Cermin Dunia Kedokteran

Predictive Model for Multiple Trauma Patients Based on Anatomical Location of Injury at RSSA Malang, Indonesia: A Sub-Study in the Development of a Multicomponent Model

Ari Prasetyadjati — 2025-09-08

Introduction: Management of trauma still poses a challenge in Indonesia without significant improvement in mortality rates in the last 12 years, especially in multiple trauma involving at least 2 organ systems. This study aims to predict the prognosis of multiple trauma patients treated at Saiful Anwar Hospital (RSSA) Malang based on the anatomical location of the injury. Methods: Retrospective cohort study of 506 multiple trauma patients in RSSA during 2021-2022. The analyses used a chi square test and logistic regression test to obtain a regression equation. Results: Multiple trauma cases in RSSA were dominated by males in productive age (15-54 years). Head injury was the most influential variable in predicting the prognosis of multiple trauma patients in hospital, followed by thoracic injury, spinal injury, and abdominal injury. The logistic regression model was quite capable of explaining the data (p=0.931; Hosmer-Lameshow test), while the area under the curve (AUC-ROC) for prognosis in hospital care from this equation was 0.706 with a 95% confidence interval of 0.653-0.759 (good category). Conclusion: Head injuries, thoracic injuries, abdominal injuries, and spinal injuries are predictors of mortality of trauma cases in hospital care in RSSA, Malang, Indonesia.

Response to Radiotherapy for Advanced Squamous Cell Carcinoma and Adenocarcinoma of the Cervix at Ulin Regional General Hospital, Banjarmasin, Indonesia

Natasha Bharat Sindunata — 2025-09-08

Introduction: Cervical carcinoma (cancer) is a malignancy in the cervix and is one of the most common cancers in women. Data released by GLOBOCAN in 2022 showed that cervical cancer ranks eighth globally. The main treatment for advanced cervical cancer is radiotherapy. The aim of this study is to compare the radiotherapy response in squamous cell carcinoma cervical cancer with the response in adenocarcinoma cervical cancer at Ulin Regional Hospital, Banjarmasin, Indonesia. Methods: This cross-sectional research used an analytical observational design. Total sample during the research period from January 2021 to December 2022. Results: Total of 128 cervical cancer patients consisting of 91 squamous cell carcinomas and 37 adenocarcinomas. Chi-square analysis found a significant association between histopathology and response to therapy; squamous cell carcinoma histopathology was more radiosensitive than adenocarcinoma. Conclusion: Histopathological type is the only characteristic significantly associated with radiation response, whereas age, stage, and tumor size are not significantly associated with radiation response.

Management of Candida Onychomycosis

Qonita Imma Irfani — 2025-09-08

Onychomycosis, also known as tinea unguium, is a fungal infection of the nail that can be caused by various types of fungi, including dermatophytes, non-dermatophyte molds, and yeasts. One specific type is candidal onychomycosis, which is caused by yeasts, particularly those from the Candida genus. This nail infection may affect all parts of the nail unit, including the nail plate, matrix, and surrounding tissue. Common clinical manifestations include nail discoloration—typically yellow or brown—thickening or softening of the nail, and increased nail fragility. Onychomycosis is one of the most frequently encountered nail disorders, with an estimated prevalence of approximately 50% of all complaints related to nail disease. Given the diverse etiologies of nail infections and broad differential diagnoses, laboratory examination is strongly recommended prior to initiating treatment. Diagnostic methods such as direct microscopy, fungal culture, and molecular testing are essential for accurate identification, enabling more targeted, effective, and cost-efficient therapy.

Management of Cognitive Disorders in Primary Care

Nabila Mayori Arsanti — 2025-09-08

The global elderly population continues to increase, mainly due to the increase in life expectancy. This condition may pose several problems, i.e., cognitive impairment. Cognitive impairment is a disorder characterized by impairment of cognitive ability and daily functioning, involving disturbances in thinking or memory causing a marked change from the individual’s previous level of functioning with a known or suspected cause. Cognitive impairment is classified into mild cognitive impairment (MCI) and dementia. Cognitive impairment is suspected if there is a decline in work and daily activities. Management in primary care consists of identifying and initial screening, assessments and examinations, and diagnosis. Environmental, psychological, and behavioral interventions; social involvement; nutritional management and sleep interventions; and neuropsychiatric symptom management may be applied. It is important to implement health services that focus on dementia screening and cognitive evaluation in order to prepare healthcare providers. General practitioners can refer patients with early signs or symptoms of cognitive impairment, such as problems with memory or language.

Antibiotic Resistance in Urinary Tract Infections in Children

Grace Erdiana — 2025-09-08

Urinary tract infection (UTI) is one of the most common infections in children. This infection occurs when bacteria from the urethra ascend into the urinary tract, causing an infection that extends from the urethra to the renal parenchyma. The etiology could be bacteria, virus, or fungi, mostly caused by Escherichia coli (E. coli). Urine culture is the gold standard for UTI diagnosis and to determine appropriate therapy, especially antibiotics. Antibiotic resistance is a global issue, as 80% of healthcare facilities prescribe antibiotics for treatment. The incidence of resistance is higher in developed countries than in non-developed countries, with the highest incidence occurring in children aged 0-5 years. Antibiotic resistance increases mortality and morbidity and is also associated with higher costs. In the case of ISK, E. coli is also the pathogen with the highest incidence of antibiotic resistance, which may be associated with inappropriate use of antibiotics. The ease of obtaining antibiotics without a doctor’s prescription and a history of previous antibiotic use are factors that contribute to antibiotic resistance.

