e-ISSN: 2549-0265 Publisher: Masters Program in Public Health, Sebelas Maret University, Jl. Ir Sutami 36A, Surakarta 57126, Central Java, Indonesia Editor in Chief: Dr. Hendrastutik Apriningsih, dr., Sp.P (K), M.Kes Sebelas Maret University, Solo, Indonesia Description: Indonesian Journal of Medicine (IJM) is an international, open-access, and double-blind peer-reviewed journal, focusing on the publication of research evidence in the areas of biomedical science, clinical medicine, and community medicine. The journal began its publication on August 20, 2015, and was published online three times yearly. Due to the increasing demand for paper publication, beginning 2019 the journal is published quarterly (January, April, July, and October) with 12 articles in each issue. IJM provides a platform for health and medical researchers to publish high-quality medical research evidence from both developed and developing countries. It primarily publishes original research papers but also welcomes papers on systematic review/ meta-analysis, debate, and commentary. IJM recognizes the under-representation of medical issues impacting populations in the developing world in international journals. Therefore, the editors encourage authors from developing countries to submit and publish their research work in this journal. All papers published in IJM are freely available as downloadable PDF files. IJM is currently abstracted and indexed in DOAJ, CABI Global Health, <a href="https://scholar.google.com/citations?hl=en&user=osLJue8AAAAJ&view_op=list_works&citft=1&citft=2&citft=3&email_for_op=jurnals2ikm%40gmail.com&gmla=ABEO0Yosi57ZJQxiQZakIlrZZMHRVeUmviBwdbh0lzH43yrzKzPMUjXemetk742be-v_8vEdqM5T_3G3EqGJ179XBDV0o_hSbPoZwf5cIWbc4lRe7kFuPWjvflaGSlyGJQDhDo9yzNy4b0H9Pxig4N0YfukfZnHqlWqT_ZCWIewjQLoHPenaAsPXiv52uR7MFDfOJ2v9p3V-pEw_7aqKDrymFattIfDDThfRcw-6tYOSkj-SAg" target="_blank" rel="noopener">Google Scholar, CrossRef, SINTA, and GARUDA.We are making efforts to get it indexed in even broader international databases. This journal is accredited by the Ministry of Research, Technology, and Higher Education, Government of Indonesia, No. 21/E/KPT/2018, effective from July 9, 2018, to July 8, 2023.
Masters Program in Public Health, Sebelas Maret University
Association Between Early-Life Nutritional Practices and Children's Feeding and Swallowing Skills
Background: Children's feeding and swallowing abilities are vital functions that support optimal growth and development, involving the complex coordination of muscles and neural systems to ensure the safe and efficient consumption of food. This study aimed to analyze the role of early-life nutritional practices in the development of feeding and swallowing abilities among children in the Surakarta region using logistic regression analysis. Subjects and Method: This cross-sectional study was conducted in Surakarta, Central Java, from April to August 2025 and involved 50 children selected through purposive sampling. The indepen­dent variables were lactation-based early nutrition and post-lactation complementary nutrition practices, while feeding and swallowing abilities served as the dependent variables. Data were collected through interviews, observations, questionnaires, and the Dysphagia Disorder Survey (DDS). Associations between variables were analyzed using logistic regression in Stata 13. Results: The results of this study indicated that both a history of appropriate lactation-based early nutrition and appropriate post-lactation complementary nutrition practices were significantly associated with children's feeding and swallowing abilities. Children with a history of lactation-based early nutrition (b= 3.13; 95% CI= 0.97 to 4.27; p= 0.002) and appropriate post-lactation complemen­tary nutrition practices (b = 2.48; 95% CI = 0.49 to 4.23; p = 0.013) were more likely to demonstrate appropriate feeding abilities. Similarly, children with a history of lactation-based early nutrition (b = 3.11; 95% CI= 1.08 to 4.76; p= 0.002) and appropriate post-lactation complementary nutrition practices (b= 3.03; 95% CI= 1.10 to 5.18; p= 0.002) were more likely to exhibit appropriate swallowing abilities. Conclusion: This study concludes that both lactation-based early nutrition and appropriate post-lactation complementary nutrition practices are significant determinants of feeding and swallowing abilities in children.
