Cermin Dunia Kedokteran

The Association Between Blood Pressure Control and Renal Function in Hypertensive Patients: Evidence from a Community Health Center in Indonesia

2026-05-18T14:15:48+07:00

Introduction: Adherence to antihypertensive therapy (AHT) plays a crucial role in achieving optimal blood pressure control and preventing long-term complications, including impaired renal function. This study aimed to analyze the association between medication adherence and blood pressure control and to evaluate renal function in hypertensive patients. Methods: This observational analytic study used a retrospective cohort design. This study was conducted at the Pakem Community Health Center using medical records of hypertensive patients participating in the Chronic Disease Management Program (Program Pengelolaan Penyakit Kronis [PROLANIS]). Blood pressure control was determined based on the average blood pressure measurements over six months. Medication adherence was assessed using the medication possession ratio (MPR) from January to June 2025, while renal function was assessed based on changes in the estimated glomerular filtration rate (ΔeGFR) in January and July 2025. Statistical analyses were performed using IBM SPSS Statistics version 26. Statistical significance was defined as p < 0.05. Results: A total of 101 patients met the inclusion criteria. Most patients had high adherence (78.2%) and controlled blood pressure (72.3%). The proportion of blood pressure control was higher in the high-adherence group than in the low-adherence group (81.0% vs. 40.9%; p < 0.001), patients with high adherence had 6.16 times higher odds of achieving blood pressure control (OR 6.16; 95% CI 2.22–17.08). No significant difference in ΔeGFR was observed between patients with controlled and uncontrolled blood pressure (3.25 ± 7.66 vs. 3.93 ± 10.19 mL/min/1.73 m²; p = 0.970). Conclusion: Medication adherence was significantly associated with blood pressure control, whereas changes in renal function did not differ significantly between patients with controlled and uncontrolled blood pressure.

Correlation of Serum Malondialdehyde with Motor Severity and Cognitive Function in Parkinson’s Disease

2026-04-01T13:46:02+07:00

Introduction: Accumulating research supports the view that oxidative stress is a key driver of the pathological processes underlying Parkinson’s disease (PD). Among biomarkers of oxidative injury, malondialdehyde (MDA)—a key lipid peroxidation product—is frequently utilized to quantify oxidative stress; however, its relationship with motor symptom severity and cognitive function in PD remains insufficiently explored. This study aimed to examine the association between serum MDA levels, motor symptom severity, and cognitive function in patients with Parkinson’s disease. Methods: This cross-sectional study included 35 patients diagnosed with PD. Motor severity was assessed using the Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III) and stratified into mild, moderate, and severe levels. Cognitive assessment utilized the Montreal Cognitive Assessment–Indonesia (MoCA-Ina) alongside trail making test part A (TMT-A) and trail making test part B (TMT-B). Serum MDA concentrations were measured using the thiobarbituric acid reactive substances (TBARS) assay. Statistical assessment was conducted using Spearman’s rank correlation alongside the Mann–Whitney U test. Results: This study revealed a meaningful positive linkage between MDA concentrations and motor symptom severity (r = 0.421, p = 0.012). Posthoc analysis indicated that patients with moderate and severe motor symptoms had higher MDA levels than those with mild symptoms (p = 0.032; p = 0.022), while no discrepancy was found between the moderate and severe groups (p = 0.421). MDA levels showed no significant association with MoCA-Ina or TMT-A performance (r = 0.206, p = 0.235; r = 0.079, p = 0.684), but patients with abnormal TMT-B performance had higher MDA levels than participants with normal results (p = 0.043). Conclusion: MDA level is linked to greater motor symptom severity and executive dysfunction in PD. The results imply that MDA may act as a promising biomarker reflecting oxidative damage–driven neurodegeneration underlying motor and executive impairments in PD.

