Indonesian Journal of Biomedicine and Clinical Sciences

Perception and use of herbal medicine by Indonesian Medical Doctors

Abraham Simatupang — 2025-02-20

Indonesia has a long experience in traditional medicine such as jamu. The government has been encouraging all sectors, especially pharmaceutical industries together with research institutions and academia to increase herbal medicine research so that herbal medicine is increasingly used in health services, including by medical doctors. Various efforts have been made but empirically it seems that this goal has not been achieved. For this reason, it is necessary to conduct a survey to determine the understanding and use of herbal medicine among doctors. I was a cross-sectional study using an electronic questionnaire distributed to doctors who are members of the Indonesian Medical Association (IMA) per province. Three-hundred sixty-two respondents from 29 out of 38 (76%) provinces of Indonesia responded, and 263 out 362 respondents (72%) are general practitioners. In prescribing herbal medicines only 18.5% prescribed, 35% did not and 46.6% sometimes prescribed, respectively. Of the eleven phytopharmaceuticals/standardised herbal medicines only one medicine No. 5 was widely recognized by respondents (46.6%). This study showed that doctors' understanding of herbal medicine still needs to be improved through various means including webinars/seminars, journals that show good clinical trials so that they are more confident when prescribing herbal medicine to their patients. There is a need for more comprehensive information regarding the indications, efficacy and side effects of herbal medicine, through books or formularies that can be accessed by doctors. In addition, respondents agreed that herbal medicine should be taught in medical schools both in the pre-clinical and clinical phases.

Multidrug resistance organisms (MDRO) infection and multidimensional approaches as predictors of mortality in complicated intra-abdominal infection

Antonius Suryanto — 2025-03-04

Complicated intra-abdominal infection (cIAI) is a frequently encountered emergency surgery case with a high mortality rate. While the mortality scoring system in cIAI has been widely adopted, its accuracy has not been fully optimized, yet. The study aimed to analyze the prognostic value of APACHE II, MPI, CCI, MODS, and MDRO infections in the mortality of patients with cIAI. A prospective cohort observational study was conducted on cIAI patients who underwent laparotomy procedures in November 2023 to July 2024 at Dr. Sardjito Hospital, Yogyakarta. Microbiological examinations in the form of identification and antibiotic sensitivity tests were carried out on intra-abdominal specimens using Vitek II. Information on demographic characteristics, clinical presentation, laboratory characteristics, and mortality outcomes was collected by following patients for 30 d of post-laparotomy care until the patient died or was discharged from the hospital. Statistical analysis was carried out using a t test, X2, and ROC curve, determining the cut-off point of the score, sensitivity, specificity, PPV, NPV, and accuracy of each prognostic variable. Out of the 91 cIAI patients who underwent laparotomy, mortality was observed in 28.6% of them. MDRO infection was identified in 52.7% of the subjects. Significant factors affecting mortality were APACHE II scores (p=0.00), MPI scores (p=0.00), MODS scores (p=0.00), and MDRO infection (p=0.03). The prognostic performance of mortality based on the AUC, sensitivity, and specificity scores were as follows: APACHE II (AUC=0.938; sensitivity=88.5%; specificity=86.2%), MPI (AUC=0.920; sensitivity=92.3%; specificity=81.5%), MODS (AUC=0.916; sensitivity=76.9%; specificity=93.8%), CCI (AUC= 0.582; sensitivity=61.5%; specificity=56.9%), and MDRO infection (AUC= 0.623; sensitivity=61.5%; specificity=63.1%). In conclusion, the APACHE II, MPI, MODS scores showed strong performance in predicting the mortality of cIAI patients. MDRO infection is significant determinant for mortality but has weak diagnostic value. Developing new algorithms that consider comprehensive factors including agents, hosts, and environments will enhance the accuracy of assessing mortality in these patients.

