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INDONESIA
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 209 Documents
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Severe Erythema Nodosum Leprosum Complicated by Warm Autoimmune Hemolytic Anemia: Navigating the Immunosuppressive Paradox Devina Ravelia Tiffany Subroto; Kadek Cahya Adwitya; I Putu Bayu Triguna
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.834

Abstract

Erythema nodosum leprosum (ENL) is a severe, systemic immune-complex mediated complication of multibacillary Hansen’s disease. While anemia of chronic disease is frequently observed in leprosy, the concurrent development of Warm Autoimmune Hemolytic Anemia (wAIHA) is an exceptionally rare and precarious clinical entity. This comorbidity creates a therapeutic paradox wherein the high-dose corticosteroids required to halt hemolysis may exacerbate the risk of sepsis in patients with necrotic skin lesions and compromised barrier function. We report the case of a 42-year-old male with multibacillary Hansen’s disease on multidrug therapy who presented with high-grade fever, progressive fatigue, and necrotic cutaneous lesions. Laboratory evaluation revealed life-threatening normocytic normochromic anemia (Hemoglobin 3.5 g/dL) and a leukemoid reaction (WBC 42,540/µL). Hemolysis was confirmed by elevated lactate dehydrogenase (564 U/L), indirect hyperbilirubinemia, and a strongly positive direct Coombs test (IgG). A diagnosis of wAIHA secondary to severe necrotic ENL was established. Standard high-dose pulse steroid therapy was deemed high-risk due to the patient’s extreme neutrophilia (NLR 80.25) and open necrotic ulcers. Consequently, a tailored regimen of intermediate-dose intravenous methylprednisolone (62.5 mg twice daily) combined with broad-spectrum antibiotics was initiated. This strategy successfully suppressed hemolysis and resolved the ENL reaction without precipitating secondary opportunistic infections. In conclusion, the coexistence of wAIHA and ENL suggests a shared mechanism of dysregulated T-cell immunity and molecular mimicry. This case demonstrates that in scenarios involving high infectious risk, an individualized, intermediate-dose corticosteroid protocol can achieve remission while mitigating the dangers of profound immunosuppression.
Evaluation of Morphine-Sparing Efficacy with Low-Dose Ketamine in Pediatric Postoperative Pain: A Pilot Randomized Controlled Trial Naim Ismail Imunu; Isngadi; Rudy Vitraludyono; Arie Zainul Fatoni
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.835

Abstract

Postoperative pain management in the pediatric population requires a delicate balance between effective analgesia and the minimization of opioid-related adverse events, particularly respiratory depression. While multimodal analgesia is the standard of care, the optimal dose-reduction potential of opioids when combined with N-methyl-D-aspartate (NMDA) antagonists remains undefined. We conducted a prospective, single-center, pilot randomized controlled trial using a double-blind observer protocol. Twenty pediatric patients aged 2 months to 7 years undergoing elective surgery were randomized into four groups. The control group (Group M) received standard continuous morphine at 0.33 µg/kg/min. Three intervention groups received fixed low-dose ketamine at 0.33 µg/kg/min combined with tapered morphine doses: Group KM-1 at 0.23 µg/kg/min, Group KM-2 at 0.16 µg/kg/min, and Group KM-3 at 0.06 µg/kg/min. The primary outcome was analgesic efficacy assessed by FLACC scores at 24 hours. Secondary outcomes included hemodynamic stability and rescue analgesia requirements. Baseline characteristics were comparable across groups. At 24 hours, the median FLACC scores were comparable between the high-dose control (Median 2.0; Interquartile Range 1.5–2.0) and the lowest morphine group (Group KM-3: Median 2.0; Interquartile Range 1.5–2.0; p = 0.438). Group KM-3 achieved an 81% reduction in morphine consumption with a 0% rescue analgesia rate, identical to the control group. In conclusion, preliminary data from this pilot study suggest that low-dose ketamine may permit a substantial reduction in morphine dosage of up to 81% without compromising analgesic efficacy. These findings warrant confirmation in larger, fully powered multicenter trials.
Penile Preservation in a Young Adult with Aggressive Spindle Cell Carcinoma: A Case of Wide Local Excision and Glanular Reconstruction in a Resource-Limited Setting Dony Marthen Bani; Syaeful Agung Wibowo
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.836

