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INDONESIA
Medical Journal of Indonesia
Published by Universitas Indonesia
ISSN : 08531773     EISSN : 22528083     DOI : 10.13181
Core Subject : Health,
Medicine & Pharmacology
This quarterly medical journal is an official scientific journal of the Faculty of Medicine Universitas Indonesia in collaboration with German-Indonesian Medical Association (DIGM) Indexed in: IMSEAR; CAB Abstracts; Global Health; HINARI; DOAJ; DRJI; Google Scholar; JournalTOCs; Ulrichsweb Global Serial Directory; WorldCat; New Jour; Electronic Journals Library; ISJD Accredited (2013-2018) by DIKTI Kemendikbud Republik Indonesia (No:58/DIKTI/Kep/2013)
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Articles 18 Documents
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Search results for , issue "Vol. 28 No. 4 (2019): December" : 18 Documents clear
A case of extensive symptomatic lower limb heterotopic ossification in a boy
Medical Journal of Indonesia Vol. 28 No. 4 (2019): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v28i4.2633

Abstract

Heterotopic ossification refers to the abnormal growth of bone in the soft tissue. This report highlighted the case of heterotopic ossification in early childhood. A 3-year-old boy was presented with poor lower limb mobility and rigid left leg. At the age of 10 days, he developed a small lump as large as a quail egg in his left groin. Within 3 months, the lump grew bigger and spread to his leg and feet. His parents claimed no trauma history. It was confirmed by computed tomography scan which revealed multiple ossifications of the soft tissue infiltrating the lower limb muscles and infiltrating the skin, the pathological features showed hard mature trabeculated bone, mature fatty tissue, and loose connective tissue. The patient was treated with a series of soft tissue resections and was still under the care of surgeon with good prognosis.
Detection of Mycobacterium leprae using real-time PCR in paucibacillary leprosy patients with negative acid-fast bacilli smears
Medical Journal of Indonesia Vol. 28 No. 4 (2019): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v28i4.2643

Abstract

BACKGROUND Leprosy is an infectious disease that is still a health problem worldwide, including in Indonesia. The clinical symptoms are similar to other skin diseases and it is difficult to establish a diagnosis for paucibacillary (PB) leprosy. Current serological and histopathological tests have limitations, especially in patients with negative acid-fast bacilli (AFB). Serological tests often give false-negative results, while histopathological results often consist of non-specific inflammation. Probe-based real-time polymerase chain reaction (RT-PCR) assays is an alternative test that may be more sensitive and more specific to detect Mycobacterium leprae. METHODS This study was done in June 2015 until March 2016; detected M. leprae in PB patients with negative AFB smears using TaqMan® probe-based RT-PCR assay on slit skin scrapings and skin biopsy specimens from 24 patients. The skin scrapings were obtained from skin tissue on ear lobes, skin lesions, as well as those from biopsy. Samples were tested with RT-PCR while histopathological examinations were only performed on skin from biopsy. RESULTS The RT-PCR assay showed positive results of 21%, 25%, and 96% for specimens obtained from skin scrapings of the ear lobe, skin lesions, and skin biopsy, respectively. On the other hand, the positive rate for the histopathological test from skin biopsy was 79%. It indicated that the TaqMan® RT-PCR assay could increase the diagnostic capacity of histopathological examination by as much as 17%. CONCLUSIONS TaqMan® PCR assay can improve the diagnostic capacity of histopathological examinations, which could be used as the new gold standard for the diagnosis of leprosy.
Anthropometric measurements associated with intertrochanteric fractures in the elderly: a case-control study
Medical Journal of Indonesia Vol. 28 No. 4 (2019): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v28i4.2680

