana; Eka Putra Setiawan; I Gde Ardika Nuaba; Made Lely Rahayu; I Ketut Suanda
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.781

Abstract

The management of advanced laryngeal squamous cell carcinoma (SCC) that persists or recurs after definitive chemoradiotherapy presents a significant clinical challenge. This challenge is profoundly amplified in the setting of distant metastatic disease (Stage IVC), where the goals of treatment shift from curative intent to palliation and quality of life preservation. Surgical salvage in this context is controversial and reserved for highly selected cases with severe, unmanageable local symptoms. We present the case of a 58-year-old male, a long-term smoker, with Stage IVC (T3N2cM1) laryngeal SCC, complicated by bone metastases. He initially underwent definitive chemoradiotherapy. Ten months later, he presented with progressive local disease, including a fungating cervical mass and impending airway compromise. A palliative salvage total laryngectomy with bilateral Modified Radical Neck Dissection (MRND) was performed to control severe local symptoms. The extensive pharyngocutaneous defect was reconstructed using bilateral pedicled deltopectoral fasciocutaneous flaps. The final histopathology confirmed viable, moderately differentiated SCC with extensive cartilage invasion and, critically, a positive deep resection margin. The postoperative course was managed successfully, with the patient showing significant improvement in local symptoms and quality of life at short-term follow-up. This case highlights the complex decision-making required for palliative surgery in metastatic head and neck cancer. The discussion focuses on the justification for aggressive local intervention to palliate debilitating symptoms, the rationale for selecting the robust bilateral deltopectoral flap for reconstruction in a hostile, irradiated field, and the profound prognostic implications of a positive surgical margin in the salvage setting. In conclusion, palliative salvage total laryngectomy can be a viable strategy to improve quality of life in selected patients with Stage IVC laryngeal cancer and overwhelming local disease. However, achieving complete oncologic clearance is a formidable challenge, and management must be tailored within a multidisciplinary framework.
Defining the Threshold: A Dose-Response Meta-Analysis of Daily Screen Time and Adverse Behavioral Outcomes in Children and Adolescents Andreas Eric
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.782

Abstract

The pervasive integration of digital media into the lives of children and adolescents has generated significant concern regarding its impact on developmental health. While associations between high levels of screen time and negative outcomes are frequently reported, the precise dose-response relationship remains poorly quantified, leaving clinicians and parents without evidence-based thresholds for guidance. This study aimed to quantitatively synthesize the evidence linking daily screen time duration to the risk of adverse behavioral outcomes in youth. Following PRISMA guidelines, a systematic search of PubMed, Embase, PsycINFO, and Scopus was conducted through February 2025. Observational studies that reported quantifiable measures of daily screen time and validated assessments of behavioral outcomes in individuals aged 3-18 years were included. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Newcastle-Ottawa Scale (NOS). A two-stage, random-effects dose-response meta-analysis using restricted cubic splines was employed to model the non-linear association between screen time (in hours/day) and the odds of adverse behavioral outcomes. From an initial 4,891 records, 7 key studies comprising 46,882 participants were included in the quantitative synthesis. The dose-response analysis revealed a significant, non-linear relationship. Compared to 30 minutes of daily screen time, the pooled odds ratio (OR) for adverse behavioral outcomes was minimal at 1 hour/day (OR 1.05; 95% CI, 0.97-1.14) but began to increase significantly thereafter. The risk became more pronounced at 2 hours/day (OR 1.31; 95% CI, 1.17-1.47), rose substantially at 4 hours/day (OR 1.82; 95% CI, 1.60-2.07), and continued to climb at 6 hours/day (OR 2.55; 95% CI, 2.15-3.03). The association was stronger in preschool-aged children compared to adolescents. In conclusion, this focused meta-analysis provides quantitative evidence for a dose-dependent association between daily screen time and behavioral problems in youth, with a notable increase in risk observed beyond two hours per day. These findings provide an evidence-based foundation for clinical guidance and public health recommendations aimed at mitigating the behavioral risks of excessive digital media exposure during critical developmental periods.
Anesthetic and Analgesic Management for Mastectomy of a Giant Phyllodes Tumor: A Case Report on the Central Role of the Serratus Anterior Plane Block Heri Dwi Purnomo; Bara Aditya; Yasyfie Asykari; Rafael Bagus Yudhistira
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.784

