ASEAN Journal of Military and Preventive Medicine
The ASEAN Journal of Military and Preventive Medicine | ISSN (e): 3031-870X | ISSN (p): 3031-9447 is an open-access, peer-reviewed publication dedicated to the advancement of knowledge in the disciplines of military medicine, biodefense, global health, emergency medicine, and associated preventive medicine. Our publication, as the foremost platform in Indonesia, provides an indispensable arena for researchers, practitioners, and academics to publish their most recent research findings, cutting-edge technology, and interdisciplinary ideas. While military medicine is our core emphasis, we encourage contributions from allied disciplines that hold translational potential and promise impact on medical practices in medical practice, humanitarian aid, and other military operations. The ASEAN Journal of Military and Preventive Medicine (AJMPM) is published 6 months, namely January and July. The ASEAN Journal of Military and Preventive Medicine is indexed by: Google Scholar
Factors Influencing The Incidence Of Stress Fractures Based On The Characteristics of Command Education Students At The Special Forces Command Education And Training Center In Batujajar, West Java, Indonesia: A Retrospective Approach With Secondary Data
Stress fractures caused by repetitive mechanical loading represent a significant threat to physical performance and operational readiness among military personnel. This study aimed to identify factors associated with stress fracture occurrence among command education students at the Special Forces Education and Training Center in Batujajar, West Java, Indonesia. A retrospective descriptive study was conducted using secondary data from forty-three documented stress fracture cases collected over a six-year period. The variables analyzed included age, body mass index (BMI), and anatomical location of the fracture. Data were analyzed using univariate and bivariate descriptive analysis to characterize the distribution of stress fractures based on the studied variables. The results showed that the majority of cases occurred in individuals aged 20–25 years (90.7%), with the left tibia being the most frequently affected anatomical site (34.9%). All subjects had BMI values within the normal range, indicating no significant association between abnormal BMI and stress fracture occurrence. These findings suggest that age and fracture location are key characteristics of stress fractures among command education students. The study provides evidence to support the development of targeted prevention and early intervention strategies aimed at reducing stress fracture incidence, improving training completion rates, and enhancing the operational readiness of special forces personnel.
Copyright (c) 2026 Claudiva Lavidya Kirana, Dian Andriani Ratna Dewi, Sissy Chen, Sausan Maulida (Author) https://creativecommons.org/licenses/by/4.0
The Relationship Between Physical Activity Levels And Cardiorespiratory Fitness Among Cadet Medical Students In The Undergraduate Medical Program Cohort 4 At The Republic Of Indonesia Defense University
Background: Physical activity plays a crucial role in maintaining cardiovascular and pulmonary health, especially for Cadet Medical Students who are required to achieve optimal physical fitness. However, it remains unclear whether the physical activity levels of Cadet Medical Students in the Undergraduate Medical Program Cohort 4 at the Republic of Indonesia Defense University meet the necessary fitness standards. Objective: This study aims to analyze the relationship between physical activity levels and cardiorespiratory fitness among cadet students. Methods: A quantitative cross-sectional design was employed, involving 72 respondents selected using a total sampling technique. Physical activity levels were assessed using the Bouchard Activity Diary, while cardiorespiratory fitness was evaluated through the 12-minute Cooper Test, which was converted into VO₂max values. Result and Analysis: The results showed that the majority of respondents had moderate (81.9%) and vigorous (18.1%) physical activity levels. The distribution of cardiorespiratory fitness indicated that 45.5% of male respondents had VO₂max classified as excellent, whereas among female respondents, the majority (53.8%) fell into the good category. Spearman’s correlation test revealed a significant positive relationship between physical activity levels and cardiorespiratory fitness (r = 0.585, p < 0.001). These findings indicate that higher physical activity levels are associated with better cardiorespiratory fitness. In conclusion, there is a significant correlation between physical activity levels and cardiorespiratory fitness among Cadet Medical Students in the Undergraduate Medical Program Cohort 4 at the Republic of Indonesia Defense University. These results highlight the importance of maintaining an optimal level of physical activity to improve cardiorespiratory.
Copyright (c) 2026 Justin Ibnu Hakim Munawar, Grace Joselini Corlesa, Roby Syah Putra Firmansyah, Markus Wibowo, Nirawan Putranto, Disty Chania, Hanum Zahra Faras Fadhilah, Antonius Reuben (Author) https://creativecommons.org/licenses/by/4.0
Cutaneous Anthrax In The Era Of Biodefense: Clinical Recognition, Biosurveillance, And Biosecurity Implications For Modern Health Care Systems - A Systematic Review
Background: Cutaneous anthrax represents the most frequent clinical manifestation of Bacillus anthracis infection with dual threat as endemic zoonotic disease and potential bioterrorism agent, necessitating modern health systems to integrate proactive biosurveillance capabilities with robust biosecurity protocols for epidemiological and national security risk mitigation. Objective: To identify pathognomonic clinical characteristics and differential diagnostic algorithms, evaluate effectiveness of integrated biosurveillance platforms in detecting outbreak early warning signals, and formulate biosecurity implications for policy development and operational readiness of health facilities. Methods: Systematic literature review utilizing PubMed, Scopus, Web of Science, and Google Scholar databases covering 2015-2025 period with inclusion criteria of original research articles, systematic reviews, and clinical guidelines. Seven high-quality articles were analyzed using thematic narrative synthesis. Results: Identification of diagnostic complexity requiring laboratory confirmation through bacteriological culture or molecular testing, temporal gap in notification averaging 6.3 days, environmental pathogen persistence of 11.40% in soil samples, seroprevalence 9-11% in high-risk populations, and corticosteroid therapy efficacy in edema reduction (P<0.002). Conclusion: Optimization of clinical recognition through molecular diagnostic integration, strengthening biosurveillance architecture based on spatiotemporal One Health analysis, and formulation of responsive biosecurity policy represent essential pillars of preparedness against emergent biological threats.
