Journal Of The Indonesian Medical Association

The Use of Cadavers in the Medical Education: Does it Inevitable? Particulare to Health Law Scope

Gembong Satria Mahardhika — 2025-03-27

Cadavers retain significant value within the realm of medicine, particularly in the context of anatomy laboratories, where they serve as crucial educational tools. Cadavers are of significant importance in facilitating the educational experience within the anatomy laboratory. Numerous research investigations have indicated that the decrease in anatomical knowledge is purportedly a contributing factor to the rise in “surgical errors” and subsequent surge in medicolegal litigation. Utilisation of cadavers for medical education and research should be conducted in a discerning, proficient, and optimal manner. At the fundamental level, individuals can access educational materials from sources such as prosection, plastination, or anatomy museums. The primary focus in higher education is placed on cadaveric dissection, particularly in relation to the development of clinical skills relevant to surgical practise.

The Menstrual Cycle Patterns and the Role of Coping Mechanisms in Medical Students with Dysmenorrhea: An Observasional Study

Ika Ulfi Khabibah — 2025-03-27

Introduction: More than 50% of women worldwide experience dysmenorrhea, and its often worsening with irregular menstrual cycles. Women adopt both adaptive and maladaptive coping mechanisms to manage pain. This study examines the relationship between menstrual cycle irregularities, dysmenorrhea severity, and coping mechanisms.

Method: This a cross-sectional study involving medical students in Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta (UMY), from September to November 2022. The inclusion criteria aged 18 to 23 years, physically healthy with no history of reproductive health issues, possessing a normal body mass index (BMI), and being non-smokers. Data on menstrual cycles pattern (normal, poly-, or oligomenorrhea), dysmenorrhea severity, and coping mechanisms were collected through online validated-questionnaires and analyzed using the Chi-Square test.

Results: Among 174 subjects, the majority experienced moderate dysmenorrhea (67.8%) and had a normal menstrual cycle (81.6%). A total of 93.6% employed adaptive coping mechanisms. This study found a significant association between the menstrual cycle and the severity of dysmenorrhea (p=0.031), as well as the effectiveness of adaptive coping in reducing dysmenorrhea severity (p=0.0001).

Conclusion: The length of the menstrual cycle is associated with dysmenorrhea severity, while adaptive coping mechanism may alleviates its intensity.

The Effects of Probiotic Supplementation on Treatment Outcomes of Patients with Active Tuberculosis: A Systematic Review of Randomized Controlled Trials

Indry Agatha Rihi Pake — 2025-03-27

Introduction: Tuberculosis, one of the most globally burdensome infectious diseases, poses high mortality and morbidity risks due to the adverse effects of treatment and disease-related complications, resulting in poor treatment adherence. Despite probiotics, treatment supplements containing live bacteria and having known immunomodulatory effects, their impact on tuberculosis therapy remains understudied. Hence, this systematic review aims to explore the effect of probiotic supplementation on the outcomes of active tuberculosis therapy, including but not limited to its effectiveness in improving tuberculosis treatment and host immunity, as well as its adverse events.

Method: A systematic review was performed by searching relevant primary clinical studies from PubMed, Embase, Google Scholar, and Clinicaltrials.gov. The included studies were assessed for risk of bias with the Revised Cochrane risk-of-bias tool for randomized trials, and the findings were synthesized qualitatively.

Results: A total of five randomized controlled trials involving 926 patients were included in this systematic review. Our findings revealed that Lactobacillus casei probiotic supplementation significantly reduced the incidence and duration of gastrointestinal side effects during tuberculosis therapy, particularly vomiting, decreased appetite, and constipation. Additionally, probiotics displayed the potential to enhance immunity by increasing lymphocyte cell counts, downregulating proinflammatory cytokines, maintaining immunoglobulin A levels in saliva, mitigating oxidative stress in gastrointestinal organs, and ameliorating gut dysbiosis.

Conclusion: These results highlight the advantageous impact of probiotics on active tuberculosis therapy outcomes. Further studies involving a more heterogeneous population investigating the adverse effects following probiotics use, and the long-term effects of probiotics supplementation are required to substantiate our findings.

Neutrophil to Lymphocyte Ratio Difference between Diabetic and Non-Diabetic COVID-19 Patients, Based on Disease Severity

Luse Loe — 2025-03-27

Background: Patients with diabetes mellitus (DM) have higher risk of complications caused by coronavirus 2019 (COVID-19). COVID-19 virus causes leukopenia and lymphopenia. The neutrophil to lymphocyte ratio (NLR) is a parameter in the complete blood count routinely performed on admission.

Method: This study aims to evaluate the difference between NLR in diabetic and non-diabetic patients based on COVID-19 severity. This is a cross-sectional, retrospective, descriptive-analytical study, and the analysis was performed using the comparison test in COVID-19 patients admitted to Hasan Sadikin Hospital from March 2020 to March 2021 using secondary data collected from medical records. There were 612 subjects included in this study.