Characteristics of Pediatric Asthma Patients at the Outpatient Clinic of a General Hospital in Padang, Indonesia

2025-11-26T18:03:51+07:00

Introduction: Pediatric asthma is a chronic respiratory disease that may affect daily activities and quality of life. This study aimed to determine the characteristics of pediatric asthma patients attending a general hospital outpatient clinic in Padang, Indonesia. Methods: A retrospective descriptive study was conducted using medical records of pediatric patients diagnosed with asthma from January 2020 to December 2022. Consecutive sampling was used, and 113 eligible medical records were included from 197 records reviewed. We analyzed demographic characteristics, asthma risk factors, disease severity, clinical manifestations, oral medication use, and inhalation device use. Results: Most patients were male (57.5%) and aged 5–11 years (64.6%), resided in Padang (91.2%), had health insurance (81.4%), and attended the pediatric outpatient clinic more than five times (54.9%). Among documented risk factors, a history of atopy was recorded in 46.0% of patients, while cigarette smoke was the most frequently documented allergen (39.8%). Intermittent asthma predominated (88.5%), with cough (97.3%) and shortness of breath (84.1%) as the most common clinical manifestations. Inhalation device use was not documented in 65.5% of patients, and most patients did not receive inhalation therapy. Conclusion: Pediatric asthma mostly affected school-aged boys and was classified as intermittent asthma. These findings show that oral medications were used more frequently than inhalation therapy, and inhalation device use was often not documented.

Efficacy of Doxycycline Prophylaxis for Prevention of Bacterial Sexually Transmitted Infections Among People with or Without HIV: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2026-01-23T16:36:03+07:00

Introduction: Bacterial sexually transmitted infections (STIs) remain a significant burden among populations at high risk, including people living with HIV (PLWH) and HIV-negative individuals receiving HIV pre-exposure prophylaxis (PrEP). This study evaluated the efficacy and safety of doxycycline pre- and post-exposure prophylaxis for preventing bacterial STIs among people with or without HIV. Methods: This systematic review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251171815). We conducted comprehensive searches in PubMed, Embase, and Cochrane CENTRAL through October 2025. We included randomized controlled trials evaluating doxycycline prophylaxis versus standard care. Meta-analysis was performed using random-effects models in RevMan 5.4. Results: Seven randomized controlled trials (2,091 participants) were included. Doxycycline prophylaxis significantly reduced bacterial STI incidence by 57% (pooled RR 0.43, 95% CI 0.35–0.53; p < 0.00001; I² = 42%). In the subgroup analysis of HIV-positive participants, doxycycline achieved a 62% reduction (RR 0.38; 95% CI 0.28–0.52). Pathogen-specific analysis showed a 72% reduction for chlamydia (RR 0.28), a 72% reduction for syphilis (RR 0.28), and a 44% reduction for gonorrhea (RR 0.56). Safety outcomes were summarized descriptively, with gastrointestinal symptoms most frequently reported; no pooled adverse-event or discontinuation estimate was calculated. The number needed to treat calculated from pooled event counts was approximately 4. Conclusion: Doxycycline prophylaxis reduced bacterial STI incidence in high-risk populations with and without HIV. These findings support considering doxycycline prophylaxis as a prevention strategy, while emphasizing limitations in regimen-specific evidence and the need for ongoing safety and antimicrobial-resistance monitoring.

Secondary Postpartum Haemorrhage due to Retained Intrauterine Blood Clot with Impaired Uterine Outflow Following Caesarean Section: A Case Report