Copyright (c) 2026 Sausan Maulida, Dian Andriani Ratna Dewi (Author) https://creativecommons.org/licenses/by/4.0
Autoimmune Bullous Diseases In Pregnancy: A Systematic Review Of Clinical Presentation, Management, And Outcomes
Background: Autoimmune bullous diseases during pregnancy are rare but clinically significant conditions that require special attention due to pregnancy-related immunological changes and the potential risk of maternal and fetal complications. Objective: This systematic review aimed to summarize the clinical characteristics, management strategies, and maternal–fetal outcomes of autoimmune bullous diseases occurring during pregnancy. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Literature searches were performed in PubMed, Scopus, Web of Science, Embase, and the Cochrane Library for studies published between January 2021 and January 2025. From the 309 articles initially identified, 10 studies met the inclusion criteria and were included in the qualitative synthesis. Results: Pemphigoid gestationis was the most frequently reported autoimmune bullous disease, with disease onset predominantly occurring during the second to third trimester of pregnancy. Clinical manifestations varied widely, ranging from mild localized lesions to generalized bullous eruptions. Systemic and topical corticosteroids were the mainstay of treatment and were associated with favorable maternal outcomes in most cases. Reported maternal complications included intrauterine growth restriction (33%), oligohydramnios, and gestational hypertension. Neonatal involvement was observed in approximately 10–17% of cases and was generally self-limiting with a good prognosis. Conclusions: The management of autoimmune bullous diseases during pregnancy requires a multidisciplinary approach to optimize both maternal and fetal outcomes. However, current evidence remains limited, highlighting the need for further studies to establish standardized and evidence-based management protocols.
Application of Tactical Combat Casualty Care in the Management of a Proximal Left Leg Gunshot Wound: From Battlefield to Surgical Amputation - A Case Report
Gunshot wounds to the lower extremities can cause life-threatening haemorrhage and vascular injury, requiring rapid intervention according to Tactical Combat Casualty Care (TCCC) principles. This case describes a 24-year-old soldier with a proximal left cruris gunshot wound managed initially under fire with a tourniquet, hemostatic agents, analgesia, and tranexamic acid. After delayed evacuation due to battlefield conditions, further stabilization and surgical management revealed open fractures and popliteal artery injury. Despite vascular repair, prolonged ischemia exceeding the golden period resulted in irreversible tissue damage, necessitating amputation. This case highlights that while TCCC effectively improves survival, timely evacuation and early definitive vascular treatment are critical for limb salvage in combat settings.
Copyright (c) 2026 Indra Pehulisa Sitepu, Hafidz Addatuang Ambong (Author) https://creativecommons.org/licenses/by/4.0
The Relationship Between Body Composition and 12 Minute Run Test Among Cadet Medical Students in The Undergraduate Medical Program Republic of Indonesia Defense University
Body composition significantly influences physical performance, including running ability. Muscle mass and fat mass are key factors in determining strength, endurance, and efficiency. This study analyzes the relationship between body composition and 12- minute running distance among cadet students in the Undergraduate Medical Program Cohort 4 at the Republic of Indonesia Defense University. This cross-sectional study measured body composition using bioelectrical impedance analysis (BIA) and assessed running performance through a 12-minute run test. Statistical analysis was conducted to evaluate the relationship between muscle mass, fat mass, and running distance. The study found a significant relationship between body composition and running performance. Male participants, with higher muscle mass and lower fat mass, outperformed females in average running distance and maximum distance achieved. Muscle mass and fat mass significantly affect 12-minute running performance, highlighting their importance in designing effective physical training programs. Further research is needed to explore additional factors influencing physical performance.
Copyright (c) 2026 Disty Chania, Justin Ibnu Hakim Munawar, Hanum Zahra Faras Fadhilah, Antonius Reuben, Grace Joselini Corlesa, Roby Syah Putra Firmansyah, Markus Wibowo, Nirawan Putranto (Author) https://creativecommons.org/licenses/by/4.0
Heated Tobacco Products as a Harm Reduction Strategy in Surgical Patients: Safer Than Smoking?
Background: Tobacco smoking is a well-established modifiable risk factor for poor postoperative outcomes, including delayed wound healing, increased infection risk, and cardiopulmonary complications. In Indonesia, smoking prevalence remains high among surgical patients, while access to and compliance with preoperative cessation interventions is limited. Heated tobacco products (HTPs), which deliver nicotine by heating rather than combusting tobacco, have emerged as a potential harm reduction alternative. However, their role and safety in surgical populations remain uncertain. Objective: This review aims to evaluate the current evidence comparing the biological and clinical effects of HTPs versus conventional cigarettes in the context of wound healing and perioperative complications, with a focus on their potential use as a harm reduction strategy in surgical patients. Methods: A narrative review methodology was employed. Literature was searched across PubMed, Scopus, and grey literature sources from 2010 to 2025. Inclusion criteria encompassed clinical and preclinical studies reporting on toxicological profiles, tissue oxygenation, immune function, wound healing, and perioperative complications associated with HTPs and combustible tobacco products. Data were extracted and thematically synthesized. Results: HTPs eliminate combustion, leading to markedly reduced emissions of tar, carbon monoxide, and other harmful byproducts. These changes may mitigate mechanisms contributing to surgical complications, including vasoconstriction, hypoxia, immune suppression, and impaired collagen synthesis. However, HTP aerosols still contain nicotine, volatile organic compounds, and heavy metals, which can continue to interfere with wound healing. Comparative evidence suggests HTPs pose a lower biological risk than smoking, but their use is not without harm. Conclusion: HTPs may offer a transitional harm reduction option for surgical patients unable to achieve smoking cessation. However, they are not risk-free and should not replace cessation as the standard of care. Further research, including human clinical trials, is needed to evaluate the safety and efficacy of HTPs in surgical contexts.
