Nusantara Medical Science Journal (NMSJ) is an open-access, peer-reviewed journal published by the Faculty of Medicine, Hasanuddin University twice a year in June and December. NMSJ encompasses basic, molecular, and clinical aspects of medical sciences, including diagnosis, treatment, prevention, and epidemiology of communicable and non-communicable diseases, especially in Asia settings. This journal publishes review articles, case reports, and original articles. All papers published in NMSJ are freely available as downloadable pdf files. NMSJ is accredited by the Directorate of General Higher Education, the Ministry of Research, Technology, and Higher Education, Indonesia. Starting in 2021, Nusantara Medical Science Journal will only accept manuscripts in English. Average Processing Time: First submission to first decision: 7 - 14 days First decision to acceptance : 45 - 60 days Acceptance to publication : 7 - 21 days ISSN (Print) : 2460-9757 | ISSN (Online): 2597-7288 ----------------------------- Submit Your Paper Author Guidelines Copyright Transfer Aggrement -----------------------------
Faculty of Medicine, Hasanuddin University.
Implementation of Discharge Planning Based on Patient Centered Care for Post Stroke Patients in the Stroke Unit: A Systematic Review
Background: Stroke is a major mortality factor necessitating coordinated care systems to prevent incidents and enhance patient prognosis. The implementation of discharge planning based on patient centered care in stroke patients aims to increase patient involvement through the provision of personalized information and shared decision making, in order to prepare patients for daily activities after discharge from the hospital. This study aims to Assess the effectiveness and impact of implementing patient-centered care-based discharge planning after stroke on patient satisfaction, quality of life, and reduction in hospital re-visits. Methods: The authors conducted a systematic review using PRISMA 2020 Guidelines. The article were derived from four electronic databases (Web of Science, JStor, PubMed, and Scopus) using keywords and terms relevant to the research topic. Consisting of full text original research articles published between 2019 and 2025 using quantitative and qualitative methods. Results: A total of 2,518 records were identified. Nine articles met the selection inclusion criteria were included due to having good methodological quality Patient-centered discharge planning interventions were associated with improved quality of life, patient satisfaction, adherence to post-discharge plans, and reduced hospital readmissions. Conclusion: Patient-centered discharge planning models positively influence patient satisfaction, quality of life, and rehospitalization rates among post-stroke patients. Implementing structured, multidisciplinary discharge planning protocols based on patient-centered care principles is crucial to improving stroke recovery outcomes.
Copyright (c) 2026 Halimatus Sa’diyah, Mira Triharini, Ilya Krisnana, Novia Caecilia Laoli, Nurma Lindawati https://creativecommons.org/licenses/by/4.0
Clinical and Epidemiological Profile of Cardiovascular Disease at Rantauprapat Hospital, North Sumatra: A Retrospective Study
Introduction: Cardiovascular disease (CVD) is a leading cause of global mortality, with a significant and growing burden in Asia. Despite this, local epidemiological data in specific regions of Indonesia remain limited. This study aims to describe the clinical and epidemiological profile of patients with CVD at a regional hospital in North Sumatra, Indonesia. Methods: A retrospective, descriptive cross-sectional study was conducted using medical records from the cardiology outpatient clinic at Rantauprapat Hospital between January 1 and December 31, 2023. Data regarding patient age, sex, primary diagnosis, and comorbidities were extracted and analyzed descriptively. Results: A total of 2,116 patients met the inclusion criteria. The majority of the patients were male (52.69%), with the largest age group being 51–60 years (33.13%). Primary heart disorders constituted 70.04% of the cases, predominantly heart failure (65.97%). Coronary and peripheral vascular diseases accounted for 29.63% of the cases, primarily driven by coronary artery disease (23.49%). Additionally, hypertension was identified as the most prevalent concurrent comorbidity, affecting 35% of the study population. Conclusion: Heart failure and coronary artery disease are the most prevalent primary cardiovascular conditions among older adults at this regional hospital, significantly exacerbated by high rates of comorbid hypertension. These findings emphasize the urgent need for enhanced primary care interventions and targeted cardiovascular risk factor management within this population.
Copyright (c) 2026 Shazni Nadia Reivana, Kartika Karo , Farida Hanum Margolang , Husnah https://creativecommons.org/licenses/by/4.0
Mandibular Metastasis as a Rare Presentation of Follicular Variant Papillary Thyroid Carcinoma: A Case Series
Introduction: Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. The follicular variant of papillary thyroid carcinoma (FV-PTC) represents a distinct histologic subtype that tends to spread hematogenously to distant organs, including bone. Mandibular metastasis from FV-PTC is exceedingly rare and may pose a diagnostic challenge, particularly when it precedes recognition of the primary thyroid lesion. Presentation of case: We report two Asian female patients presenting with mandibular masses. The first patient had a history of total thyroidectomy for papillary thyroid carcinoma (follicular variant) ten years earlier. Imaging revealed an extensive osteolytic lesion of the right mandible. Histopathology of an incisional biopsy confirmed metastatic PTC, and the patient underwent right hemimandibulectomy with immediate reconstruction using a titanium plate. The second patient presented with a large, painful left mandibular mass without any history or clinical evidence of thyroid disease. Imaging showed a destructive lytic lesion of the left mandible, while neck ultrasonography revealed no thyroid enlargement. Biopsy suggested FV-PTC of thyroid origin. The patient underwent left hemimandibulectomy with titanium plate reconstruction. Final histopathology in both cases confirmed FV-PTC metastasis to the mandible. Conclusion: Mandibular metastasis from FV-PTC is a rare manifestation that may occur as late recurrence after thyroidectomy or as the first indication of an occult thyroid carcinoma. Comprehensive diagnostic workup and appropriate surgical reconstruction are crucial to achieve local disease control and preserve function. Clinicians should consider metastatic thyroid carcinoma in the differential diagnosis of lytic mandibular lesions, even in the absence of a palpable thyroid
Copyright (c) 2025 William Hamdani, Erwin A. Patabang, Haryasena Haryasena , Djonny Ferianto, John Pieter Jr., Salman Ardi Syamsu https://creativecommons.org/licenses/by/4.0
Le Fort Fractures: A Narrative Review of Diagnosis and Management
Le Fort fractures represent complex midfacial fractures typically resulting from high-velocity trauma, characterized by the separation of the maxillary structure from the cranial base. This narrative review synthesizes contemporary literature regarding the etiopathogenesis, classification, diagnosis, and management of these fractures. Diagnosis requires a comprehensive clinical assessment supplemented by non-contrast computed tomography (CT) as the gold standard for delineating fracture patterns and buttress involvement. The review discusses the clinical relevance of classical Le Fort classifications alongside Wassmund and Marciani modifications to guide surgical planning. Management strategies prioritize initial stabilization according to Advanced Trauma Life Support (ATLS) principles, particularly airway control, followed by definitive surgical intervention. Open reduction and internal fixation (ORIF) remains the primary surgical modality, focusing on the restoration of vertical and horizontal buttresses, occlusion, and orbital integrity. Postoperative care is critical for preventing complications such as infection, malunion, and ocular dysfunction. Ultimately, successful management necessitates a multidisciplinary approach combining precise imaging and rigid fixation to restore facial aesthetics and function while minimizing long-term morbidity.