post-lactation complementary nutrition history
Feeding and swallowing abilities; lactation-based early nutrition history; post-lactation complementary nutrition history
Copyright (c) 2026 Indonesian Journal of Medicine
Association Between Obesity and S­evere Knee Osteoarthritis
Background: Knee osteoarthritis is a common degenerative joint disease that causes pain, functional limitation, and reduced quality of life, especially among adults and older individuals. Obesity is an important modifiable risk factor that may contribute to disease progression and structural joint damage. This study aimed to evaluate the association between obesity and severe knee osteoarthritis based on the Kellgren–Lawrence classification. Subject and Methods: This analytical observational study used a cross-sectional design and secondary data from medical records of patients diagnosed with knee osteoarthritis at PKU Muhammadiyah Bantul Hospital from November 2024 to November 2025. A total of 104 eligible patients were selected using total sampling. Osteoarthritis severity was classified as mild (Kellgren–Lawrence grades 1–2) or severe (grades 3–4). The independent variables were age, sex, and obesity status, while the dependent variable was knee osteoarthritis severity. Data were analyzed using the Independent t-test and Chi-square test, with statistical significance set at p < 0.05. Results: The mean age of participants was 58.59 ± 11.03 years, and 75.0% were female. Obesity was found in 72.1% of participants, while severe knee osteoarthritis was identified in 33.7%. Patients with severe osteoarthritis were significantly older than those with mild osteoarthritis (61.69 ± 9.25 vs. 57.01 ± 11.58 years; p = 0.041). Obesity was significantly associated with severe knee osteoarthritis (p = 0.028), with obese patients having 3.20 times higher odds of severe disease than non-obese patients (95% CI: 1.10–9.32). Sex was not significantly associated with severity (p = 0.281). Conclusion: Obesity and older age were significantly associated with severe knee osteoarthritis, while sex was not. Weight management may help reduce the risk of disease progression.
Identification of Physiotherapy Problems in Patients with Chronic Obstructive Pulmonary Disease at Respira Hospital Yogyakarta: An Observational Study
Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. Common symptoms include dyspnea, chest pain, reduced thoracic expansion, and impaired pulmonary function. This study aimed to identify physiotherapy-related problems among patients with COPD at Respira Hospital Yogyakarta. Subject and Methods: This observational study was conducted from June to August 2025 at the Physiotherapy Outpatient Clinic of Respira Pulmonary Hospital, Yogyakarta. Physiotherapy-related problems were assessed using the modified Medical Research Council (mMRC) Dyspnea Scale, COPD Assessment Test (CAT), thoracic mobility measurements, Visual Analog Scale (VAS), Peak Flow Meter (PFM), and Incentive Spirometer. Results: A total of 102 patients with COPD participated in the study. Most participants were male (60.8%). Grade 2 dyspnea was reported by 50.0% of subjects, while 65.7% had moderate COPD symptoms. Impaired thoracic mobility was observed in 40.2%–47.1% of patients. Chest pain was reported by only one subject. Severe airflow obstruction was found in 60.8% of participants, with a mean peak expiratory flow of 52.08% of the predicted value. Impaired inspiratory capacity was identified in 48.0% of subjects. Conclusion: The main physiotherapy-related problems identified among patients with COPD at Respira Hospital Yogyakarta were dyspnea, COPD symptoms, impaired thoracic mobility, reduced peak expiratory flow, and decreased inspiratory capacity.
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD), physiotherapy, thoracic mobility, dyspnea, peak expiratory flow
When the Eustachian Tube Is Normal: Selective Epitympanic Dysventilation Syndrome in Primary Acquired Cholesteatoma – An Evidence-Based Case Report
Background: Primary acquired cholesteatoma is a benign yet locally destructive middle ear lesion with an incompletely understood pathogenesis. While Eustachian tube dysfunction is commonly implicated, it does not explain cases with normal middle ear pressure. Selective epitympanic dysventilation syndrome (SEDS) has been proposed as an alternative mechanism involving localized ventilation impairment within the epitympanum. This study aims to provide a clearer understanding of the clinical features of cholesteatoma associated with SEDS, which may help clarify its etiopathogenesis, support earlier detection, limit disease progression, and guide more appropriate, individualized clinical decision-making. Case presentation A 55-year-old female presented with one year of persistent, malodorous left otorrhea and progressive hearing loss over three months. Otoscopy revealed mucopurulent discharge with an attic perforation. Nasoendoscopy showed a patent Eustachian tube. Audiometry demonstrated mild conductive hearing loss (31.25 dB), and tympanometry showed a Type A curve, indicating normal middle ear pressure. Mastoid MSCT revealed opacification of mastoid air cells and antrum with intact ossicles and no mesotympanic involvement, suggesting a localized ventilation disorder consistent with SEDS. Conclusion: SEDS is an important and underrecognized mechanism in primary acquired cholesteatoma. Its recognition is essential for early diagnosis and for guiding surgical strategies that restore epitympanic ventilation to prevent recurrence.
