Indonesian Journal of Medicine (IJM)
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Duration vs Discipline: Uncovering Therapy Adherence Antiretrovirals in People with HIV
Full text linkBackground: HIV is a retrovirus targeting the immune system, requiring continuous antiretro-viral therapy (ARVs) for effective management. In Indonesia, 329,581 HIV cases were documented from 1987 to 2022, with only 51% receiving ARVs. Adherence is crucial for treatment success, but prolonged therapy may impact medication compliance. This study investigates the correlation between ARV treatment duration and adherence levels at Dr. Moewardi Hospital.
Subjects and Method: A cross-sectional observational study was conducted at the Voluntary Counseling and Testing (VCT) clinic, involving 60 HIV-diagnosed individuals selected through purposive sampling. Therapy duration was extracted from medical records, and adherence was assessed using the MMAS-8 questionnaire during June and July 2024. Bivariate analysis employed the Spearman correlation coefficient test.
Results: The study sample predominantly consisted of individuals aged 36-45 years, with the majority having completed high school education. The mean therapy duration was 5.60 ± 3.64 years, ranging from 1 to 15 years. Adherence levels varied significantly, with 48.3% of patients demonstrating high adherence, characterized by a mean therapy duration (Mean= 6.86 years; SD= 3.62). Moderate adherence was observed in 16.7% of participants, with a mean therapy duration (Mean= 6.60 years; SD= 2.55). Low adherence was found in 35.0% of patients, associated with a shorter mean therapy duration (Mean= 3.38 years; SD= 3.14). There was a positive and sig¬nificant association between therapy duration and adherence level (r= 0.415; p= 0.001).
Conclusion: The length of antiretroviral therapy (ART) exhibits a favorable correlation with adherence levels among individuals living with HIV. An extended duration of the therapeutic regimen is correlated with an enhanced adherence rate. This observation underscores the significance of sustained support, particularly during the initial years of the treatment course
Determinant Analysis of Hypertension in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study in Medan, North Sumatera, Indonesia
Full text linkBackground: Type 2 diabetes mellitus (T2DM) and hypertension are two chronic conditions that frequently co-occur and pose a significant health burden. At Padang Bulan Primary Healthcare Center in Medan, out of 260 Prolanis participants, 117 T2DM patients sought treatment, and 90 of them were diagnosed with hypertension. This study aimed to analyze the determinants of hypertension in T2DM patients receiving care at Padang Bulan Primary Healthcare Center in Medan.
Subjects and Method: An analytical cross-sectional study was conducted on 100 T2DM patients selected through consecutive sampling. Data were collected using structured question¬naire, anthropometric measurement, and blood pressure and blood glucose examinations. The variables studied included sociodemographic characteristics (gender, education, occupation, marital status) and clinical characteristics (body mass index, duration of T2DM, blood glucose levels, family history). Data analysis was performed using Chi-square test.
Results: The majority of respondents were women (62%), highly educated (79%), and obese (87%). The prevalence of hypertension in T2DM patients was notably high (>70%) across all groups. However, bivariate analysis showed no statistically significant relationship between any of the studied variables and the incidence of hypertension (p>0.05).
Conclusion: There was no significant relationship between sociodemographic and clinical factors with the incidence of hypertension in T2DM patients. Nevertheless, the high prevalence of hypertension indicates the importance of a comprehensive approach in managing both condition
Effectiveness of Combined Acupuncture Therapy and Turmeric (Curcuma longa Linn) on Blood Protein Profile in Osteoarthritis Patients
Full text linkBackground: Osteoarthritis (OA) is a degenerative disease of the joints that commonly occurs in the hands, waist, a. nd knees. One of the efforts to control OA is with acupuncture. This study aims to analyze the effectiveness of the combination of acupuncture and turmeric herbs on reducing the levels of total protein, albumin, and globulin in OA patients.
