Journal Of The Indonesian Medical Association http://mki-ojs.idionline.org/jurnal <p>Journal Of The Indonesian Medical Association (JInMA) atau Majalah Kedokteran Indonesia (MKI) merupakan jurnal ilmiah kedokteran yang berada dibawah naungan Pengurus Besar Ikatan Dokter Indonesia (PB IDI) dan jurnal terakreditasi Kemenristek DIKTI.&nbsp;</p> <p>MKI JInMA memuat beberapa tipe artikel yaitu artikel penelitian, laporan kasus,<em> evidence-based case reports</em> (EBCR), tinjauan pustaka, dan editorial.</p> <p>MKI JInMA saat ini terbit dengan frekuensi per dua bulan.&nbsp;</p> <p>&nbsp;</p> PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI) en-US Journal Of The Indonesian Medical Association 2089-1067 Is Radiofrequency Ablation Better than Venous Stripping for Management of Chronic Venous Insufficiency? http://mki-ojs.idionline.org/jurnal/article/view/519 <p>Chronic venous insufficiency (CVI) is a disease of the vein due to valve dysfunction, venous obstruction, or both. This results in increased vein pressure and related to disruption in the vein system.</p> Reynaldo Halomoan Leonard Christianto Singjie Jonny Setiawan Copyright (c) 2021 Journal Of The Indonesian Medical Association 2021-11-27 2021-11-27 71 5 206 208 10.47830/jinma-vol.71.5-2021-519 In Vitro Synergism of Sulbactam- Cefoperazone and Fosfomycin Against Escherichia Coli and Klebsiella Aeromobilis from Indonesia http://mki-ojs.idionline.org/jurnal/article/view/546 <p><em><strong>Introduction</strong>: There is no susceptibility data of E. coli and K. aeromobilis in Indonesia, even data regarding minimal inhibitory concentration (MIC)-based susceptibility of E. coli and K. aeromobilis towards single antibiotic or combination of fosfomycin (FOS) and sulbactam-cepoferazone (SUL-CPZ) is very scarce, even though the data is required by clinicians. </em><br><em><strong>Methods</strong>: A descriptive observational study was carried out at the Microbiology Clinical Laboratory of the Faculty of Medicine, Universitas Indonesia. Thirty strains each of clinical isolates of E. coli and K. aeromobilis were subjected to MIC determination against FOS and SUL-CPZ. For susceptibility criteria, we adopted the Eucast guideline. The synergism of the combined antibiotics was determined by checkerboard titration. One strain of E. coli and K. aeromobilis showing a synergistic and independent effect against the combined antibiotics was subjected to a time-kill assay. The post-antibiotic effect (PAE) was determined on a strain of E. coli showing synergism against the combined antibiotics. </em><br><em><strong>Results</strong>: The MIC level of all strains decreased when the bacteria were exposed to the combined antibiotics. Synergism was observed in 53.3% of E. coli and 56.8% of K. aeromobilis. No antagonism was observed. Higher bacterial death during the first four hours occurred with the isolate, showing synergism compared to the isolate showing an independent effect. The PAE of E. coli was longer when exposed to combined antibiotics. </em><br><em><strong>Conclusion</strong>: In vitro synergism of FOS and SUL-CPZ was observed in the majority of isolates and could be used as the basis for further research on empirical treatment</em></p> Agus Syahrurachman Atna Permana Copyright (c) 2021 Journal Of The Indonesian Medical Association 2021-11-27 2021-11-27 71 5 209 214 10.47830/jinma-vol.71.5-2021-546 Visual Acuity Before and After bevacizumab Injection on Diabetic Retinopathy patient in Zainoel Abidin Hospital Banda Aceh http://mki-ojs.idionline.org/jurnal/article/view/308 <p><em><strong>Introduction</strong>: Diabetic retinopathy is a complication of diabetes and is one of the leading causes of blindness. Diabetic retinopathy occurs when the blood vessels in the retina are damaged and this is associated with hyperglycemia and other conditions in diabetes. Bevacizumab is used to treat diabetic retinopathy and other diseases that affect the retina. Bevacizumab injection is used to prevent vision loss by blocking the abnormal development of blood vessels in the retina. This study aims to examine the characteristics and visual acuity of diabetic retinopathy patients before and after bevacizumab injection.</em><br><em><strong>Methods</strong>: This type of research is a retrospective descriptive conducted by collecting data from medical records that meet the inclusion criteria. Data were collected from January 1, 2019 to December 31, 2019, totaling 69 eyes from 40 patients as the study sample.