selective epitympanic dysventilation syndrome
Primary acquired cholesteatoma, selective epitympanic dysventilation syndrome, epitympanum, middle ear ventilation disorders, retraction pocket
Unilateral Left-Sided Tessier Type 4 Facial Cleft in a 6-Mont-Old Infant: A Case Report with Surgical Reconstruction and Outcome
Background: Cleft Tessier is the most complex classification characterized by oro-orbital malformations with a transverse defect in the mouth extending to the nose and crossing to the lower eyelids. Recent research shows a lack of optimal reconstruction techniques, both surgical methodology and procedural. This case report aims to describe the clinical presentation, surgical reconstruction methodology, and outcomes in a 6-month-old baby with a left unilateral Tessier type 4 facial cleft. Subject and Methods: A 6-month-old female newborn appears with a congenital left unilateral facial cleft that has existed since birth. Ocular examination showed partial involvement of the lower eyelid with a risk of exposure, while the eyeball was intact. Tessier type 4 cleft arises from failure of fusion between the maxillary and lateral nasal prominences during embryogenesis. Results: Surgical management focuses on restoring both function particularly ocular protection and oral competence and facial aesthetics. Early intervention during infancy offers advantages such as improved tissue healing, better adaptation to facial growth, and reduced psychosocial impact. The reconstruction results achieved good initial functional and esthetic outcomes. Further monitoring during the growth period is necessary to assess facial asymmetry and hyperpigmentation that may occur. Conclusion: Infant reconstruction can yield better esthetics and function, although monitoring and follow-up actions are necessary.
Tessier type 4 cleft, Facial cleft reconstruction, Craniofacial surgery, Pediatric
Analysis of Risk Factors for Spinal Postural Disorders among Primary School Children
Background: Spinal postural disorders (kyphosis and lordosis) are increasingly prevalent among primary school children during the pre-pubertal phase when the spine remains structurally plastic. Evidence on screen time, physical activity, ergonomics, and nutritional status as simultaneous risk factors remains limited. This study examined their associations and identified the dominant determinant. Subjects and Method: A cross-sectional study was conducted at an Integrated Islamic Primary School in Bekasi, Indonesia. A total of 240 students aged 9–12 years were enrolled by total sampling. The dependent variable was spinal postural disorder (kyphosis and/or lordosis), assessed by Occiput Wall Distance and Lumbar Wall Distance. Independent variables were screen time, physical activity, learning ergonomics, and nutritional status (BMI-for-age z-score, WHO AnthroPlus). Data were analysed by chi-square, Spearman correlation, multivariable logistic regression, and path analysis (SEM-ML). Results: Prevalence of spinal postural disorders was 77.5% (kyphosis 55.8%; lordosis 63.3%; both simultaneously 44.2%). High screen time (>2 h/day) was found in 87.5% (mean 4.90±2.10 h/day), 61.7% were physically inactive, and 67.5% had abnormal nutritional status. Multivariable analysis identified BMI (aOR=1.12; 95% CI=1.04 to 1.21; p=0.002), high screen time (aOR=2.18; 95% CI=1.03 to 4.61; p=0.041), and physical inactivity (aOR=2.61; 95% CI=1.27 to 5.35; p=0.009) as independent predictors. Obesity showed the strongest bivariate association (OR=3.80; 95% CI=1.80 to 8.10; p<0.001). Path analysis confirmed BMI as the dominant determinant (total effect=0.38; CFI=1.00; RMSEA=0.00) and physical activity as a partial mediator of the BMI (Sobel z=2.34; p=0.019) and screen time (Sobel z=2.50; p=0.012) pathways. Conclusion: Obesity, high screen time, and physical inactivity pose a high risk of spinal postural disorders. Weight management, screen time restriction, and increased physical activity are essential.
Profile of Skin Biopsy Patients Undergoing Histopathological Examination at Universitas Sebelas Maret Hospital, Surakarta, Indonesia, in 2024
Background: The clinical presentation of various skin diseases often overlaps, necessitating ancillary examinations to establish an accurate diagnosis. Skin biopsy followed by histopathological evaluation remains the standard method to confirm a wide range of dermatological disorders. This study aims to describe the demographic, clinical, and histopathological profiles of skin biopsy patients as well as to evaluate clinicopathological concordance. Subjects and Method: This retrospective descriptive study utilized secondary data from medical records of patients who underwent skin biopsy and histopathological examination between January and December 2024 at Universitas Sebelas Maret Hospital. Patients with complete medical records and available histopathological results were included, while those with incomplete data were excluded. Variables analyzed included demographic characteristics (age and sex), lesion site, clinical indications for biopsy, and histopathological diagnosis. Results: A total of 29 patients underwent skin biopsy during the study period. The majority were male (51.72%) and within the 46–65-year age group (48.28%). The most common biopsy site was the upper extremities (41.38%). Histopathological findings showed that erythematosquamous and infectious disorders were the most frequent diagnoses (20.7% each). The least common diagnosis was vesiculobullous disease, with only one case (3.45%). The concordance rate between clinical and histopathological diagnoses was 93.1%. Conclusion: Most skin biopsy patients were males aged 46–65 years, with lesions commonly located on the upper extremities. Erythematosquamous and infectious dermatoses were the predominant diagnostic categories. The high clinicopathological concordance (93.1%) emphasizes the reliability of histopathology in confirming dermatologic diagnoses.