Subjects and Method: The Randomized Controlled Trial (RCT) study was conducted at Redy Clinical Laboratory in August 2024. A total of 50 patients with OA were divided into two groups: (1) Intervention group of combination of acupuncture and turmeric herbs (n= 25); and (2) The control group was given acupuncture (n=25). The dependent variables are total protein, albumin, and globulin. The independent variable was a combination of acupuncture and turmeric herbs. The difference in the average increase in protein, albumin, and globulin levels in each group was analyzed using the Independent test.
Results: The average protein level in the combination group of acupuncture therapy and turmeric herbs (Mean= 8.40; SD= 0.27) was higher than the control group (Mean= 7.74; SD= 0.33), and this result was statistically significant (p <0.001). The average albumin level in the combination group of acupuncture therapy and turmeric herbs (Mean= 5.07; SD= 0.49) was higher than the control group (Mean= 4.84; SD= 0.66), but this result was statistically insignificant (p= 0.156). The average globulin levels in the combination group of acupuncture therapy and turmeric herbs (Mean= 3.41; SD= 0.88) were higher than the control group (Mean= 3.17; SD= 0.65), but this result was statistically insignificant (p = 0.280).
Conclusion: The combination of acupuncture therapy and turmeric herbs is effective in increasing total protein, albumin, and globulin levels in OA patients
Association of Antiretroviral Regimens and CD4 Counts with Dyslipidemia in HIV Patients: Implications for Metabolic Management
Full text linkBackground: Dyslipidemia, a key risk factor for cardiovascular disease, is prevalent among people living with HIV/AIDS receiving antiretroviral therapy. This study aims to evaluate the impact of different ART regimens on lipid profiles in HIV patients and identify regimens with better outcomes in lipid profile levels.
Subjects and Method: An observational study was conducted from June to August 2024 at Dr. Saiful Anwar Regional General Hospital, Malang, Indonesia. Participants were recruited using consecutive random sampling, including HIV patients on ART for at least three months. Independent variables included ART regimens and CD4 counts, while the dependent variable was dyslipidemia status. Data were collected via demographic forms, medical record reviews, and lipid profile analysis. Statistical analysis was performed using chi-square and t-tests, with significance set at p < 0.05.
Results: Of the 110 participants, 38.2% were identified with dyslipidemia. The highest dyslipidemia rates were observed in patients using the Duviral Alluvial regimen (80.0%), followed by Duviral Neviral (71.4%). Newer regimens, TLD and TLE, were associated with lower dyslipidemia rates (31.3% and 36.0%, respectively; p = 0.045). A significant association was also noted between dyslipidemia and CD4 counts, with dyslipidemic patients showing higher mean CD4 counts (560.29 cells/μL) compared to non-dyslipidemic individuals (378.40 cells/μL; p = 0.009).
Conclusion:
Newer ART regimens such as TLD and TLE are associated with better lipid profile outcomes and lower dyslipidemia risk compared to older regimens. Higher CD4 counts may reflect an increased risk of lipid abnormalities, emphasizing the need for lipid monitoring and regimen optimization in HIV care
Septic Shock and Multi-Organ Dysfunction Syndrome in a Patient with Extensive Tophaceous Gout, Diagnostic and Management Challenges in South Papua: A Case Report
Full text linkIntroduction: Septic shock and multiple organ dysfunction syndrome (MODS) are interrelated medical conditions arising from the body's response to severe infection. Extensive tophaceous gout is recognized for its potential to worsen kidney failure, thereby negatively impacting the prognosis of patients suffering from septic shock and MODS.
Case presentation: This case report describes a male patient in his 40s who presented to the emergency department in an unresponsive state and was diagnosed with septic shock, likely secondary to pneumonia, which progressed to MODS. The patient also had uncontrolled hyperuricemia, resulting in extensive tophaceous gout that may have contributed to renal failure. Despite receiving appropriate fluid resuscitation, vasopressors, and antibiotics, the patient succumbed to severe complications. Key challenges in managing this case included limited diagnostic resources, low health awareness, and unclear health insurance coverage, particularly in the context of medical care in South Papua, Indonesia.