Copyright (c) 2025 Jeffrey Ariesta Putra, Dianita Angeline (Author) https://creativecommons.org/licenses/by/4.0
Copyright (c) 2025 Disty Chania, Justin Ibnu Hakim Munawar, Hanum Zahra Faras Fadhilah, Antonius Reuben, Grace Joselini Corlesa, Roby Syah Putra Firmansyah, Markus Wibowo, Nirawan Putranto (Author) https://creativecommons.org/licenses/by/4.0
Effects of Switching from Conventional Cigarettes to Combustion-Free Nicotine Delivery Systems (C-FNDS) on Salivary TNF-α Levels and Gingival Conditions, A Randomized Controlled Trial
Introduction: Tobacco smoking is an independent risk factor for periodontitis. Studies indicated that periodontal deterioration is more pronounced in active smokers than in non- smokers and former smokers. Inflammation response in smokers is impaired as well as gingival blood vessel functions. Smokers demonstrated elevated salivary TNF-α levels but reduced clinical signs of inflammation. The present study evaluated changes in salivary TNF-α levels and gingival conditions in smokers who switched to Combustion- Free Nicotine Delivery Systems. Material and Methods: Forty smokers were randomly allocated to an experimental and a control group. The experimental group had to switch to Combustion-Free Nicotine Delivery Systems for six months, while the control group did not change their smoking habits. Inflammation in the gingiva was assessed using Modified Gingival Index (MGI) scores, and saliva was collected on day 0, day 90, and day 180 to evaluate TNF-α levels. An unpaired T-test was employed, with a p-value <0.05 considered significant. Results: This study demonstrated that switching from tobacco smoking to C-FNDS for 6 months resulted in a statistically significant decrease in salivary TNF-α levels (p < 0.05). The mean MGI was greater in the smoking group than in the switching group. This indicates a correlation between TNF-α levels and the degree of inflammation. The switching group exhibited a reduction in TNF-α levels, and clinically, the gingival inflammation was less severe than that of the control group. Conclusion: Switching from smoking to C-FNDS resulted in reduced salivary TNF-α levels and diminished gingival inflammation during 6 months.
Combustion Free Nicotine Delivery Systems
Copyright (c) 2025 Hanna Adianita, Indra Mustika Setia Pribadi, Amaliya Amaliya (Author) https://creativecommons.org/licenses/by/4.0
Trauma and Body Temperature Management In Tropical Regions Trauma and Temperature
Trauma patients are exposed to hypothermia. Mortality of trauma patients with hypothermia is multiplied by four or five. Interactions of hypothermia with hemostasis and cardiovascular system are deleterious. The effects on coagulation are multiple and directly contribute to increase mortality, making hypothermia a major component of the "lethal triad". Causes of hypothermia in the trauma patient are multiple, (1) environmental, the risk increases when the ambient temperature decreases, (2) clinical, the risk increases with severity and also (3) therapeutic, for example by the infusion of solutes at room temperature. Optimal management is, first, based on early measurement and continuous monitoring of body temperature. The therapeutic objective is to maintain a body temperature at least equal to 36°C. Limiting the undressing of the patient, protecting him from the cold with a survival blanket, installing him quickly in a heated ambulance, using patient rewarming devices, infusing warmed fluids are the fundamental elements of the management of a traumatized patient, at risk of hypothermia. These guidelines should be applied worldwide, including in tropical regions.
Copyright (c) 2025 Frédéric Lapostolle, Dabor Resiere, Bruno Megarbane, Jean-Marc Pujo (Author) https://creativecommons.org/licenses/by/4.0
The Relationship Between Body Mass Index And Waist-To- Hip Ratio On Menstrual Cycle In Female Cadets Of Cohort 4 Republic Of Indonesia Defense University
Background: Women's reproductive health is often influenced by anthropometric factors such as Body Mass Index and Waist-to-Hip Ratio. This study aims to analyze the relationship between BMI and WHR on the menstrual cycle among female cadets in cohort 4 of the Republic of Indonesia Defense University. Methods: The research uses an observational analytic method with a quantitative approach and a cross-sectional design. The sampling technique is Non-Probability Sampling, involving a number of population respondents from the 125 female cadets in cohort 4 of UNHAN RI who meet the inclusion and exclusion criteria. Data were collected through anthropometric measurements and research instruments in the form of a questionnaire related to the menstrual cycle. Results: The results were analyzed using the Fisher Exact statistical test with a significance level of α=0.05, resulting in a p-value of 0.164 for the relationship between BMI and the menstrual cycle and a p-value of 0.000 for the relationship between WHR and the menstrual cycle. Conclusion: This indicates that there is no relationship between BMI and the menstrual cycle, but there is a relationship between WHR and the menstrual cycle among the female cadets in cohort 4 of UNHAN RI. Based on these findings, interventions are needed to maintain a healthy nutritional status, an ideal body fat distribution, and increased physical activity among female cadets to support optimal reproductive health.