Aneurysm in Clinoid Segment of Left Internal Carotid Artery in Normotension-Glaucoma with Chronic Headache

Fabianus Anugrah Pratama — 2025-09-08

Pendahuluan: Aneurisma adalah pembengkakan atau tonjolan abnormal pada dinding arteri. Lokasi aneurisma bervariasi, termasuk aneurisma serebral, aneurisma aorta toraks, dan aneurisma aorta abdomen. Aneurisma biasanya tidak menimbulkan gejala kecuali jika pecah. Kasus: Perempuan, berusia 32 tahun, dengan sakit kepala kronis selama 10 tahun terakhir. Hasil pemeriksaan mata menunjukkan peningkatan perbandingan diameter cup terhadap diskus saraf optik kedua mata tanpa tekanan intraokular yang meningkat. Hasil CT angiografi menunjukkan aneurisma pada segmen klinoid arteri karotis interna kiri dengan morfologi sakular, leher berukuran 4,39 mm, dan kubah berukuran 2,1 mm. Diskusi: Aneurisma intrakranial yang tidak pecah, glaukoma normotensi (NTG), dan sakit kepala kronis memiliki mekanisme disregulasi vaskular yang sama, seperti vasospasme dan gangguan aliran darah, yang mungkin menjelaskan manifestasi klinis yang tumpang tindih. Pada pasien ini, aneurisma segmen klinoid ICA kemungkinan berkontribusi pada sakit kepalanya yang kronis, dan mengobatinya dapat berpotensi meningkatkan frekuensi sakit kepala dan perubahan penglihatan terkait NTG. Simpulan: Karena ketidaktersediaannya peralatan pencitraan resonansi magnetik (MRI) dan ruang intervensi untuk angiografi subtraksi digital, kasus ini menyoroti kegunaan CT angiografi dalam mendiagnosis masalah anatomis, terutama pada kasus sakit kepala kronis, meskipun angiografi kateter masih dianggap sebagai standar emas. Pasien dirujuk untuk prosedur intervensi. Fabianus Anugrah Pratama, Petrus Sewe Pajo. Aneurisma Arteri Karotis Internal Kiri Segmen Klinoid pada Glaukoma Tekanan Normal dengan Nyeri Kepala Kronis.

Acute Coronary Syndrome After Insecticide Spraying: A Suspected Association with Organophosphate Exposure

Hari Nugroho — 2025-09-08

Introduction: Organophosphate is one of the most commonly used insecticides to control vector-borne illnesses. Both organophosphate and biodiesel (commonly used as solvents for outdoor space spraying methods) intoxications have cardiovascular manifestations. Case: A 58-year-old male with a sudden onset of shortness of breath after spraying insecticides 1 hour before admission. On examination, there were no SLUDGEM (salivation, lacrimation, urination, defecation, gastrointestinal distress, emesis, miosis) fndings. Bibasilar rales were present on auscultation, and a 12-lead ECG showed ST elevation in leads V1-V6. There was no preceding chest pain. The patient received oxygen, antiplatelet loading, and insulin therapy for hyperglycemia and was prepared for primary PCI. Diagnostic coronary angiography revealed a mid-LAD total occlusion, and a drug-eluting stent was implanted with fnal TIMI 3 fow. Discussion: Dyspnea has various causes, including organophosphate (OP) poisoning, which may result in cholinergic syndrome, respiratory dysfunction, and life-threatening cardiovascular complications. Early recognition through rapid diagnostic evaluation and timely interventions such as atropine, oximes, and reperfusion therapy in STEMI are essential to improve survival and outcomes. Conclusion: Early recognition and prompt revascularization are critical in STEMI to reduce infarct size and improve outcomes. Organophosphate exposure may be associated with cardiovascular efects, and clinicians should consider acute coronary occlusion in patients with respiratory complaints after insecticide exposure, even in the absence of classical cholinergic signs.

Erythroderma Suspected to be Caused by Allopurinol Drug Reaction: Case Report

Pradissa Avia Emeralda — 2025-09-08

Introduction: Erythroderma is a condition of generalized erythema and scaling of the skin. It has been associated with DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome and is potentially life-threatening. Case: A 55-year-old female with generalized erythema, pruritus, malaise, and edema of her face for 7 days. She had a history of type 2 diabetes mellitus and was in oral allopurinol treatment for the last 2 weeks. Extensive generalized erythematous plaques and hyperkeratotic scales were observed on the face, neck, chest, arms, legs, back, and glutea. Laboratory workup revealed eosinophilia, mild hypoalbuminemia, hyperglycemia, and elevated liver enzyme level. Discussion: Erythroderma is an emergency case in dermatovenereology and needs hospitalization. A patient with drug-induced erythroderma with internal organ involvement has been associated with DRESS syndrome and needs further observation of cardiac, liver, and kidney status. Conclusion: Allopurinol is a potential trigger for erythroderma. Drug-induced erythroderma is closely related to DRESS syndrome. Allopurinol use requires caution to avoid complications and prevent recurrence.