Copyright (c) 2025 Amanda Refa Madani, I Gede Sutawan https://creativecommons.org/licenses/by/4.0
Twists and Turns in The Fibrinolytic Therapy of Infero-Posterior ST Elevation Myocardial Infarction and Right Ventricular Infarction Patient with Cardiogenic Shock: A Case Report
Introduction: Fibrinolytic therapy is preferred for ST-segment elevation myocardial infarction (STEMI) when the timeframe for percutaneous coronary intervention (PCI) cannot be achieved. Although effective, fibrinolytics are also associated with several adverse effects in addition to the complications of STEMI itself. Case: A 45-year-old active smoker man presented with chest pain, dyspnea, and diaphoresis for the past hour. Electrocardiography revealed infero-posterior STEMI with right ventricular infarction. Echocardiography demonstrated akinetic inferior, infero-septal, and posterior walls with an estimated right atrial pressure of 15 mmHg. Management: Therapy consisted of aspirin, clopidogrel, furosemide, and streptokinase infusion. Within five minutes of initiating streptokinase, the patient developed sudden hypotension that required norepinephrine, dobutamine, and dopamine. At approximately halfway of the streptokinase infusion, he developed accelerated idioventricular rhythm which progressed to pulseless ventricular tachycardia lasting for one minute. Before defibrillation was performed, his rhythm reverted to sinus, after which a bolus of amiodarone was administered. Given his instability, streptokinase was discontinued after approximately 70 percent of the total dose had been delivered. Outcome: The patient was transferred to the intensive care unit with stable hemodynamic, resolved chest pain, and more than 50 percent ST-segment resolution on ECG. Heparin, atorvastatin, maintenance amiodarone, and furosemide were added to his regimen. He continued to improve clinically and was discharged without complication. Conclusion: This case shows that fibrinolysis remains essential when PCI is unavailable, but streptokinase can cause hemodynamic and arrhythmic complications, highlighting the need for close monitoring and rapid intervention in resource-limited settings.
Copyright (c) 2025 Jonathan Edbert Afandy, Taslim https://creativecommons.org/licenses/by/4.0
Comparison Of The Accurancy Of Prenatal And Postnatal Screening For The Detection Of Congenital Heart Disease : Systematic Review
Introduction: Congenital heart disease (CHD) is one of the most common congenital anomalies and remains a leading cause of neonatal morbidity and mortality worldwide. Early detection through prenatal and postnatal screening plays a crucial role in improving clinical outcomes; however, the diagnostic accuracy of these screening approaches varies across studies. Method: This systematic review was conducted and reported in accordance with the PRISMA 2020 guidelines. A comprehensive literature search was performed in PubMed, Embase, Web of Science, and the Cochrane Library up to December 20, 2025. Title, abstract, and full-text screening were independently conducted by two reviewers, with disagreements resolved through discussion. Eligible studies were English-language articles published between 2015 and 2025 that reported the diagnostic accuracy of prenatal screening (ultrasonography or fetal echocardiography) and/or postnatal screening (pulse oximetry or clinical examination) for CHD detection. Risk of bias and methodological quality were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Due to substantial heterogeneity among studies, data were synthesized narratively. Conclusions: Prenatal and postnatal screening methods exhibit complementary strengths in the detection of CHD. The implementation of an integrated two-stage screening strategy (prenatal–postnatal) is recommended as an optimal approach to enhance early detection and reduce neonatal morbidity and mortality associated with CHD, particularly in low- and middle-income countries.
Copyright (c) 2026 Fadiyah Ulfah Khalid Fadiyah https://creativecommons.org/licenses/by/4.0
Clinicopathological Profile and Disease-Free Survival in Stage I-II Endometrial Cancer at Cipto Mangunkusumo Hospital
Introduction: This study aimed to describe the clinicopathological profile and evaluate the disease-free survival (DFS) of patients with FIGO 2009 stage I–II endometrioid endometrial cancer, and to determine the prognostic value of key factors, emphasizing lymphovascular space invasion (LVSI) and tumor grade. Methods: A retrospective cohort of 111 patients treated between January 2017 and December 2022 was analyzed. Variables included age, menopausal status, BMI, depth of myometrial invasion, LVSI, and tumor grade. Survival was estimated using the Kaplan–Meier method; associations were assessed with Fisher’s exact test, and independent prognostic factors were identified using multivariate Cox regression analysis Results: The median follow-up for the 111 patients was 32 months. Most were stage IB (42.4%), aged 45–60 years (46.8%), postmenopausal (73%), and obese (63%). Stage-specific DFS rates were: Stage IA – 94.6% (1-year), 87.8% (2-year), 87.8% (3-year); Stage IB – 93.6% (1-year), 91.0% (2-year), 91.0% (3-year); Stage II – 92.6% (1-year), 88.9% (2-year), 88.9% (3-year). LVSI positivity (15.3%) and high tumor grade emerged as the strongest prognostic factors. Multivariate analysis confirmed LVSI as an independent predictor across all stages, with hazard ratios ranging from 3.85 in stage IA to 4.25 in stage IB and 12.5 in stage II (p<0.05). In stage II, LVSI-positive patients showed a 57.1% 3-year DFS versus 100% in LVSI-negative patients. Conclusions: LVSI and tumor grade are independent, interrelated prognostic markers in early-stage endometrial carcinoma. Their integration into risk stratification refines adjuvant therapy guidance. Implementation requires standardized pathological reporting and efficient referral systems to improve long-term surveillance adherence.
