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All Journal Narra J The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia International Journal of Cell and Biomedical Science
Ardani, Yanuar
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Perbedaan Serotonin Plasma dan Kortisol Saliva terhadap Gejala Depresi pada Pasien Pasca Sindrom Koroner Akut Firmansyah, Irman; Shatri, Hamzah; Putranto, Rudi; Ardani, Yanuar; Ginanjar, Eka; koesnoe, sukamto; Rizka, Aulia; Isbagio, Harry; Yunir, Em
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
Publisher : UI Scholars Hub

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Abstract

Introduction. Psychological disorders are closely associated with hormonal factors, including cortisol and serotonin. In patients with acute coronary syndrome (ACS), autonomic dysfunction and dysregulation of the hypothalamic-pituitaryadrenal (HPA) axis can occur, leading to an increase in cortisol levels that may worsen the prognosis of ACS patients. Therefore, it is important to understand the hormonal impact, namely cortisol and serotonin levels, on depressive symptoms, which will be examined in this study. Methods. This was a cross-sectional study to determine the impact of cortisol and serotonin in the incidence of depression in post-treatment ACS patients at the ICCU RSUPN dr. Cipto Mangunkusumo, Jakarta. Data collection from patients meeting the inclusion criteria was carried out 10-14 days post-treatment through interviews, HADS questionnaire completion, physical examinations, and laboratory tests. The Mann-Whitney test was used to examine the differences between serotonin and salivary cortisol levels in patients with and without depression. Results. Among the 73 ACS patients included in this study, the average age was 57.53 (9.97) years, with 68.5% was male. Posttreatment depression was observed in 15.1% of subjects. The median serotonin levels were lower in patients with depression [175 (147 – 227.64) ng/mL vs. 189.31 (152.87-235.44) ng/mL], while cortisol levels were higher in patients with depression [3.09 (1.46-6.26) ng/mL vs. 2.15 (0.92-3.91) ng/mL]. However, the statistical analysis showed no significant differences between plasma serotonin and depression (p=0.482) or saliva cortisol and depression (p=0.275). Conclusions. There were no significant differences in cortisol and serotonin levels concerning depressive symptoms among post-acute coronary syndrome patients. Nevertheless, this study holds clinical importance due to the observed lower plasma serotonin levels and higher saliva cortisol levels in ACS patients with depression.
Selective Serotonin Reuptake Inhibitors and Risk of Gastrointesinal Bleeding In Dyspepsia: An Evidence-Based Case Report Shatri, Hamzah; Zulkifly, Steven; Putranto, Rudi; Makmun, Dadang; Fauzi, Achmad; Maulahela, Hasan; Faisal, Edward; Irvianita, Vinandia; Ardani, Yanuar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 2 (2023): VOLUME 24, NUMBER 2, August, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2422023182-191

Abstract

Aim: This evidence-based case report aims to provide the latest evidence about the risk of gastrointesinal (GI) bleeding in selective serotonin reuptake inhibitor (SSRI) users with dyspepsia.Method: The literature search was conducted in four major electronic databases (PubMed, Cochrane, Scopus, ProQuest). The selected articles were sorted through screening abstract based on the inclusion and exclusion criteria. Critical appraisal was performed by using validated critical appraisal tool.Results: Of 247 records from extensive literature searching, three eligible studies (one randomized clinical trial and two cohort studies) were obtained to answer the clinical question. All studies showed SSRIs did not increase the risk of GI bleeding in patients with functional dyspepsia and peptic ulcer. However, the adverse event of SSRIs might be under-reported.Conclusion: According to the evidence, the risk of GI bleeding in SSRIs users with dyspepsia is still unclear. Larger size of sample of controlled trial study is recommended to be conducted to calculate the precise risk of GI bleeding in SSRI users with dyspepsia.
Psycho-Neuro-Autonomic Aspect of Burnout Syndrome: A Literature Review Oliviera, Ivona; Ardani, Yanuar; Shatri, Hamzah
International Journal of Cell and Biomedical Science Vol 2 No 6 (2023)
Publisher : Stem Cell and Cancer Research (SCCR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59278/cbs.v2i6.40

