Medical Journal of Indonesia
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Stand-alone middle meningeal artery embolization in chronic subdural hematoma patient presenting cognitive decline: a case report
No full textChronic subdural hematoma (cSDH) is a neurological disorder that commonly occurs in the elderly with high morbidity and mortality. Current treatment for cSDH consists of conservative therapy, surgical evacuation, and endovascular therapy, or a combination of all the methods. Endovascular therapy for cSDH management involving middle meningeal artery embolization (MMAE) has become a promising therapeutic option for clinicians as it offers a minimally invasive, safe, and effective choice with a low recurrence rate. MMAE using particles can also be performed in frail elderly patients who cannot undergo large craniotomy procedures. We presented a case of a subdural hematoma patient with cognitive decline using a therapeutic strategy of stand-alone MMAE, which resulted in cognitive function improvemen
Effects of edaravone on hypoxia-induced lethality in male Swiss albino mice
No full textBACKGROUND Edaravone has recently been used to treat acute cerebral infarction. This study aimed to evaluate the protective effects of edaravone against hypoxia-induced lethality and oxidative stress in mice using 3 experimental models of hypoxia: asphyxia, circulatory, and hemic hypoxia.
METHODS 60 Swiss albino mice from the animal facility of Mazandaran University of Medical Sciences, Iran, were randomly housed in groups of 10 during January–March 2020 and received edaravone for 4 consecutive days. After inducing hypoxia, oxidative stress, lipid peroxidation (LPO), and glutathione (GSH) content were assessed.
RESULTS The findings showed significant protective effects of edaravone in all hypoxia models, with the strongest effects in asphyxia and circulatory hypoxia, showing a dose-dependent response. It prolonged survival time at 2.5 mg/kg by 26.08 (0.79) min (p = 0.031) In addition, edaravone significantly inhibited hypoxia-induced oxidative stress (LPO and GSH oxidation) in all 3 hypoxia models.
CONCLUSIONS Edaravone exhibits an excellent protective effect against different models of hypoxia by decreasing oxidative stress in brain tissue. In addition, the results showed dose-dependent effects of edaravone in the asphyxia and circulatory hypoxia models. Antioxidant activity might be a proposed mechanism for the anti-hypoxic activity of this drug
Reproductive function after radioactive iodine treatment for differentiated thyroid carcinoma patients: a systematic review
No full textBACKGROUND Thyroid cancer is one of the most prevalent cancers in the endocrine system, with a rapidly rising incidence over the past 3 decades. Treatment for patients with differentiated thyroid cancer (DTC) typically includes surgery, radioactive iodine (I-131) therapy, and levothyroxine (L-T4) suppressive therapy. This study aimed to explore the potential side effects of I-131 therapy on reproductive function in men and women with DTC.
METHODS A literature search was performed using 4 databases (PubMed, ScienceDirect, BioMed Central, and Google Scholar), limited to English publications since 2013. Clinical trials and observational studies that evaluated I-131 in DTC, focused on reproductive-age patients, and included pre-therapy or during-therapy examinations, administered doses, and treatment frequencies of I-131 were selected. The Joanna Briggs Institute Critical Appraisal Checklist is used as a comprehensive evaluation tool, and the literature quality was categorized as high, moderate, and low.
RESULTS The final 17 articles examined the effect of I-131, with 13 focusing on women's reproductive function and 4 on men's. Women who received I-131 therapy can lower anti-Mullerian hormone levels and disrupt menstrual cycles within the first year, and it does not affect subsequent pregnancies. For men, the therapy led to elevated levels of follicle-stimulating hormone and luteinizing hormone, along with changes in sperm quantity, morphology, and motility, which tend to normalize within a year post-therapy.
CONCLUSIONS The reproductive side effects associated with I-131 therapy are generally transient, with most individuals experiencing a return to normal within 1 year following treatment
Validation and adaptation of the Indonesian version of thyroid cancer quality of life questionnaire
Full text linkBACKGROUND The rising incidence of thyroid cancer in Indonesia has become a public health concern. This study was aimed to evaluate the validity of the thyroid cancer-quality of life-Indonesian version (ThyCa-QoL-ID).
METHODS This cross-sectional study involved translating the original ThyCa-QoL questionnaire from English to Indonesian (T1), which was then back-translated into English (T2). The T2 questionnaire was compared with the original ThyCa-QoL questionnaire to refine T1, resulting in T3. The T3 questionnaire underwent cognitive and transcultural validation through individual assessment and focus group discussions with 10 doctors and 10 nurses at Cipto Mangunkusumo Hospital and St. Carolus Hospital, and 5 patients with thyroid cancer from St. Carolus Hospital. This process ensured cultural, language, and literacy adaptation processes for patients across different age groups.
RESULTS The ThyCa-QoL questionnaire demonstrated validity, with all questions showing correlation calculation (r) above the r table. Test-retest reliability was measured by calculating the intraclass correlation coefficient for each question on the ThyCa-QoL questionnaire. The reliability test can be seen in the value of Cronbach’s alpha (0.915), exceeding the standard Cronbach’s alpha value standard (0.6).