Copyright (c) 2025 Muhammad Rizkinov Jumsa, Kartiwa Hadi Nuryanto, Tricia Dewi Anggraeni, Tantri Hellyanti https://creativecommons.org/licenses/by/4.0
Maternal Obesity, Metabolic Syndrome, and Long-Term Effects on Offspring: A Developmental Origins of Health and Disease (DOHaD) Perspective
Introduction: The global prevalence of obesity among women of reproductive age has increased markedly over the past two decades, reaching 24% in high-income and 16% in low- and middle-income countries. This trend contributes to adverse maternal and neonatal outcomes, including a 2–4-fold higher risk of gestational diabetes, a threefold increase in preeclampsia, and up to a 50% higher caesarean delivery rate. Maternal metabolic disorders also have long-term consequences for offspring metabolic and cardiovascular health. Objective: To synthesize current biological and epidemiological evidence linking maternal metabolic status to offspring health within the Developmental Origins of Health and Disease (DOHaD) framework. Methods: A comprehensive search was conducted in PubMed, Scopus, and Web of Science from January 2015 to September 2025 using keywords related to maternal obesity, metabolic syndrome, DOHaD, offspring health, and epigenetics. Included studies comprised human and animal research with follow-up beyond two years, while case reports, editorials, and studies without long-term outcomes were excluded. Findings: From 22 eligible studies, consistent evidence indicates that maternal obesity and metabolic syndrome affect offspring through placental dysfunction, systemic inflammation, and epigenetic reprogramming. Offspring of obese mothers show a 1.5–2.8-fold increased risk of obesity and insulin resistance during adolescence and adulthood. Epigenome-wide analyses reveal altered methylation of genes regulating lipid metabolism (LEP, IGF2) and inflammatory pathways, supporting the DOHaD hypothesis. Conclusion: Maternal metabolic health critically shapes offspring developmental and metabolic outcomes. Preconception and antenatal interventions targeting metabolic optimization provide key opportunities to prevent intergenerational transmission of metabolic risk and promote healthier future generations.
Copyright (c) 2025 Nabila Aulia Tsaqifah, Rifdah Hanifah, Firda Asma'ul Husna, Mailani Dwi Hidayati, Dwi Widyawati , Ghea Farmaning Thias Putri, Ainina Al Shadrina https://creativecommons.org/licenses/by/4.0
Thyroglossal Duct Cyst: Clinical Insights from a Case Report
Introduction and importance: A thyroglossal duct cyst (TGDC) is the most common congenital mass found in the neck region. TGDC originates from the thyroglossal duct and persists along the descending groove of the thyroid gland, from the foramen caecum to the superior thyroid gland in front of the trachea. Presentation of case: A 46-year-old man presented with a slowly enlarging lump at the anterior midline of the neck, first noticed about 10 years earlier. On examination, a well-defined, round, cystic mass measuring 3.5 × 3.3 cm was found superior to the thyroid cartilage. The mass moved with tongue protrusion and swallowing and was mobile, painless, and non-tender. These findings were consistent with a thyroglossal duct cyst. Discussion: Thyroglossal duct cyst (TGDC) is a congenital midline neck mass resulting from the persistence of the thyroglossal duct during thyroid descent. Diagnosis is based on clinical features and imaging, with the Sistrunk procedure serving as the gold standard treatment to prevent recurrence. The patient underwent successful surgical excision without complications, and histopathology confirmed the diagnosis. Conclusions: The Sistrunk's Procedure surgery was conducted successfully with no postoperative complication in this case.
Copyright (c) 2025 Robert Christeven, Florean Hartungi https://creativecommons.org/licenses/by/4.0
The Correlation between Plasma IL-17 Levels, Lymphocyte Counts, and Neutrophil Counts with the Colonisation of Candida sp. in Tuberculosis Patients with a Treatment History
Introduction: Tuberculosis (TB) patients with a history of ATT therapy are associated with changes in IL-17 levels, lymphocyte counts, and neutrophil counts. Increased IL-17 levels, lymphocyte counts and neutrophil counts indicate colonisation of Candida sp. fungus. Changes in the immune response in TB patients with Candida sp. colonisation may cause complications of TB that affect the treatment success rate. Methods: This research was designed for observational analytical study with a cross-sectional design. 59 subjects are divided into 3 groups, consisting of 21 TB-positive people with Candida sp. colonisation, 21 TB-positive people without Candida sp. colonisation, and 17 TB-negative people with Candida sp. colonisation. Plasma IL-17 levels are examined using the ELISA test, while the lymphocyte and neutrophil counts are seen from previous study examinations (AFFECT). Results: The plasma IL-17 levels in the TB-positive group with Candida sp. colonisation were 24.05 pg/ml (IQR 21.77-30.50). The plasma IL-17 levels in the TB-positive group without Candida sp colonisation were 23.08 pg/ml (IQR 19.11-32.46). The plasma IL-17 levels in the TB-negative group with Candida sp. colonisation is 20.72 pg/ml (IQR 18.51-22.84) pg/ml, (p=0.046). However, there are no statistically significant difference was observed in lymphocyte and neutrophil counts (p=0.078). Conclusions: The differences in IL-17 levels that occur in the TB group with Candida sp colonisation may serve as an immunological signal suggesting the need for fungal assessment if the TB patients do not improve their treatment outcome after undergoing ATT for over 6 months.
Copyright (c) 2025 Vycke Yunivita, Mutiara Anastasia, Intan M.W Dewi, Chrysanti Murad https://creativecommons.org/licenses/by/4.0
Evaluation of Systemic Immune-Inflammation Index for Predicting Mortality in Sepsis Patients
Introduction: This study aims to measure the accuracy of Systemic Immune-Inflammation Index (SII) in predicting 28-day mortality in sepsis patients in intensive care unit. Methods: This study was conducted as a retrospective cohort study. The study was conducted in the intensive care unit of Dr. Wahidin Sudirohusodo General Hospital. The study subjects consisted of all sepsis patients admitted to the intensive care unit during the period January 2023 to December 2023 who met the inclusion criteria. Results: Total sample is 147 participants. Systemic Immune-Inflammation Index (SII) showed a significant difference in predicting sepsis mortality. SII has an AUC value of 0.763 with a sensitivity of 69.6% and a specificity of 71.1% at a cut-off of 2003.395. Conclusions: Systemic Immune-Inflammation Index (SII) scores are associated with increased mortality in sepsis patients in the intensive care unit of Dr. Wahidin Sudirohusodo Hospital. The SII can be a prediction tool in clinical practice in predicting mortality of sepsis patients.