2026-08-13T10:12:59+07:00

Introduction: Postpartum hemorrhage (PPH) is the main cause of maternal mortality, ranging from 18%–50% of deaths worldwide. Secondary postpartum hemorrhage (SPPH) is defined as bleeding 24 hours to 12 weeks after delivery. Clinically worrisome uterine hemorrhage develops within 1 to 2 weeks in perhaps 1 percent of women. Such bleeding most often is the result of abnormal involution of the placental site. In some cases, uterine involution is hindered because of infection, retained placental tissue, or other causes. Such subinvolution is accompanied by varied intervals of prolonged lochia as well as irregular or excessive uterine bleeding. Another cause of subinvolution is incompletely remodeled uteroplacental arteries. These noninvoluted vessels are filled with thrombosis and lack an endothelial lining. Perivascular trophoblasts are also identified in the vessel walls, suggesting an aberrant interaction between uterine cells and trophoblasts. Secondary postpartum hemorrhage is most commonly associated with endometritis and retained products of conception, particularly retained placental tissue. However, this case highlights an uncommon mechanism of secondary postpartum hemorrhage associated with a retained intrauterine blood clot, which causes incomplete spiral artery remodeling. Case: A 36-year-old woman with approximately 2,000 mL of bleeding 9 days after elective cesarean delivery. Ultrasonography examination showed a blood clot in the uterus measuring 10.77 x 12.85 cm; a 700 mL blood clot was removed from the uterus by suction curettage. Postoperative ultrasound evaluation found the uterus in good condition without blood clots. Discussion: In this case, the retained blood clot is attributed to obstructed uterine outflow resulting from the lack of prior dilatation of the internal os, rather than to retained placental tissue. Consequently, this case offers an opportunity to discuss retained intrauterine blood clots as a rare and potentially underrecognized mechanism of secondary postpartum hemorrhage following cesarean delivery. Conclusion: In this case, secondary postpartum hemorrhage was caused by uterine subinvolution resulting from the retention of blood clots within the uterus, which prevented complete remodeling of the uteroplacental arteries.

Successful Live Birth in Partial Hydatidiform Mole: A Case Report

2025-11-04T07:19:28+07:00

Introduction: Partial hydatidiform mole (PHM) is a rare form of gestational trophoblastic disease characterized by abnormal trophoblastic proliferation accompanied by the presence of a fetus. Most cases end in miscarriage, while live births are extremely uncommon. Case: A 22-year-old primigravida diagnosed with PHM, intrauterine growth restriction (IUGR), and oligohydramnios underwent cesarean delivery at 35–37 weeks of gestation, resulting in a live female infant (1,750 g; Apgar scores 8/9). The enlarged placenta (1,180 g) was histopathologically confirmed as PHM. The newborn developed hypoglycemia, thrombocytopenia, and hyperbilirubinemia requiring intensive care, while the mother recovered uneventfully with declining β-hCG levels. Discussion: This case is remarkable as such an occurrence is extremely rare, as most PHM pregnancies end in spontaneous abortion during the first or second trimester due to chromosomal abnormalities and placental insufficiency. Postpartum follow-up revealed a gradual decline in β-hCG levels until they returned to normal, indicating the absence of persistent gestational trophoblastic disease. Conclusion: Pregnancies complicated by PHM require multidisciplinary care and close monitoring, including vigilance during the antenatal period, postpartum evaluation, and appropriate neonatal management to prevent and manage potential complications. Although rare and often associated with poor outcomes, PHM with live birth can achieve favorable results.

Hypokalemia and Hemoperitoneum from Retrograde Menstruation in a Woman with Peritoneal Dialysis – A Case Report

2025-08-29T19:49:34+07:00

Introduction: Hypokalemia in peritoneal dialysis (PD) can be caused by dialysate potassium loss, low intake of potassium-rich foods, or gastroenteritis. Hemoperitoneum is a non-mechanical complication of peritoneal dialysis, common in menstruating women. Case: A 52-yearold woman with end stage renal disease (ESRD) on PD was admitted to the emergency department with persistent vomiting and bloody dialysate. The patient had a history of type 2 diabetes, controlled with antidiabetic drugs. Her serum potassium was 2.0 mEq/L. Ultrasound showed simple ovarian cysts and uterine myomas. She was diagnosed with severe hypokalemia, hemoperitoneum, type 2 diabetes, and ESRD. The treatment included oral and intravenous potassium chloride, tranexamic acid, and frequent dialysate changes. After a one-month follow-up, no complications were reported. Discussion: The hypokalemia was likely associated with gastrointestinal potassium loss and inadequate intake of potassium-rich foods. The temporal relationship between menstruation and bloody dialysate, together with the absence of cyst rupture or peritonitis, supported retrograde menstruation as the probable cause of hemoperitoneum. Conclusion: Hypokalemia may result from gastrointestinal losses, inadequate potassium intake, while menstruation might cause bloody dialysate in PD.