A neonate presenting with hip septic arthritis: a rare case report

Hilmi Muhammad — 2025-03-12

Hip septic arthritis is a serious condition that requires prompt diagnosis and treatment to prevent complications such as joint destruction, growth arrest, or the spread of infection. The incidence of septic arthritis ranges from 2 to 10 cases per 100,000 individuals per year generally. Although septic arthritis can affect people of all ages, it is more common in the elderly and infants under 5 y.o. We described a case of a 5-mo.o. child who presented with right hip swelling for ten d. The patient started acting agitated and appeared to be in a lot of discomfort whenever her right leg was moved. The patient is taken to a traditional massage therapist and gets a massage. Then, the patient's right hip began to swell, accompanied by intermittent fever and limited hip movement. The patient was hospitalized for four d due to hip dislocation and received skin traction with broad-spectrum antibiotic therapy, but no clinical improvement was observed. The patient was then referred to Dr. Sardjito General Hospital, Yogyakarta, Indonesia and underwent emergency open debridement followed by immediate IV antibiotic treatment. Traditional massage therapy can cause further musculoskeletal injury, causing the formation of hematoma or hemarthrosis and even causing the development of septic arthritis. As soon as septic arthritis is suspected, adjusted antibiotic treatment and adequate joint drainage are necessary, as this condition is an orthopedic emergency, especially in neonates. From this case can be concluded that early diagnosis and treatment of septic arthritis in newborns is very important to prevent complications. The public needs to understand the dangers of massage for musculoskeletal injuries during the acute phase.

Effect of Hibiscus sabdariffa Linn. on the development of atherosclerosis in diabetes mellitus: a rapid review

Fakhrul Gamal Putra — 2025-02-20

Atherosclerosis is closely linked to disturbances in lipid metabolism and chronic inflammation. In diabetes mellitus (DM), hyperglycemia exacerbates atherosclerosis by inducing structural changes in blood vessel endothelium through chronic inflammation triggered by oxidized low-density lipoprotein (OxLDL) formation. Inflammation plays a major role in atherosclerosis pathogenesis, with OxLDL, nuclear factor kappa B (NFkB), intercellular adhesion molecule-1 s(ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) being crucial players in this process. Hibiscus (Hibiscus sabdariffa Linn.) a medicinal plant rich in polyphenols, is believed to have a role to prevent atherosclerosis development through its antioxidant activity, inhibiting vascular smooth muscle cell (VSMC) proliferation, and modulating inflammation pathways. This review explores the potential of hibiscus to prevent atherosclerosis development in DM, focusing on its phytochemical compounds and their impact on oxidative stress, hyperlipidemia, and inflammation pathways. The review highlights the importance of targeting VSMC proliferation, migration, and inflammatory responses mediated by ICAM-1 and VCAM-1 to attenuate atherosclerosis progression. Hibiscus shows promise as a natural treatment for atherosclerosis, but further research is still needed to fully understand its mechanisms and therapeutic potential.

The relationship between frailty incidence and polypharmacy in the elderly age group in Melinggih Village, Gianyar Regency, Bali

Tjokorda Istri Ratih Pradnyandari Pemayun — 2025-03-19

The risk of the elderly population experiencing frailty is more significant in women than man. Several factors are associated with the frailty include the pattern of women’s daily activities being more than men’s, unbalanced nutrition needs, and women suffering more from comorbid diseases, such as osteoporosis,
fractures of bone hip, and other degenerative diseases. This study aimed to investigate the relationship between frailty incidence and polypharmacy in the elderly group in Melinggih Village, Gianyar, Bali. This cross-sectional study used secondary data from interviews and questionnaires conducted in December 2022. Samples were collected using a total sampling method. The analysis was conducted using univariate and bivariate analysis, with Chi square tests applied using SPSS 25.0 for Windows. Ninety-five of the 97 patients involving this
study had a history of treatment with < 2 types of drugs (non-polypharmacy), while 2 patients with more >2 types of drugs (polypharmacy). No significantly relationship between the number of drugs consumed and frailty status (p= 0.303). In conclusion, no relationship between frailty and polypharmacy is reported in Melinggih Village, Gianyar, Bali.

