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Rachmat Hidayat
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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 195 Documents
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Preoperative Fasting Duration as a Potential Predictor of Glycemic Instability in Non-Diabetic Emergency Surgery Patients: A Prospective Observational Pilot Study Mustaqiem Isda; Aswoco Andyk Asmoro; Ristiawan Muji Laksono; Rudy Vitraludyono
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.v5i5.789

Abstract

Preoperative fasting is a cornerstone of anesthetic safety, yet in emergency surgery, fasting periods are frequently prolonged and unregulated. The metabolic consequences of such extended fasting in non-diabetic patients, who are often assumed to be metabolically resilient, are poorly understood. This pilot study aimed to investigate the association between prolonged fasting and pre-induction glycemic instability. We conducted a prospective, observational pilot study at a tertiary referral hospital, enrolling 30 non-diabetic adult patients (ASA I-E/II-E) undergoing emergency surgery. The primary exposure was preoperative fasting duration, analyzed as both a continuous variable and a dichotomized category (≤8 vs. >8 hours). The primary outcomes were pre-induction blood glucose levels, analyzed continuously and with two categorical thresholds: glycemic instability (<85 mg/dL) and clinically significant hypoglycemia (<70 mg/dL). Associations were assessed using Chi-Square tests and Spearman's rank correlation. A majority of patients (60%) fasted for >8 hours. A strong negative correlation was found between the duration of fasting and pre-induction blood glucose levels (Spearman's ρ = -0.78, p<0.001). Using the <85 mg/dL threshold, 83.3% of patients fasting >8 hours exhibited glycemic instability, compared to 25% of those fasting ≤8 hours (p=0.002). Using the standard <70 mg/dL threshold, 55.6% of patients fasting >8 hours developed clinically significant hypoglycemia, compared to 8.3% of those fasting ≤8 hours (p=0.011). In conclusion, this pilot study provides a strong preliminary signal that prolonged preoperative fasting is significantly associated with a decline in blood glucose and an increased incidence of both glycemic instability and clinically significant hypoglycemia in non-diabetic emergency surgical patients. These findings challenge the assumption of metabolic security in this population and underscore the urgent need for larger, definitive studies. Routine pre-induction glucose monitoring should be strongly considered as a potential safety standard in this vulnerable group.
Beyond Viral Load: The Clinical and Endocrine Profile of ART-Naive HIV-Infected Men with Hypogonadism, Opportunistic Infections, and Malnutrition Yulianto Kusnadi; Fahrenheit; Harun Hudari
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.v5i5.792

Abstract

In patients with advanced human immunodeficiency virus (HIV), the clinical presentation often extends beyond immunodeficiency to a syndemic of interacting comorbidities. Male hypogonadism is a critical but often under-recognized endocrine dimension of this syndrome. This study aimed to characterize the clinical, metabolic, and endocrine profile of antiretroviral therapy (ART)-naive men to provide a comprehensive baseline understanding of this syndemic state before therapeutic intervention. An analytical cross-sectional study was conducted from April to October 2024, enrolling 64 consecutively presenting ART-naive men with HIV at a tertiary hospital in Palembang, Indonesia. We performed a comprehensive assessment including WHO clinical staging, nutritional evaluation (BMI), and screening for comorbidities. Endocrine status was assessed by measuring total testosterone, Luteinizing Hormone (LH), and serum albumin, from which bioavailable testosterone was calculated using the Vermeulen formula. Bivariate correlations and comparative analyses were conducted to explore relationships between variables. The cohort presented with profound immunodeficiency (median CD4 count: 23.5 cells/µL) and advanced disease (92.2% in WHO Stage 3 or 4). A high burden of opportunistic infections (40.6% pulmonary tuberculosis) and malnutrition (48.4% underweight; median serum albumin: 3.25 g/dL) was observed. Based on total testosterone (<300 ng/dL), the prevalence of hypogonadism was 32.8%. However, analysis using the more physiologically relevant calculated bioavailable testosterone (<70 ng/dL) revealed a higher prevalence of 42.2%. Secondary (hypogonadotropic) hypogonadism was the overwhelmingly dominant etiology (28.1%). Bioavailable testosterone was significantly and positively correlated with both CD4 count (ρ=0.35, p=0.005) and BMI (ρ=0.41, p=0.001). In conclusion, ART-naive men presenting with advanced HIV in this setting are caught in a syndemic of immunodeficiency, infectious disease, malnutrition, and profound endocrine dysfunction. The high prevalence of secondary hypogonadism, strongly associated with the severity of immune collapse and poor nutritional status, highlights the HPG axis as a key casualty of systemic illness. These findings provide a compelling rationale for integrating routine hormonal and metabolic screening into the initial assessment of all men newly diagnosed with HIV.
Conservative Management of a Giant 27-cm Myoma in Pregnancy: A Case Report and Review of the Literature I Made Mega Kencana Putra; I Gusti Gede Mayun Surya Darma
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (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.v5i6.793

