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Comparing sedative and non-sedative reduction techniques in paediatric intussusception: Insights from a 6-year study

Purnomo E, Gibran K, Makhmudi A, Andi D, Gunadi

Med J Malaysia, 2024 Aug;79(Suppl 4):38-43.
PMID: 39215413

INTRODUCTION: Intussusception is a prevalent paediatric emergency condition. The standard of care involves the reduction using air or fluid enema is considered a safe procedure. Sedation-induced muscle relaxation thus optimising the treatment. We present a comprehensive 6- year study involving non sedative reduction (NSR) versus sedative reduction (SR) utilising ketamine and midazolam.
MATERIALS AND METHODS: A retrospective cohort study was conducted between January 2017 and July 2023 in Yogyakarta, Indonesia. A total of 85 children diagnosed with intussusception underwent hydrostatic reduction, which employed water-soluble contrast administered into the rectum. Cases that were unsuccessful in reduction underwent immediate surgical intervention.
RESULTS: Among the 85 children with intussusception underwent reduction, 22 children underwent the SR procedure and 63 underwent NSR procedure. We found a successful outcome in 17 cases (77%) of SR procedure with one recurrent and the other five (23%) got surgical reduction such as anastomosis resection (3 cases) due to Meckel- Diverticula. On the other hand, we found 24 successful cases (38.0%) in NSR procedure with one recurrent after case. 39 others who failed with NSR continued to surgical reduction. Manual reduction was done for 31 patients with one case mortality due to pulmonary bleeding. Anastomosis resection (4 cases) and, stoma (4 cases) were decided for others surgical reduction. The relative risk (RR) on this study was 2.02 (p value < 0.05, CI 95%).
CONCLUSION: Implementation of the SR procedure may reduce surgery rates in paediatric intussusception, thereby enhancing patient management. Furthermore, the success rate of hydrostatic reduction higher in under sedation procedure. We contribute to evolve insight of non-operative approaches of paediatric intussusception management, particularly in the Yogyakarta.
Uncommon splenic cysts in paediatric patients: A case series

Febrianti M, Purnomo E, Dwihantoro A, Makhmudi A, Kashogi G

Med J Malaysia, 2024 Aug;79(Suppl 4):91-94.
PMID: 39215423

Splenic cysts are uncommon and classified into parasitic and non-parasitic origins. Non-parasitic cysts are further categorised into primary and secondary forms; primary cysts develop congenitally and progress into adulthood and secondary cysts result from factors such as abdominal trauma, infection or ischemia. This case series presents three instances of splenic cysts in children. The first case involves a splenic epidermoid cyst, the second a pseudocyst and the third a splenic epithelial cyst. All patients exhibited an abdominal lump in the left quadrant that increased in size over time, without additional symptoms. The third patient had a history of abdominal blunt trauma a year prior to symptom onset. Treatment approaches varied: the first and third patients underwent total splenectomy, while the second patient underwent aspiration drainage with frozen section analysis and partial splenectomy. All patients, first, second and third, were discharged 6, 3 and 5 days postoperatively, respectively, without complications. Splenic epithelial cyst (SEC) emerged as the predominant primary non-parasitic splenic cyst type, with an unclear pathogenesis. Typically asymptomatic, splenic cysts are commonly detected incidentally during imaging or exploratory laparotomy. Histopathology stands as the gold standard diagnostic method for splenic cysts. Although rare, paediatric splenic cysts should be considered in cases of abdominal trauma. Imaging serves a vital role in diagnosis, guiding decisions between conservative or surgical interventions based on cyst size, symptoms and associated complications.
Fulltext Chemical constituents, usage and pharmacological activity of Cassia alata

Fatmawati S, Yuliana, Purnomo AS, Abu Bakar MF

Heliyon, 2020 Jul;6(7):e04396.
PMID: 32685725 DOI: 10.1016/j.heliyon.2020.e04396

Cassia alata or locally known as Ketepeng Cina (Indonesia) and Gelenggang (Malaysia) has been used as a traditional medicine to treat various diseases, especially skin diseases. In addition, C. alata has been reported to have potential anti allergic, anti inflammatory, antioxidant, anticancer, antidiabetic, and antifungal. Metabolite compounds that have been isolated from C. alata include flavones, flavonols, flavonoids glycosides, alatinon, alanonal and β-sitosterol-β-D-glucoside. The compounds have been isolated mainly from the leaves. Further identification is needed to discover the secondary metabolites from other parts of the plant such as seed, flower and bark which are reported to have potent antibacterial and antifungal activity. Therefore, this article highlights the secondary metabolites and biological activity of this plant which has been shown to have pharmacological properties against selected diseases.
Risk factor for inappropriate use of prophylactic antibiotics in inguinal hernia repair surgery