Abstract

BACKGROUND Femoral intertrochanteric fracture is an important cause of disability in the elderly. Low muscle mass, especially those of the lower limbs, has been associated with osteoporosis and higher fall incidents. This study was aimed to assess the association between the anthropometric indices and intertrochanteric fractures. METHODS This case-control study was performed from September 2013 to July 2015. The criteria of case group were elderly patients with intertrochanteric fractures admitted in Dr. Sardjito Hospital within 72 hours after a low energy injury without multiple fractures or pathological fracture. For control group, the subjects were matched according to age and gender without any fracture. Thigh and calf circumferences were done on healthy limbs. Body mass index (BMI) was calculated. History of steroid use was obtained. Adjusted odds ratio (OR) was calculated using logistic regression after analyzed with student's t-test or chi-square test. RESULTS There were 82 subjects on each group. Smaller thigh and calf circumferences and also lower BMI were risk factors of intertrochanteric fractures. Thigh circumference <39 cm (aOR 5.12; 95% CI 2.30–€“11.43; p < 0.001) and calf circumference <29 cm (aOR 9.42; 95% CI 4.14–€“21.40; p < 0.001) were independently associated with intertrochanteric fracture after adjustment of BMI and steroid use. CONCLUSIONS Calf and thigh circumferences were independently associated with femoral intertrochanteric fractures in Indonesian elderly.
A randomized clinical trial of nasogastric tube insertion in intubated patient: comparison between finger method and reverse Sellick maneuver
Medical Journal of Indonesia Vol. 28 No. 4 (2019): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v28i4.2704

Abstract

BACKGROUND Finger method is a new simple technique of nasogastric tube (NGT) insertion for intubated patients which only requires the practitioner'€™s own fingers. This study was aimed to compare the feasibility of finger method and the standard reverse Sellick maneuver in NGT insertion for intubated patients. METHODS This was a single-blinded, randomized clinical trial that included 210 patients aged 18–€“65 years old who were intubated under general anesthesia and needed NGT insertion. Initially, subjects were randomly allocated by the third party into two groups: subjects who had NGT insertion with finger method and those with reverse Sellick maneuver. Success rate of NGT insertion at the first attempt, duration of the procedure, and complication rate of blood spots were all recorded. Chi-square test and Mann–Whitney analysis were used to analyze the data. RESULTS Success rate of NGT insertion at the first attempt in finger method group was higher in comparison with reverse Sellick maneuver group (81.6% versus 60%, respectively, p = 0.002). Likewise, the median of NGT insertion duration was longer in finger group compared to reverse Sellick maneuver group (13 sec versus 12 sec, respectively, p < 0.001) but it was not clinically significant. Moreover, the complication rate of blood spots found during the procedure was lower in subjects with finger method than with reverse Sellick maneuver (10.7% versus 28%, respectively, p = 0.003). CONCLUSIONS Using finger method was more feasible than reverse Sellick maneuvers in NGT insertion.
Radial extracorporeal shockwave therapy on calcaneal spurs: a randomized controlled trial
Medical Journal of Indonesia Vol. 28 No. 4 (2019): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v28i4.3039

Abstract

BACKGROUND The effectiveness of extracorporeal shockwave therapy (ESWT) in handling pain and calcaneal spurs is still controversial, whereas research on the effectiveness of ESWT in the reactive ossification process of calcaneal spurs, involving osteoprotegerin (OPG) and the receptor activator of nuclear factor-kappa B (RANK), does not exist. This study was aimed to assess the effect of ESWT on pain, the length of the spur, plasma OPG and RANK level on the calcaneal spur. METHODS This study was a randomized controlled trial in patients with calcaneal spurs. ESWT was administered at the pain point by applying 2,000 shocks, at an intensity of 2 bars, given six times with a 7‖10-day interval. The visual analog scale (VAS) data, plasma OPG and RANK level were analyzed using Mann–€“Whitney U test, whereas spur size was analyzed using chi-square test. RESULTS One month after therapy at rest (p < 0.001) and when walking after getting up (p = 0.020), the VAS was lower than that in the control group. The plasma OPG level was lower than control group shortly after therapy (p < 0.001). The plasma RANK level was higher than control group shortly after therapy (p < 0.001). ESWT did not affect the reduction of spur measurement (p = 0.382). CONCLUSIONS ESWT reduced pain, decreased plasma OPG level, and increased plasma RANK level. Although ESWT did not have any effect on spur reduction, it affected plasma OPG and RANK level that play a role in the activity of osteoblasts and osteoclasts.
The future of radiotherapy and immunotherapy concomitantly in cancer management
Medical Journal of Indonesia Vol. 28 No. 4 (2019): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v28i4.3211

