Medical Journal of Indonesia
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Safety and immunogenicity of the CoV2-Bio in a healthy population aged 18 years and older in Indonesia
No full textBACKGROUND According to the WHO Target Product Profiles for COVID-19 Vaccines, vaccine development should be indicated for active immunization in all populations, in conjunction with other control measures to curtail the pandemic. Several RBD-based COVID-19 vaccines are being evaluated and have shown advantages. CoV2-Bio was developed based on the wild-type SARS-CoV-2 RBD amino acid sequence, representing residues of the spike protein of the Wuhan-Hu-1 isolate. This study aimed to evaluate the safety and immunogenicity of CoV2-Bio when compared to CoronaVac.
METHODS This was an observer-blinded, randomized controlled prospective study of safety and immunogenicity of the CoV2-Bio in healthy adult population. A total of 54 healthy participants were randomized to receive either 3 doses of CoV2-Bio or 2 doses of CoronaVac, and 1 dose of placebo, administered 28 days apart. Participants were followed up for safety and immunogenicity. IgG antibody titers (ELISA) and neutralization assay against Wuhan and Delta strains were evaluated at baseline, Days 28, 56, and 84. We assessed seropositive rate, seroconversion, and GMT as parameters.
RESULTS Both vaccines were well tolerated and induced good antibody response. The incidence rate and intensity of local and systemic adverse events did not differ between vaccine and control groups. The vaccine group showed a larger proportion of seroconversion (4-fold increase antibody) (87.5% versus 46.2%, p = 0.001) and higher GMT (305.9 AU/ml versus 102.4 AU/ml, p<0.001) when compared to control group.
CONCLUSIONS 3 doses of the CoV2-Bio are safe and immunogenic in healthy adult population. 3 doses of the CoV2-Bio COVID-19 vaccine produce a better immunogenicity profile compared to CoronaVac
Developing an online reproductive health module on sexually transmitted infections for Indonesian adolescents: a qualitative mixed methods study
No full textBACKGROUND A notable rise in sexually transmitted infection (STI) cases among youth correlates with a lack of reproductive health awareness, affecting nearly 80% of Indonesian adolescents. Additionally, sociocultural taboo acts as a challenge to reproductive health implementation in Indonesia. Therefore, this study aimed to develop an online reproductive health module focused on STIs for Indonesian adolescents.
METHODS This research was a mixed methods approach, integrating quantitative study using univariate analysis (survey and questionnaire) and qualitative study using the Delphi method (open discussion and focus group discussion). The study was conducted between March 2 and July 28, 2022. We began by conceptualizing a literature-based module, an online survey, and virtual discussions involving students, teachers, and parents. Then, we consulted with clinical psychologists and dermatovenereologists. Additionally, students completed an assessment to establish a baseline of their knowledge, attitudes, and behaviors (KAB) regarding reproductive health and STIs.
RESULTS Of 327 high school students across Jakarta, analysis of the 129 completed KAB surveys showed that only 56.6% and 65.1% attained acceptable scores (>65) for knowledge and behavior, respectively, with 24.8% being at risk for STIs. Key recommendations included incorporating multimedia elements, ensuring clarity and simplicity in language, adopting non-judgmental tone, providing comprehensive explanations of STIs and their long-term impact, and supporting learning with face-to-face sessions and ongoing access to concise, cost-effective educational resources.
CONCLUSIONS Adolescents need a comprehensive, interactive, instructive, accessible, non-discriminatory reproductive module that strengthens the self-concept that upholds Indonesian values and norms
Artificial intelligence for enhanced diagnostic precision of prostate cancer
No full textBACKGROUND Accurate diagnosis and grading of prostate cancer are essential for treatment planning. The role of artificial intelligence in prostate cancer intervention and diagnosis (RAPID) is a study aimed at developing artificial intelligence (AI) models to enhance diagnostic precision in prostate cancer by distinguishing malignant from non-cancerous histopathological findings.
METHODS Histopathological images were collected between 2023 and 2024 at the Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia. The dataset included benign prostatic hyperplasia and prostate cancer cases. All slides were digitized and manually annotated by pathologists. Patch-based classification was performed using convolutional neural network and transformer-based models to differentiate malignant from non-malignant tissues.
RESULTS A total of 529 whole-slide images were processed, yielding 26,418 image patches for model training and testing. Deep learning models achieved strong performance in classification. Architectures including EfficientNetV2B0, Xception, ConvNeXt-Tiny, and Vision Transformer (ViT) achieved near-perfect classification outcomes. EfficientNetV2B0 reached an AUC of 1.00 (95% CI: 1.00–1.00), sensitivity 0.99 (95% CI: 0.99–1.00), and specificity 1.00 (95% CI: 1.00–1.00). Xception and ConvNeXt-Tiny both achieved AUC 1.00 (95% CI: 1.00–1.00) with sensitivity and specificity of 1.00 (95% CI: 1.00–1.00). ViT performed strongly with AUC 0.999 (95% CI: 0.99–1.00), sensitivity 0.99 (95% CI: 0.99–0.99), and specificity 0.99 (95% CI: 0.99–0.99).