Hendrawan F, Nugrahningsih DAA, Purnomo E, Azdy NA

Med J Malaysia, 2024 Aug;79(Suppl 4):58-62.
PMID: 39215416

INTRODUCTION: There are some complications that can arise after surgery, like surgical site infection (SSI). In hernia repair, SSI incidence is low. Hence, the clinical practice guideline (CPG) published by the HerniaSurge Group (THG) does not recommend prophylactic antibiotics for hernia repair. Despite the unnecessary use of prophylactic antibiotics, regarding patient safety, prophylactic antibiotics can be used. However, each hospital has its own CPG and recommended antimicrobials based on the infection cases in its site. Regarding antimicrobial resistances, evaluating prophylactic antibiotics is essential to prevent increasing incidence of antimicrobial resistance cases. The aim of this study is to evaluate the use of prophylactic antibiotics in hernia inguinal cases.
MATERIALS AND METHODS: This cross-sectional analytic study used patients' medical records between 2015 to 2020. Demographic data, surgery data and the used antimicrobial data were extracted and written in case report form. Identification of risk factors for inappropriate use of prophylactic antibiotics was done using logistic regression.
RESULTS: We identified 55 inappropriate times of preoperative prophylactic antibiotic therapy cases out of 80 cases and 63 cases in post-operative antibiotics were different from the guideline. Statistical analysis did not find any factor related to inappropriate therapy time.
CONCLUSION: The misuse of prophylactic antibiotics was frequently found regarding the duration of prophylactic antibiotics in both pre- and post-surgery setting. Nonetheless, no risk factor was identified with the inappropriate use of prophylactic antibiotics.
Fulltext The data on exploratory factor structure of [pre-service] teacher beliefs about educational research scale

Purnomo YW, Prananto IW, Driana E, Saparanti K, Nuriadin I, Ismail SN

Data Brief, 2020 Dec;33:106578.
PMID: 33318973 DOI: 10.1016/j.dib.2020.106578

This article presents data on factors that depict [pre-service] teacher beliefs about educational research. A cross-sectional survey was used to collect the data that involved 352 final-year students working on their undergraduate theses. The students were registered in the faculty of teacher training and education in one of the private universities with an A (excellent) accreditation in Jakarta, Indonesia. The participants were selected conveniently. Exploratory factor analysis was performed to reveal the factors comprised in the data. 49 out of 72 items formed five factors: negative views about educational research, positive views about educational research, knowledge about educational research, open-mindedness, and accessibility.
Fulltext Malagasy Genetic Ancestry Comes from an Historical Malay Trading Post in Southeast Borneo

Brucato N, Kusuma P, Cox MP, Pierron D, Purnomo GA, Adelaar A, et al.

Mol Biol Evol, 2016 09;33(9):2396-400.
PMID: 27381999 DOI: 10.1093/molbev/msw117

Malagasy genetic diversity results from an exceptional protoglobalization process that took place over a thousand years ago across the Indian Ocean. Previous efforts to locate the Asian origin of Malagasy highlighted Borneo broadly as a potential source, but so far no firm source populations were identified. Here, we have generated genome-wide data from two Southeast Borneo populations, the Banjar and the Ngaju, together with published data from populations across the Indian Ocean region. We find strong support for an origin of the Asian ancestry of Malagasy among the Banjar. This group emerged from the long-standing presence of a Malay Empire trading post in Southeast Borneo, which favored admixture between the Malay and an autochthonous Borneo group, the Ma'anyan. Reconciling genetic, historical, and linguistic data, we show that the Banjar, in Malay-led voyages, were the most probable Asian source among the analyzed groups in the founding of the Malagasy gene pool.
Fulltext Glucose-6-phosphate dehydrogenase deficiency: molecular heterogeneity in southeast Asian countries

Matsuo M, Nishiyama K, Shirakawa T, Padilla CD, San LP, Suryantoro P, et al.