Copyright (c) 2025 Tresnasih Nuraeni, Elies Fitriani, Flora Ekasari, Satria Pratama, Agus Sutarman (Author) https://creativecommons.org/licenses/by/4.0
The Effectiveness of the 20-20-20 Algorithm in Reducing the Risk of Computer Vision Syndrome (CVS) Among Millitary Medical Cadets at the Republic of Indonesia Defense University
Background: The digital era has changed many aspects of life, especially in education and the professional field, with increased reliance on computers and Visual Display Terminals (VDT) for work, communication, and learning. In academic environments, particularly among medical students, computers are essential for accessing information and completing assignments. However, excessive screen use can cause health risks, especially eye strain and visual discomfort. Medical students often engage in long study sessions and rely on digital resources, but constant exposure without adequate breaks can result in fatigue, decreased concentration, and vision problems. One common condition associated with prolonged screen time is Computer Vision Syndrome (CVS). To reduce the risk of CVS, the 20-20-20 algorithm is highly recommended, which involves taking a 20-second break every 20 minutes to look at an object 20 feet away. This study aims to evaluate the effectiveness of the 20-20-20 algorithm among medical students at the Republic of Indonesia Defense University and to determine whether its implementation significantly reduces the risk of CVS, as well as increasing awareness about digital eye strain and providing recommendations for students, educators, and institutional policymakers. Methods: The method used in this research is a true experimental design with a one group pretest-posttest approach. A total of 77 cadets from the Military Medicine Study Program participated in this research. They underwent CVS symptom measurements before the intervention, followed by the application of the 20-20-20 algorithm for two weeks, and then repeated symptom measurements after the intervention. The collected data was analyzed using the McNemar test to determine the effectiveness of the algorithm in reducing CVS symptoms. Results: There was a significant change in CVS symptoms after implementing the 20-20-20 algorithm. Of the 77 respondents, 34 respondents did not experience CVS symptoms at the pretest and still did not experience symptoms at the posttest. A total of 25 respondents who previously experienced CVS symptoms managed to overcome this condition after intervention. Statistical analysis showed a p-value of 0.000, which indicated a significant difference between CVS symptoms before and after intervention. Conclusion: The 20-20-20 algorithm was shown to be effective in reducing the risk of Computer Vision Syndrome (CVS) among military medical students. With a p-value < 0.05, these results indicate that this algorithm can be an effective solution for computer users who have the potential to experience CVS.
Copyright (c) 2025 Muhammad Daffa Akbar Prasetyo, Nirawan Putranto, Satria Pratama, Elies Fitriani (Author) https://creativecommons.org/licenses/by/4.0
Effect of Filler and Slip Casting Methods with Nano TiO₂ Anatase as Anti-Candida Albicans on Extraoral Maxillofacial Prostheses: A Laboratory Experiment
Background: Extraoral maxillofacial prostheses using polyurethane material are currently widely used in various rehabilitation treatments after maxillofacial surgery. Among the advantages of polyurethane material, this material also has various weaknesses, including being easily attached to bacterial biofilms or Candida albicans which can cause material degradation and can cause disturbances in the balance of the oral microflora. One effort that can be made to prevent adhesion and colonization of Candida albicans on material surfaces is by improving surface properties using anatase titanium dioxide nanoparticles which have antimicrobial properties, especially against Candida albicans because they have photocatalytic properties that can inhibit the growth of Candida albicans colonies. This research aimed to determine the effect of applying anatase titanium dioxide (TiO₂) nanoparticles to polyurethane plates on the growth of Candida albicans biofilms. Methods: The design of this research is experimental laboratory research. Subjects were divided into two groups, namely: the treatment group and the control group. The treatment groups were divided into two types of treatment, namely the addition group using the anatase nano-titanium dioxide filler method (1, 2, 3, and 4%), and the surface coating group using the anatase nano titanium dioxide slip casting method (1, 2, 3, and 4%). Candida albicans was cultured and grown to form a biofilm on polyurethane plates in each group. Results: Treatment with polyurethane surface coating using 4% nano titanium dioxide anatase using the slip casting method showed the lowest number of Candida albicans colonies. Conclusion: Nano titanium dioxide anatase (TiO₂) surface coating on polyurethane plates is the most treatment that can inhibit Candida albicans biofilm formation.
Copyright (c) 2025 Teguh Tri Widodo, Silvia Vera Indrawati (Author) https://creativecommons.org/licenses/by/4.0
The Relationship of Stress Level to the Menstrual Cycle in Indonesia Defense University Military Medical Cadets
Background: Menstruation is a natural process in the productive age range of 1-16 years and will end when entering menopause at around 51 years of age. Stress is one of the many variables that affect a person's menstrual cycle. Medical students are one of the groups with quite high levels of stress. Therefore, researchers conducted this research to determine the relationship between stress levels and the menstrual cycle in female medical student cadets. Methods: This study sought to ascertain how stress levels and the menstrual cycle of medical student cadets Indonesia Defense University related to one another. This research is analytical observational research with cross sectional design using sample of medical student cadets Indonesia Defense University. Results: The results obtained were that most respondents had moderate stress (66.3%) but still have normal menstrual cycles (77.2%) and the p value using the chi square test was 0.008. Conclusion: There was a relationship between the level of stress and the menstrual cycle in medical student cadets Indonesia Defense University.