Abstract

Penile sarcomatoid squamous cell carcinoma, also known as spindle cell carcinoma, is a rare and aggressive malignancy characterized by biphasic histology. Its management in young adults under 40 years of age is challenging, particularly in resource-limited settings where advanced diagnostic adjuncts like immunohistochemistry are often unavailable, necessitating reliance on morphological diagnosis and clinical acumen. We report the case of a 36-year-old uncircumcised male presenting with a rapidly growing, 2.5 cm exophytic glanular mass (cT2N0M0). Diagnostic workup relied on clinical assessment and morphological evaluation to rule out differentials, as immunohistochemical markers were unavailable. The patient underwent penile-sparing wide local excision (WLE) with intraoperative frozen section control (5 mm margins) and primary glanular reconstruction. Due to the high-grade histology and resource constraints preventing dynamic sentinel node biopsy, the patient was managed with a strict active surveillance protocol for the inguinal basin. Histopathology using Hematoxylin and Eosin (H&E) staining confirmed a high-grade malignancy with a predominant population of atypical spindle cells arranged in fascicles, consistent with Spindle Cell Carcinoma. Deep and lateral margins were negative. At 12-month follow-up, the patient remains disease-free with no evidence of local recurrence or inguinal lymphadenopathy. The International Index of Erectile Function (IIEF-5) score remained stable (23/25), indicating excellent functional preservation. In conclusion, penile preservation via WLE is a viable option for selected cases of Spindle Cell Carcinoma. In resource-limited settings where immunohistochemistry is inaccessible, accurate diagnosis relies on identifying characteristic morphological features on H&E staining combined with clinical history. Strict surveillance is mandatory to monitor for nodal progression in the absence of invasive staging.
Adiposity-Induced Voiding Dysfunction: Unraveling the Association Between Overweight Status and Symptom Severity in Non-Retentive Benign Prostatic Hyperplasia Iman Hakim Wicaksana; Setya Anton Tusarawardaya; Suharto Wijanarko; Wibisono; Amru Sungkar
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.845

Abstract

Benign prostatic hyperplasia (BPH) has historically been viewed through a prostato-centric lens, attributing lower urinary tract symptoms (LUTS) primarily to prostatic volume and mechanical obstruction. However, this model fails to account for the substantial symptom burden observed in patients without significant retention or massive enlargement. Emerging evidence suggests that systemic metabolic dysregulation, particularly adiposity, plays a crucial role in the pathophysiology of LUTS. This study aims to evaluate the association between Overweight status and the subjective severity of LUTS in a specific cohort of non-retentive BPH patients, thereby isolating metabolic contributors from acute mechanical failure. We conducted an observational analytic cross-sectional study at the Urology Polyclinic of RSUD Dr. Moewardi, Surakarta, Indonesia, from June 2024 to January 2025. The study enrolled 110 men diagnosed with BPH who met strict criteria for non-retentive status (post-void residual <150 mL, no indwelling catheter). Participants were stratified into normal BMI (<25 kg/m²) and Overweight (≥25 kg/m²) groups. Symptom severity was quantified using the International Prostate Symptom Score (IPSS). Data were analyzed using the Mann-Whitney U test and Chi-square analysis. The cohort comprised 72 (65.5%) normal-weight and 38 (34.5%) overweight patients. A statistically significant disparity in symptom severity was observed. The overweight group exhibited a significantly higher mean IPSS (17.87 ± 5.18) compared to the normal group (11.54 ± 4.71) (p<0.001). Notably, 44.7% of overweight patients presented with severe LUTS, compared to only 5.6% of normal-weight patients. Conversely, 90.9% of patients with mild symptoms belonged to the normal-weight group. In conclusion, overweight status is significantly associated with increased LUTS severity in non-retentive BPH patients. The findings suggest that adiposity exacerbates voiding dysfunction through systemic inflammatory, hormonal, and autonomic pathways independent of urinary retention. These results advocate for the integration of weight management as a core therapeutic strategy in BPH care.
Hemodynamic Stability via Ultrasound-Guided Axillary Brachial Plexus Block with Levobupivacaine-Dexamethasone in a Patient with Impending Thyroid Storm and Hand Fracture Anak Agung Ngurah Aryawangsa
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.855

