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All Journal Open Access Indonesian Journal of Medical Reviews Jurnal Sintak
Steven Jonathan
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Civil Engineering, Building, Construction & Architecture Control & Systems Engineering Decision Sciences, Operations Research & Management Health Professions Mathematics Medicine & Pharmacology

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FAKTOR-FAKTOR YANG MEMPENGARUHI KESEHATAN MENTAL REMAJA DI KOTA BATAM Widya, Widya Reza; Serly Tri Ananda; Tiara Ivanca; Alya Fadilah; Steven Jonathan
JURNAL SINTAK Vol. 1 No. 1 (2022): SEPTEMBER 2022
Publisher : LPPM-ITEBA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (282.32 KB)

Abstract

Sejak pandemi Covid-19 tidak sedikit remaja Indonesia memiliki masalah mental emosional. Untuk mengatasi hal tersebut, perlu diketahui faktor yang mempengaruhi kesehatan mental remaja. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh variabel pola asuh orang tua, kondisi kesehatan lingkungan dan sosial ekonomi terhadap kesehatan mental remaja di Kota Batam dengan menggunakan analisi regresi linier berganda. Populasi dalam penelitian ini adalah remaja di Kota Batam. Penentuan jumlah sampel menggunakan metode lameshow dengan hasil 200 responden dan untuk teknik pengambilan sampelnya menggunakan teknik purposive sampling. Hasil penelitian ini menunjukan bahwa terdapat pengaruh yang signifikan dari pola asuh orang tua, kesehatan lingkungan dan sosil ekonomi terhadap kesehatan mental remaja di Kota Batam.
Severe Hyponatremia with Normokalemia in Pembrolizumab-Lenvatinib Combination Therapy for Metastatic Renal Cell Carcinoma: A Case of Suspected Secondary Adrenal Insufficiency and Clinical Differentials Devina Ravelia Tiffany Subroto; Steven Jonathan; I Putu Bayu Triguna
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.826

Abstract

The combination of Pembrolizumab and Lenvatinib has become the standard first-line treatment for advanced renal cell carcinoma (RCC). However, the overlapping toxicity profiles of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) create significant diagnostic challenges, particularly regarding electrolyte disturbances. Differentiating ICI-induced secondary adrenal insufficiency from TKI-induced toxicity or syndrome of inappropriate antidiuretic hormone (SIADH) is critical, especially in resource-limited settings where rapid hormonal assays are unavailable. A 67-year-old male with metastatic clear cell RCC presented with confusion, fatigue, and nausea 14 days after initiating palliative Pembrolizumab and Lenvatinib. He had a history of partial nephrectomy and was on Candesartan. Evaluation revealed severe hypotonic hyponatremia (113 mmol/L), acute kidney injury (Creatinine 2.2 mg/dL), and a hypertensive crisis (BP 229/138 mmHg). Notably, despite renal impairment and angiotensin receptor blocker therapy, potassium levels were normal (4.2 mmol/L). The hyponatremia was refractory to 3% hypertonic saline. Suspecting secondary adrenal insufficiency, empiric high-dose corticosteroids were administered, resulting in rapid normalization of serum sodium and resolution of symptoms. In conclusion, in patients receiving ICI-TKI therapy, the specific profile of severe hyponatremia with normokalemia—particularly in the context of renal insufficiency and RAAS blockade—serves as a high-value clinical indicator of preserved mineralocorticoid function. This points toward secondary adrenal insufficiency rather than primary adrenal injury or TKI-induced renal tubular acidosis. This case underscores the utility of deductive physiology in oncology practice.
Co-Authors Alya Fadilah Devina Ravelia Tiffany Subroto I Putu Bayu Triguna Serly Tri Ananda Tiara Ivanca Widya, Widya Reza