Southeast Asian J Trop Med Public Health, 2003;34 Suppl 3:127-9.
PMID: 15906715

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is common in malaria endemic regions and is estimated to affect more than 400 million people worldwide. Deficient subjects are mostly asymptomatic but clinical manifestations range from neonatal jaundice due to acute hemolytic anemia to chronic non-spherocytic hemolytic anemia. To date, biochemical parameters allowed more than 400 different G6PD variants to be distinguished thereby suggesting a vast genetic heterogeneity. So far, only a small portion of this heterogeneity has been confirmed at the DNA level with the identification of about 90 different point mutations in the G6PD coding sequence. To determine the molecular background of G6PD deficiency in Southeast Asian countries, we conducted molecular analyses of G6PD patients from the Philippines, Malaysia, Singapore, Vietnam and Indonesia. The most prevalent mutation identified differs from country to country, thus suggesting independent mutational events of the G6PD gene.
Asian consensus recommendations on optimizing the diagnosis and initiation of treatment of hepatitis B virus infection in resource-limited settings

Gane EJ, Charlton MR, Mohamed R, Sollano JD, Tun KS, Pham TTT, et al.

J Viral Hepat, 2020 05;27(5):466-475.
PMID: 31785182 DOI: 10.1111/jvh.13244

Asia has an intermediate-to-high prevalence of and high morbidity and mortality from hepatitis B virus (HBV) infection. Optimization of diagnosis and initiation of treatment is one of the crucial strategies for lowering disease burden in this region. Therefore, a panel of 24 experts from 10 Asian countries convened, and reviewed the literature, to develop consensus guidance on diagnosis and initiation of treatment of HBV infection in resource-limited Asian settings. The panel proposed 11 recommendations related to diagnosis, pre-treatment assessment, and indications of therapy of HBV infection, and management of HBV-infected patients with co-infections. In resource-limited Asian settings, testing for hepatitis B surface antigen may be considered as the primary test for diagnosis of HBV infection. Pre-treatment assessments should include tests for complete blood count, liver and renal function, hepatitis B e-antigen (HBeAg), anti-HBe, HBV DNA, co-infection markers and assessment of severity of liver disease. Noninvasive tests such as AST-to-platelet ratio index, fibrosis score 4 or transient elastography may be used as alternatives to liver biopsy for assessing disease severity. Considering the high burden of HBV infection in Asia, the panel adopted an aggressive approach, and recommended initiation of antiviral therapy in all HBV-infected, compensated or decompensated cirrhotic individuals with detectable HBV DNA levels, regardless of HBeAg status or alanine transaminase levels. The panel also developed a simple algorithm for guiding the initiation of treatment in noncirrhotic, HBV-infected individuals. The recommendations proposed herein, may help guide clinicians, to optimize the diagnosis and improvise the treatment rates for HBV infection in Asia.
Machine learning improves the prediction of significant fibrosis in Asian patients with metabolic dysfunction-associated steatotic liver disease - The Gut and Obesity in Asia (GO-ASIA) Study

Verma N, Duseja A, Mehta M, De A, Lin H, Wong VW, et al.

Aliment Pharmacol Ther, 2024 Mar;59(6):774-788.
PMID: 38303507 DOI: 10.1111/apt.17891

BACKGROUND: The precise estimation of cases with significant fibrosis (SF) is an unmet goal in non-alcoholic fatty liver disease (NAFLD/MASLD).
AIMS: We evaluated the performance of machine learning (ML) and non-patented scores for ruling out SF among NAFLD/MASLD patients.
METHODS: Twenty-one ML models were trained (N = 1153), tested (N = 283), and validated (N = 220) on clinical and biochemical parameters of histologically-proven NAFLD/MASLD patients (N = 1656) collected across 14 centres in 8 Asian countries. Their performance for detecting histological-SF (≥F2fibrosis) were evaluated with APRI, FIB4, NFS, BARD, and SAFE (NPV/F1-score as model-selection criteria).
RESULTS: Patients aged 47 years (median), 54.6% males, 73.7% with metabolic syndrome, and 32.9% with histological-SF were included in the study. Patients with SFvs.no-SF had higher age, aminotransferases, fasting plasma glucose, metabolic syndrome, uncontrolled diabetes, and NAFLD activity score (p 140) was next best in ruling out SF (NPV of 0.757, 0.724 and 0.827 in overall, test and validation set).
CONCLUSIONS: ML with clinical, anthropometric data and simple blood investigations perform better than FIB-4 for ruling out SF in biopsy-proven Asian NAFLD/MASLD patients.
Fulltext Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)

Sarin SK, Choudhury A, Lau GK, Zheng MH, Ji D, Abd-Elsalam S, et al.