Correlation of Serum Immunoglobulin-E Level With Allergic Rhinitis Severity Based on Symptoms Classification
Background: Allergic rhinitis (AR) is defined as an Imunoglobulin-E (IgE) -mediated reactions to inhaled allergens in atopic individual, with symptoms including runny nose, itchy nose, nasal congestion, and sneezing. Serum IgE was a reliable diagnostic marker for allergic rhinitis. This study aimed to reveal the correlation between IgE levels and the severity of allergic rhinitis symptoms according to the Allergic Rhinitis and Its Impacts on Asthma (ARIA) classification. Subject and Methods: A cross-sectional observational study was conducted involving 45 patients diagnosed with allergic rhinitis at the Otorhinolaryngology outpatient clinic. Subjects were identified through clinical evaluation, blood screening, and skin prick tests. Serum total IgE levels were measured using the enzyme-linked immunosorbent assay (ELISA) method. Allergic rhinitis severity was categorized according to the ARIA classification into mild and moderate groups. Data were analyzed using the Chi-square test, and the association was presented as prevalence ratio (PR) with a 95% confidence interval (CI). Results: Forty-five patients with allergic rhinitis comprised of 30 females (66.70%) and 15 males (33.30%). The average IgE levels examination results were 204.24 IU/ml, with 23 subjects (48.89%) classified as standard, while those with higher-than-normal IgE levels were 22 subjects (53.49%). The Pearson chi-square test showed a significant correlation between higher-than-normal IgE levels and ARIA severity (PR = 1.65; 95% CI = 1.03–2.64; p = 0.045) Conclusion: Elevated serum IgE levels were significantly associated with greater allergic rhinitis severity based on ARIA classification and may serve as a useful supporting marker for disease severity assessment.
IMPACT OF PATENT DUCTUS ARTERIOSUS CLOSURE ON LINEAR GROWTH AND WEIGHT GAIN IN CHILDREN: A PROSPECTIVE COHORT STUDY
Background: Patent ductus arteriosus (PDA) can cause pulmonary circulatory volume overload and hemodynamic disturbances that result in feeding difficulties, recurrent infections, and growth retardation. PDA closure intervention is expected to improve physiological conditions, thereby supporting improvements in linear growth and weight gain. Subject and Methods: This prospective cohort study was conducted at Dr. Moewardi General Hospital from January 2024 to July 2025. The target population was children diagnosed with patent ductus arteriosus (PDA). Subject was all of pediatric PDA patients at Dr. Moewardi General Hospital Surakarta who underwent PDA closure procedures (total sampling). Subjects with complete anthropometric data such as body weight and height at PDA pre-procedure, with 3 and 6 months after PDA procedure (post-procedure) were selected. The dependent variables were changes in height (cm) and body weight (kg), measured using standard anthropometric methods. Data were analyzed using the Friedman test for repeated measures, followed by paired Wilcoxon tests with Bonferroni correction for post-hoc comparisons. Results: Total there were 48 children who underwent PDA closure with complete anthropometric data at PDA pre- and 3 to 6 months post-procedure. Mean height significantly increased 4.5% from 83,60 ± 26,23 cm at PDA pre-procedure to 87,34 ± 24,87 cm at 3 months post-procedure, and increased 8.1% to90,39 ± 23,64 cm at 6 months post-procedure( p<0,001). Mean body weight also significantly increased 9.3% from 11,49 ± 12,21 kg at PDA pre-procedure to 12,56 ± 11,93 kg at 3 months post-pocedure then increase 16.1% to 13,34 ± 11,88 kg at 6 months post-procedure (p<0,001). The height and weight of children with PDA closure increased over the observation period. Conclusion: PDA closure is associated with a significant increase in linear growth and weight gain up to 6 months post-procedure.