Abstract

The perioperative management of patients with uncontrolled hyperthyroidism requiring emergency surgery presents an acute clinical challenge, as surgical trauma and anesthesia can precipitate a life-threatening thyroid storm. This case report examines the strategic role of regional anesthesia in mitigating such risks through complete afferent blockade and sympathetic stabilization. A 28-year-old male presented with multiple right-hand fractures following a motorcycle accident. The patient had a history of untreated hyperthyroidism for one year and exhibited classic clinical thyrotoxicosis, including tachycardia of 104 bpm, hypertension of 164/90 mmHg, bilateral exophthalmos, and hyperkinesis. Laboratory investigations confirmed primary hyperthyroidism with a markedly elevated free T4 of 86.6 pmol/L and suppressed TSH. His Burch-Wartofsky Point Scale (BWPS) score was calculated at 30, indicating an impending thyroid storm. Following rapid medical optimization with propylthiouracil, propranolol, hydrocortisone, and amlodipine, surgical intervention was successfully performed under ultrasound-guided axillary brachial plexus block. The anesthetic mixture comprised 20 mL of 0.5 percent levobupivacaine and 8 mg of perineural dexamethasone. The patient demonstrated remarkable hemodynamic stability throughout the two-hour procedure, maintaining a systolic blood pressure between 115 and 135 mmHg and a heart rate between 82 and 94 bpm, without progressing to a thyroid crisis. In conclusion, ultrasound-guided regional anesthesia, specifically the axillary approach, offers a superior safety profile for thyrotoxic patients by avoiding airway instrumentation and preventing the sympathetic surges associated with general anesthesia. The synergistic use of levobupivacaine and dexamethasone provides a dual benefit of enhanced cardiac safety and peripheral endocrine stabilization.
Low-Dose Prophylaxis versus On-Demand Therapy in Hemophilia Management: A Systematic Review and Meta-Analysis of Clinical Outcomes and Cost-Effectiveness in Resource-Limited Settings Rijalun Arridho; Rudy Afriant
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.859

Abstract

Hemophilia A and B impose a catastrophic burden in resource-limited settings (RLS), where the standard of care—high-dose primary prophylaxis—remains economically inaccessible. Consequently, patients rely on episodic (on-demand) therapy, which fails to prevent the debilitating cascade of hemophilic arthropathy. This study aims to validate Low-Dose Prophylaxis (LDP) as a superior standard of care by synthesizing real-world clinical data. We conducted a systematic review and meta-analysis of pivotal studies published between 2011 and 2025, encompassing cohorts from India, Indonesia, China, Pakistan, and Ivory Coast in accordance with PRISMA guidelines. Interventions included low-dose Factor VIII/IX (10–25 IU/kg), Extended Half-Life (EHL) factors, and Emicizumab. Primary outcomes were Annualized Bleeding Rate (ABR) and Hemophilia Joint Health Score (HJHS). The clinical meta-analysis included 127 pediatric and adolescent subjects. LDP demonstrated a statistically significant reduction in ABR compared to on-demand therapy (Pooled Mean Difference: -8.14; 95% CI: -10.5 to -5.7; p<0.001). EHL prophylaxis reduced mean ABR from 6.0 to 0.07. Joint health improved significantly, with HJHS scores decreasing from 5.42 to 2.28 (p=0.0013) post-intervention. Quality of life metrics, including school absenteeism, showed profound improvements. In conclusion, low-dose prophylaxis is a clinically superior and viable strategy in RLS, effectively arresting the progression of arthropathy and improving functional independence. Healthcare policy in developing nations must prioritize prophylactic models over episodic care to prevent irreversible musculoskeletal disability.
Efficacy of Multimodal Prehabilitation vs. Standard Care on Postoperative Morbidity and Quality of Life in Major Gastrointestinal Oncology Surgery: A Systematic Review and Meta-Analysis Stephen William Soeseno; Made Agus Dwianthara Sueta
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.864