</em><br><em><strong>Results</strong>: The results showed that most of the eyes had NPDR, which amounted to 55 (80%) eyes. Prior to bevacizumab injection, visual acuity of 6/6 – 6/18 was 18%, visual acuity of 6/19 – 6/60 was 37.7% and visual acuity of 5/60 – 1/∞ was 43.5%. After injection of bevacizumab, visual acuity of 6/6 – 6/18 was 27.5%, visual acuity of 6/19 – 6/60 was 42% and visual acuity of 5/60 – 1/∞ was 30.4%. In this study, eyes that did not experience changes in visual acuity were 52.2%, eyes that had improved 34.8% and eyes that had decreased 13%.</em><br><em><strong>Conclusion</strong>: In conclusion, after the injection of bevacizumab, the eyes that did not experience changes in visual acuity were more after 1 month follow-up, namely 52.2%.</em></p> Nirwana Lazuardi Sary Saiful Basri Firjatullah Copyright (c) 2021 Journal Of The Indonesian Medical Association 2021-11-27 2021-11-27 71 5 215 219 10.47830/jinma-vol.71.5-2021-308 The Predictor Factors of Cognitive Disorders Thirty Days Post Mild-Moderate Ischemic Stroke http://mki-ojs.idionline.org/jurnal/article/view/412 <p><em><strong>Introduction</strong>: There is an increasing attention on post stroke cognitive impairment. The post stroke cognitive impairment often diagnosed late. There were only few studies that measured the predictive factors for cognitive impairment post-acute ischemic stroke in Indonesia. The aim of this study is measure the predictive factors for the post stroke cognitive impairment in acute ischemic stroke.</em><br><em><strong>Method</strong>: This was a cohort study. The patients included were more than 18 years old, and diagnosed with acute ischemic stroke. The subjects were measured with Mini Mental State Examination (MMSE) and Clock Drawing Test (CDT) examination at day-30 at Bethesda Hospital Yogyakarta. Patients who had a history of cognitive impairment were excluded. The result of MSSE and CDT at day-30 were the outcome of this study. To determine the relationship between the independent variable and the dependent variable, it was analysed using Chi-square method followed by multivariate logistic regression. </em><br><em><strong>Result</strong>: A total of 140 subjects were included in the study with an average age of 62,8 years, 86 (61,4%) male and 54 (38,6%) female. Ninety-one subjects, which is 65% from total subjects, experienced post stroke cognitive impairment. The analysis of multivariate showed age &gt;70 years, education level ≤ 6 years, modified Rankin score &gt;3 at diagnosis, Barhtel Index (BI) score ≤ 4 at diagnosis, the number of multiple lesions and the location of lesion in the cortex was an independent predictor factor affecting cognitive impairment 30 days after acute ischemic stroke. </em><br><em><strong>Conclusion</strong>: Age &gt;70 years, education level ≤ 6 years, modified Rankin score &gt;3 at diagnosis, Barhtel Index score ≤ 4 at diagnosis, the number of multiple lesions and the location of lesion in the cortex were independent predictive factors affecting cognitive impairment 30 days after acute ischemic stroke.</em></p> Rizaldy Taslim Pinzon Carmelia Anggraini Copyright (c) 2021 Journal Of The Indonesian Medical Association 2021-11-27 2021-11-27 71 5 220 227 10.47830/jinma-vol.71.5-2021-412 Blood Glucose Levels and Severity of COVID-19 in Patients with Diabetes Mellitus in Intensive Care Unit: A Case Series http://mki-ojs.idionline.org/jurnal/article/view/358 <p><em><strong>Introduction</strong>: The severity of coronavirus disease 2019 (COVID-19) ranges from mild flu to respiratory distress and death. Diabetes mellitus (DM) is considered as one of the risk factors for infection susceptibility and disease severity. This case series reports the clinical features, ancillary test findings, and mortality in patients with severe COVID-19 and DM.</em><br><em><strong>Case Illustration</strong>: This study reports three female patients, aged 50-68 years old, with severe COVID-19 and DM whom were hospitalized in intensive care unit from April to July 2020. Two patients presented with hyperglycemia upon admission. During hospitalization, two patients tended to be hyperglycemic, while the other one had more episodes of hypoglycemia. Two patients suffered from hospital-associated pneumonia and acute kidney injury throughout hospital stay. One patient passed away.