Abstract

Immunotherapy is a developing field in cancer treatment. Immunotherapy using immune checkpoint inhibitors has been successful in treating patients with metastatic disease, as well as patients who are refractory to standard treatments. Although immunotherapy has yielded considerably positive outcomes, its clinical benefits are limited to a small subset of patients. A combination of radiotherapy and immunotherapy has been shown to provide greater clinical benefits to more patients. Radiation, particularly hypofractionated radiation with stereotactic radiosurgery or stereotactic body radiotherapy, works by priming T cells, upregulating proinflammatory chemokines, and increasing the immunogenicity of tumor cells. Tumor cells develop immunosuppressive mechanisms that protect them from attack by the immune system. Immunotherapy works by disrupting the ability of tumor cells to setup these defenses. When combined with radiotherapy, it can synergistically enhance tumor cell death via cytotoxic T cells, thus causing systemic tumor regression and generating better clinical response.
The functional status, rehospitalization, and hospital cost reduction in geriatric patients after the implementation of the universal health coverage program in the national referral hospital Indonesia
Medical Journal of Indonesia Vol. 28 No. 4 (2019): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v28i4.3214

Abstract

BACKGROUND Universal health coverage program (UHCP) might implicate negatively toward geriatric care with its impact on higher cost. The evaluation had to be made, especially in functional status, rehospitalization, and cost-effectiveness. METHODS Retrospective cohort study with historical control was done. Seventy two geriatric inpatients in the pre-UHCP group and 86 in the UHCP group were recruited from Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Subjects with geriatric syndromes admitted from July to December 2013 (pre-UHCP era) and January to June 2014 (UHCP era). Functional status changes, rehospitalization, and process indicators were observed. Cost reduction was calculated using the incremental cost-effectiveness ratio (ICER), whereby costs, functional status changes, and rehospitalization of both groups were used to identify the differences. RESULTS Proportions of functional status increase were 35.3% and 34.8% in the pre- UHCP and UHCP groups, respectively (p = 1.00) and the decrease were 5.9% and 4.5% in the pre-UHCP and UHCP group, respectively (p = 1.00). Rehospitalization rates were 21.7% and 18.1% (p = 0.603) in the pre-UHCP and UHCP groups, respectively. Mean hospital expenses were between 17.1 million IDR (1,221 USD; 1 USD = 14,000 IDR) for the pre-UHCP group and 20.8 million IDR (1,486 USD) for the UHCP group. ICER showed that hospitalization cost was 3.7 million IDR (264 USD) higher to increase 1 activity of daily living score in the UHCP era. As for rehospitalization, the cost was 600,000 IDR (43 USD) less, with 3.6% smaller in readmission. CONCLUSIONS There was no changes in patients’ functional status after the UHCP implementation. There was a reduction in rehospitalization with lower cost in the UHCP era.
Association between HLA-Cw6 allele expression and characteristics of Javanese ethnic psoriasis patients in Indonesia
Medical Journal of Indonesia Vol. 28 No. 4 (2019): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v28i4.3283