CONCLUSIONS The ThyCa-QoL-ID was confirmed as a valid and reliable tool for assessing the QoL of patients with thyroid cancer in Indonesia
Comparison between free and pedicled anterolateral thigh flaps and surgical outcomes in soft tissue reconstruction
Full text linkBACKGROUND The anterolateral thigh (ALT) flap, harvested either as a free flap with microsurgical anastomosis or as a pedicled flap with an intact blood supply, is widely used to repair soft tissue defects. This study aimed to evaluate the ALT flap, both free and pedicled variants, as a reliable option for reconstruction, focusing on flap viability and complications.
METHODS This cross-sectional study included 30 patients who underwent free or pedicled ALT flap reconstruction at IGNG Ngoerah Hospital, Bali, between 2020 and 2024. Inclusion criteria were complete medical records and confirmed vascular flow on preoperative Doppler ultrasound. Statistical analysis was performed using Fisher’s exact test for bivariate analysis. The primary outcomes evaluated were the incidence of complications and their association with the type of flap.
RESULTS ALT flaps were used as free flaps in 60% of cases and as pedicled flaps in 40%. Most patients were adult males, with flap placements mainly in the abdomen (36.7%). Wound dehiscence and necrosis occurred in 13.3% of cases. Wound dehiscence and complications requiring follow-up occurred more frequently in patients undergoing free flap procedures (38.9% versus 8.3%, p<0.001; 22.2% versus 0%, p = 0.001). In contrast, the incidence of necrosis was comparable between the two flaps (16.75% versus 8.3%, p = 0.632).
CONCLUSIONS The free ALT flap showed a higher risk of partial flap necrosis and required more intensive monitoring. Pedicled ALT flap demonstrated a lower complication rate and more straightforward postoperative care, suggesting a more favorable option
Association between vaspin rs2236242 gene polymorphism and atherosclerosis in ischemic stroke patients with diabetes mellitus in the Indonesian population
No full textBACKGROUND Stroke is the third leading cause of morbidity and second in mortality worldwide. Diabetes mellitus (DM) is a risk factor for stroke. Vaspin and single nucleotide polymorphism (SNP) rs2236242 involved DM pathogenesis. This study aimed to explore the correlation between SNP rs2236242, serum vaspin levels, and atherosclerosis in patients with ischemic stroke and DM.
METHODS This study was conducted in Dr. Moewardi Hospital from 2022 to 2023. The case group included patients with ischemic stroke and DM, while the controls were those with ischemic stroke only. Tetra-primer amplification refractory mutation system-polymerase chain reaction was used to determine the genotypes.
RESULTS There were 31 cases and 33 control. SNP rs2236242 showed that odds ratio (OR) (95% confidence interval [CI]) for AA-TT was 0.273 (0.241–0.305) and for TA-TT was 0.315 (0.298–0.341). The OR (95% CI) for allele A to T was 0.789 (0.373−1.669). The mean (standard deviation) serum vaspin level in the case group compared to the control was 1,570 (2,108) ng/ml versus 1,630 (1,428) ng/ml (p = 0.064). Higher vaspin levels were found in T allele of the TT (1,523 [2,269] ng/ml, p = 0.021) and TA (1,760 [1,349] ng/ml, p = 0.004) genotype groups than the A allele of the AA genotype group (0.914 [0.329] ng/ml).
CONCLUSIONS Vaspin gene polymorphism AA genotype or A allele significantly reduces vaspin levels in patients with ischemic stroke with DM
Expression of DUSP1, LINC02202, and LINC01554 as a biomarker panel in the diagnosis and prognosis of breast cancer
No full textBACKGROUND Breast cancer is a major global health challenge, with diverse and complex gene expression profiles. Long noncoding RNAs (lncRNAs) have emerged as key regulators of various cancers, including breast cancer. This study aimed to investigate the expression and prognostic value of dual specificity phosphatase 1 (DUSP1), LINC02202, and LINC01554 in breast cancer tissues and explore their association with clinical parameters.
METHODS DUSP1, LINC02202, and LINC01554 expression in healthy and breast tumor tissues were compared using in vitro and in silico conditions. In silico conditions examined their association with patient survival and disease prognosis through Kaplan−Meier and receiver operating characteristic curves. In vitro conditions examined the association between their expression and clinical parameters, such as tumor size, disease stage, and disease prognosis.
RESULTS Our study found that DUSP1, LINC02202, and LINC01554 were significantly downregulated in breast tumor tissues compared to healthy tissues, as shown by both in vitro and in silico analyses. Their expression levels are also significantly associated with the prognosis of breast cancer. Notably, only LINC02202 expression was significantly correlated with reduced patient survival and tumor size.
CONCLUSIONS This study provides novel insights into the expression and function of DUSP1 mRNA, LINC02202, and LINC01554 lncRNAs in breast cancer and identifies potential biomarkers and therapeutic targets for this disease
Effect of matrix metalloproteinase-9 inhibitors in hepatitis B virus replication
No full textBACKGROUND Hepatitis B virus (HBV) remains difficult to eradicate due to the persistence of covalently closed circular DNA (cccDNA). Matrix metalloproteinase-9 (MMP-9) enhances HBV replication, but the effects of its inhibition remain unexplored. This study aimed to investigate the effects of MMP-9 inhibitors on HBV replication markers.