Patent ductus arteriosus; PDA closure; linear growth; body weight; prospective cohort
Associations Between Non-Ergonomic Working Posture,Work-Related Stress, Smoking Habits, and Physical Activitywith Low Back Pain among Police Personnel in theSpecial Region of Yogyakarta
Background: Low back pain is one of the most common musculoskeletal complaints among police personnel. Several factors, including working posture, work-related stress, smoking habits, and physical activity, are presumed to be associated with the occurrence of low back pain. This study aimed to analyze factors associated with low back pain among police personnel. Subjects and Method: This analytic observational study with a cross-sectional design involved 226 male and female police personnel aged 20–40 years in the Special Region of Yogyakarta, selected using total sampling. The dependent variable was the occurrence of low back pain, while the independent variables included working posture, work-related stress, smoking habits, physical activity, age, and years of service. Data were collected using the Rapid Upper Limb Assessment (RULA) to assess working posture, the Police Stress Questionnaire–Operational (PSQ-Op) to measure work-related stress, and the Numeric Rating Scale (NRS) to assess low back pain intensity. Data were analyzed using the Chi-square test and path analysis. Results: Path analysis showed significant direct effects of non-ergonomic working posture (b = 0.19; 95% CI = 0.09 to 0.29; p < 0.001), work-related stress (b = 0.35; 95% CI = 0.23 to 0.46; p < 0.001), smoking habits (b = 0.17; 95% CI = 0.05 to 0.29; p = 0.007), physical activity (b = −0.16; 95% CI = −0.27 to −0.05; p = 0.006), and age (b = 0.11; 95% CI = 0.01 to 0.22; p = 0.034) on the occurrence of low back pain. Years of service had an indirect effect on low back pain through age (b = 0.99; 95% CI= 0.98 to 0.99; p < 0.001). Conclusion: Non-ergonomic working posture, work-related stress, smoking habits, physical activity, and age have direct effects on the occurrence of low back pain.
Effectiveness of 2% Lidocaine Combined with Acupressure on Anxiety, Stress, and Pain Levels During Pleural Puncture Procedures
Background: Pleural puncture (thoracentesis) often causes anxiety, stress, and pain. Although 2% lidocaine is commonly used for analgesia, its effect on psychological distress is limited. Acupressure may help reduce both pain and emotional discomfort. This study evaluated the effectiveness of 2% lidocaine combined with acupressure in patients undergoing pleural puncture. Subjects and Method: A randomized controlled trial was conducted on 36 patients undergoing pleural puncture at Dr. Moewardi Regional General Hospital, Surakarta, Indonesia. Patients were allocated to three groups: Control (2% lidocaine 4 cc), Treatment 1 (2% lidocaine 4 cc + acupressure), and Treatment 2 (2% lidocaine 2 cc + acupressure). Acupressure was applied 20 minutes prior to the procedure at points PC6, Yintang (EX-HN3), Hegu (LI4), and Baihui (GV20). Anxiety, stress, and pain were assessed using DASS-21 and Numeric Rating Scale (NRS) before and after the procedure. Data were analyzed using Shapiro-Wilk normality test, Levene homogeneity test, ANOVA, paired t-test, and post hoc LSD test. Results: Anxiety scores were lower in treatment 1 (Mean=5.66; SD=2.38) and treatment 2 (Mean= 5.16; SD=2.48) than in the control group (Mean=8.00; SD=3.07; p=0.009). Stress scores were also lower in treatment 1 (Mean=4.50; SD=2.27) and treatment 2 (Mean=4.33; SD=2.53) versus control (Mean=7.16; SD=3.01; p=0.001). Pain scores were reduced in treatment 1 (Mean=1.50; SD=1.31) and treatment 2 (Mean=1.33; SD=0.88) compared with control (Mean=2.91; SD=1.67; p=0.036). No significant differences were found between treatment groups (p>0.05). Conclusion: Acupressure combined with 2% lidocaine effectively reduces anxiety, stress, and pain during pleural puncture. Lower-dose lidocaine provided comparable outcomes when combined with acupressure.
