Dian Medical Journal

Feasibility of Using Passive Digital Phenotyping Data from Smartphones as Emerging Health Sensors in Medical Students: A Pilot Exploratory Study

2026-06-10T07:13:30+00:00

Background: Noncommunicable diseases and mental-health–related risks are rising among young adults in low- and middle-income countries. With near-universal smartphone use among Indonesian students, passively captured digital traces may offer low-cost signals of lifestyle balance relevant to student wellbeing.

Objective: To characterize smartphone-derived behavioral signatures of daily balance (screen exposure, sleep regularity, mobility, and notification–pickup dynamics) among Indonesian medical students and test their group-level associations as an exploratory foundation for future early-warning models.

Methods: Cross-sectional study of undergraduate medical students (UNISSULA, Indonesia) using iPhones ≥6 months. Anonymized screenshots from Apple Health and Screen Time (July–August 2024) provided daily steps, sleep duration, screen time, notifications, pickups, and dominant app category (social vs entertainment; two independent raters). Normality was assessed; non-parametric tests (Spearman’s rho, Kruskal–Wallis) were applied where appropriate.

Results: Forty-three students participated (n=43). Means (±SD): steps 3,546 ± 1,987/day, screen time 7.0 ± 2.3 h/day, sleep 4.2 ± 1.6 h/night, notifications 304 ± 151/day, pickups 143 ± 57/day. App-use distribution showed a polarity: 53.5% social-dominant vs 46.5% entertainment-dominant users. Screen time correlated negatively with sleep (ρ = −0.531, p < 0.001). Notifications correlated positively with pickups (ρ = 0.781, p < 0.001). Entertainment dominance application usage was associated with fewer steps than social dominance one (ρ = −0.455, p = 0.002; Kruskal–Wallis p = 0.03). Longer screen time predicted lower step count (p = 0.031).

Conclusions: Smartphone-derived metrics reveal a behavioral signature of imbalance: longer screen exposure, entertainment-heavy use, and high notification; pickup intensity linked to lower mobility and shorter sleep. These exploratory findings support the feasibility of smartphone data as candidate early-warning inputs for student wellbeing dashboards in resource-limited settings. Future longitudinal studies with psychometric/clinical labels, multi-device inclusion, and privacy-preserving pipelines are warranted.

Chronic Suppurative Otitis Media with Complication of Brain Abscess: A Case Series Report

2026-04-30T07:06:26+00:00

Introduction & Objective: Chronic suppurative otitis media (CSOM) can lead to life-threatening intracranial complications that require prompt management. The recommended management consists of abscess evacuation through craniotomy followed by mastoidectomy. This case report aims to evaluate the differences in management approaches between two cases of CSOM complicated by brain abscess. Methods: Two patients diagnosed with CSOM with brain abscess were included. The diagnoses were established through history taking, and thorough examination. The first patient underwent craniotomy for abscess evacuation followed by mastoidectomy, whereas the second patient underwent craniotomy alone without mastoidectomy. Results: The first patient showed significant improvement two months postoperatively. The second developed recurrent abscess one month after initial craniotomy and subsequently underwent re-craniotomy with radical mastoidectomy, resulting in full recovery. Conclusion: CSOM with brain abscess requires rapid and aggressive multidisciplinary management, involving abscess evacuation through craniotomy followed by tympanomastoidectomy or radical mastoidectomy.

Carbon Monoxide Poisoning A Case Study

2026-04-30T06:36:26+00:00

Introduction: Carbon monoxide (CO) is a colorless and odorless gas that often becomes a cause of injury and even accidental death worldwide. CO poisoning can come from defective heating systems, motor vehicle exhaust, or fire in poorly ventilated spaces.

Case study: A case is reported of death of an adult woman and her family who were found dead inside a vehicle on a toll road. The victims were found in a closed car without any obvious signs of external violence. External examination showed some parts of the body with bright red discoloration (cherry red lividity), and no blunt force injuries were found. Based on witness information around the scene, the victims were suspected to be exposed to carbon monoxide gas due to prolonged exposure to vehicle exhaust in a closed space. Forensic examination and medicolegal findings indicated death due to carbon monoxide poisoning.