Abstract

Mastectomy for giant breast tumors presents a formidable clinical challenge due to the anticipated extensive surgical trauma, significant inflammatory response, and high risk of severe postoperative pain. This intense nociceptive barrage can lead to central sensitization and the development of debilitating Post-Mastectomy Pain Syndrome (PMPS). A robust, opioid-sparing multimodal analgesic strategy is therefore not just beneficial, but essential. The Serratus Anterior Plane Block (SAPB) is a regional anesthetic technique integral to such a strategy. We present the case of a 39-year-old, 60 kg female with a giant (24 x 22 x 18 cm) right-sided phyllodes tumor scheduled for mastectomy. The anesthetic plan consisted of general anesthesia and a preemptive, ultrasound-guided deep SAPB using 20 mL of 0.25% levobupivacaine. The procedure was performed with meticulous attention to sonoanatomy and technique. Intraoperatively, the patient maintained profound hemodynamic stability with minimal requirement for volatile anesthetic. Postoperatively, the patient reported complete analgesia, with Visual Analog Scale (VAS) scores of 0 at rest and 0-1 with movement (dynamic pain) for the first 24 hours. Sensory testing confirmed a dense block from T2 to T7. The patient required no rescue analgesia, mobilized early, and reported high satisfaction with her recovery. The final pathology confirmed a borderline phyllodes tumor. In conclusion, this case report demonstrates that a meticulously performed, ultrasound-guided deep SAPB can serve as the cornerstone of an effective, opioid-sparing analgesic regimen for high-pain-risk breast surgery. It can provide complete and functional postoperative analgesia, enhance hemodynamic stability, and facilitate recovery, embodying the core principles of Enhanced Recovery After Surgery (ERAS) pathways.
Acinar Gland Hyperplasia Masquerading as Pancreatic Head Carcinoma: A Case Report on a Diagnostic and Surgical Dilemma Prima Maulana Cahyo Nugroho; Suryo Wahyu Raharjo
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.785

Abstract

The preoperative differentiation of benign from malignant pancreatic head masses presents a significant clinical challenge. While pancreatic ductal adenocarcinoma (PDAC) is the primary concern, rare benign pathologies can be radiologically and clinically indistinguishable from cancer, leading to diagnostic uncertainty and complex surgical decisions. A 61-year-old male presented with a classic triad of obstructive jaundice, significant weight loss, and right upper abdominal pain. A contrast-enhanced computed tomography (CT) scan of the abdomen revealed a solid mass in the head of the pancreas, causing concomitant dilation of the common bile and pancreatic ducts—the "double duct sign." These findings were highly suggestive of pancreatic head carcinoma, prompting a decision for surgical intervention. The patient underwent a standard pancreaticoduodenectomy (Whipple procedure). Surprisingly, the final histopathological examination of the resected specimen revealed no evidence of malignancy. The diagnosis was benign acinar gland hyperplasia. The postoperative course was complicated by a delayed post-pancreatectomy hemorrhage from a gastroduodenal artery pseudoaneurysm, which was successfully managed with minimally invasive transarterial embolization (TAE). In conclusion, acinar gland hyperplasia is an exceedingly rare benign condition that can precisely mimic the clinical and radiological features of pancreatic cancer. This case underscores the current limitations of preoperative diagnostics and affirms that aggressive surgical management is justified in patients with a high suspicion of malignancy, as the risk of withholding surgery for a potentially curable cancer outweighs the risk of resecting a benign lesion. Furthermore, it highlights that the Whipple procedure carries a significant risk of life-threatening complications, such as delayed hemorrhage, irrespective of the underlying pathology, necessitating vigilant postoperative care.

Page 18 of 20 | Total Record : 200

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