Results: The case illustrates the interplay between chronic gout and acute infection. Hyperuricemia may contribute to renal impairment, weaken immune defenses, and worsen outcomes in septic patients—challenges in health access, diagnostics, and patient awareness further complicated management.
Conclusion: Our case report emphasizes the possible contribution of unmanaged gout to the deterioration of septic shock, leading to MODS
Associations between Gender, Social Support, and Residence, with Perception of Stigma in People with HIV/AIDS: A Meta-Analysis
No full textBackground: The stigma of society towards ODHA itself is influenced by various factors, where there are three factors that can be used as a benchmark, namely gender, place of residence, and social support. This study aims to estimate the magnitude of the influence of gender, social support and housing on the perception of stigma in people with HIV/AIDS, based on the results of a number of previous primary studies.
Subject and Method: This study is a meta-analysis and systematic review study, with PICO, Population: ODHA patients (People with HIV/AIDS), Intervention: Women, low social support and village dwelling, Comparison: men, high social support and urban dwelling, Ooucome: HIV/AIDS stigma. Primary study searches used electronic databases: PUBMED, BMC, Scopus and Scient Direct published from 2012 to 2022. The keywords used are "people living with HIV" AND "gender" AND "social support" AND "residence" AND "perceived stigma HIV, cross-sectional"". There are 9 English fulltext arithmetic with effect size using adjusted odds ratio from 2012 to 2022. Articles selected with PRISMA Flow and analyzed using RevMan 5.3.
Result: This meta-analysis was conducted on 9 primary studies from India and Ethiopia with a sample = 14,191 HIV/AIDS patients. This study showed that the risk of stigma perception increased with female sex (aOR=1.35, CI 95%=0.75 to 2.46; p=0.320; I²=91%) and rural housing (aOR=1.49; CI 95%=0.89 to 2.47; p=0.130), but it is not statistically significant. The risk of stigma perception decreased with high social support (aOR=0.53; CI 95%=0.32 to 0.90; p=0.020), and the results are statistically significant.
Conclusion: The risk of stigma perception increases with female gender, rural housing and high social support
Paraspinal Abscess Secondary to Spondylodiscitis: A Rare Presentation with Progressive Neurological Deficits and Systemic Infection
Full text linkBackground: Spondylodiscitis is a rare but serious spinal infection that may result in neuro-logical and systemic complications, especially when associated with paraspinal abscess formation. This case highlights its clinical severity and the importance of early intervention. This study aims to highlight the clinical importance and potential severity of spondylodiscitis, particularly when complicated by paraspinal abscess formation.
Case Presentation: A patient presented with progressive lower back pain, bilateral lower limb weakness, and systemic symptoms including fever and night sweats. Laboratory tests revealed hypoalbuminemia, leukocytosis, and anemia. MRI imaging identified a paraspinal abscess at the L3–L5 levels, resulting in lumbar canal stenosis and worsening neurological deficits. Emergency surgical intervention was undertaken, consisting of abscess drainage, laminectomy for neural decompression, and posterior spinal stabilization. Intraoperative findings included a substantial purulent collection, necessitating extensive debridement. Postoperatively, the patient demonstra¬ted clinical improvement with ongoing antibiotic therapy, nutritional support, and rehabilitation.
Discussion: Spondylodiscitis with paraspinal abscess is a diagnostic challenge due to its insidious onset and non-specific presentation. Delayed recognition increases the risk of severe neurological impairment and systemic sepsis. MRI is the gold standard for early detection, while micro¬biological confirmation is crucial for targeted treatment. A multidisciplinary approach is essential. Surgical intervention is indicated for progressive neurological deficits, extensive abscess formation, or spinal instability, with timely antibiotic therapy playing a critical role in infection control.