Factors influencing auditory verbal therapy outcome among children with cochlear implant

Nourma Wahyu Andriani — 2025-03-20

Early intervention with cochlear implants and habilitation with auditory-verbal therapy (AVT) methods can promote better development later in childhood. A previous study reported that communication methods,
educational methods, duration of communication, frequency of therapy, and type of therapy influencing the effectiveness of amplification in children based on observations from parents. The AVT assessment uses several
assessments that can help determine a child’s hearing skill level, one of which is the early learning accomplishment profile (E-LAP). The study aimed to assess the factors influencing auditory–verbal therapy (AVT) outcomes among children with cochlear implants. It was an analytical observational study with a cross-sectional design in several home therapy. The assessment was using E-LAP. Chi-square test and multivariate logistic regression were used to measure the association between categorical variables. From 52 subjects, there were 32.7% who had received their cochlear implants <3 yr, 67.3% ≥3 yr, 51.9% ≥3 yr using cochlear implant, 53.8% good family participation, 51.9% had undergraduate parents, 71.2% had a profound hearing before implant, 86.5% underwent routine therapy, and 55.8% had a good outcome in AVT. This study showed age of implantation (p= 0.043), optimal family participation (p=0.006), and frequency of AVT (p= 0.002) were related to the outcomes of AVT. From multivariate logistic regression the duration of implant use was the most related (p=0.008). In conclusion, age of implantation, duration of implant use, family participation, and frequency of AVT are related to the outcomes of AVT.

Correlation between D-dimer and first-ever acute ischemic stroke (AIS) severity in Dr. Sardjito General Hospital, Yogyakarta

Abdul Gofir — 2025-03-21

Acute ischemic stroke (AIS) continuing to be an entity causing morbidity and mortality worldwide. The National Institutes of Health Stroke Scale (NIHSS) is a largely used as clinical assessment instrument to measure neurological deficit of stroke. Studies concerned that D-dimer, a fibrin degradation product, has as a potential biomarker in predicting stroke severity and prognosis. This study aimed to investigate the correlation between D-dimer levels and NIHSS score in patients with a first-ever AIS. This cross-sectional study used the stroke registry data of the Dr. Sardjito General Hospital, Yogyakarta from October 2021 to December 2022. A total 83 patients who met the inclusion and exclusion criteria were involved. The blood D-dimer level was measured during admission. The NIHSS scores were assessed within 24 hr of admission. The correlation between D-dimer levels and NIHSS scores were analysed using Spearman’s test. Multiple analysis was performed to evaluate the association of non-dependent risk factors using multiple logistic regression. The mean age of subjects was 60.77±11.08 yr, with a slightly males predominant (54.2%). The mean value of NIHSS score was 6.59 ± 7.00 and D-dimer level was 712.02 ± 1159.2 ng/mL. A significant positive correlation between D-dimer and NIHSS score (r= 0.475; p= 0.01) was observed. Furthermore, D-dimer remained showing an independent association with on-admission NIHSS score (p= 0.026). In conclusion, D-dimer level in stroke patients is associated with more severe on-admission NIHSS score.

Comparison of GeneXpert and line probe assay for the detection of Mycobacterium tuberculosis in direct sputum samples