Abstract

Background: Burnout syndrome are symptoms resulting from stress due to burden and stressors of high workload, as seen in health workers. Burnout syndrome can trigger psychological and physiological disorders, mainly related to the autonomic nervous system and the Hypothalamus-Hypophysis Axis pathway. Psychological disorders could be assessed using Maslach Burnout Inventory (MBI), while physiological disorders of the neuro-autonomic imbalance could be assessed using Heart Rate Variability (HRV). Aim: To study about the psycho-neurological aspect of burnout syndrome. Methods: A systematic literature review using the PRISMA method, through four stages, namely identification, screening, feasibility, and accepted results. Results: Literature search was performed using PubMed and Google Scholar databases. Seven articles fulfilled the inclusion criteria. Five out of seven articles showed association between HRV and burnout score, while two articles showed no association between HRV and burnout score. Discussion: In the presence of stress, the autonomic nervous system activates the amygdala and hypothalamus, which subsequently triggers response from the adrenal gland to produce noradrenaline, which in turn affects the autonomic nervous system. A low HRV signifies inflexibility of the sympathetic and parasympathetic nervous system. Contradicting results may be caused by difference in sample and HRV confounding factors such as difference of physical activity, exercise, underlying disease, medication. Conclusion: There is an association between burnout score and HRV, which implies the presence of neuro-autonomic dysfunction in burnout patients. Further research is needed to rule out confounding factors.
Validity and reliability testing of the Shatri Sinulingga psychosomatic test (SSPT) questionnaire as a screening instrument for psychosomatic disorders in Indonesia Shatri, Hamzah; Sinulingga, Dika I.; Faisal, Edward; Irvianita, Vinandia; Putranto, Rudi; Ardani, Yanuar; Erlita, Diana; Jeger, Dian P.; Browijoyo, Isa A.
Narra J Vol. 4 No. 3 (2024): December 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i3.1373

Abstract

The incidence of psychosomatic disorders is increasing in Indonesia, and therefore screening instruments that are culturally appropriate for the Indonesian population are needed. The aim of this study was to assess the validity and reliability of the Shatri Sinulingga psychosomatic test (SSPT) questionnaire as a screening instrument for psychosomatic disorders in Indonesia. An analytic descriptive cross-sectional study divided into two stages (questionnaire formulation and distribution through the Psikosom.id application) was conducted in 2023. The validity test was carried out using the product moment technique, and Cronbach's alpha assessment was carried out to evaluate the reliability of the questionnaire. A total of 372 participants were included, with a mean age of 39.24 years old. The SSPT questionnaire scores had strong correlations with the scores of hospital anxiety and depression scale (HADS) (r=0.668; p<0.001) and the Symptom Checklist-90 (SCL-90) (r=0.674; p<0.001); and moderately correlated with the score of fatigue severity scale (FSS) (r=0.505; p<0.001) and Pittsburgh Sleep Quality Index (PSQI) (r=0.492; p<0.001). The correlation coefficient (r) value of each SSPT question ranged from 0.389–0.726, and all r higher than r table with an overall Cronbach’s alpha of 0.744. The SSPT questionnaire's strong predictive performance: had a sensitivity of 75.6% and specificity of 71.4% with an area under the curve (AUC) of 81% (95%CI: 76.6–85.4%; p<0.001) to HADS; sensitivity of 80% and specificity of 58.6% with an AUC of 75.1% (95%CI: 70–80.2%; p<0.001) to FSS; sensitivity of 64% and specificity of 67.5% with an AUC of 71.2% (95%CI:  65.4–77%; p<0.001) to PSQI; and had sensitivity of 78% and specificity of 67.4% with an AUC of 80.9% (95%CI:  76.6–85.3%; p<0.001) to SCL-90. The study highlights that the SSPT questionnaire is valid and reliable to be used as a screening instrument for psychosomatic disorders in Indonesia.
Effects of traditional music therapy on the psycho-neuro-immuno-endocrine aspect of burnout syndrome in healthcare workers: A randomized controlled trial Ardani, Yanuar; Shatri, Hamzah; Koesnoe, Sukamto; Yunir, Em; Wiguna, Tjhin; Wibowo, Heri; Sawitri, Dian R.; Sarwono, Sugeng J.; Masyur, Muhtaruddin; Ricardo, William; Katarina, Matilda; Anggono, Rendi F.
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.1686