The Role of Rotavirus Vaccines in Reducing the Number of Cases and Length of Hospitalization of Children with Diarrhea

Natasha Dianasari Devana — 2025-09-08

Diarrhea remains one of the leading causes of morbidity and mortality among children in developing countries, including Indonesia. One of the most common causes of severe acute diarrhea is rotavirus infection, which is highly contagious through the fecal-oral route and can lead to severe dehydration and even death. Efective prevention can be achieved through rotavirus vaccination, which has been proven to reduce incidence, prevent transmission, and decrease disease severity. Rotavirus vaccination in children is known to be benefcial in controlling cases of rotavirus diarrhea, and since 2023, the rotavirus vaccine has been part of Indonesia's national immunization program, provided free of charge to infants according to the Ministry of Health's immunization schedule. Multiple studies have shown that this immunization reduces the risk of serious complications, shortens hospital stays, decreases hospitalization rates, and lessens the economic burden on families due to medical costs and lost productivity. Broad implementation of rotavirus vaccination is therefore a key strategy to improve child health and reduce diarrhea-related mortality in Indonesia.

ETEC Vaccine: A New Solution for Preventing Foodborne Disease

Ninda Inayah — 2025-09-08

Diarrhea remains a leading cause of under-fve mortality globally and in Indonesia. In 2020, the mortality rate for children aged 12-59 months due to diarrhea was 4.55%. Enterotoxigenic Escherichia coli (ETEC) is estimated to cause approximately 220 million episodes of diarrhea annually worldwide. ETEC vaccines are being developed to prevent the acute disease burden and long-term sequelae such as growth and cognitive impairment linked to repeated infections. Public health models suggest that an ETEC vaccine has the potential to reduce 4.2%–6.0% of deaths due to diarrhea, particularly among infants and children in low-resource settings, and decrease antibiotic use, thereby improving treatment cost efciency. This paper reviews ETEC structure and pathogenesis, clinical features, and the current vaccine pipeline focused on colonization factor (CF) antigens and LT/ST toxins. The highlighted leading candidates, including ETVAX (an oral inactivated whole-cell vaccine currently in phase 2b), and multivalent approaches targeting the most prevalent CFs, which could theoretically protect against 70%-80% of circulating disease-causing strains in at-risk populations.

Norovirus Gastroenteritis and the Development of Norovirus Vaccines

Aribowo I Kadek — 2025-09-08

Viral gastroenteritis is responsible for millions of diarrhoea cases annually. Norovirus is currently reported to be the second leading cause of acute diarrhoea worldwide, after rotavirus, in all paediatric age groups in both developed and developing countries. Norovirus is a single-stranded RNA virus belonging to the Caliciviridae family. The largest human strain belongs to genogroup II, genotype 4 (II.4). Transmission is primarily faecal-oral with humans as the principal host; the virus itself has a very low infectious dose, persists across diverse temperatures and surfaces, and can be shed pre-symptomatically, enabling rapid spread. Clinical features include nausea, vomiting, abdominal cramps, and diarrhea, with heightened dehydration risk among young children, older adults, and immunocompromised individuals. To date, norovirus vaccine development still encountered difculties, including the complex nature of norovirus, human immune response, virus culture, and limited animal models for vaccine testing. Currently, several vaccines are still in the pre-clinical stage. Vaccine development needs to be accelerated while maximizing prevention of norovirus infection.

Indonesia's Preparedness for Polio Outbreaks

Agnes Margareta Tanoto — 2025-09-08

Since the launch of Global Polio Eradication Initiative (GPEI) in 1988, global polio eradication eforts have succeeded in reducing polio cases by 99% and eradicated polio virus type 2 in 2015. Although Indonesia has obtained free-polio certifcation in 2014, polio outbreaks still occur. Recent polio outbreak involved circulating vaccine-derived poliovirus (cVDPV) and vaccine-derived poliovirus type 2 (VDPV2), highlighting weaknesses in fuctuating immunization coverage and the impact of the COVID-19 pandemic, which disrupted routine immunization programs. The government’s response through the National Immunization Week (PIN) and the Outbreak Response Immunization (ORI) strategy aims to address these outbreaks, but challenges such as logistical difculties, community education, and a shortage in human resources remain signifcant. Indonesia also faces issues in ensuring consistent immunization coverage, especially in high-risk areas like Papua; difculty of communication and challenges in reaching remote areas add complexity to the fght against polio. A holistic approach involving various sectors and stakeholders, along with enhanced communication and coordination eforts, is key to addressing the future threat of polio. Agnes Margareta Tanoto, Jeceline Sutarto, Helen Susanto. Indonesia’s Readiness to Polio Outbreak.