Abstract

The coexistence of pregnancy and uterine leiomyomas is common, but the presence of a giant myoma (>10 cm) presents profound diagnostic and therapeutic challenges. These cases carry significant risks of maternal and fetal morbidity, including compressive symptoms, preterm labor, and malpresentation. Management strategies are contentious, often balancing the high risks of antenatal myomectomy against the uncertainties of conservative observation. We present the case of a 24-year-old primigravida at 25 weeks of gestation with a giant, partially degenerated uterine leiomyoma measuring 26.9 x 18.7 x 24.7 cm. The patient presented with significant abdominal distension, pain, and imaging findings of moderate right-sided hydroureteronephrosis. The sheer size of the mass displaced the uterus and induced a stable transverse lie of the fetus. Despite the considerable risks and the suggestion of potential malignant degeneration on initial MRI, which was later considered less likely, the patient, after extensive multidisciplinary counseling, opted for conservative management with the goal of reaching fetal viability. The pregnancy was closely monitored with serial ultrasonography and clinical evaluation. In conclusion, this case demonstrates that expectant management, even in the face of a giant, symptomatic uterine myoma causing significant anatomical distortion and organ compression, can be a viable strategy. Through meticulous multidisciplinary surveillance and patient-centered decision-making, a successful neonatal outcome was achieved. This report underscores the importance of individualized care plans and highlights the potential for conservative management to succeed in extraordinary clinical scenarios.
Solitary Sinonasal Neurofibroma in an Elderly Male: A Rare Presentation and Surgical Management Jessica Filbertine; I Gde Ardika Nuaba; I Ketut Suanda; Ida Ayu Alit Widiantari; I Wayan Lolik Lesmana
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (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.v5i6.794

Abstract

Solitary sinonasal neurofibromas are rare peripheral nerve sheath tumors whose diagnosis is frequently confounded by non-specific symptoms and radiological features that mimic common inflammatory conditions. In the elderly, a unilateral sinonasal mass necessitates a high index of suspicion for neoplasia, yet diagnostic pitfalls remain a significant clinical challenge. A 65-year-old male with no stigmata of neurofibromatosis type 1 presented with a three-year history of progressively worsening unilateral nasal obstruction. Endoscopy revealed a large, pale, firm, non-friable mass. Computed tomography (CT) demonstrated an extensive, non-enhancing soft tissue mass originating in the left maxillary sinus, causing significant expansile bone remodeling and extending into multiple adjacent sinuses. The initial radiological impression was extensive sinonasal polyposis. However, an incisional biopsy followed by a comprehensive morphological analysis confirmed the diagnosis of a benign spindle cell tumor consistent with neurofibroma. The patient underwent complete tumor excision via a left lateral rhinotomy. The postoperative course was uneventful, with no recurrence at 12-month follow-up. In conclusion, this case underscores the critical importance of a thorough diagnostic workup for unilateral sinonasal masses in the elderly, where radiological findings can be misleading. Histopathological analysis is indispensable for the definitive diagnosis of spindle cell tumors in this location. For massive, maxillary-based neurofibromas with extensive lateral and anterior involvement, the lateral rhinotomy remains a vital and superior surgical approach, providing the necessary exposure to uphold the fundamental principle of complete oncologic resection and maximize the probability of a curative outcome.
Ultrasound-Guided Supraclavicular Block as a Primary Anesthetic for Humerus Biopsy in a High-Risk Patient with a Compressive Goiter and Atrial Fibrillation: A Case Report Muhammad Husni Thamrin; Muhammad Ridho Aditya; Nabila Vika Intansari
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (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.v5i6.795