Abstract

Burnout syndrome (BOS) is an occupational phenomenon highly prevalent among healthcare workers, particularly physicians and nurses. Despite its prevalence, no single therapy universally addresses all cases of BOS. The aim of this study was to develop a novel approach to managing BOS through traditional music therapy, evaluated from psychosomatic, neurological, immunological, and endocrine perspectives. The study involved 80 participants who were randomly assigned to either the intervention or control group. The intervention group received traditional music therapy for 10–15 minutes, three times a week, over four weeks. Key outcomes were assessed at weeks 2 and 4. Measurements included the Maslach Burnout Inventory (MBI), heart rate variability (HRV), saliva cortisol, saliva β-endorphin, saliva immunoglobulin A (IgA), and serum FOXP3. Instruments included the MBI-HSS questionnaire and HRV measuring devices. Over four weeks, significant improvements were observed in the MBI scores (p=0.001), HRV (p=0.001), and FOXP3 delta (p=0.035) in the intervention group compared to the control group. However, no significant differences were found for cortisol, β-endorphin, or IgA. These findings suggest that traditional music therapy positively impacts the psychological, neurological, and immunological aspects of BOS and potentially influences immunological and endocrine responses. Future research should explore the effects of longer intervention durations, test varying doses, and examine the combination of music therapy with other non-pharmacological treatments to enhance its therapeutic potential.
Heart Rate Variability as a Prognostic Tool for Palliative Patient : A Literature Review Charlex, Harold Jefferson Matthew; Ardani, Yanuar; Shatri, Hamzah
International Journal of Cell and Biomedical Science Vol 2 No 5 (2023)
Publisher : Stem Cell and Cancer Research (SCCR)

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Abstract

Introduction: Heart rate variability (HRV) is the fluctuation in the interval between two heartbeats. Decreased HRV indicates less flexibility of the autonomic nervous system (ANS) to physiological changes and is associated with poorer disease progression and mortality in several diseases. We reviewed conditions where HRV can be utilized as a predictive tool for palliative patients. Methods: We performed a comprehensive search in PubMed, ScienceDirect, and Google Scholar to find articles related to HRV and prognosis for cancer-related disorders, cardiovascular disease, and sepsis. 41 relevant articles were selected and reviewed. Results: ANS changes due to chronic cancer pain and metastastic bone cancer can be detected by HRV analysis and increased vagal activity is related with longer survival on advanced cancer patients. Lower HF is a risk factor for shorter life expectancy of metastatic or recurrent breast cancer. SDNN and RMSSD reduction correlates with poorer survival in NSCLC and metastatic brain cancer. Increased risk of stroke was observed in patients with lower RMSSD and SDNN. Reductions of both scores and LF were associated with two times increased risk of myocardial infarction and higher mortality one year after stroke. A decrease in HRV is related to mortality but is not specific to cardiovascular disease. SDNN and HF are HRV parameters that are most consistently correlated with sepsis and can predict mortality within 30 days of hospitalization. Conclusion: HRV analysis helps in assessing the prognosis of diseases. Typically, reduced HRV is linked to worse outcomes and increased mortality rates in conditions such as cancer, cardiovascular disease, and sepsis.
Factors Influencing the Barriers to Performing Five Daily Prayers among Muslim Inpatients at RSUP Dr. Kariadi Sofro, Muchlis Achsan Udji; Ardani, Yanuar; Sammy, Alwi
International Journal of Cell and Biomedical Science Vol 3 No 7 (2024)
Publisher : Stem Cell and Cancer Research (SCCR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59278/cbs.v3i7.45

Abstract

Background: Prayer is a fundamental obligation for Muslims, performed five times daily. For hospitalized Muslim patients, maintaining regular prayer routines can be challenging due to physical limitations, hospital infrastructure barriers, lack of religious knowledge, and insufficient support from healthcare providers. Objective: This study aims to identify the barriers Muslim inpatients face in performing prayers and to propose recommendations for improving spiritual accommodations in hospital settings.Methods: A qualitative study was conducted at RSUP Dr. Kariadi using in-depth interviews and participatory observation. Thirty Muslim inpatients, along with family members and medical personnel, were involved. Data were collected through semi-structured interviews and direct observations, then analyzed using thematic analysis to identify major influencing factors.Results: Physical limitations such as pain (40%), difficulty standing (50%), and movement restrictions from medical devices (33.3%) were key barriers. Facility-related issues, including inaccessible prayer rooms (70%) and lack of prayer aids (55%), significantly impacted patients' ability to pray. Religious knowledge gaps were notable, with 60% of patients unaware of permissible prayer adjustments (rukhsah). Furthermore, 80% reported no assistance from healthcare staff in facilitating prayer. Psychological factors such as stress (30%) and fatigue (25%) also affected patients' motivation, while encouragement from family and staff (50%) positively influenced prayer practices. Conclusion: Muslim inpatients encounter multiple barriers to performing prayers during hospitalization. Structured interventions, including improving hospital facilities, providing religious education, and training healthcare providers in spiritual care, are essential to support the spiritual well-being of Muslim patients.
A 36-Year-Old Male with Snake Bite Grade I Manus Dextra Case Report Dewi, Ratna; Pranandari, Ayun; Ardani, Yanuar
International Journal of Cell and Biomedical Science Vol 3 No 8 (2024)
Publisher : Stem Cell and Cancer Research (SCCR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59278/cbs.v3i8.54