Conclusion: This case illustrates the importance of early diagnosis and timely surgical manage-ment in spondylodiscitis with paraspinal abscess. Multimodal treatment improves outcomes and helps prevent long-term disability
A Rare Case Of Retinal Arterial Microaneurysm: Clinical Features And Diagnostic Insights
Full text linkBackground: In Retinal Arterial Macroaneurysms (RAM), the central retinal artery suffers from acquired focal hypertension. Clinical manifestations of the disease are diverse and easily misdiagnosed. Several imaging modalities may be used in order to confirm the diagnosis of RAM. This article aims to describe the clinical features and method of diagnosis of an uncommon case of retinal artery microaneurysm.
Case report: A 57-year-old woman presented with a progressive loss of vision in her right eye months prior. Visual acuity in the right eye was 0.8 log 13. Upon funduscopic inspection of the right eye, firm exudates with low tortuosity and submacular hemorrhage were observed. The right eye’s OCTA revealed a localized expansion and significant constriction with twisted blood vessels on the reverse side of the deformed vessel, while the OCT of the macula revealed submacular hemorrhage. The patient was diagnosed with ruptured retinal Arterial Macroaneurysm or Macular Telangiectasia Type I and Retinopathy Hypertensive Grade II of both eyes, No Diabetic Retinopathy of both eyes with Diabetes Mellitus and Hypertension. The right eye of the patient received concentrated laser photocoagulation and an intravitreal injection of anti-VEGF.
Conclusion: RAM is an acquired vascular disease defined by restricted, fusiform, or saccular dilation in the first three arteries of the main retinal artery. Retinal microaneurysms can be diagnosed with various imaging modalities. Ram may be treated with intravitreal anti-VEGF drugs, combination therapy, or laser photocoagulation
Risk Factors for Nasal Symptoms, Olfactory Disorders and Mucociliary Transport in Factory Workers
Full text linkBackground: Occupational exposure to a variety of individual chemicals has been associated with olfactory dysfunction, which is important for many occupational groups that rely on intact olfactory function to perform their jobs and for their safety. We aim to determine the risk factors for nasal symptoms, olfactory disorders and mucociliary transport in spice factory workers in Semarang.
Subjects and Method: This was a cross-sectional study. A sample of 600 factory workers filled out the NOSE Scale and QOD-NS questionnaires, having their ears, nose, and throat examined, and calculated the time in which the participants tasted sweetness after being given saccharin to the inferior turbinate. The analysis used were univariate, bivariate and multivariate analysis.
Results: Of 600 respondents, 52.2% were women, 87.8% had reported no nassal symptoms, 81.5% had normal NOSE scale, and 83.3% had normal mucociliary transport. Risk factors for nasal disorders, smell disorders, and mucociliary transport disorders were age ≥40 years old, male, smoking, longer exposure time, obesity, and PPE use.
Conclusion: There is a significant association between occupational risk factors and nasal symptoms, olfactory disorders and mucociliary transport disorders. The most influential factor is discipline in using PPE to prevent nasal disorders, olfactory disorders and mucociliary transport disorders
Preventing Occupational Musculoskeletal Disorders: Effect of Stretching Exercise in Reducing Pain Among Factory Workers
Full text linkBackground: Musculoskeletal disorders (MSDs), often caused by prolonged static and repetitive sitting, can lead to pain and discomfort. Regular stretching every two hours may help alleviate this pain. This study aimed to evaluate the effectiveness of performing stretching exercises every two hours in reducing pain associated with the risk of MSDs.
Subjects and Method: A quasi experimental study was carried out at Berdijaya Factory, Surakarta, Central Java, Indonesia. A total of 40 factory workers with MSDs complaint was recruited using a purposive sampling. The dependent variable was pain. The independent variable was stretching exercise every 2 hours per day for 2 weeks. Pain was measured using numeric rating scales (NRS). The data were tested before and after intervention using paired t test.
Results: After two weeks of intervention, mean of pain score (Mean= 3.88; SD= 1.25) was lower than before (Mean= 5.08; SD= 1.09), with (p = 0.025).
Conclusion: Stretching exercises performed every 2 hours per day for 2 weeks can reduce musculoskeletal pain among factory workers