Massage Therapy as a Strategy for Managing Stress and Physical Symptoms in Pre-Menopause Women
Background: Pre-menopause is a transitional phase characterized by decreased estrogen and triggers various physical and psychological complaints, such as hot flashes, sleep disturbances, muscle pain, fatigue, and stress, that can reduce women’s quality of life and productiv ity. Massage therapy, as a non-pharmacological intervention, is known to reduce cortisollevels, increase endorphins, improve blood circulation, and promote musclerelaxation, potentially effectively reducing stress and physical complaints in premenopausal women at the community level. This study aims to analyze the effectiveness of massage therapy in reducing stress and physical symptoms among premenopausal women. Subjects and Method: This quasi-experimental study involved 64 premenopausal women members of Ibu Aisyiyah Mulyorejo group who were divided into an intervention group (n=32) who received massage therapy and a control group (n=32) without massage. Massage therapy was given twice a week for 30–45 minutes per session, while changes in physical and psychological complaints were measured using the Menopause Rating Scale (MRS) before and after the intervention and analyzed using the Wilcoxon and Mann–Whitney tests at a significance level of p<0.05. Results: Before the intervention, 97% of respondents in the intervention group were classified as having severe complaints, while 3% were in the moderate category. Following massage therapy, all respondents demonstrated improvement, with 75% categorized as having moderate complaints and 25% as having mild complaints, and no participants remaining in the severe category. The Wilcoxon test indicated a significant reduction in MRS scores within the intervention group (p = 0.002; r = 0.87), while the Mann–Whitney test showed that post-intervention MRS scores in the intervention group were significantly lower than those in the control group (p = 0.005). Conclusion: Massage therapy is effective in reducing psychological and physical complaints in premenopausal women and can be recommended as a community-based complementary strategy for managing stress and somatic symptoms in this group
pre-menopause, massage therapy, stress, physical complaints, Menopause Rating Scale
The Diagnostic and Therapeutic Challenges of A Progressive Male Breast Cancer with Brain Metastases: A Case Report
Background: Male breast cancer (MBC) is a rare malignancy that is often associated with advanced stages and poor prognosis due to lack of public awareness and early screening, along with stigmatization of the disease. Aims: This case report aims to highlight the diagnostic and therapeutic challenges of rapidly-progressive MBC in resource-limited healthcare, particularly those compounded by systemic and patient-attributable delays, and emphasize the importance of prevention and early detection of breast cancer in the male population. Subject report: We report the case of a 71-year-old man with a three-month history of a progressively enlarging lump on right breast, weight loss, and right-sided hemiparesis. Medical history included chronic heart failure, dyslipidemia, heavy smoking, and labour work background. The diagnosis of invasive ductal breast carcinoma was established through clinical assessment, imaging, and biopsy. Results: The patient underwent primary tumor resection (PTR) in the form of radical mastectomy, where the main purpose was tumor debulking, revealing tumor invasion into the pectoralis major muscle (pT4 disease). The clinical course was severely impacted by Treatment Delay, encompassing Provider Delay and Patient Delay, which was caused by logistical, operational, and policy barriers. This delay critically postponed the scheduled non-contrast computed tomography (CT) of the head. The delayed CT subsequently revealed multiple metastases. The patient was then referred for immunohistochemistry (IHC) evaluation and systemic therapies but passed away before the scheduled workup due to a declining neurological state from confirmed brain metastases. Conclusion: This case underscores how the challenges of rapidly progressive MBC with brain metastases, combined with a variety of delays and constrained treatment options, resulted in a poor outcome. It highlights the critical need for increased awareness, stigma reduction, and streamlined resource pathways to improve early detection and timely intervention in resource-limited settings.
Breast cancer, Male, Treatment Delays, Metastases
Plasma Serotonin Levels and Depression Scores in Informal Caregivers of Patients with Dementia and without Dementia: A Systematic Review
Background: Depression frequently affects informal caregivers, particularly those caring for dementia patients due to greater emotional and caregiving burdens. This study aims to compare depression levels and plasma serotonin concentrations between dementia and non-dementia caregivers. Subjects and Method: A systematic review was conducted using PRISMA guidelines. Articles were searched from PubMed, ScienceDirect, and Google Scholar between 2015–2024 using the keywords: dementia caregiver, non-dementia caregiver, depression, and serotonin. Nine primary observational studies met the inclusion criteria: full-text availability, adult informal caregivers, and quantitative measurement of depression and/or serotonin. Data were synthesized narratively. Results: Most studies demonstrated higher depression levels among dementia caregivers compared to non-dementia caregivers. Emotional distress, patient behavioral symptoms, and caregiving duration were identified as major contributing factors. One study showed lower plasma serotonin associated with higher depressive scores, supporting possible biological involvement. Conclusion: Dementia caregivers exhibit greater depressive symptoms than non-dementia caregivers, potentially linked to caregiving burden and serotonin imbalance. Early psychological screening and targeted support interventions are recommended.