Abstract

Background: Snakebite remains a major global public health concern, particularly in tropical regions like Indonesia. Snake envenomation may lead to local and systemic manifestations including erythema, swelling, pain, hypotension, respiratory distress, and even death. Case: A 34-year-old male presented to the Emergency Department of Esensia Main Clinic with the chief complaint of a traumatic wound on the right hand resembling a snakebite, accompanied by hand swelling, pain, nausea, and dizziness. The patient had applied a cloth bandage prior to arrival. Results: The patient was diagnosed with a grade I snakebite of the right hand (manus dextra) based on clinical history and physical examination. Management included administration of anti-snake venom serum (ASVS). Conclusion: Venomous snakebites can result in severe outcomes, including death; thus, early and appropriate management is crucial. In this case, medical treatment included administration of ASVS.
Human-Umbilical Cord-Mesenchymal Stem Cells (hUC-MCSs) Therapy with Extravesicles (EVs) Booster Improves Recovery in Type 2 Diabetes Mellitus with Cardiovascular Disease Nugraha, Dendi Krisna; Jutadi; Anggoro, Naufal Sebastian; Sari, Fikriya Novita; Ardani, Yanuar
International Journal of Cell and Biomedical Science Vol 4 No 10 (2025)
Publisher : Stem Cell and Cancer Research (SCCR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59278/cbs.v4i10.66

Abstract

Background: Type 2 diabetes (T2DM) is a chronic metabolic disorder characterized by insulin resistance and β-cell dysfunction, leading to persistent hyperglycemia and complications. Studies have explored mesenchymal stem cell (MSC)-based therapies and their extracellular vesicles (EVs) as novel approaches for metabolic regulation and tissue repair. Case: A 43-year-old male patient exhibited symptoms including excessive thirst and hunger, frequent urination, fatigue, and intermittent blurry vision. He had type 2 diabetes and recently worsened symptoms. The obese patient had elevated blood glucose, HbA1c, triglycerides, and uric acid. He received umbilical cord-derived mesenchymal stem cells (161,6 × 106 cells), followed by seven intramuscular EV injections (1.5 cc each), along with diet and antioxidant supplements. Results: Three months after the conclusion of treatment, laboratory test showed significant improvement, with fasting glucose levels measuring at 91 mg/dL, HbA1c levels at 5,1%, triglyceride levels at 151 mg/dL, uric acid levels at 4,9 mg/dL, and an erythrocyte sedimentation rate of 12 mm/hr. The clinical symptoms such as nocturia, fatigue, and neuropathic pain, demonstrated a substantial improvement, as well as led to the resolution of skin xerosis and heel fissures. Conclusion: This case suggests that combined UC-MSC and EV therapy, complemented by lifestyle modification, may contribute to metabolic stabilization and symptomatic relief in T2DM patients.
Co-Authors Achmad Fauzi Anggono, Rendi F. Anggoro, Naufal Sebastian Aulia Rizka, Aulia Browijoyo, Isa A. Charlex, Harold Jefferson Matthew Dadang Makmun Dian R. Sawitri, Dian R. E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Eka Ginanjar Em Yunir, Em Erlita, Diana Faisal, Edward Harry Isbagio Hasan Maulahela, Hasan Heri Wibowo Irman Firmansyah Irvianita, Vinandia Ivona Oliviera, Ivona Jeger, Dian P. Jutadi Katarina, Matilda Masyur, Muhtaruddin Muchlis Achsan Udji Sofro Nugraha, Dendi Krisna Pranandari, Ayun Ratna Dewi Ricardo, William Rudi Putranto Sammy, Alwi Sari, Fikriya Novita Sarwono, Sugeng J. Sinulingga, Dika I. Sukamto Koesnoe Tjhin Wiguna Zulkifly, Steven