Copyright (c) 2025 Haizah Nurdin, Syamsul Hilal Salam, Andi Husni Tanra, Ari Santri Palinrungi, A.M. Irsyad Sulkifli Mangga Barani, Faisal Muchtar https://creativecommons.org/licenses/by/4.0
Non-involuting congenital hemangioma have angioproliferative features of both congenital vascular malformations and of vascular tumors- insights from apoptosis, autophagy and senescence
Backgrounds: Non-Involuting Congenital Hemangiomas (NICH) are benign vascular lesions distinguished by the proliferation of micro-vessels. Currently, the underlying pathophysiology and connection with congenital vascular malformations remain uncertain. This study aims to explore age-related discrepancies in NICH and compare them with malformations by examining histological characteristics and assessing markers for cell death, maturation and proliferation. The goal is to ascertain whether NICH should be classified as vascular tumors or vascular malformations, in order to properly classify them within the wide spectrum of vascular anomalies. Methods: Paraffin blocks of 36 clinically documented cases of NICH (n=12) and congenital vascular malformations (n=24) were immunostained using antibodies against cell-death (C-Caspase-3) and cell-cycle related proteins (Ki67, p62, LC3B, p21, p27), and immunodouble stained with smooth muscle actin antibody for identifying immunolocalization with vessel walls. Three independent observers conducted semi-quantitative scoring of stained samples. Statistical analysis was employed to compare differences between NICH in two age groups (young and old), and congenital vascular malformations. Results: Clinical history in combination with histology and Ki67 categorized the lesions into four groups: NICH younger ages (n=7), NICH old ages (n=5), non-proliferative vascular malformations (n=12), and proliferative vascular malformations (n=12). C-Caspase-3 and LC3B showed significantly higher expression in the younger age group of NICH (p<0.05) and proliferative AVM (p<0.05). The senescence marker p21 was elevated only in proliferative AVM, while p27 exhibited higher expression in both NICH and proliferative AVM compared to non-proliferative vascular malformations. Conclusions: This study revealed distinct expression patterns of cell cycle related proteins in different types of benign vascular anomalies and within the same type across different age groups. NICH, despite sharing certain clinical characteristics (onset in utero, no tendency to regress) with congenital vascular malformations, displayed a persistent vasoproliferative behavior and different patterns of apoptosis, autophagy and senescence. These findings may endorse the view that NICH should not be classified as congenital vascular malformations. However, NICH revealed similarities with AVM subtypes harbouring a vasoproliferative component. Therefore, it could be argued whether proliferative components of AVM are really part of the developmental disorder itself , or could represent a (reactive) epiphenomenon.
Copyright (c) 2025 Amalia Mulia Utami, Gonca Cinkara, Kartika Ratna Pertiwi, Max M. Lokhorst, Onno J. de Boer , Chantal MAM van der Horst , Lorine B. Meijer-Jorna , Allard C. van der Wal https://creativecommons.org/licenses/by/4.0
Strategies for Managing Preoperative Anxiety in Children: A Comprehensive Approach
Introduction: Preoperative anxiety is prevalent among pediatric patients and may adversely affect anesthetic induction, postoperative recovery, and long-term psychological outcomes. It arises from developmental vulnerability, lack of understanding, and exposure to unfamiliar environments. Method: This narrative review synthesizes evidence from studies retrieved via PubMed, ScienceDirect, and EBSCO, using keywords related to preoperative anxiety, pediatric patients, and management strategies. The review explores both risk factors and intervention modalities. Results: The database search using predefined keywords yielded a total of 193 articles. After screening and eligibility assessment, 22 articles met the inclusion criteria and were included in this literature review. Conclusions: A comprehensive, individualized approach combining both pharmacological and non-pharmacological strategies is essential to effectively manage preoperative anxiety in children. Early identification of risk factors and tailored interventions can significantly enhance perioperative experiences and outcomes.
Copyright (c) 2025 Riswandi Riswandi, Kohar Hari Santoso, Lucky Andriyanto https://creativecommons.org/licenses/by/4.0
Challenges in Managing Myocardial Stunning Following Cardiac Arrest in a Very High-Risk NSTE-ACS Patient: A Case Report
Introduction: Myocardial stunning is a reversible myocardial dysfunction that can occur due to various conditions, including focal ischemia—such as acute coronary syndrome (ACS)—and global ischemia, such as cardiac arrest. The proposed mechanisms include oxygen free radical damage during early reperfusion and altered calcium inflow leading to transient myofilament desensitization. Case Presentation: A 61-year-old woman with a history of uncontrolled hypertension and obesity presented with sudden loss of consciousness lasting one hour, preceded by chest pain and dyspnea. She experienced cardiac arrest and achieved return of spontaneous circulation (ROSC) after 10 minutes of cardiopulmonary resuscitation. Initial echocardiography showed a left ventricular ejection fraction (LVEF) of 32.9% and global hypokinesia. She was diagnosed with very high-risk non-ST-elevation ACS (NSTE-ACS), with suspected left main coronary artery obstruction or three-vessel disease. Her clinical course was complicated by acute pulmonary edema, respiratory failure, and cardiogenic shock. Management included intubation, dual antiplatelet therapy, anticoagulation, statin therapy, and inotropic support with dopamine and dobutamine. Her hemodynamic status improved within 18 hours, and she was extubated. On the third day post-arrest, follow-up echocardiography revealed a restored LVEF of 69.5% with normal wall motion. The patient was discharged after 9 days and continued to do well on outpatient follow-up for at least 6 months. Conclusions: Myocardial stunning should be considered in post-cardiac arrest and ACS patients with transient ventricular dysfunction. Early supportive care and close monitoring are essential, particularly in settings lacking advanced cardiac interventions.