CONCLUSIONS RAPID demonstrated high potential as an AI-based diagnostic tool for prostate cancer, showing excellent accuracy in histopathological classification using the Indonesian dataset. These findings highlight the feasibility of deploying deep learning models to support diagnostic decision-making in clinical practice
Conservative surgery for stage IC2 mucinous borderline ovarian tumor: a five-year follow-up case report
Full text linkMucinous borderline ovarian tumors (MBOTs) represent a significant portion of all borderline ovarian tumors, including variants such as microinvasion and intraepithelial carcinoma, which have a higher recurrence risk. Conservative surgery is recommended for patients with MBOTs seeking fertility preservation, despite remaining a debated option to reduce recurrency. This case highlighted successful MBOT management using conservative surgery with unilateral salpingo-oophorectomy, providing insights into optimal recurrence control. A 30-year-old woman presented with abdominal enlargement, with imaging revealed a large right ovarian mass suspected to be malignant. A left salpingo-oophorectomy was performed, with final histopathology confirming MBOTs with microinvasion and intraepithelial carcinoma. No malignancy was found in the peritoneal fluid, and no adjuvant therapy was given due to fertility preservation reasons. No recurrence after 5 years of follow-up. This report highlights the potential of conservative surgery as a fertility-preserving option for young patients with stage IC2 MBOTs
Subcutaneous emphysema: an indirect sign of anastomotic leak in cecal volvulus
No full textCecal volvulus (CV) is a rare cause of intestinal obstruction. A 22-year-old man with cerebral palsy presented with intestinal obstruction symptoms for 2 days. Abdominal computed tomography (CT) revealed a severely dilated cecum, confirmed as CV, during exploratory laparotomy. A right hemicolectomy with primary anastomosis was performed due to an unhealthy cecum. However, his postoperative recovery was stormy as he developed right flank subcutaneous emphysema, but the surgical drain was empty. Follow-up CT showed no extravasation of oral contrast from the lumen, but a relaparotomy noticed a small leak at the posterolateral aspect of the anastomosis, which was reinforced. He recovered well and was discharged 5 days after the relaparotomy. In conclusion, despite being uncommon, subcutaneous emphysema can become an indirect sign of an anastomotic leak even in a negative CT scan
Intracranial dural arteriovenous fistula presenting like longitudinally extensive transverse myelitis
No full textIntracranial dural arteriovenous fistula (DAVF) that drains into spinal perimedullary veins can generate longitudinally extensive transverse myelitis (LETM)-like lesion, which often represents a significant diagnostic and therapeutic challenge. This is a case report of a 50-year-old male referred with all extremity weaknesses. Despite receiving high-dose intravenous steroids for suspected myelitis, no improvement was recorded. Spinal imaging showed abnormal hyperintensity extending from the T6 vertebral level to the medulla, and a flow void lesion from the cervicomedullary junction up to the L3 level. Angiography confirmed a Cognard type V spinal DAVF, which was treated with transarterial embolization of the feeding vessel. Follow-up angiography showed complete occlusion of the fistula without any backflow. Flow voids are no longer visible on MRI conducted 3 weeks post-procedure. Unfamiliarity with these disorders often leads to delays in diagnosis and treatment. Therefore, it is essential to consider intracranial DAVF as a differential diagnosis for LETM-like lesions
Prevalence of calcaneal spur among foot and ankle patients at the Cape Coast Teaching Hospital, Ghana
No full textBACKGROUND A calcaneal spur is a bony protrusion that grows from the calcaneus. This study aimed to estimate the prevalence of calcaneal spurs and associated risk variables (age, gender, and type) in patients undergoing foot and ankle X-ray examinations at the Cape Coast Teaching Hospital.
METHODS A retrospective cross-sectional approach and non-probability purposive sampling were used to analyze radiographic reports. A total of 323 radiographic reports from patients undergoing ankle and foot X-ray examinations between July 2020 and July 2023 were selected from 1,690 radiographs and analyzed using Microsoft Excel 2019 and SPSS software version 26.0.
RESULTS The overall prevalence was 34.7% (112/323), with 112 cases indicating calcaneal spurs. Of the patients, 72 (64.3%) were females. Among the cases, 53 (47.3%) were plantar spurs, 40 (35.7%) were dorsal spurs, and 19 (17.0%) exhibited both types. The highest prevalence was found in the 51–60 age group, representing 30 (26.8%) cases. Age was found to have a significant association with calcaneal spur development (p = 0.044).