Hepatol Int, 2020 Sep;14(5):690-700.
PMID: 32623632 DOI: 10.1007/s12072-020-10072-8

BACKGROUND AND AIMS: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis.
METHODS: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19.
RESULTS: Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR = 2.1 (1.1-3.7), p = 0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR = 8.1 (1.9-38.8), p = 0.002] predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5 (11.6%)] or acute decompensation [4 (9%)]. Liver related complications increased (p
Fulltext First integrative trend analysis for a great ape species in Borneo

Santika T, Ancrenaz M, Wilson KA, Spehar S, Abram N, Banes GL, et al.

Sci Rep, 2017 07 07;7(1):4839.
PMID: 28687788 DOI: 10.1038/s41598-017-04435-9

For many threatened species the rate and drivers of population decline are difficult to assess accurately: species' surveys are typically restricted to small geographic areas, are conducted over short time periods, and employ a wide range of survey protocols. We addressed methodological challenges for assessing change in the abundance of an endangered species. We applied novel methods for integrating field and interview survey data for the critically endangered Bornean orangutan (Pongo pygmaeus), allowing a deeper understanding of the species' persistence through time. Our analysis revealed that Bornean orangutan populations have declined at a rate of 25% over the last 10 years. Survival rates of the species are lowest in areas with intermediate rainfall, where complex interrelations between soil fertility, agricultural productivity, and human settlement patterns influence persistence. These areas also have highest threats from human-wildlife conflict. Survival rates are further positively associated with forest extent, but are lower in areas where surrounding forest has been recently converted to industrial agriculture. Our study highlights the urgency of determining specific management interventions needed in different locations to counter the trend of decline and its associated drivers.
Fulltext Global Demand for Natural Resources Eliminated More Than 100,000 Bornean Orangutans

Voigt M, Wich SA, Ancrenaz M, Meijaard E, Abram N, Banes GL, et al.

Curr Biol, 2018 03 05;28(5):761-769.e5.
PMID: 29456144 DOI: 10.1016/j.cub.2018.01.053

Unsustainable exploitation of natural resources is increasingly affecting the highly biodiverse tropics [1, 2]. Although rapid developments in remote sensing technology have permitted more precise estimates of land-cover change over large spatial scales [3-5], our knowledge about the effects of these changes on wildlife is much more sparse [6, 7]. Here we use field survey data, predictive density distribution modeling, and remote sensing to investigate the impact of resource use and land-use changes on the density distribution of Bornean orangutans (Pongo pygmaeus). Our models indicate that between 1999 and 2015, half of the orangutan population was affected by logging, deforestation, or industrialized plantations. Although land clearance caused the most dramatic rates of decline, it accounted for only a small proportion of the total loss. A much larger number of orangutans were lost in selectively logged and primary forests, where rates of decline were less precipitous, but where far more orangutans are found. This suggests that further drivers, independent of land-use change, contribute to orangutan loss. This finding is consistent with studies reporting hunting as a major cause in orangutan decline [8-10]. Our predictions of orangutan abundance loss across Borneo suggest that the population decreased by more than 100,000 individuals, corroborating recent estimates of decline [11]. Practical solutions to prevent future orangutan decline can only be realized by addressing its complex causes in a holistic manner across political and societal sectors, such as in land-use planning, resource exploitation, infrastructure development, and education, and by increasing long-term sustainability [12]. VIDEO ABSTRACT.
Fulltext Global Practice Patterns in the Evaluation of Non-Obstructive Azoospermia: Results of a World-Wide Survey and Expert Recommendations

Shah R, Rambhatla A, Atmoko W, Martinez M, Ziouziou I, Kothari P, et al.

World J Mens Health, 2024 Apr 03.
PMID: 38606865 DOI: 10.5534/wjmh.230333

PURPOSE: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations.
MATERIALS AND METHODS: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries were analyzed descriptively, with a Delphi process used for expert recommendations.
RESULTS: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate.
CONCLUSIONS: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.
Fulltext Global Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations

Rambhatla A, Shah R, Ziouziou I, Kothari P, Salvio G, Gul M, et al.

World J Mens Health, 2025 Jan;43(1):92-122.
PMID: 38606867 DOI: 10.5534/wjmh.230339

PURPOSE: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA.
MATERIALS AND METHODS: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process.
RESULTS: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit.
CONCLUSIONS: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.

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