Copyright (c) 2025 Salsabila Azka, Trevicko Mahotamma Ardiansyah, Syahnadira Puspita Handadari, Adinda Ratulia Suwarno, Mozart Mozart, Arief Setyawan, Rachma Hidana, Elies Fitriani (Author) https://creativecommons.org/licenses/by/4.0
Exploring the Potential of 5% Dextrose Prolotherapy for Partial Achilles Tendon Tears Using Ultrasound Guidance: A Case Report
Background: Partial Achilles tendon tears are common injuries among athletes and active individuals, often treated conservatively or surgically. 5% dextrose prolotherapy has emerged as a potential non-surgical intervention to promote tendon healing by stimulating collagen synthesis and tissue repair. Case Presentation: We report the case of a 35-year-old male who developed sharp heel pain and tenderness after walking for 30 minutes. Ultrasound imaging confirmed a 0.5 cm partial Achilles tendon tear, located 2 cm from the calcaneus insertion. The patient opted for conservative treatment, which included three sessions of ultrasound-guided 5% dextrose prolotherapy, administered weekly with 3 cc injections. Additionally, a structured rehabilitation program comprising immobilization, progressive weight-bearing, and strengthening exercises was implemented. Conclusion: This case suggests that ultrasound-guided 5% dextrose prolotherapy may provide a viable, non-surgical treatment option for partial Achilles tendon tears, leading to pain relief and functional improvement. Further research is needed to confirm its efficacy in larger patient populations.
Copyright (c) 2025 Lita DN Tambunan, Widiya Rahmi (Author) https://creativecommons.org/licenses/by/4.0
Mosquito Shield - Transfluthrin Spatial Repellents Against Malaria-Transmitting Anopheles: Systematic Review and Meta-Analysis
Background: A major worldwide health concern, mosquito-borne illnesses primarily affect tropical areas that sustain the mosquito life cycle. In tropical and subtropical regions, vulnerable populations are disproportionately affected by malaria, one of the most well-known mosquito-borne diseases. The WHO African Region is the region with the largest incidence of malaria. Despite the significant success of conventional vector control techniques like indoor residual spraying (IRS) and insecticide-treated nets (ITNs), protection gaps still exist, calling for innovative approaches. This study analyzes the effectiveness of transfluthrin as an innovative spatial repellent that operates without electricity or fire to prevent human-Anopheles mosquito contact. Methods: A systematic review and meta-analysis assessed Mosquito Shield™ (transfluthrin-based spatial repellent) for reducing malaria vector exposure. Literature from 2019–2024 was searched in databases including Medline and PubMed using terms like “Spatial Repellent” and “Transfluthrin.” Eligible randomized controlled trials in malaria-endemic areas were analyzed for outcomes on Human Landing Catch (HLC), Incidence Rate Ratio (IRR), and Protective Efficacy (PE). Quality appraisal was conducted using Rob 2.0. Results: Two studies met the inclusion criteria, showing that Mosquito Shield™ significantly reduced mosquito landings compared to placebo, with PE ranging from 34.2% to 70%. The pooled analysis confirmed a statistically significant reduction in mosquito exposure, though high heterogeneity suggests variations in effectiveness by region and mosquito species.
Copyright (c) 2025 Dinda Puspha Nurhanifah, Dian Andriani Ratna Dewi, Anggie Hernita Azzura, Hanum Zahra Faras Fadhilah, Fitrawan Alfiansyah, Anastasia Refina Renate, Prihati Pujowaskito (Author) https://creativecommons.org/licenses/by/4.0
Stem Cell Transplantation Therapy in Systemic Sclerosis:A Systematic Review
Introduction: Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by systemic inflammation, tissue fibrosis, vascular dysfunction, and reduced quality of life. Autologous hematopoietic stem cell transplantation (HSCT) has been developed as a therapeutic option for severe SSc patients who do not respond to standard treatment. Objective: To evaluate the benefits and risks of autologous hematopoietic stem cell transplantation in the management of systemic sclerosis. Methods: A review was conducted on three randomized controlled trials (RCTs) comparing HSCT with cyclophosphamide use. Results: Selective non-myeloablative HSCT improved event-free survival and physical function, while selective myeloablative HSCT showed improvement in skin scores. However, both procedures carried a higher risk of severe adverse effects compared to cyclophosphamide. No significant differences in overall mortality were observed, and evidence on non-selective non-myeloablative HSCT remains limited. Conclusion: Although HSCT shows potential as a therapeutic option for SSc, the risks of severe adverse effects and mortality must be carefully considered. Further studies are needed to compare the effectiveness of HSCT with modern therapies, such as mycophenolate mofetil.
Copyright (c) 2025 Arif Rachman, Shalya Regita, Muhammad Zhafran Maulana, Ni Made Ayu Widiyasih, Nabil Ramaseno, Nuzuludz Dzikra, Ilham Syahputro, Jafar Elyas, Dinda Puspa, Arya Duta Dharma, Arfiyanti Arfiyanti, Prihati Pujowaskito, Ruth Je Deborah Octavia (Author) https://creativecommons.org/licenses/by/4.0
Case Report: Effective Use of the Orticochea Flap in the Surgical Treatment of Non-Hodgkin Lymphoma
Non-Hodgkin lymphoma is a malignant disease arising from lymphoid tissues, primarily affecting the lymph nodes. The clinical manifestations and histological appearances of non-Hodgkin lymphoma are diverse, typically presenting with swelling, pain, and ulcers in the head and neck region. This case report discusses the management of a 55-year-old immunocompetent female patient presenting with a large, painless mass extending from the neck to the occipital region of the scalp, mimicking the features of a sarcoma. Closing scalp defects poses a significant challenge for plastic surgeons due to the limited tissue and variable elasticity of the scalp. Orticochea flap, also known as the "banana peel" flap was performed on the patient after the removal of the tumor mass. The orticochea flap technique allows for greater surface area coverage while maintaining vascularity, resulting in quicker procedures and good aesthetic outcomes.