CONCLUSIONS Both plantar and dorsal calcaneal spurs were significantly associated with age, with the 51–60 age group at higher risk
Emicizumab prophylaxis in severe hemophilia A with inhibitor: impact on quality of life and musculoskeletal outcomes
No full textEmicizumab has been acknowledged for its effectiveness in preventing bleeding in patients with hemophilia A developing inhibitors. This report examined the impact of emicizumab prophylaxis on health-related quality of life (HRQoL) and musculoskeletal outcomes in a 10-year-old male with severe hemophilia A and a high titer of factor VIII (FVIII) inhibitor, presenting with hemophilic arthropathy on the right knee and left elbow. He had been unable to walk and was previously treated on-demand with a plasma-derived FVIII concentrate. He received emicizumab prophylaxis for 16 months. HRQoL was evaluated using a hemophilia-specific questionnaire, while musculoskeletal outcomes were assessed using hemophilia early arthropathy detection with ultrasound (HEAD-US) and the hemophilia joint health score (HJHS). During treatment, no breakthrough bleeding occurred, and the patient regained the ability to walk. Emicizumab prophylaxis significantly improved in HRQoL, especially in physical health and sports and and school domains, aligning with bleeding rates, HEAD-US, and HJHS assessments
Effects of Physalis angulata extracts on bleomycin-induced rat: analysis on lung inflammation and fibrosis
No full textBACKGROUND Scleroderma is an immune-mediated connective tissue disease, with interstitial lung disease as one of its manifestations. Physalis angulata (P. angulata) or ciplukan has shown potential in treating fibrosis, but its role in preventing lung inflammation and fibrosis remains unknown. This study aimed to evaluate the effect of P. angulata extract in a bleomycin (BLM)-induced scleroderma rat.
METHODS Sprague-Dawley rats were divided into 6 groups. For lung inflammation prevention, 3 groups received: (1) BLM only, (2) BLM+50 mg/kgBW P. angulata, and (3) BLM+100 mg/kgBW P. angulata. After 14 days, rats were sacrificed and bronchoalveolar lavage (BAL) leukocyte count, interleukin-6 (IL-6) levels, and lung injury score were assessed. For fibrosis prevention, another 3 groups received the same interventions and were sacrificed after 51 days. Fibrosis score, fibrosis area, hydroxyproline, transforming growth factor-beta (TGF-β), and matrix metalloproteinase-13 (MMP-13) levels were analyzed. BLM was administered subcutaneously, while P. angulata was given orally for 14 days. IL-6, TGF-β, and MMP-13 were measured by ELISA and hydroxyproline by colorimetric method. Mean differences and p-values were calculated using appropriate statistical tests.
RESULTS P. angulata extract did not prevent lung inflammation, as there were no differences in BAL leukocyte count (p = 0.126), IL-6 levels (p = 0.173), or lung injury scores (p = 0.397) between the BLM-only group and those receiving P. angulata. The extract also did not prevent lung fibrosis, with no differences in fibrosis scores (p = 0.173), fibrosis area (p = 0.359), hydroxyproline (p = 0.295), TGF-β (p = 0.374), or MMP-13 (p = 0.088) levels among groups.
CONCLUSIONS P. angulata extract did not prevent the development of lung inflammation or fibrosis
Factors contributing to the prevalence of potential drug-drug interactions among hospitalized elderly patients in a tertiary hospital in Eastern Java, Indonesia
No full textBACKGROUND Drug-drug interactions (DDIs) are the primary cause of adverse drug events. However, studies on potential DDIs (pDDIs) in hospitalized older adult patients in Indonesia remain limited. Therefore, this study aimed to investigate the prevalence and potential risk factors of pDDIs in this population.
METHODS A prospective observational study assessing the medical profiles of hospitalized elderly patients was conducted at Universitas Airlangga Hospital from September 2023 to February 2024. Patient characteristics were recorded, and Micromedex® Drug-Reax software was used to check the pDDIs. Ethical approval was obtained for this study (No. 078/KEP/2023). Data were analyzed using SPSS software (version 26).
RESULTS Of the 409 patients, 41.9% of the prescriptions contained pDDIs. Furthermore, 73 prescriptions (17.1%) had at least one pDDI, with 1–6 interactions per prescription. Of the 369 identified pDDIs, 209 (56.6%) were major interactions. Logistic regression analysis revealed increased odds of pDDIs in patients with previous medication use (adjusted odds ratio [aOR] = 2.254; crude odds ratio (cOR] = 1.771), polypharmacy (aOR = 16.309; cOR = 11.709), circulatory diseases (aOR = 4.082; cOR = 4.788), and genitourinary diseases (aOR = 1.819; cOR = 1.855). Conversely, patients with digestive system diseases had a significantly lower risk (aOR = 0.573; cOR = 0.608).
CONCLUSIONS This study found a high prevalence of pDDIs (41.1%) among older hospitalized patients in Indonesia. Modifiable factors, such as polypharmacy and previous medication use, can reduce the risk of pDDIs and avoid adverse events