Surgical Treatment Of Pendred Syndrome With Thyroid Nodule: A Case Report
Introduction and importance: Pendred syndrome (PS) is a genetic disease inherited in an autosomal recessive pattern. In PS patients, the ability of thyroid gland to accumulate iodide in the follicle lumen is disrupted, causing insufficient thyroid hormone synthesis and goiter to occur as compensation. However, this symptom does not often appear, as goiter is only detected in 30–75% of PS patients. Presentation of case: A 33-year-old Buginese man complained of a painless mass in the neck. In the past 3 months, the mass has shown rapid growth, followed by symptoms of agitation, irritability, and hyperhidrosis. The patient was previously diagnosed with nodular goiter and was taking Levothyroxine. Furthermore, there was a history of the same disease in the patient’s grandmother and younger sibling. Physical examination showed grade III goiter (WHO criteria) with hard consistency and no palpable nodules. Laboratory tests showed routine blood tests, kidney and liver function in normal limits, 1.14 ng/dL FT4, free triiodothyronine level of 6.07 pg/dL, and 2,401 mIU/L TSH level. Chest X-ray results showed tracheal narrowing at the level of the superior thoracic aperture. Similarly, thyroid USG showed that the size of the right lobe was enlarged and anechoic. CT (Computerized Tomography) scan of the cervix showed diffuse enlargement in each lobe and the patient was diagnosed with PS. Right isthmolobectomy and thyroid biopsy were carried out and pathological anatomical examination results showed thyroid follicular nodular disease with cystic degeneration. After surgery, thyroxine hormone replacement therapy was continued. Discussion: Surgical intervention strategies may be employed to inhibit the advancement of disease and mitigate thyroid enlargement, consequently decreasing the likelihood of obstruction and malignancy. Conclusions: In cases of PS with large thyroid nodules pressing on the trachea, isthmolobectomy was carried out to obtain good results and no recurrence.
Copyright (c) 2025 Djonny Ferianto, Salman Ardi Syamsu, Vannes Caesar Palebangan Sapan, Indra, Elridho Sampepajung, John Pieter Jr https://creativecommons.org/licenses/by/4.0
The Immunoreactivity of recombinant protein MPT63 Mycobacterium tuberculosis as serodiagnostic tuberculosis
Introduction: Mycobacterium tuberculosis protein-63 (MPT63) is an extracellular protein encoded by the Rv1926c gene with a size of 16 kDa. MPT63 can specifically induce macrophage activation, stimulate cytokine production (TNF-α and IL-6), and stimulate Th1 cells. The immunogenic properties of MPT63 can be concluded from the presence of a high density of T cell epitopes in the N-terminal immunodominant. This research aims to emphasize and determine the antibody response from the administration of the MPT63 antigen as a candidate in active TB serodiagnostic testing. Methods: This type of research is quantitative and is a diagnostic study. Serum samples were taken from Hasanuddin University Hospital stored biological material with 10 for healthy serum and 36 for sick serum. The determination of optical density values ​​is based on the results of the ELISA reader. The determination of optical density values ​​is based on the results of the ELISA reader. Sensitivity and specificity were tested using the Mc Nemar formula and then they calculated the sensitivity and specificity values ​​manually. Results: Based on the interpretation of the ELISA test from the MPT63 antigen, the antibody reaction response was obtained for a sensitivity of 50% and a specificity of 58.33%. Conclusions: Antibody responses to an antigen that is used indicate that all samples successfully respond well to the serum antigen in the serum of healthy and active tuberculosis but have a sensitivity that is still lacking.
Copyright (c) 2024 Ian Imanuel Fidhatami, R Agus, M N Massi https://creativecommons.org/licenses/by/4.0
Perioperative Pediatric Transfusion Strategy
Introduction: In the modern healthcare system, blood transfusion is an essential treatment that plays a significant role in the clinical improvement of adult and pediatric patients. Given the physiological and hematological differences between children and adults, careful planning and an individualized approach are essential to maximize its effectiveness and avoid serious side effects. Method: A thorough review of the literature was performed, utilizing PubMed, Embase, and the Cochrane Library, to gather evidence on pediatric perioperative transfusion practices. The search encompassed studies published between 2013 and 2024, employing a combination of terms and free-text keywords, as well as Boolean operators, to refine the results. Conclusion: Intraoperative blood loss in pediatric patients requires special attention with an approach that includes pre to postoperative management. This approach must be adapted to the anatomical and physiological differences of children compared to adults. Research, development of universal transfusion strategies, and education and training for medical personnel are essential to improve blood management and prevention of complications.
Copyright (c) 2025 Ahmad Nur Islam, Elizeus Hanindito, Muhammad Ramli Ahmad, Maman Surya Permana, Hanna Aulia Namirah https://creativecommons.org/licenses/by/4.0
Twin Reversed Arterial Perfusion Sequence (TRAPS): A Case Report
Introduction and importance: Acardiac twins are a complication of monozygotic twin pregnancies. Twin Reversed Arterial Perfusion Sequence (TRAPS) is reported to occur in approximately 1% of monochorionic twin pregnancies and 1 in 35,000 pregnancies. The objective is to provide a brief description of acardiac twins. Presentation of case: A 25-year-old multigravida, 35/36 weeks of twin pregnancy. On ultrasound examination of acardiac twins, no heart structure, head bones, and sternum were found, and the shape of the fetus was unclear. Vaginal delivery was carried out; the first live female baby was born, followed by the acardiac baby. The acardiac baby is seen to have imperfect development of the head and upper extremities, Spina bifida, deformity of the lower extremities, Phocomelia of the lower limb, and Split foot. After 9 days, the baby's condition improved, and she was allowed to go home. Discussion: TRAPS's etiology and pathophysiological mechanisms are still poorly understood. Ultrasound findings show an absent or non-functioning heart in one twin, malformation with cystic hygroma, and generalized edema. The first baby (donor twin) was born prematurely, weighing 2200 grams, and there were no signs of heart failure, while the second baby (acardiac) was born weighing 1050 grams. Current therapy for acardiac twins aims to prevent congestive heart failure in the donor twin and stop blood flow to the acardiac twin. Conclusions: Early diagnosis of abnormalities in monochorionic pregnancy using ultrasound in the first trimester plays a role in assessing the prognosis for the viability of the pregnancy.