Traditional Treatment Choices for Managing Dysmenorrhea Among Adolescent Girls: An Application of the Health Belief Model
Background: Dysmenorrhea is a common reproductive health problem among adolescent girls and often interferes with daily activities. Various management strategies are used to alleviate dysmenorrhea, including the use of traditional medicine. This study aimed to examine the influence of Health Belief Model (HBM) constructs on the choice of traditional medicine for reducing dysmenorrhea among adolescent girls. Subject and Methods: This quantitative study employed a cross-sectional design carried out in Boyolali Regency, Central Java, Indonesia. A total of 200 female adolescents were selected using stratified random sampling. Data were collected using a standardized questionnaire that had been tested for validity and reliability. Multivariate data analysis was conducted using path analysis to identify both direct and indirect effects among variables. Results: The selection of traditional medicine for dysmenorrhea management among adolescent girls was directly influenced by perceived benefits (b = 1.29; 95% CI= 0.61–1.97; p < 0.001) and perceived severity (b= −0.14; 95% CI= −0.71 to 0.43; p= 0.631). Meanwhile, perceived susceptibility (b= 0.81; 95% CI= 0.17–1.45; p= 0.013), perceived barriers (b= −1.53; 95% CI= −2.29 to −0.77; p < 0.001), cues to action (b= 1.44; 95% CI= 0.80–2.09; p < 0.001), and self-efficacy (b= −0.98; 95% CI= −1.61 to −0.34; p = 0.003) had indirect effects on the choice of traditional medicine. The resulting path model demonstrated good goodness-of-fit. Conclusion: Health Belief Model constructs can be effectively applied as a framework for understanding the selection of traditional medicine. HBM-based interventions that emphasize increasing perceived benefits and managing perceived barriers are recommended to support informed reproductive health decision-making among adolescents
Health Belief Model, traditional medicine, dysmenorrhea, adolescent girls
The Impact of Cognitive Impairment on Rehabilitation Outcomes among Geriatric Populations: A Systematic Review
Background: Cognitive impairment is a common issue in older adults and may significantly affect rehabilitation outcomes. Understanding the extent of its impact on medical rehabilitation is crucial for optimizing patient care and tailoring interventions for geriatric populations. Subjects and Method: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature searches were performed using Google Scholar and PubMed to identify studies that examined the relationship between cognitive impairment and medical rehabilitation outcomes in the elderly. No restrictions were applied regarding publication dates or geographic regions, but only studies published in English were included. Out of 123 studies initially identified, 13 met the inclusion criteria, and 11 were included in the qualitative synthesis. Results: The analysis revealed that cognitive impairment negatively influenced rehabilitation outcomes in older adults. Patients with higher Mini-Mental State Examination (MMSE) scores demonstrated better functional recovery and greater improvements in rehabilitation. In contrast, those with significant cognitive impairment experienced reduced gains, highlighting a clear association between cognitive status and rehabilitation success. Conclusion: Cognitive impairment poses a substantial barrier to optimal rehabilitation outcomes among geriatric patients. These findings underscore the importance of incorporating cognitive assessment into rehabilitation planning and providing tailored interventions that address cognitive deficits. Enhancing rehabilitation strategies for individuals with cognitive impairment may improve functional recovery and overall quality of life in older populations.
Early vs. Late Initiation of Hemodialysis: Early Initiation as a Life-Saving Option in Stage III Leptospirosis Induced Acute Kidney Injury
Background: Leptospirosis is a zoonotic disease endemic in tropical regions with a high burden among low-income populations. Its clinical spectrum ranges from mild illness to severe Weil’s disease, which may involve multiple organs with common and severe complication is acute kidney injury (AKI) with no specific therapy exists. In this report, we describe how early hemodialysis may improve outcomes. Case Presentation: A 60-year-old man presented with a 10-day history of fever. He also reported calf pain and jaundice that had appeared one week prior to admission. Over the past week, the patient experienced decreased urinary frequency, with urine becoming more concentrated in color. Laboratory tests revealed thrombocytopenia, leukocytosis, elevated SGOT and SGPT levels, hyperbilirubinemia, and azotemia. Leptospira IgM was positive. Urinalysis demonstrated proteinuria and bilirubinuria. The patient’s Modified Faine’s Criteria score was 34, and his SOFA score was 11. Results: Patient was diagnosed with Weil's disease with AKI III complicated by sepsis. The furosemide stress test was administered to the patient but the results was not favorable therefore hemodialysis was initiated leading to an improvement in the patient’s condition. Conclusion: Early initiation of hemodialysis in patients with leptospirosis induced AKI provides favorable immediate outcome and prevents them from falling into uremic syndrome leading to mortality.
Weil’s disease, leptospirosis, early hemodialysis, outcome, uremic syndrome
Anti-inflammatory and Anti-infertility Effects of Ethanol Extract of Turmeric (Curcuma longa) in Male Wistar Rats with Type 2 Diabetes Mellitus Induced by Streptozotocin-Nicotinamide-High Fat Diet
Background: Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder associated with chronic inflammation and male reproductive dysfunction. The ethanol extract of turmeric (Curcuma longa) has demonstrated potential as an alternative therapeutic agent due to its anti-inflammatory and reproductive restorative properties. This study aims to analyze the anti-inflammatory and anti-infertility effects of the ethanol extract of Curcuma longa in male Wistar rats with T2DM induced by a streptozotocin-nicotinamide-high fat diet (STZ-NA-HFD). Subjects and Method: Thirty male Wistar rats were randomized into six groups (n=5): normal control (K1), diabetic control (K2), positive control (T2DM + metformin 45 mg/kgBW, K3), and three treatment groups receiving Curcuma longa extract at doses of 50 mg/kgBW (K4), 100 mg/kgBW (K5), and 150 mg/kgBW (K6). Diabetes was induced with STZ (55 mg/kgBW) and nicotinamide (120 mg/kgBW). Blood glucose, IL-6, testosterone levels, sperm count, and sperm motility were evaluated after 21 days of treatment. Results: The turmeric extract significantly reduced blood glucose levels (p<0.001) and IL-6 concentrations from 574.06±68.99 to 214.06±78.71 ng/mL at a dose of 150 mg/kgBW (p<0.001). Normal sperm motility increased significantly at 150 mg/kgBW (20.0±2.55%) compared to the diabetic control (8.40±2.07%) (p=0.008). Conclusion: The ethanol extract of Curcuma longa demonstrated significant anti-inflammatory activity by reducing IL-6 levels and improving glycemic control. Its anti-infertility effect was reflected by enhanced sperm motility, particularly at the 150 mg/kgBW dose. These findings indicate that Curcuma longa possesses potential as an adjuvant therapy for the management of T2DM and its associated complications.