Copyright (c) 2025 Anastasia Dessy Harsono, Metaudina Chandra Pratiwi, Dominic Melino Tjokrovonco (Author) https://creativecommons.org/licenses/by/4.0
N-Terminal Prohormone Brain Natriuretic Peptide as a Predictor of Acute Kidney Impairment Due to Contrast in Patients with Stage I-III Chronic Kidney Disease Undergoing Cardiac Catheterization – Indonesian Perspective
Copyright (c) 2024 Jonny Jonny, Thomas Rikl, Ananda Rossi, Bhimo Aji Hernowo (Author) https://creativecommons.org/licenses/by/4.0
Recessive Dystrophic Bullous Epidermolysis With Squamous Cell Carcinoma: A Rare Case Report
Epidermolysis bullosa (EB) is a genetic disorder in which the skin layer and other epithelia attached to the underlying connective tissue are disrupted with a tendency to form blisters and vesicles after mild trauma or friction. Other organs, like as the esophagus, can be damaged by some forms of EB, and subsequent problems might require several procedures. While there has been substantial progress in illness classification, specifically identifying the genes and proteins involved, there have been limited advancements in disease therapy. The care of an EB patient focuses on suppressing symptoms, protection of the skin, and minimizing complications. This case report presents the unique case of a 13-year-old girl diagnosed with recessive dystrophic epidermolysis bullosa complicated by squamous cell carcinoma. Multiple erosional efflorescences appear geographically defined boundaries covered with brownish yellow crusts, dystrophic scars, milia. Contractures of both fingers and toes (pseudosyndactyly) were present. The diagnosis was established through a comprehensive evaluation including history, physical examination, and relevant tests. The patient's parents did not have any of these problems and were not linked. There is no family history of the patient suffering from comparable problems. Therapy is therefore focused on the prevention of lesions and complications. The complexity of the therapeutic strategy depends on the severity of the patient's lesions. Optimal management of this disease can only be done through a multidisciplinary team of different disciplines. The management given is Sodium Fusidate cream every 12 hours applied to open erosions, open compresses NaCl 0.9% every 8 hours for 15-20 minutes, on crusts, levertrans on erosion areas. The prognosis for individuals with this condition remains uncertain, highlighting the challenges in addressing the complex nature of this disease.
Copyright (c) 2024 Sissy Sissy, Mahfudz Shidiq, Clara Virginia Allun, Daniel Ahmad Romero (Author) https://creativecommons.org/licenses/by/4.0
Modified Keystone Flap: A Versatile Reconstruction for Mastectomy Defects – Our Clinical Experience
Introduction: The closure of extensive defects in reconstructive surgery is a common challenge. The keystone flap technique has gained popularity due to its adaptability and reliance on fascia, providing a reliable blood supply and offering a better match for skin color compared to skin grafts. However, keystone flap necrosis can occur due to tension and inadequate tissue perfusion. To address this, a modified keystone flap technique called the "doubled-handle saucepan" was developed, resulting in improved flap vitality and reduced tissue necrosis, particularly in mastectomy defects. Materials and method: We assessed 16 female patients who underwent “doubled-handle saucepan” keystone flaps after modified radical mastectomy (MRM). The average dimensions of wounds in this study were 23.1 ± 3.8 cm × 16.9 ± 2.9 cm, with the largest defect measuring 28.0 cm × 21.5 cm. The average size of the modified keystone flap was 36.3 ± 3.8 cm × 21.2 ± 2.2 cm. Results and Discussion: Modified keystone flap demonstrated effective performance in managing extensive defects without any complication. The average operation time in our study was 124.3 ± 11.2 minutes. Conclusion: The "double-handled saucepan" keystone flap technique is a unique and dependable method derived from the original keystone flap which effectively covers defects and maintains flap vitality without tension by ensuring vascularization at the skin bridge. This modified keystone flap technique proves highly effective for reconstruction after modified radical mastectomy (MRM), offering time efficiency and no need for a secondary donor site makes it an appealing alternative to free flaps or other local flap techniques in many cases.
Copyright (c) 2024 Anastasia Dessy Harsono, Dominic Melino Tjokrovonco (Author) https://creativecommons.org/licenses/by/4.0
The Role Of Strain Echocardiography Examination For Clinical Evaluation Of Patients With Myocarditis
Background: Myocarditis, an inflammatory condition of the heart muscle, can be challenging to diagnose, particularly in young adults, due to its variable presentation and overlap with other cardiac conditions. Cardiac strain echocardiography, which measures myocardial deformation, has emerged as a promising diagnostic tool in this context. Case Presentation: We report the case of a 30-year-old female who presented with symptoms of shortness of breath and arrhythmias. Initial evaluations included a 24-hour Holter monitor, which detected irregular heart rhythms, and a cardiac MRI, which revealed inflammation consistent with myocarditis. Despite these findings, conventional echocardiographic assessments were inconclusive. Cardiac strain echocardiography was subsequently employed, showing significant alterations in global longitudinal strain, which provided critical diagnostic insight into myocardial involvement and severity. Management and Outcome: The patient was started on a regimen of heart failure medications, including ACE inhibitors, beta-blockers, and diuretics, tailored to manage his symptoms and reduce myocardial stress. Follow-up with cardiac strain echocardiography demonstrated improvements in myocardial strain patterns, correlating with clinical improvement and resolution of symptoms. Conclusion: This case underscores the value of cardiac strain echocardiography in diagnosing myocarditis in young adults. The technique's ability to detect subtle myocardial dysfunction not evident on conventional imaging highlights its role as an adjunctive tool in the comprehensive assessment of myocarditis. Further studies are warranted to establish its utility and optimize diagnostic protocols in this patient population.