Discussion: Carbon monoxide poisoning is a cause of death that is often difficult to recognize because clinical and postmortem findings are not specific. The mechanism of death is mainly due to tissue hypoxia caused by formation of carboxyhemoglobin and also direct cellular toxicity. The classic sign such as cherry-red lividity is rarely found and not pathognomonic, so toxicological examination by measuring COHb level is important for diagnosis. In deaths occurring in enclosed spaces without signs of violence, consistency between environmental condition, autopsy findings, and high COHb levels supports the conclusion of accidental carbon monoxide poisoning. This finding emphasizes the importance of forensic awareness and prevention efforts to reduce mortality from CO poisoning.

Conclusion: Carbon monoxide poisoning is an important cause of accidental death in forensic practice. Establishing diagnosis requires comprehensive evaluation including crime scene investigation, forensic examination of the body, and medicolegal analysis to determine the cause and mechanism of death.

A Wolf in Sheep’s Clothing: Xanthogranulomatous Pyelonephritis Mimicking Infection Revealing Underlying Renal Squamous Cell Carcinoma

2026-05-22T09:20:37+00:00

Renal masses associated with chronic infection may pose significant diagnostic challenges. We report a 59-year-old man presenting with abdominal pain and a palpable left abdominal mass. Initial ultrasound suggested severe hydronephrosis with proximal ureteral stone and a solid intrarenal lesion. Contrast-enhanced CT findings were consistent with Xanthogranulomatous Pyelonephritis. The patient subsequently underwent nephrectomy. Histopathological examination unexpectedly revealed Renal Squamous Cell Carcinoma. This case highlights the importance of considering underlying malignancy in chronic inflammatory renal conditions and emphasizes the role of imaging and histopathology in establishing definitive diagnosis.

Clinical Pathway–Based Quality and Cost Control in Type D Hospitals: A Practical and Ethical Framework

2026-05-22T04:12:40+00:00

Hospitals operating under universal health coverage face increasing pressure to balance quality of care, patient safety, and cost efficiency, particularly in resource-limited settings. This paper proposes a practical and ethical framework for quality and cost control in Type D hospitals using clinical pathways as the core operational instrument. A policy and practice approach was adopted, drawing on professional experience in hospital clinical governance and management. Clinical pathways standardize care processes, reduce unnecessary variation, support rational use of generic and locally produced medicines, and strengthen patient safety without compromising quality. Clinical pathway–based quality and cost control offers an ethically sound and operationally feasible approach for hospitals operating under case-based reimbursement systems.

Difference of Neutrophil to Lymphocyte Ratio (NLR) Value and Pain Scale in Herniorrhaphy Surgery with Mesh and Non-Mesh Repair

2026-04-30T06:50:49+00:00

Introduction: Inguinal hernia accounts for 75% of all abdominal wall hernias. Herniorrhaphy becomes the definitive procedure for inguinal hernia. This procedure is aimed to close the defect and perform tension-free repair using Mesh. However, the use of mesh has been associated with increasing of several complications such as risk of infection and inflammation which lead to chronic post-operative pain.

Objective: Our study objective is to analyze the difference of herniorrhaphy Mesh and Non-mesh Repair method based on the neutrophil to lymphocyte ratio (NLR) value and visual pain scale. Method: An experimental study with post-only design, single blind involving hernia patients who were indicated to undergo herniorrhaphy surgery. Research subjects were obtained by consecutive sampling until the minimum sample size of the study was fulfilled. Patients who fulfilled the inclusion criteria, did not have exclusion criteria, and were willing to participate in the study would become research subjects. Evaluation was performed on neutrophil to lymphocyte ratio (NLR) value and pain scale at 4 hours after surgery. Pain scale was measured using visual analogue scale (VAS) measurement tool with scale 0-10, where score 0 means no pain and score 10 means severe pain.

Results: NLR value in the mesh group was significantly higher compared to the non-mesh group (8.56 ± 1.87 vs 4.56 ± 1.5; p<0.001). Correlation evaluation found that there was a significant correlation between NLR value and VAS score with moderate positive correlation level (p=0.023; r=0.400).

Conclusion: Inguinal hernia patients who underwent herniorrhaphy with mesh method significantly had higher NLR value compared to non-mesh group. The increasing of NLR value has been associated with the increasing degree of pain based on VAS score.