Type 2 diabetes mellitus, Curcuma longa, anti-inflammatory, fertility, interleukin-6, spermatogenesis
Copyright (c) 2025 Indonesian Journal of Medicine
Evaluation of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Diabetic Kidney Disease Patients: A Hospital-Based Cross-Sectional Analysis
Background: Diabetes mellitus represents a chronic metabolic disorder with globally increasing prevalence and is one of the leading causes of microvascular complications such as diabetic kidney disease (DKD). Chronic inflammation plays a crucial role in DKD pathogenesis, prompting exploration of simple inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). This study aimed to determine the relationship between NLR and PLR values with the incidence of DKD. Subject and Methods: This cross-sectional study employed consecutive non-random sampling technique. The study population consisted of all patients visiting Cinta Kasih Tzu Chi Cengkareng Hospital from January to April 2025, totaling 128 respondents. Secondary data from medical records were analyzed using Chi-Square test to determine associations between NLR and PLR (categorized as high vs low) with diabetic kidney disease incidence. Statistical analysis employed Chi-Square test with significance set at p<0.050. Results: Among 128 respondents, 64 (50.00%) were diagnosed with diabetic kidney disease. High NLR group comprised 101 respondents (78.90%), with 50 (39.10%) having DKD. High PLR group totaled 32 respondents (25.00%), with 19 (14.80%) having DKD. NLR demonstrated no significant association with DKD incidence (PR= 0.96; CI95% 0.48 to 1.41; p=0.828). PLR also showed no significant association with DKD incidence (PR= 0.89; CI95% 0.52 to 1.53; p=0.552). Conclusion: Neither NLR nor PLR demonstrates a significant relationship with diabetic kidney disease incidence at Cinta Kasih Tzu Chi Cengkareng Hospital. These findings suggest that NLR and PLR cannot be used as standalone predictors for DKD and should be considered alongside other clinical parameters in comprehensive diabetes management protocols.
Health Belief Model Application in Bone Fracture Treatment-Seeking Behavior: Preferences for Traditional Bone-Setting Treatment versus Orthopedic Surgery
Background: Bone fractures are a significant public health issue, with 178 million new cases globally in 2019 and a prevalence of 5.5% in Indonesia. The Indonesian community tends to choose traditional treatment such as herbal medicine or surgical treatment for fractures, influenced by sociodemographic factors, culture, and individual perceptions. This study aims to analyze the Health Belief Model (HBM) factors that affect the choice of bonr fracture treatment services in the community. Subjects and Method: This cross-sectional study was conducted in Surakarta during April–May 2025, involving 200 participants, comprising 100 users of traditional bone-setting treatment and 100 users of orthopedic care. Data were collected using an online questionnaire covering demographic characteristics and HBM constructs. The data were analyzed using univariate methods, bivariate analysis with simple logistic regression, and multivariate analysis employing path analysis. Results: The decision to choose type bone fracture treatment care was directly influenced by perceived susceptibility (b = -2.30; 95% CI: -3.09 to -1.50; p < 0.00), benefits (b = 1.80; 95% CI: 0.89 to 2.72; p < 0.00), self-efficacy (b = 1.36; 95% CI: 0.51 to 2.22; p < 0.00), and action cues (b = 3.80; 95% CI: 1.70 to 5.90; p < 0.00), while the perception of barriers indirectly lowers self-efficacy (b = -0.65; 95% CI: -1.29 to -0.02; p < 0.04). Conclusion: The HBM constructs, especially perceived vulnerability, benefits, self-efficacy, and action cues, significantly influence the choice of treatment for fractures. Educational interventions are recommended to enhance the perception of the benefits of medical services and strengthen the self-efficacy of the community.
Health Belief Model, fractures, limb amputation, bone surgery, health behavior