Global Longitudinal Echocardiography Strain
Copyright (c) 2024 Ardhestiro H. Putro (Author) https://creativecommons.org/licenses/by/4.0
The Effect of Intensive Medical Rehabilitation on the Functional Capacity of TNI Soldiers with Chronic Phase of Lower Extremity Injuries
Rehabilitation plays a crucial role in the recovery of patients, improving their quality of life and reducing the risk of complications by restoring a person's functional capacity after experiencing an injury. Chronic musculoskeletal injuries that are not handled optimally have the potential to cause disability for soldiers, making it impossible for soldiers to return to duty according to their main duties. Lower extremity injury is related to the potential reduction in a person's functional capacity, related to their functions, namely mobility, fitness, strength and agility. Active military soldiers with chronic lower extremity injuries underwent an intensive - structured medical rehabilitation program 3 times a week for 8 weeks. At the end of the rehabilitation program, statistically significant differences were found in the increase in cardiorespiratory fitness capacity and agility compared to pre-intervention. Even in chronic conditions, intensive medical and structural rehabilitation programs in cases of lower limb injuries, can significantly increase functional capacity in assessing cardiorespiratory fitness and agility in accordance with TNI soldier fitness standards.
Copyright (c) 2024 Rifqi Averrouza (Author) https://creativecommons.org/licenses/by/4.0
Gene & Cell Therapy for Cancers: The Promise of Chimeric Antigen Receptor (CAR)-T Cells
The pharmacology of cell and genetic therapy represents a highly advanced and contemporary treatment technology, capable of addressing the root causes of numerous diseases with remarkable accuracy and precision at the DNA and molecular levels. Genetic technology aims to develop treatments for genetic disorders caused by inherited genetic mutations, which affect millions of people worldwide and are often life-threatening terminal illnesses. Moreover, pharmacologists and genetic biologists are striving to treat hereditary disorders. By integrating cell and genetic molecular biology, scientists have developed Chimeric Antigen Receptor T-Cell (CAR-T) technology, which has been approved for the treatment of blood cancer. Cell-based and genetic therapy is a groundbreaking therapeutic approach poised to become a cornerstone in the future treatment of degenerative and malignant diseases, particularly cancer, congenital or genetic disorders.
Chimeric Antigen Receptor T-Cells (CAR-T)
Copyright (c) 2024 Prof. Taruna Ikrar (Author) https://creativecommons.org/licenses/by/4.0
Biological Threats as Emerging Challenges in Modern Military Biodefense
A biological threat refers to an infectious disease with the potential to spread and cause an outbreak. The challenges posed by rapidly changing and increasingly complex biological threats became apparent after the global COVID-19 pandemic, leading to a decline in the preparedness of nations and sluggish responses. Despite the potential severity of casualties, military readiness should be the first line of defense, emphasizing deep prevention. The role of the military in overcoming threats becomes an urgency that cannot be avoided and must be an integral part of the handling of biological threats nationally.
Copyright (c) 2024 Mayor Ckm dr. Nizamuddin Ubaidillah (Author) https://creativecommons.org/licenses/by/4.0
Temperature and Cardiovascular Morbidity
The negative influence of extreme heat on cardiovascular health has been observed across various geographical locations across the world. In the state of New York, discovered a significant increase in cardiovascular disease (CVD) related emergency department, following an extremely hot day. Increase in 3-day delayed CVD hospital admissions with every 1°C above the temperature-health effect curve (29°C–36°C). Another study conducted in China, estimated that the cumulative relative risk of having an out-of-hospital cardiac arrest (OHCA) following a day with extreme heat. Analogous impacts of extreme heat on cardiovascular morbidity have also been observed in Australia and Korea. Data from Thai Nguyen province in Vietnam with the daily weather, observed no statistically significant association between hot temperatures and CVD-related hospital admission over the course of lag days 0–30. Contradictory evidence was also found in epidemiological studies conducted across Europe. A systematic review and meta-analysis of twenty-one studies also failed to detect a significant association between cardiovascular morbidity and ambient temperature.
Copyright (c) 2024 Harikrishna Halaharvi, Paul J. Schramm, Ambarish Vaidyanathan (Author) https://creativecommons.org/licenses/by/4.0
The Significance of Entrepreneurial Leadership in Armed Forces Hospitals
Background: Currently, merely possessing leadership or entrepreneurial qualities is insufficient for assuming the role of a hospital head in the armed forces. Successful hospital leadership necessitates the embodiment of Entrepreneurial Leadership (EL), a contemporary model combining leadership excellence with an entrepreneurial spirit. The capacity of a hospital to advance is profoundly shaped by its economic acumen, and to thrive, leaders surpassing EL standards are imperative. Methods: A scoping review was conducted utilizing the Google Scholar database and PubMed, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. A total of 136 articles from various studies conducted between 2018 and 2023, spanning diverse countries, were reviewed. Extraction focused on 5 studies from 4 countries that implemented leadership interventions among doctors, dentists, and hospitals. Discussion: In light of the global impact of the COVID-19 pandemic, the landscape of hospital management is undergoing rapid transformation. Internet-based technologies are becoming essential for hospitals to address service requirements and enhance efficiency, thereby increasing overall effectiveness. Only leaders possessing EL can ensure the survival, development, and competitiveness of hospitals amidst these evolving challenges. Conclusion: The characteristics of EL exhibited by hospital leaders significantly influence the performance, continuity, effectiveness, and productivity of competitive hospital enterprises. The application of EL enables hospitals to attain superiority, professionalism, resilience, innovation, and adaptability to various changing conditions.