Abstract

The anesthetic management of patients with multiple severe comorbidities presents a formidable clinical challenge. Pathological fractures secondary to metastatic disease often require procedural intervention in individuals with pre-existing cardiopulmonary, airway, and cerebrovascular compromise. General anesthesia in such patients carries a prohibitively high risk of hemodynamic collapse, airway loss, and perioperative mortality. We present a case where a targeted regional anesthetic technique was pivotal in ensuring patient safety. A 59-year-old woman with a pathological fracture of the right humerus, suspected to be a metastasis from thyroid carcinoma, was scheduled for a core needle biopsy. Her medical history was profoundly complex, including a massive, airway-compressing thyroid goiter, persistent atrial fibrillation, recent ischemic stroke with residual hemiparesis, bilateral pneumonia with pulmonary edema, uncontrolled type 2 diabetes mellitus, and acute-on-chronic kidney disease. Given the extreme risks associated with general anesthesia and airway manipulation, we opted for an ultrasound-guided right supraclavicular brachial plexus block as the sole anesthetic. The block was performed successfully using 20 mL of 1.5% lidocaine with epinephrine, providing dense sensorimotor anesthesia of the upper limb. The patient remained hemodynamically stable, spontaneously breathing, and comfortable throughout the procedure, with no perioperative complications. In conclusion, this case demonstrates that an ultrasound-guided supraclavicular block is a safe, effective, and hemodynamically superior alternative to general anesthesia for upper limb procedures in a patient with a confluence of critical airway, cardiac, pulmonary, and neurological comorbidities. This approach obviates the need for airway instrumentation, preserves spontaneous ventilation, and minimizes systemic physiological trespass, thereby enhancing patient safety in the highest-risk surgical populations.
Ultrasound-Guided Regional Anesthesia for Clavicle Fixation in a Pregnant Patient with Traumatic Brain Injury: A Case Report and Pathophysiological Review Koko Agung Tri Wibowo; Aura Ihsaniar; Husni Thamrin
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (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.v5i6.797

Abstract

The anesthetic management of a third-trimester pregnant patient with a concurrent traumatic brain injury (TBI) and a surgical fracture presents a profound clinical dilemma. The conflicting demands of maternal neuroprotection, fetal stability, and surgical anesthesia necessitate a carefully considered approach, as standard general anesthesia carries significant risks for both mother and fetus. A 25-year-old female at 28 weeks’ gestation presented after a motor vehicle accident with a displaced right clavicle fracture and a TBI characterized by a clinically mild presentation (Glasgow Coma Scale 14) and a radiologically significant acute subdural hemorrhage. To provide surgical anesthesia for open reduction and internal fixation while circumventing the risks of general anesthesia, a primary regional anesthetic was performed. An ultrasound-guided single-shot interscalene brachial plexus block, supplemented with a superficial cervical plexus block, provided dense surgical anesthesia. This technique ensured remarkable maternal hemodynamic stability, maintained a reassuring Category I fetal heart tracing throughout, and completely avoided intraoperative systemic opioids and sedatives. The postoperative course was notable for excellent, opioid-sparing analgesia and an uncomplicated recovery for both mother and infant. In conclusion, this case provides an illustrative example of how a meticulously executed regional anesthetic technique can serve as a primary and potentially superior modality in this high-risk patient population. It successfully navigated the competing pathophysiological demands, suggesting that regional anesthesia should be a first-line consideration in select, complex trauma scenarios involving pregnancy and TBI.
The Crescendo Reaction in Patch Testing: A Key Diagnostic Sign in Allergic Contact Cheilitis from Modern Matte Lipsticks Rahmat Firdaus Dwi Utama; Harijono Kariosentono; Ayu Kusuma Dewi; Shelly Lavenia Sambodo; Stella Gracia Octarica; Sugih Primas Adjie
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (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.v5i6.798