Abstract

BACKGROUND Psoriasis is an autoimmune disease with involvement of genetic and environmental factors. The HLA-Cw6 allele is the strongest genetic factor that correlates with earlier onset and more severe clinical manifestation of psoriasis. In Javanese ethnic, HLA-Cw6 allelic expression has not been identified, although increasing psoriasis patients were found in hospital dermatology departments. The study was aimed to determine the allelic expression of HLA-Cw6 based on the onset and severity of psoriasis in Javanese ethnic. METHODS A cross-sectional study was conducted from March to September 2018. Sixty psoriasis patients in the Margono Soekarjo Hospital and Banyumas Regional General Hospital were recruited consecutively. Psoriasis type, diagnosis, onset, and disease severity were assessed by dermatologists. HLA-Cw6 allelic expression was identified by DNA isolation, quantitative testing, and HLA-Cw6 genotyping. Fisher’s exact and chi-square tests were used to evaluate the association of HLA-Cw6 with age, clinical type, disease severity, onset, and gender. RESULTS The HLA-Cw6 allele positivity was identified at 297 base pairs (bp), while control showed at 618 bp bands. Among 60 subjects, 13 subjects (22%) showed HLACw6 positivity, and 47 subjects (78%) were HLA-Cw6 negative. HLA-Cw6 genotypes were similarly distributed concerning age, onset, gender, clinical type, and disease severity in psoriasis patients of Javanese ethnic (p > 0.05). CONCLUSIONS HLA-Cw6 expression type may not have influence to the characteristics of patients with psoriasis.
Perception of internet addiction among psychiatric residents in an urban area in Indonesia
Medical Journal of Indonesia Vol. 28 No. 4 (2019): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v28i4.3316

Abstract

BACKGROUND In the last two years, many suspected cases of internet addiction have been reported by the media. However, many physicians do not have comprehensive knowledge of internet addiction. Currently, there has been no study conducted among psychiatric residents. This study was aimed to determine the perception of internet addiction among psychiatric residents. METHODS This cross-sectional study was done from April to May 2018. Subjects were recruited by a total sampling method consisting of all psychiatric residents of the Faculty of Medicine, Universitas Indonesia. Perceptions of internet addiction were measured using the illness perception questionnaire revised version for addiction. The calculation of subscales was based on the algorithms available for this instrument. The Mann–€“Whitney U test was used to determine the association of different years of psychiatric education and the perception of internet addiction. RESULTS Fifty-two subjects completed the survey, and 85% of them reported feeling that they did not have adequate knowledge of internet addiction. They believed that their current knowledge was not sufficient to make diagnosis and management decisions. Junior residents had significantly lower consequence scale scores, with mean (standard deviation) scores of 4.1 (0.54) for juniors and 4.4 (0.48) for seniors (p = 0.021). CONCLUSIONS Psychiatric residents perceived internet addiction as emotionally stressful, understandable, and cyclical, but difficult to control. Senior psychiatric residents had a better perception internet addiction consequences compared with their juniors, who have received only basic knowledge about addiction without clinical exposure, but the perceptions could still be improved.
Safety profile of Td vaccination in Indonesian pregnant women: a post-marketing surveillance study
Medical Journal of Indonesia Vol. 28 No. 4 (2019): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.v28i4.3321

Abstract

BACKGROUND The Indonesian Expanded Program of Immunization has implemented tetanus and diphtheria (Td) vaccination to replace the tetanus toxoid vaccine in pregnant women since the year 2016. Td vaccine is administered to protect against diphtheria and tetanus to the mother and her baby as well. This prospective study was conducted to assess the adverse reactions after Td immunization; besides, a retrospective study was conducted to observe the presence of severe local reaction (Arthus reaction), premature birth, and low birth weight history in the medical records of pregnant women who had received Td immunization in the past year. METHODS A prospective observational study was conducted in 200 pregnant women. Local reactions and systemic events occurring within 28 days after immunization were recorded in the diary card and were confirmed by the health worker in the follow-up visit. A retrospective study was also conducted to evaluate 750 medical records of pregnant women who had received Td immunization. The study was conducted from September 2017 to January 2018. The study has been registered at ClinicalTrials.gov ID: NCT03383653. RESULTS In 185 pregnant women who completed the study, the most common local reaction was pain, occurring in 33.5% of subjects within 24 hours after vaccination. Fever, other systemic reactions, and serious adverse events were not reported during the observation. In the retrospective study, 647 medical records were validated. No Arthus reaction was observed. The prevalence of premature birth was 1.24%, and that of low birth weight was 2.63%, which were below the normal rates. CONCLUSIONS Td vaccination in pregnant women was safe and well-tolerated.

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