</em><br><em><strong>Discussion</strong>: All patients had fluctuating general condition and unstable blood glucose levels during hospitalization. One patient passed away due to respiratory distress, while the other two were discharged after their general condition improved. Hyperglycemic and hypoglycemic states in DM patients are proposed to play a role in the severity of COVID-19 infection.</em><br><em><strong>Conclusion</strong>: DM may aggravate COVID-19 infection. Initial normal blood glucose levels upon admission does not guarantee good prognosis; therefore, blood glucose control in COVID-19 patients remains extremely crucial.</em></p> Fatira Ratri Audita Arini Ika Hapsari Andi Marsa Nadhira Muhammad Hafiz Aini Copyright (c) 2021 Journal Of The Indonesian Medical Association 2021-11-27 2021-11-27 71 5 228 233 10.47830/jinma-vol.71.5-2021-358 Experience in Diagnosing Neuronal Ceroid Lipofuscinosis Type-2 http://mki-ojs.idionline.org/jurnal/article/view/452 <p><em><strong>Introduction</strong>: Developmental regression is always an alarming symptom in children as it is an early sign of some genetic disorders, one of which is neuronal ceroid lipofuscinosis (NCL). NCL is a group of rare neurodegenerative disorder caused by accumulation of intracellular ceroid lipofuscin. Since 2017 an enzyme replacement therapy (ERT) has been approved by Food and Drug Administration (FDA) for this disease. The symptoms of NCL could be managed by ERT if detected early, and the child could live normally.</em><br><em><strong>Case</strong>: We present a case of a 6-year-and-5-month-old boy with developmental regression, speech delay, recurrent seizure, and visual impairment, who was diagnosed with NCL type 2 after genetic testing. Compound heterozygous mutations in tripeptidyl-peptidase 1 (TPP1) gene was revealed, consistent with very low level of TPP1 enzyme in this patient.</em><br><em><strong>Discussion</strong>: NCL is a fatal disease which is often misdiagnosed in early stage. Diagnostic delay of NCL often occurs due to lack of awareness which often leads to premature death.</em><br><em><strong>Conclusion</strong>: Knowledge regarding the disease is important for early detection and to slow down the disease progression.</em></p> <p>&nbsp;</p> Lanny Christine Gultom Valensia Vivian The Copyright (c) 2021 Journal Of The Indonesian Medical Association 2021-11-27 2021-11-27 71 5 234 240 10.47830/jinma-vol.71.5-2021-452 Current Management of Febrile Seizure in Children http://mki-ojs.idionline.org/jurnal/article/view/558 <p><em>A febrile seizure is a seizure associated with an increase of body temperature of more than 38°C. This condition is not caused by the central nervous system (CNS) infection and electrolyte or metabolic imbalance. A febrile seizure can affect children from the age of 6 months to 6 years. A febrile seizure is the common cause of seizure in children with benign clinical course dan good prognosis which will disappear at six years old. The diagnosis is achieved based on clinical manifestation, and the clinician should exclude CNS infection, especially in complex febrile seizures. Based on the literature, the indication of supporting examination and therapy has changed significantly. Laboratory examination, electroencephalography, and imaging only indicated if the patient’s condition was in line with the guideline. Management of the febrile seizure consists of symptomatic and prophylaxis therapy. The recommendation of the febrile seizure treatment includes management during the seizure, intermittent prophylaxis therapy, and long-time maintenance therapy. The recommendation of the prophylaxis therapy was formed based on Indonesia’s condition. A febrile seizure is often the cause of a patient’s over-anxiety. Therefore, education about the good prognosis, clinical course, risk, and benefit of prophylaxis therapy is needed. General practitioners, pediatricians, and neurologic pediatricians are expected to implement the recommendation to minimalize the over-use of supporting examination and treatment.</em></p> Setyo Handryastuti Copyright (c) 2021 Journal Of The Indonesian Medical Association 2021-11-27 2021-11-27 71 5 241 247 10.47830/jinma-vol.71.5-2021-558