Copyright (c) 2025 Prilly Astari, Efendi Lukas https://creativecommons.org/licenses/by/4.0
Geospatial analysis of type B and C hepatitis in South Sulawesi
Introduction: Hepatitis C and B are two infectious diseases that increase distribution and high mortality and morbidity. Conditions that exacerbate the economic burden of these two viral hepatitis infections are complications of cirrhosis and gastrointestinal bleeding. This study sought to assess the risk levels of hepatitis C and B across various districts and cities in South Sulawesi. It involved identifying spatial clusters of affected individuals through an analytical model, employing Generalized Poisson Regression to evaluate the potential impacts of these viral infections. Methods: The natural break method is a quantifiable technique for identifying value clusters indicative of data distribution and for detecting geographical illness clusters, using Global Moran’s I statistics. This research utilizes data from health insurance members diagnosed with hepatitis C and B between January 2020 and December 2022, including 24 districts and cities in South Sulawesi Province. Results: According to the results of the Local Morans I analysis, there is no significant clustered hepatitis C and B in all districts and cities in South Sulawesi from 2020 until 2022. Conclusions: In South Sulawesi, the incidence of hepatitis C and B cases reported to National Social Health Insurance Administration Body (BPJS Kesehatan) appeared to manifest randomly or sporadically.
Copyright (c) 2024 Rini Rachmawarni Bachtiar, Andi Alfian Zainuddin, Rahmawati Minhajat1, Sri Jayanti https://creativecommons.org/licenses/by/4.0
Histopathological Difference of Inflammatory Cells Infiltration into Fetal Membranes of PROM and Non-PROM
Introduction: Premature rupture of membranes (PROM) remains one of several causes of premature birth that increases both maternal mortality ratio and neonatal mortality rate. Inflammation of fetal membranes leads to release of inflammatory mediators and resulting in weakness of fetal membranes, particularly the amniotic membrane. The amniotic membrane in PROM has a focal weakness, which differs from the membrane in non-premature rupture of membrane (non-PROM) that has a generalized weakness. This research aimed to determine histopathological difference of inflammatory cells infiltration into fetal membranes of PROM and non-PROM. Methods: Quantitative observation was applied to this research. Cross-sectional design was used for analyzing data. Primary data was collected from the delivery room and operating theater of Emergency Department in dr. Ramelan Central Naval Hospital (RSPAL dr. Ramelan) Surabaya. Data collection started from August to November 2019 using total population sampling technique. Results: A total of 40 samples histopathologically examined showed that 11 out of 20 (55%) fetal membranes in PROM had polymorphonuclear (PMN) cells infiltration and 9 (45%) did not have PMN cells infiltration, 1 out of 20 (5%) fetal membranes in non-PROM had PMN cells infiltration and 19 (95%) did not have PMN cells infiltration. The prevalence ratio (PR) of PROM based upon the presence of PMN cells infiltration into fetal membranes was 2.85 (PR>1). The significance level of Chi-square test was 0.001 (ρ>0.05). Conclusions: The difference of inflammatory cells infiltration into fetal membranes of PROM and non-PROM was statistically significant.
Copyright (c) 2025 KETUT EDY SUDIARTA, FABIOLLA FABIOLLA, MITA HERDIYANTINI https://creativecommons.org/licenses/by/4.0
Potential of Cat’s Whisker (Orthosiphon stamineus B) As Antidiabetic in Traditional Medicine of The Dayak Tribe in West Kalimantan : A Literature Review
Introduction: Diabetes mellitus or better known as diabetes is a disease characterized by the body's inability to produce insulin or the inability to use insulin (insulin resistance). The high prevalence of diabetes sufferers in Indonesia requires attention and treatment, especially through medication. One of Indonesia's advantages compared to other countries is the biodiversity and cultural diversity sector in Indonesia, namely medicinal plants. The cat's whisker plant (Orthosiphon stamineus B) can be an alternative treatment for treating complications of diabetes mellitus. Cat's whisker leaves contain orthosiphon glucose, saponins, essential oils, flavonoids, polyphenols, potassium salts and myoinositol, several substances contained in this plant have the potential to lower blood sugar levels. Methods: This writing is a literature review by collecting literature from English and Indonesian language articles from 2014-2024, most of which are research articles. Results: The search using the keywords, resulting in a final total of 5 articles to be included in the literature review. Conclusion: This research reveals that cat's whiskers (Orthosiphon stamineus B) show potential as an effective antidiabetic agent. Treatment with Orthosiphon stamineus B extract significantly reduced blood glucose levels, increased insulin secretion, and increased ghrelin and GLP-1 levels, all of which contribute to glucose regulation
Syarifah Nurul Yanti Rizki Syahab Assegaf
Copyright (c) 2025 Galih Abisatya Hartono Putra, Sari Andayani, Dianelita Asyifa Qisthi, Candra Aurelion, Taufiq Mochammad, Mistika Zakiah, Syarifah Nurul Yanti Rizki Syahab Assegaf https://creativecommons.org/licenses/by/4.0
The Dermatofibrosarcoma Protuberans In A 13-Year-Old: A Rare Case Of Soft Tissue Sarcoma Of The Skin
Introduction and importance: Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma that primarily affects middle-aged adults but can also occur in children. Despite its low metastatic potential, DFSP displays aggressive local behavior and a high rate of local recurrence. Diagnosis in children can be delayed due to confusion with other skin conditions. This case report aims to discuss the case management of dermatofibrosarcoma protuberans in a 13 year old female. Presentation of case: A 13-year-old female patient presented with a progressively enlarging lump on the left eyelid, initially resembling small brown spots that coalesced over 7 months. Intermittent bleeding and pain were reported. Physical examination revealed a dark brown mass in the left frontotemporal region, with solid, non-fragile characteristics. Clinical diagnosis suggested a suspicious malignant skin tumor, confirmed as basal cell carcinoma. Treatment involved wide excision and flap reconstruction. Post-operative care included infusion, antibiotic injection, and pain management. The patient's prognosis was favorable, though functional impairment was possible. Follow-up revealed histopathological findings of pigmented dermatofibrosarcoma protuberans. Discussion: DFSP is a rare but significant malignancy that poses diagnostic challenges due to its varied clinical presentations and histopathological features. While primarily affecting young to middle-aged individuals, it can also manifest in pediatric populations. Diagnosis typically involves histopathological assessment, confirming characteristic spindle cell proliferation with CD34 expression. Surgical excision remains the cornerstone of treatment, complemented by adjuvant therapies like imatinib mesylate or radiation in select cases. Regular surveillance, comprising frequent evaluations in the initial post-excision period followed by yearly monitoring, is imperative for detecting any recurrence or metastasis promptly. Conclusions: The structured approach in DFSP ensures optimal patient management and outcomes. Surgical management with Wide local excision (WLE) or Mohs micrographic surgery (MMS) is the gold standard in the treatment of DFSP.