METHODS Primary hepatocyte cultures were obtained from the livers of 6 Tupaia javanica. Cultures were infected with HBV from human sera and divided into control and intervention groups. The intervention group received MMP-9 inhibitors at 1, 3, and 7 nM. The control group received phosphate-buffered saline. Levels of hepatitis B surface antigen (HBsAg), HBV DNA, cccDNA, MMP-9, interferon alpha and beta receptor subunit 1 (IFNAR1), and interferon beta (IFN-β) were measured in both groups before and 72 hours post-intervention.
RESULTS MMP-9 inhibitor administration at 1, 3, and 7 nM consistently reduced HBsAg, HBV DNA, cccDNA, and MMP-9 levels, though not statistically significant. Median HBV DNA levels at 1, 3, and 7 nM were 7.05, 5.29, and 5.98 ×103 copies/ml, respectively. Mean cccDNA levels at 1, 3, and 7 nM were 14.15, 11.04, and 13.94 ×103 copies/ml, respectively. The 3 nM dose increased IFNAR1 levels, while the 7 nM dose increased IFN-β, but neither change was significant. Among the tested doses, 3 nM showed the most favorable effects despite the lack of significance.
CONCLUSIONS MMP-9 inhibitor suppressed HBsAg, HBV DNA, cccDNA, and MMP-9 while increasing IFNAR1 and IFN-β in vitro
Clinical profiles and treatment evaluation of tuberculous uveitis in tertiary eye hospital in Jakarta
Full text linkBACKGROUND Tuberculous uveitis (TU) is the second most common cause of intraocular inflammation in Indonesia. This study aimed to determine the clinical characteristics of patients with TU and the therapies used at Jakarta Eye Center (JEC) Eye Hospitals and Clinics.
METHODS This retrospective descriptive study included 265 eyes of 189 patients diagnosed with TU at the JEC Eye Hospital and Clinics between January 2018 and June 2022. This study used secondary data collected by reviewing patient medical records, including clinical profiles and therapeutic characteristics recorded during treatment. Data were analyzed using SPSS software version 24 for Windows.
RESULTS Most patients (68.3%) complained of blurry vision, and 99 (52.4%) underwent an interferon-gamma release assay. HIV infection was present in 8.5% of the patients, and 4.8% had diabetes mellitus. Among them, 27 (14.3%) had posterior uveitis, 34 (18.0%) had anterior uveitis, and 127 (67.2%) had panuveitis. The most common feature of inflammation was vitreous opacity. Visual acuity (VA) improved to 0.4 (1.11) after treatment. The most common complication was cataract formation (71 patients). In the group that received combination therapy with systemic steroids and anti-tuberculosis treatment (ATT), 58.7% had a better VA.
CONCLUSIONS TU has several clinical manifestations. Treatment with systemic steroids, ATT, or a combination of both can improve VA
Tumor apparent diffusion coefficient value and ratio in magnetic resonance imaging on cervical cancer
Full text linkBACKGROUND Diffusion-weighted magnetic resonance imaging (DW-MRI) is a noninvasive, non-contrast sequence for cancer detection. Research involving DW-MRI in cervical cancer has revealed lower apparent diffusion coefficient (ADC) values. This study aimed to evaluate the difference in tumor ADC values and ADC ratios (tumor-to-urine and tumor-to-muscle) with respect to tumor staging (early versus late) and histopathology (squamous cell carcinoma versus adenocarcinoma).
METHODS This retrospective study included 56 patients with cervical cancer, divided into early- and late-stage groups. DW-MRI was performed in all patients, and the tumor ADC value, ADC ratio between the tumor and urine (ADC ratiot−u), and ADC ratio between the tumor and gluteal muscle (ADC ratiot−m) were measured. Statistical methods were employed to assess the difference in the tumor ADC value, ADC ratiot−u, and ADC ratiot−m with respect to cervical cancer stages and histopathological findings.
RESULTS The median tumor ADC value was lower in the early-stage group than in the late-stage cervical cancer (0.75 × 10−3 mm²/s versus 0.8 × 10−3 mm²/s, p = 0.022). However, no differences were observed in ADC ratiot−u and ADC ratiot−m concerning the tumor staging, nor in ADC value, ADC ratiot−u, and ADC ratiot−m concerning histopathological findings (p = 0.29, 0.67 and 0.35, respectively), with no significant differences in the ADC ratiot−u (p = 0.153) and ADC ratiot−m (p = 0.260). In receiver operating characteristic analysis, the tumor ADC value was 75.0% sensitive and 50.0% specific in predicting late-stage cervical cancer with a cut-off value of 0.750 × 10−3 mm2/s.
CONCLUSIONS The median tumor ADC value in early-stage patients was significantly lower than in the late-stage patients, suggesting that tumor ADC value has valuable potential for characterizing cervical cancer staging