Abstract

Allergic contact cheilitis (ACC) from lipsticks is a frequent diagnostic challenge, often mimicking irritant contact cheilitis (ICC). The patch test is the diagnostic standard, but its accuracy relies heavily on the interpretation of reaction dynamics over time. This report illustrates the pivotal role of the crescendo reaction pattern in confirming an allergic etiology. A 21-year-old female presented with a six-month history of debilitating pruritus, papules, and subsequent xerosis with severe post-inflammatory hyperpigmentation on her lips. The symptoms were directly correlated with the daily use of several popular commercial matte and long-lasting lipsticks. Patch testing was performed with the European Standard Series and the patient’s own cosmetic products. While standard allergens were negative, three specific lipsticks elicited a classic crescendo reaction: a weak positive (+) erythema at 48 hours that intensified to a strong positive (++) reaction with papules and palpable infiltration at the 72- and 96-hour readings. This dynamic confirmed a Type IV hypersensitivity reaction and a diagnosis of ACC. Management focused on strict allergen avoidance and barrier repair, resulting in complete resolution of symptoms and significant improvement in her quality of life. In conclusion, the crescendo pattern observed in patch testing is a compelling in vivo marker of an allergic, memory T-cell-driven immune response. Its presence provides conclusive evidence for ACC, reliably distinguishing it from the decrescendo pattern characteristic of irritation. Meticulous observation of the temporal evolution of patch test reactions is paramount for accurate diagnosis and effective patient management in cheilitis.
Fulminant Perianal Donovanosis Manifesting as Septic Shock in a Treatment-Naïve AIDS Patient: A Clinico-Pathological Case Report Rahmat Firdaus Dwi Utama; Muhammad Eko Irawanto; Ayu Kusuma Dewi; Shelly Lavenia Sambodo; Stella Gracia Octarica; Sugih Primas Adjie
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (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.v5i6.799

Abstract

Donovanosis (Granuloma Inguinale), caused by Klebsiella granulomatis, is a rare sexually transmitted infection that can follow a devastating course in severely immunocompromised individuals. Its clinical progression in the context of advanced acquired immunodeficiency syndrome (AIDS) is not extensively documented. We present a case of fulminant donovanosis to illustrate its potential for rapid systemic deterioration and mortality. A 20-year-old Indonesian man, with a recent diagnosis of human immunodeficiency virus (HIV) for which he was treatment-naïve, presented with a two-month history of extensive, painful perianal ulcerations. Clinical examination revealed large, coalescing, "beefy-red" ulcers in the perianal and gluteal regions. Laboratory investigations confirmed profound immunosuppression (CD4+ T-cell count: 3 cells/µL; HIV viral load: >750,000 copies/mL). The diagnosis of donovanosis was definitively established by the microscopic identification of pathognomonic intracellular Donovan bodies on a Giemsa-stained tissue smear, with findings corroborated by histopathological analysis of a skin biopsy. Despite the initiation of appropriate antibiotic and supportive therapy, the patient's condition rapidly progressed to septic shock and multi-organ dysfunction syndrome, leading to his death within six days of hospital admission. In conclusion, this case highlights the aggressive, life-threatening nature of donovanosis in the setting of advanced AIDS. The profound collapse of cell-mediated immunity likely facilitated uncontrolled bacterial replication and systemic dissemination, rendering standard antibiotic therapy ineffective. This report serves as a critical clinical reminder to maintain a high index of suspicion for donovanosis in immunocompromised patients presenting with atypical anogenital ulcers, as early diagnosis and aggressive multimodal management are paramount.
Global Cephalometric Norms for Pediatric Soft Tissue Profiles: A Systematic Review and Meta-Analysis of Racial and Ethnic Variations Asep Darya Darma Putra; Yona ladyventini; Bobby
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.800