R Lia Kusumawati — 2025-04-09

Tuberculosis (TB) remains a major global health issue, particularly in low-and- middle-income countries (LMICs) like Indonesia. Diagnostic methods for TB and multidrug-resistant TB (MDR-TB) such as Lowenstein-Jensen (LJ) solid media and Mycobacterium Growth Indicator Tube (MGIT), are time-consuming, causing delays in patient management. Rapid molecular diagnostics, like the GeneXpert MTB/RIF ultra assay and line probe assay (LPA), offer faster and more accurate detection of Mycobacterium tuberculosis and drug resistance. This study aimed to compare the efficacy of GeneXpert and LPA in detecting M. tuberculosis and assessing drug resistance in sputum samples from 20 patients with confirmed TB. The samples were categorized into four groups based on GeneXpert results: very low, low, medium, and high DNA concentration. GeneXpert identified 20% of samples as rifampicin-resistant, while LPA identified 35%. Additionally, LPA detected isoniazid resistance in 10% of samples. The five discordance results between GeneXpert and LPA, from samples with very low DNA concentrations, were confirmed using MGIT 960 culture DST as the gold standard. The LPA successfully identified 2 (10%) Hr-TB among TB cases detected by the GeneXpert TB/ RIF. While LPA demonstrates superior performance characteristics, particularly in detecting isoniazid, GeneXpert demonstrated better sensitivity and specificity, making it a more reliable diagnostic tool under suboptimal conditions, followed by culture-based DST to assure accuracy and examine resistance to other drugs.

Correlation between differentiation grade and lymphovascular invasion in colorectal adenocarcinoma

Nana Liana — 2025-04-09

Colorectal carcinoma is the third most common malignant tumor worldwide. It is a heterogeneous disease with diverse clinicopathological and prognostic characteristics. The TNM (tumor, node, metastasis) staging system is currently used as a prognostic predictor. However, its predictive value is limited, as approximately 30% of patients with lymph node-negative disease die due to metastasis progression. It is suspected that other prognostic factors other than TNM staging system, may play a significant role. Differentiation grade and lymphovascular invasion have been proposed as essential prognostic factors for lymph node-negative colorectal carcinoma. This study aimed to evaluate the correlation between differentiation grade and lymphovascular invasion in colorectal carcinoma. It was an observational study with a cross-sectional design. Samples were collected from 4 Anatomical Pathology laboratories in West Sumatera in 2018. A total of 97 paraffin blocks of colorectal adenocarcinoma met the inclusion criteria. Differentiation grade and lymphovascular invasion were evaluated according to the 2019 World Health Organization (WHO) classification. The correlation between differentiation grade and lymphovascular invasion was analyzed using Fisher's Exact test. A p value <0.05 considered statistically significant. The most prevalent age group for cases of colorectal adenocarcinoma was 51–60 yr (36.1%). Low-grade differentiation was the most common grade of differentiation (72.2%). Lymphovascular invasion in small vessels was commonly encountered (73.3%). High-grade differentiation adenocarcinomas had 100% lymphovascular invasion. A significant correlation between differentiation grade and lymphovascular invasion was observed (p = 0.031). This study confirms that lymphovascular invasion is a valuable predictor of colorectal carcinoma progressiveness.

Familial atrial septal defect: a case report in Indonesia

Muhammad Gahan Satwiko — 2025-03-20

Familial atrial septal defect (ASD) is defined as the occurrence of ASD in the first-degree family of the ASD patient. Recently, familial ASD has been increasingly studied. Familial ASD could manifest as an isolated ASD or with other abnormalities. Furthermore, because ASD is usually asymptomatic, it is very difficult to recognize ASD in a first-degree family based only on symptoms. However, if the family was screened using electrocardiography or echocardiography, the occurrence of familial ASD could be found. Therefore, screening plays an important role in detecting familial ASD. We reported an ASD patient with several occurrences of familial ASD.

ABSTRAK

Atrial septal defect (ASD) familial didefinisikan sebagai terjadinya ASD di keluarga tingkat pertama pada pasien ASD. Studi mengenai ASD familial saat ini telah semakin banyak dilakukan. ASD familial dapat bermanifestasi sebagai ASD yang terisolasi ataupun ASD yang disertai dengan abnormalitas yang lain. Selain itu, karena ASD biasanya asimptomatik, sangat sulit mengenali ASD pada keluarga tingkat pertama hanya berdasarkan gejalanya. Meski demikian, jika keluarga tersebut diperiksa menggunakan elektrokardiografi atau ekokardiografi maka dapat ditemukan terjadinya ASD familial. Oleh karena itu, skrining memegang peranan penting dalam deteksi ASD familial. Kami melaporkan pasien ASD dengan beberapa kejadian ASD familial.