Application of third molar maturity index for Indonesia minimum legal age of marriage: a pilot study.

IBackground: Child marriage is recognised as a harmful practice. Recently, Indonesia enacted a new law to raise the minimum age of marriage from 16 to 19 years old for women, creating no minimum age difference between males and females. However, this improvement may be detrimental for individuals in remote areas with no legal documentation and the common practices of age falsification to reach the minimum age of marriage. Therefore, implementing an age estimation technique for juveniles is mandatory to reduce the risk of child marriage. METHODS: this study used the third molar maturity index (I3M) to distinguish an individual under or over 19 years old. I3M values from 222 digital OPGs aged between 15 to 23.99 years were calculated. The sample was randomly assigned as a training dataset (n = 156) and testing dataset (n = 66). The logistic regression model was created using a 5-fold cross-validation method, and the Youden's Index Value was used to establish the I3M cut-off value. RESULTS: the logistic regression model showed significance in both sex and I3M value for predicting the probability of minimum age of marriage. I3M cut-off values of 0.08 and 0.09 for males and females, respectively, were taken. The accuracy of this test was 80% for both sexes in the testing dataset. CONCLUSIONS: the outcome of this pilot study showed a promising result of using I3M as a dental age estimation method to determine whether an individual is over or under 19 years old to comply with the newly enacted legal age of marriage in Indonesia. Future research should be carried out using a balanced age cohort for each sex and a more extensive training sample size to investigate the influence of sex in the cut-off value calculation.

Does elective orthopaedic surgery in pandemic era increase risk of developing COVID-19? A combined analysis of retrospective and prospective study at Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

BACKGROUND: To date, no recommendations have been published on when and how to start again carrying out elective, non-urgent surgery on COVID-19-negative patients after the epidemic peak has been reached in a given country or region and the pressure on healthcare facilities, healthcare workers and resources has been released by so far that elective surgery procedures can be safely and ethically programmed again. This study aims to investigate whether elective orthopaedic surgery will increase the risk of developing COVID-19. MATERIALS AND METHODS: This was a combined retrospective and prospective studies performed at a national tertiary hospital in Jakarta, Indonesia. Subjects were patients who underwent elective orthopaedic surgeries at our institution from April to May 2020. Those who were previously infected with COVID-19 from polymerase chain reaction (PCR) reverse transcriptase (RT) examination obtained via nasopharynx and oropharynx swab, as well as those who were reluctant to participate were excluded from the study. RESULTS: A total of 35 subjects (mean age 32.89 ± 17.42) were recruited. Fifteen (42.9%) subjects were male, and 20 subjects (57.1%) were female. Mean duration of surgery was 240 min with the longest and shortest duration of 690 and 40 min, respectively. General anaesthesia was performed in the majority of cases in 18 surgeries (51.4%) with local anaesthesia as the least in 2 surgeries (5.7%). Length of stay of our study was 6 days of average. None of the patients developed symptoms suggestive of COVID-19 infection. CONCLUSION: We found that elective orthopaedic surgery may not be associated with increased cases of COVID-19 cases. However, our study was limited by short duration of follow-up. Further studies are required in order to investigate the affect of undergoing elective surgery and the number of COVID-19 cases.

Wide resection versus curettage with adjuvant therapy for giant cell tumour of bone.

PURPOSE: To determine the association between type of surgery (wide resection versus curettage with adjuvant therapy) and outcome in patients with giant cell tumour (GCT) of bone. METHODS: Records of 30 male and 52 female consecutive patients aged 10 to 62 years who underwent wide resection (n=57) or curettage with adjuvant therapy (n=25) for primary GCT of bone were reviewed. The surgical decision was based on patient age, tumour location, functional demand, and patient preference. The median tumour size was 8.5 cm. Tumours were classified as stage 1 (n=4), stage 2 (n=60), and stage 3 (n=18), and 25%, 68.3%, and 83.3% of them were treated with wide resection, respectively. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) score; the maximum score was 30. RESULTS: The wide resection and curettage with adjuvant therapy groups were comparable in terms of patient age, gender, tumour size, location, symptoms, tumour stage, type of biopsy, and MSTS score. The MSTS score was excellent in 50.2% of patients, good in 38.7% of patients, and fair and poor in the remaining patients. The MSTS score was not associated with tumour stage or type of surgery. Four patients in the wide resection group had metastasis to the lung. They also had lower haemoglobin level (10.6 vs. 12.7 g/dl, p=0.020) and higher percentage of stage-3 tumour (100% vs. 17.9%, p=0.001) but had no recurrence (0% vs. 6.4%, p=0.774), compared with those without metastatsis. All died from massive haemoptysis and respiratory failure. Eight patients died; their haemoglobin level was lower than that of patients who were still living (11.2 vs. 12.7 g/dl, p=0.032). Mortality was associated with metastasis (100% vs 5.2%, p<0.001) but not recurrence or complication. Two patients in each group had recurrence; recurrence was not associated with type of surgery. CONCLUSION: There was no association between type of surgery and tumour recurrence, metastasis, or outcome. Curettage with adjuvant therapy was more commonly performed for stage 1 and 2 tumours, whereas wide resection was more for stage 3 tumours. Metastasis was associated with stage 3 tumour and mortality but not recurrence.