Delayed Detection of Sperm in the Ejaculate Following Failed Microdissection Testicular Sperm Extraction in a Man With Azoospermia: A Case Report

2026-08-10T09:30:02+07:00

Introduction: Non-obstructive azoospermia (NOA) affects 10%–15% of infertile males, posing a significant challenge in fertility management. Microdissection testicular sperm extraction (mTESE) is regarded as the gold standard for sperm retrieval for NOA. However, even when mTESE fails to retrieve sperm, unexpected postoperative findings may still occur. Case: A 31-year-old male with primary infertility and azoospermia underwent two surgical sperm retrieval procedures: percutaneous epididymal sperm aspiration (PESA) and mTESE. Hormonal and genetic evaluations revealed no abnormalities, but no sperm were retrieved during either procedure. Remarkably, six days after surgery, a self-ejaculated sample yielded five motile spermatozoa, which were immediately cryopreserved for intracytoplasmic sperm injection. Histopathology indicated moderate spermatogenesis with Johnsen scores of 6.0 and 7.0 for the right and left testes, respectively, highlighting residual spermatogenic activity. Discussion: The postoperative appearance of spermatozoa may reflect focal or intermittent spermatogenesis that was not detected during surgical sampling. The histopathological findings support the presence of limited residual sperm production despite unsuccessful PESA and mTESE. Conclusion: The detection of motile spermatozoa after failed mTESE highlights the importance of postoperative for follow-up, repeated semen analysis, and timely cryopreservation in the fertility management of patients with NOA.

Diagnostic Challenges in Detecting Thyroid Microcarcinoma Using [99mTc]Tc-Sestamibi WashOut Index (WOIND) in Toxic Intrathoracic Multinodular Goiter: A Case Report

2025-12-13T20:13:52+07:00

Introduction: Intrathoracic multinodular goiter is a type of goiter that extends partially or completely into the thoracic cavity. Hyperthyroidism is uncommon in this condition, and the incidence of malignancy is also low (approximately 5.9%). [99mTc]Tc-Sestamibi washout index (WOind), with a cutoff of −19%, is used as an additional modality to assess the malignancy risk of hypofunction thyroid nodules, with a high negative predictive value of 100%. However, cancer detection is decreased in microcarcinomas, resulting in false-negative results. Case: A 54-yearold female with hyperthyroidism and intrathoracic multinodular goiter complained of a goiter and palpitations for one year. Fine-needle aspiration (FNA) cytology showed bilateral adenomatous goiter (Bethesda II). The patient was treated with propylthiouracil for one month, resulting in subclinical hyperthyroidism. A [99mTc]Tc-Pertechnetate uptake test was normal and showed predominant cold and warm nodules in multinodular goiter. The [99mTc]Tc-Sestamibi WOind ranged from -30% to -52% in all nodules (indicating benign). SPECT/CT showed tracheal deviation due to the large goiter, with a recommendation for resection. Postoperative histopathological results showed a focus of micropapillary thyroid carcinoma follicular variant in ƒthe left lobe, and adenomatous goiter in the right lobe and isthmus. The small size of the microcarcinoma in large adenomatous goiters makes it difficult to detect with FNA cytology and [99mTc] Tc-Sestamibi WOind. A focus of microcarcinoma is very unlikely to show malignant imaging characteristics, including on [99mTc] Tc-Sestamibi WOind. Discussion: Despite benign FNAB findings and a negative [99mTc]Tc-Sestamibi WOind scan, postoperative histopathology revealed micropapillary thyroid carcinoma, representing a false-negative result likely related to the small tumor size and limited detectability within a large, heterogeneous goiter. Conclusion: The [99mTc]Tc-Sestamibi WOind is a useful adjunct in diagnosing malignancy in thyroid nodules. However, clinicians must be aware of the possibility of false negatives, especially in cases of microcarcinoma within large adenomatous goiters.