Result: We found a higher NLR median in diabetic (4.1, IQR 2.3-6.2) than non-diabetic (2.9, IQR 2.0-4.0) subjects, with p<0.001. Increased NLR was seen in diabetic COVID-19 subjects with mild to moderate severity, median NLR in diabetic group 4.1 (IQR: 2.3-6.2) vs 2.9 (IQR: 2.0-4.0) in non-diabetic group (p=<0.001). The median NLR was significantly higher in severe-critical diabetic subjects (4.8, IQR 3.0-6.8) than in mild-moderate non-diabetic subjects (2.9, iQR 2.0-4.0).

Conclusion: NLR differs between the diabetic and non-diabetic groups depending on the severity of the disease. The NLR is an important parameter in assessing the severity of disease in COVID-19.

Evaluation of POSSUM and P-POSSUM Diagnostic Tests as Mortality Predictors In Emergency Laparotomy Patients at Dr. Zainoel Abidin Regional General Hospital Banda Aceh

Novrianda Eka Putra — 2025-03-27

Introduction: Laparotomy is a frequent surgical procedure carried out in emergency settings due to various indications and related to a considerable amount of postoperative mortality rate. POSSUM and P-POSSUM are known as two of the most favorable methods to calculate the likelihood of postoperative mortality, so that optimization of patient management can be achieved. The purpose of this research is to assess the predictive power of POSSUM and P-POSSUM scoring systems for emergency laparotomy patients in terms of accuracy, sensitivity, specificity, and Area Under the Curve (AUC) value.

Method: This study uses an observational analytical method with a prospective cohort approach, and was performed at Dr. Zainoel Abidin Regional General Hospital Banda Aceh since January until May 2024. Mortality status was observed for 30 days after surgery. The accuracy of POSSUM and P-POSSUM was assessed based on sensitivity, specificity, and AUC values obtained from the Receiver Operating Characteristic (ROC) curve.

Results: A total of 13 subjects experienced mortality within 30 days after surgery out of 29 subjects involved in this study. Analysis based on the ROC curve shows that POSSUM and P-POSSUM equally have 100% sensitivity and 75% specificity. The AUC values obtained were 0.851 and 0.837 respectively.

Conclusion: POSSUM and P-POSSUM scoring systems have good accuracy as mortality predictors in emergency laparotomy patients.

Mucinous Ovarian Cystadenoma (Borderline) with Pseudomyxoma Peritonei: A Case Report

Fadhel Aulia Rizal — 2025-03-27

Introduction: Neoplastic ovarian cyst is a product of an abnormal growth of ovarian cells. WHO (2005) designate borderline tumors as an atypical growth lacking both benign and malignant attributes. Borderline Surface Epithelial Tumor (SET) prevalence occurs around 15 – 20%, whereas 10 -13% were serous and 5 – 7% mucinous.

Case Illustration: Fifty-seven years old P6A0 female was admitted to the emergency department of M. Ashari General Hospital with lower abdominal pain and urinary retention. The complaints started in the last 27 hours earlier. Ultrasound examination showed a 9.52x11.53x11.43 cm multiloculated cyst mass with septum on the upper left aspect of uterus. Bilateral salphingo-oophorectomy, radical hysterectomy, omentectomy, appendectomy and peritoneal washing were performed. Histopathological exam was conducted, concluding the patient had mucinous ovarian cystadenoma (borderline) with pseudomyxoma peritoneum.

Discussion: Ovarian Cystadenomas is a neoplastic cyst originating from epithelial tissues of the ovary. Incidence were at peak on the 6th to 7th decade of life. The patient underwent surgery procedure, histopathology department reported the patient had mucinous ovarian cystadenoma (borderline) with pseudomyxoma peritoneum on the appendix.

Conclusion: Histopathology examination showed the patient had mucinous ovarian cystadenoma (borderline) and pseudomyxoma peritoneum. The tumor was borderline due to polymorphic nucleus, irregular cell hyperplasia without stromal involvement.

Forensic Biomechanic Aspect Of Trauma Due To Airsoft Gun Plastic Pellet

Ade Firmansyah Sugiharto — 2025-03-27

The biomechanical aspects of trauma caused by airsoft gun plastic pellets depend on the energy generated by the pellet and the tissue resistance. The airsoft gun plastic pellet creates lower energy compare to firearm, thus creating non-lethal effect to human body, but sufficient for creating tissue damage. This energy is determined by the velocity, weight, and diameter of the plastic pellet.. Indonesia allows for a maximum of 2 Joule energy, 8 mm in diameter, and 0,4 gram in maximum weight for airsoft gun plastic pellet. When it hits body surface, this characteristics will create energy of 3,98 J/cm², and 7 J/cm² with 6 mm plastic pellet diameter. The most common case of injury due to airsoft gun plastic pellet is eye ball injury. With a resistance of 4.3-4.8 J/cm², trauma from airsoft gun plastic pellets can result in corneal abrasion, hyphema, contusion, and even rupture.. Skin has much higher resistance, which is 23,99 J/cm2. Some injury may still be found, including erythema and 5 mm skin penetration.