Abstract

Major gastrointestinal oncology surgery induces profound physiological stress, precipitating a severe reduction in functional capacity and high rates of postoperative complications. Traditional perioperative pathways optimize intraoperative and postoperative care but systematically overlook preoperative functional reserves. A systematic review and meta-analysis were conducted in strict adherence to PRISMA guidelines. Systematic searches were executed across PubMed, Embase, Cochrane CENTRAL, and Scopus from database inception to March 2026. High-quality clinical trials evaluating multimodal prehabilitation against standard care in gastrointestinal cancer surgery were analyzed. Pooled odds ratios (OR) and standardized mean differences (SMD) with 95% Confidence Intervals (CI) were calculated using a random-effects model, with heterogeneity assessed via the $I^2$ statistic. Multimodal prehabilitation significantly reduced overall 30-day postoperative complications compared to standard care (OR 0.35, 95% CI: 0.18–0.69, p=0.010, $I^2$=42%). This was driven primarily by a striking decrease in Grade II pulmonary infections. Functional capacity was remarkably preserved; prehabilitated patients demonstrated statistically superior walking distances postoperatively (SMD 1.25, 95% CI: 0.95–1.55, p<0.001). Sarcopenic patients receiving targeted nutritional supplementation with beta-hydroxy beta-methylbutyrate exhibited sustained improvements in chair rise repetitions (Mean Difference 4.0, 95% CI: 2.5–5.5) and significant physiological remodeling of intramuscular adipose tissue. In conclusion, multimodal prehabilitation fundamentally alters the physiological trajectory of patients undergoing major gastrointestinal oncology surgery. By proactively mitigating surgical stress and attenuating catabolic decline, this intervention ensures superior functional restitution and minimizes short-term morbidity.
Comparative Evaluation of Target-Controlled Infusion versus Syringe Pump Bolus for Remifentanil Administration on the Incidence of Apnoea and Bradycardia during General Anaesthesia Induction: A Double-Blind Pilot Randomised Controlled Trial Ardhana Surya Aji; Bambang Novianto Putro; Andy Nugroho
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 2 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i2.876

Abstract

Remifentanil is widely utilized during general anaesthesia induction to attenuate adverse haemodynamic responses to tracheal intubation. However, its profound analgesic efficacy is inherently linked to dose-dependent adverse effects, primarily opioid-induced respiratory depression (apnoea) and bradycardia. This pilot study evaluates the safety profile of pharmacokinetically guided target-controlled infusion (TCI) compared to conventional syringe pump (SP) bolus administration. A double-blind, pilot randomised controlled trial was conducted involving 36 ASA I–II patients undergoing elective maxillofacial surgery. Patients received a standardized co-induction of propofol (2.0 mg/kg), followed by remifentanil via SP (1 µg/kg over 60 seconds) or TCI (initial effect-site concentration [Ce] of 6 ng/mL for 5 minutes, reduced to 4 ng/mL). Primary outcomes were the incidence of apnoea (>15 seconds) and bradycardia (<50 bpm). Apnoea occurred in 33.3% of the SP group versus 16.7% in the TCI group (RR 2.00; p=0.222). Mean onset of apnoea was 41.0±11.0 seconds (SP) and 31.0±3.6 seconds (TCI) (p=0.085). Bradycardia was observed in 72.2% of the SP cohort and 50.0% in the TCI cohort (RR 1.44; p=0.153). All bradycardic events were transiently managed with 0.5 mg of atropine. In conclusion, in this pilot cohort, remifentanil delivered via TCI did not achieve statistical superiority over SP bolus administration in reducing the incidence of apnoea or bradycardia. Fully powered clinical trials are required to definitively establish any pharmacokinetic safety advantages.
Management of Refractory Mechanical Ventilation Weaning in a Geriatric Neurocritical Patient with ARDS and COPD Using the ISCCM 2023 Guidelines: A Case Report Sugeng Budi Santoso; Septian Adi Permana; Ryan Arifin
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 2 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i2.880

Abstract

Mechanical ventilator weaning failure occurs in 20–30% of critically ill patients, with the risk significantly amplified by chronic obstructive pulmonary disease (COPD), acute neurological impairment, and severe hypoxemia. A 72-year-old female with COPD developed acute respiratory distress syndrome (ARDS) secondary to hospital-acquired pneumonia (HAP) following a re-craniotomy for an epidural hematoma. Following an initial extubation failure marked by hypercapnia (PaCO₂ 50.7 mmHg), the patient required reintubation. Her initial PaO₂/FiO₂ ratio of 127 mmHg indicated severe gas exchange impairment. Management utilized the 2023 Indian Society of Critical Care Medicine (ISCCM) guidelines. To facilitate weaning, the sedation strategy was transitioned from an initial thiopental infusion to dexmedetomidine, while continuous electrocardiographic monitoring was employed during the rapid correction of severe hypokalemia. The integration of early percutaneous dilatational tracheostomy (PDT), targeted diuresis, and resolution of ventilator-induced diaphragmatic dysfunction (VIDD) improved her PaO₂/FiO₂ ratio to 295 mmHg. In conclusion, successful ventilator liberation in complex neurocritical cases requires a rigorous, multidisciplinary approach. Integrating the ISCCM ABCDEFGHI bundle ensures the systematic correction of pathophysiological barriers, metabolic derangements, and sedation accumulation, leading to favorable clinical outcomes.

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