Abstract

The diagnostic standards in orthodontics have been historically based on Caucasian cephalometric norms, an approach that is increasingly inappropriate for a diverse global population and can lead to misdiagnosis in pediatric patients aged 9-18. This study aimed to systematically review the literature and perform a meta-analysis to establish and compare key soft tissue cephalometric estimates for pediatric populations across various major racial and ethnic groups. Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, Web of Science, and Embase was conducted for studies published between January 2015 and August 2025. We included cross-sectional studies reporting mean and standard deviation for soft tissue cephalometric measurements in untreated adolescents from distinct ethnic groups. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Newcastle-Ottawa Scale. A random-effects model was used to calculate pooled mean estimates, 95% confidence intervals (CI), and 95% prediction intervals (PI) for key parameters. The search yielded 1,842 articles; seven studies met the inclusion criteria, comprising 1,240 individuals. Significant differences in pooled means were found across all parameters, with profound statistical heterogeneity. Subjects of African descent displayed the most convex facial profile (pooled mean G’-Sn-Pog’: 164.8°; 95% CI: 163.1-166.5; I²=92%). In contrast, Caucasian subjects exhibited the straightest profile (172.5°; 95% CI: 170.9-174.1). Lip prominence was greatest in the African descent group (+3.5 mm to E-line; 95% CI: 2.8-4.2; I²=91%) and retrusive in the Caucasian group (-2.1 mm; 95% CI: -2.8 to -1.4). The 95% prediction intervals were substantially wider than the confidence intervals, highlighting extensive inter-population variance. In conclusion, clinically significant variations in pediatric soft tissue profiles exist among different racial and ethnic groups. The extreme heterogeneity found in this analysis is a critical finding, suggesting that the concept of a single numerical "norm" is flawed even within broad ethnic categories. This meta-analysis provides a quantitative foundation for a more cautious, individualized diagnostic approach that respects the wide spectrum of normal human facial variation.
The Differential Biopsychosocial Burden of Psoriasis and Vitiligo: A Comparative Analysis of Participation Restriction and its Clinical and Psychiatric Correlates Nurrachmat Mulianto; Shelly Lavenia Sambodo; Muhammad Eko Irawanto; Arie Kusumawardani
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (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.v5i6.805

Abstract

Visible skin diseases like psoriasis vulgaris and vitiligo impose a significant psychosocial burden. However, the comparative impact on real-world functioning and the interplay of clinical, social, and psychiatric factors remain poorly understood, particularly in non-Western populations. This study aimed to quantitatively compare participation restriction between these two conditions and to identify its key biopsychosocial predictors. This comparative cross-sectional study, conducted in a tertiary Indonesian hospital, enrolled 50 patients (25 with psoriasis vulgaris, 25 with non-segmental vitiligo). The primary outcome was participation restriction, measured by the 18-item Participation Scale (P-Scale). Clinical severity was assessed using the Psoriasis Area and Severity Index (PASI) and Vitiligo Area Scoring Index (VASI). Crucially, depressive and anxiety symptoms were screened using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale, respectively. A hierarchical multiple linear regression analysis was performed to identify predictors of participation restriction. Patients with psoriasis reported profoundly higher mean P-Scale scores (43.16 ± 5.01) compared to those with vitiligo (25.72 ± 4.21; p < 0.001), indicating more severe restrictions. Psoriasis patients also exhibited significantly higher scores for depressive symptoms (PHQ-9: 11.52 ± 3.18 vs. 5.68 ± 2.29; p < 0.001) and anxiety symptoms (GAD-7: 10.24 ± 2.95 vs. 5.12 ± 2.15; p < 0.001). The hierarchical regression model was highly significant (F(7, 42) = 28.14, p < 0.001), explaining 82.4% of the variance in P-Scale scores. After controlling for demographic and clinical factors, a diagnosis of psoriasis (β = 0.45, p < 0.001), higher clinical severity (β = 0.28, p = 0.002), and higher depressive symptom severity (PHQ-9 score; β = 0.39, p < 0.001) were significant independent predictors of greater participation restriction. In conclusion, psoriasis vulgaris is associated with a dramatically greater burden of participation restriction than vitiligo. This burden is driven by a complex interplay of the disease's clinical severity, its inherent diagnosis-specific factors, and, critically, comorbid depressive symptoms. These findings underscore the necessity of a biopsychosocial approach in dermatology, advocating for routine mental health screening and integrated care models to address the multifaceted drivers of disability in patients with chronic inflammatory skin disease.

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