History, Risk Factors, Etiology, and Pathogenesis of Down Syndrome

2025-03-12T00:40:51+07:00

Down syndrome is a congenital genetic disorder caused by abnormalities in the number, structure, or arrangement of chromosome 21 that cause cognitive impairment, congenital malformation, immune disorder, congenital heart disease, and other disorders. It is the most common chromosomal abnormality worldwide. ‘Down syndrome’ is named in honor of John Langdon Heydon Down, who described its clinical manifestations in an article in 1866. Down syndrome is a congenital genetic disorder caused by abnormalities in the number, structure, or arrangement of chromosome 21 that cause cognitive impairment, congenital malformation, immune disorder, congenital heart disease, and other disorders. It is the most common chromosomal abnormality worldwide. ‘Down syndrome’ is named in honor of John Langdon Haydon Down, who described its clinical manifestations in an article in 1866. Down syndrome may result from classic trisomy 21, Robertsonian translocation, or chromosomal mosaicism. Maternal age is the most common risk factor, as pathogenesis is linked to biological ovarian aging. Biological ovarian aging may increase the risk of chromosome 21 nondisjunction through hormonal imbalance, depletion of the oocyte pool, impaired cohesion function, oxidative stress, and altered elimination of aneuploid embryos. Knowledge of risk factors and their etiopathogenesis may help recommend an ideal maternal age for pregnancy. A better understanding of these mechanisms may support genetic counseling, pregnancy planning, and appropriate prenatal screening.

The Nipah Virus Infection: A Narrative Review

2026-03-03T20:18:24+07:00

Nipah virus (NiV) infection is a zoonotic disease causing recurring outbreaks since 1998. Nipah virus is highly contagious, responsible for high morbidity and mortality, and has the potential to become a pandemic. World Health Organization (WHO) has put this zoonotic disease on its priority pathogen list. Nipah virus can be transmitted to humans directly from bats or through an intermediary animal. It primarily affects the respiratory system and central nervous system acutely and is rapidly progressive. The case fatality rate of Nipah virus infection is high, ranging from 40% to 75%. Nipah virus infection causes acute, rapidly progressing problems, particularly in the respiratory system and the central nervous system. Within 6 months after acute infection, some cases have persistent neurological and psychiatric symptoms, which include fatigue, neurological problems, and depression. To date, no clinically approved antivirals and vaccines are available to treat NiV infection to date. This narrative review explores the latest updates on Nipah virus infection to help prepare effective strategies to prevent transmission of the Nipah virus.

Success in Treating Dry Age-Related Macular Degeneration with AREDS 2

2025-09-02T12:29:23+07:00

Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss. Recent 5-year follow-up findings confirm that AREDS2 formula (vitamins C and E, lutein, zeaxanthin, zinc, copper) significantly reduces the risk of progression from intermediate to advanced AMD. New analyses suggest AREDS2 supplements may slow geographic atrophy (GA) expansion towards the fovea in late-stage dry AMD, potentially preserving central vision. The supplement is recommended for patients with intermediate or advanced AMD, not in early stages. The AREDS2 formula does not prevent the onset of AMD or restore vision that has already been lost. Its main role is to reduce the risk of disease progression in appropriately selected patients. Lutein and zeaxanthin are preferred to β-carotene because β-carotene increases the risk of lung cancer, particularly among current and former smokers. Long-term use should be based on the AMD stage, smoking history, comorbidities, and potential interactions with other medications. Regular ophthalmological monitoring remains necessary to assess disease progression and detect conversion to neovascular AMD.