Copyright (c) 2023 Windy Rhomadani Putra . https://creativecommons.org/licenses/by/4.0
The Cure Rate of COVID-19 Patients with Comorbid Hypertension
Introduction: Coronavirus Disease 2019 (COVID-19) is an outbreak that has resulted in a global pandemic. In 2020, 185 countries were affected, and more than 3,000,000 cases have been reported worldwide, with more than 210,000 deaths. COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2), an RNA virus that can cause respiratory system disorders. Hypertension, commonly called high blood pressure, is a health problem that often occurs in the community because its prevalence is relatively high throughout the world. Approximately 7.5 million deaths, or 12.8% of all annual deaths in the world, are caused by hypertension. Generally, the presence of comorbid hypertension in COVID-19 can worsen the patient's condition. Methods: This literature review study aims to determine the recovery rate of COVID-19 patients with comorbid hypertension. Journals in this literature review used three databases, including Google Scholar, PubMed, and Science Direct, using the keywords COVID-19 with Hypertension and COVID-19 with Hypertension. The literature search was adjusted based on the inclusion and exclusion criteria. Results: The search results obtained 25 journals consisting of 4 national journals and 21 international journals. The results showed that the average recovery rate for COVID-19 patients with comorbid hypertension was 75.40%. Factors influencing the recovery rate of COVID-19 patients with comorbid hypertension include ACE-2, ACEI/ARBs, age, male, and cytokines. Conclusions: It can be concluded that the presence of comorbid hypertension affects the recovery rate of COVID-19 patients.
Copyright (c) 2025 Made Widiantara Giri, I Made Subhawa Harsa https://creativecommons.org/licenses/by/4.0
A Rare Case of Aplastic Anemia in Toxic Typhoid Fever
Introduction and importance: Typhoid fever is one of the representative febrile diseases in the tropics, with unhygienic environmental conditions and poor public health systems. Pancytopenia from hemophagocytic lymphohistiocytosis is a rare complication of typhoid fever, which may be fatal if untreated. Presentation of case: A 20-year-old woman presented to our tertiary care center with high-grade fever, body pain, and slurring of speech. Investigations showed pancytopenia, TUBEX IgM Salmonella test positive, lymphadenopathy, and peripheral blood smear showed aplastic anemia after ruling out other possibilities and diagnostics. The patient responded to culture-sensitive antibiotics, steroids, and supportive care. Discussion: Pancytopenia in typhoid fever patients is linked to the mechanism of HLH (Hemophagocytic lymphohistiocytosis). Conclusion: It is essential to diagnose and treat toxic typhoid fever with an appropriate antibiotic to prevent complications.
Copyright (c) 2024 MUTIARA PUTRI NOVITA NOVITA, Irma Zaimatuddunia https://creativecommons.org/licenses/by/4.0
Relationship Between Position and Work Duration with Suspect Carpal Tunnel Syndrome in Maxim Online motorcycle taxi at Makassar
Introduction: Online motorcycle taxi is a service that is currently widely used in goods delivery services and other forms of services. There are several things that are not considered by online motorcycle taxi drivers when driving, namely the driving position that is not good and correct. The more consumer demand for online motorcycle taxi applications, the higher the working hours of online motorcycle taxi drivers which leads to increased complaints of pain in the body. This study aims to determine the relationship between position and duration of work with complaints of suspected carpal tunnel syndrome in maxim motorcycle taxi drivers in Makassar City. Methods: The sampling technique in this study was purposive sampling through a cross sectional approach. Respondents in this study were riders aged 17 years and over as many as 373 riders who met the exclusion and inclusion criteria. Work position was measured using REBA, Work Duration was measured using a work duration questionnaire, while Suspect carpal tunnel syndrome complaints were measured using Phalen's Test. Results: The Kolmogorov Smirnov normality test shows a significance value (p) of 0.000, meaning that the data is not normally distributed (p <0.05). Then the correlation test between the two variables using the Spearman's rho test (p), namely the work position with complaints of suspected carpal tunnel syndrome obtained results (p=0.025; r=0.116 *) which means there is a significant relationship between the two variables and for the duration of work with complaints of suspected carpal tunnel syndrome obtained results (p=0.448; r=0.39) which means there is no relationship between the two variables. Conclusions: The distribution of maxim online motorcycle taxi drivers' work positions in the city of Makassar is dominated by respondents who experience the high risk category and category of work duration are more than 8 hours/day. There is a significant relationship between work position and complaints of suspected carpal tunnel syndrome on maxim online motorbike taxis in the city of Makassar. There is no significant relationship between work duration and complaints suspect carpal tunnel syndrome on maxim online motorcycle taxi in Makassar city.
Copyright (c) 2024 Marfuah Nawawi -, Melda Putri, Yery Mustari https://creativecommons.org/licenses/by/4.0
Therapeutic Exergaming and Its Feasibility in Developing Countries Setting
Introduction: Games have an important role from a social point of view in human and cultural development. Exergaming is a form of digital gaming that combines video games and physical activity that uses a motion tracking device to record gestures and complete gameplay on a screen. Therapeutic exergaming has the potential to facilitate improved balance, including reducing center of pressure (CoP) variability, home-based exercise for older adults, and exercise for people with balance disorders. Method: for this literature review we searched journals taken from search engines such as google, google scholar, Pubmed, and PubMed Central, published from the inception of the respective databases to June 2022. The keywords therapeutic exergaming, exergaming, video game, physical therapy, consoled game, virtual reality were used in writing this literature. The literature search and journal reading were limited to sources which was free and written in English. We addressed several aspects of exergaming such as the device sensor feedback, its application to augment therapy and to manage diseases, and its implementation in developing countries. Conclusions: The benefits of exergaming have been widely studied and are known to have many positive effects on health, such as improving cognitive function, increasing physical activity, exercising balance, and improving vascular function. Exergaming has become an alternative therapy in Huntington's disease, Parkinson's disease, and as a means of gait rehabilitation in geriatric patients. Exergaming also has the potential to reduce the risk of obesity in children.