Copyright (c) 2024 Dian Andriani Ratna Dewi, Lila Irawati Tjahjo Widuri, Ni Made Wiliantari, Sherryn Sherryn (Author) https://creativecommons.org/licenses/by/4.0
Heat Therapy Intervention and Pulse Dose Itraconazole as Combination Treatment for Chromoblastomycosis: An Unusual Case Report
Chromoblastomycosis (CBM) is a rare chronic fungal infection caused by dematiaceous fungi, presenting a significant challenge in Indonesia. This case involves a 54-year-old man who reported a lump on his right leg persisting for 10 years. Examination revealed multiple erythematous nodules with well-defined borders and a verrucous surface, forming a linear pattern around the ankle, some covered by brownish crusts. The patient denied itching and pain in the lesions. The initial diagnosis of chromoblastomycosis was confirmed through culture and histopathology. Treatment involved pulsed doses of intraconazole and heat therapy. Remarkably, lesions significantly improved after one month, underscoring the efficacy of combination therapy for chromoblastomycosis. Pulsed dose itraconazole enhances treatment compliance with its cost-effectiveness, while heat therapy, as a physical intervention, proves to be an easily administered option with promising efficacy. Considering the prolonged management required for CBM, it is imperative to factor in the patient's socioeconomic condition during treatment planning.
Copyright (c) 2024 Sissy Sissy, Clara Virginia Allun, Daniel Ahmad Romero, Mahfudz Shidiq (Author) https://creativecommons.org/licenses/by/4.0
Introducing the Camry Electronic Hand Dynamometer EH101 as a Functional Strength Measurement Tool among Healthy Teenagers in Jakarta, Indonesia
Hand grip strength (HGS) is correlated with activities of daily living (ADL) and is intricately related to lung function. The American College of Sports Medicine recommends incorporating hand grip strength tests as a component of musculoskeletal fitness assessment for children. The hydraulic Jamar dynamometer, developed by Bechtol in 1954, is the most widely used tool among clinicians for measuring HGS. Currently, the widely available HGS measurement tool in Indonesia is the Camry electronic hand dynamometer EH101. This study aimed to introduce a new tool, known for its easy accessibility and affordability. An analytical observational design with a cross-sectional method. 19 males and 19 females, aged between 12–18 years, in one junior high school and one senior high school in Central Jakarta, who find inclucion criterias. There were differences of the results between both tools for all parameters. However, we detected consistency in term of the values of measurements. When the Jamar® measured a lower result than the other parameter, the Camry® would measure the same. A significant correlation between both values, as measured by Camry® and Jamar® (>0.7) that might be interpreted as a strong correlation of statistical significance. Camry EH101 had a significant correlation with Jamar, indicating consistency in measurements despite observed value gaps. While the Camry holds promise for use in Indonesia due to its affordability and accessibility, further investigation is warranted. It is recommended to calculate sensitivity and specificity of the Camry, considering its unique cut-off points for clinical application.
Copyright (c) 2024 Nury Nusdwinuringtyas, Ni Luh Made Murniasih Jayanthi, Endang Ernandini, Peggy Sunaryo, Jonathan Alvin Wiryaputra (Author) https://creativecommons.org/licenses/by/4.0
Human PPARG Gene Mutation as Risk Factor for Type 2 Diabetes Melitus: In Silico Analysis
Introduction: Type 2 diabetes (T2DM) involves genetic and environmental factors. PPARG, encoding peroxisome proliferator-activated receptor gamma, is one of the key gene in T2DM development. Our study investigates PPARG variants' role as risk factor for T2DM by in silico analysis. Methods: We identified Single Nucleotide Polymorphisms (SNPs) within the PPARG gene via UniProt and analyzed their effects using Ensembl Variant Effect Predictor (VEP). The VEP analysis provided us four important indicators: impact assessment, Sorting Intolerant from Tolerant (SIFT) score, PolyPhen score, and clinical significance. We also investigated PPARG's interactions with other T2DM-related genes using StringDB. Results: In our analysis of 35 UniProt-sourced SNPs, 32 underwent successful VEP analysis.The SIFT indicators identified 23 of SNPs as deleterious, The PolyPhen identified 18 of SNPs as probably damaging . Impact assessments revealed that 27 had a moderate impact on gene function. Clinically, 8 of the SNPs were considered pathogenic and rs1805192 emerged as a notable risk factor for T2DM. Additionally, StringDB analysis confirmed PPARG's role in the T2DM-associated gene network, from the 25 proteins involved in T2DM, 21 of them exhibit correlations with PPARG. Discussion: PPARG SNPs variant has a significant impact on T2DM as a risk factor. However, SNPs associated with T2DM vary across different populations. Conclusion: Analysis of PPARG genetic variations highlights their significant association with T2DM susceptibility in specific populations. Bioinformatics tools are useful for investigating genetic mutations but require additional research, such as functional studies, to improve reliability as their outcomes are primarily predictions.
Copyright (c) 2024 Naufal Yafi Rais Wiguna, Taufik Hidayat B, Putrya Hawa, Jonny Jonny (Author) https://creativecommons.org/licenses/by/4.0