Copyright (c) 2024 Husnul Mubarak, Andi Amirah Shaleha Junaed https://creativecommons.org/licenses/by/4.0
Estimated VO2 max Analysis with Six-Minute Walking Test on Obese Patients in Primary Health Care in Makassar
Introduction: Obesity poses a severe threat to global health, making it a significant epidemiological concern that requires special attention. It is associated with several risk factors for various diseases. Alarmingly, one in three Indonesian adults is obese, with the obesity rate steadily increasing. Studies have shown that excess fat mass is linked to higher mortality and morbidity from cardiovascular disease, which is currently Indonesia's leading cause of death. To assess a person's functional capacity and ability for basic physical activity, the 6-minute walking test (6MWT) is utilized, as it proves to be a powerful predictor of morbidity and mortality rates. Therefore, this study aims to analyze the association between VO2 max using 6MWT in obese patients of Makassar City. Methods: This study was a cross-sectional study. The samples comprised all obese individuals who provided signed approval letters and were registered at Makassar City's 20 Public Health Centers. Consecutive sampling was used to gather the samples. Subsequently, the samples were examined and categorized based on their level of obesity. The 6MWT results are then used with Nury's Formula to produce an estimated VO2max result. To analyze the association between VO2 max using 6MWT and obesity, statistical analysis was conducted using the Mann-Whitney test, with significant results indicated by (p < 0.05). Results: A total of 163 participants comprised the study's sample, with the majority being female and aged 50 years or older. After filling out the questionnaire, data show that most of the obese participants had a family history of cardiovascular disease (CVD), experienced significant stress levels, and had average BMIs falling into the category of obesity. According to the study, the average distance covered in the 6-minute walking test was 340.18 meters (±82.6 meters). When the study participants were ranked by their estimated VO2 max, the average value was 15.10±5.52 for those with first-degree obesity. Following them were participants with second-degree obesity, with results averaging 15.03±5.39 (p = 0.021). Conclusion: A significant inverse association exists between obesity and VO2 max, which means that the more obese a person is, the lower their VO2 max tends to be.
Copyright (c) 2023 Nusantara Medical Science Journal https://creativecommons.org/licenses/by/4.0
Intussusception And Obstructive Ileus Et Causa Caecal Tumor In Children
Introduction and importance: Intussusception/invagination is a condition where the intestine is folded and infiltrates into other parts of the intestine, which can cause obstructive ileus. One of the causes of intussusception in children is a tumor or colorectal malignancy. Treatment should be started as soon as possible concurrently with fluid resuscitation management. Presentation of cases: A 9-month-old female patient complained of flatulence, inability to defecate, and often color vomiting since 4 days ago. The examination result of 3 three-position abdominal photos is a high obstruction ileus. Exploratory laparotomy, loop modification ileostomy, and to-side anastomosis of the ascending colon and ileum were performed. Histopathological examination of the caecum tissue is non-specific inflammation and lymph nodes with sinus histiocytosis. Discussion: 9 months old is a risk factor for intussusception. The patient's condition is acute. Icteric sclerae or jaundice may occur with gastrointestinal lymphoma tumor types. Histopathological examination shows the process of histiocytosis in the lymph nodes and the activation of adaptive immune cells. Conclusions: Intussusception is the most common cause of obstructive ileus in children. One of the causes of intussusception in children is a tumor that requires operative management.
Copyright (c) 2024 Y. Kusumo Adi Arji Atmanto, Mutmainnah, Ibrahim Abd. Samad https://creativecommons.org/licenses/by/4.0
Rabies: Diagnostic, Treatment, and Prevention
Rabies is a neurological disease with fatal impacts because it has a high mortality rate. Animals, primarily dogs, mediate the spread of rabies. Clinical findings of rabies are divided into two categories: classic rabies (furious type) and paralytic type. Furious rabies has many cardinal features, such as fluctuating consciousness, aerophobia or hydrophobia, inspiratory spasm, and autonomic dysfunction. Ascending paralysis with a lower motor neuron lesion is the initial sign of paralytic rabies. The rabies virus invades and lives in neurons. It is virulent. Besides clinical findings, the diagnostic approach can involve radiology, microbiology, and histopathology. There are not only symptomatic treatments for rabies patients but also vaccines, immunoglobulin, and antivirals to decrease the progressivity of the disease. Vaccination programs and animal control have become essential in reducing rabies cases in Indonesia.
Copyright (c) 2024 Andi Kurnia Bintang, Muhammad Iqbal Basri, Mimi Lotisna, Michael Carrey https://creativecommons.org/licenses/by/4.0
Repetitive Transcranial Magnetic Stimulation (rTMS) as Non-Invasive Therapeutic for Post-Stroke Dysphagia: A Case Report
Introduction and importance: One of the worst complications that affects people with stroke is dysphagia. Dysphagia causes mortality through dehydration, malnutrition, aspiration pneumonia, and suffocation. For stroke survivors to have better results, post-stroke dysphagia must be adequately addressed using proven treatment methods. Presentation of case: A 64-year-old man complaints of difficulty swallowing with Gugging Swallowing Screen scoring (GUSS)= 7 (severe dysphagia) with left hemiparesis and slurred speech due to ischemic stroke on August 14th 2022. Head CT Scan found bilateral lacunar basal ganglia infarcts with brain atrophy. Patients were treated with standard ischemic stroke therapy, medical rehabilitation and repeated Transcranial Magnetic Stimulation (rTMS) procedures for 10 sessions. GUSS was carried out after the 10th session of rTMS and increased to 14 (moderate dysphagia). Discussion: By stimulating the esophagus cortex bilaterally in post-stroke dysphagia, rTMS is known to be beneficial in modulating cortical excitability and minimizing the imbalance between the hemispheres. Furthermore, it appears to be safe and well-accepted by patients. Conclusions: Our case study shows that rTMS in bilateral esophageal cortex is safe and has therapeutic potential in patients with post-stroke dysphagia.