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INDONESIA
MEDICINUS
Published by PT Dexa Medica
ISSN : 1979391X     EISSN : 29638399     DOI : 10.56951
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health
Tujuan penerbitan jurnal Medicinus adalah untuk meningkatkan wawasan dan menambah khasanah pengetahuan para praktisi medis dan farmasis di bidang kedokteran dan kefarmasian. Ruang lingkup dari jurnal ilmiah ini adalah publikasi artikel-artikel ilmiah yang bisa disajikan dalam bentuk penelitian (research), laporan kasus (case report), teknologi dan klinis kefarmasian, serta ulasan literatur medis.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 234 Documents
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Jantung yang Tidak Tahu Sedang Diobati: Kardiotoksisitas Anthracycline dan Urgensi Kardio-Onkologi Raymond R. Tjandrawinata
MEDICINUS Vol. 39 No. 6 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/49s0cn95

Abstract

Anthracycline-based chemotherapy has long been a cornerstone in the management of various malignancies, however, this antineoplastic class carries a frequently under-recognized consequence in the form of subclinical cardiac injury thatdevelops long before clinical manifestations become apparent. Cardiotoxicity mediated by topoisomerase IIβ dysregulation and oxidative stress does not occur abruptly, but cumulatively, with an incidence of approximately 9% among exposed populations. The physiological paradox further complicates this phenomenon, as compensatory mechanisms may mask ongoing myocardial damage, allowing early intervention window to be frequently missed. This article argues that the traditional boundaries between oncology and cardiology are no longer sufficient, and that an integrated cardio-oncology approach, incorporating active cardiac surveillance as soon as the initiation of therapy, should be regarded as clinical necessity rather than merely a consultative option.
Physiologically Based Pharmacokinetic (PBPK) Simulation of Supratherapeutic Meropenem Exposure and Potential Pharmacokinetics/Pharmacodynamics (PK/PD) Discordance in a Critically Ill Pediatric Patient: A Case Report Andika Yusuf Ramadhan
MEDICINUS Vol. 39 No. 7 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/je8s9k71

Abstract

Background: Meropenem is widely used in critically ill pediatric patients; however, sepsis and renal impairment can markedly alter its pharmacokinetics profile, increasing the risk of drug accumulation. Furthermore, therapeutic drugmonitoring is not readily available in many clinical settings. Case presentation: A 6-year-old child (body weight 18.6 kg, height 102 cm) presented with severe pneumonia and sepsis complicated by acute kidney injury. Laboratory findings showed elevated serum creatinine (1.9 mg/dl), reduced estimated glomerular filtration rate (eGFR)(22.17 ml/minute/1.73 m²), mild hypoalbuminemia (3.2 g/dl), and elevated transaminase levels (AST 67 U/l, ALT 89 U/l). Intravenous meropenem was administered, and a physiologically based pharmacokinetic (PBPK) model was utilized toassess and predict drug exposure. Methods: PBPK simulations were performed using PK-Sim®, incorporating pediatric physiology, impaired renal clearance, low protein binding, and drug-specific physicochemical properties. Results: The model predicted marked meropenem accumulation following repeated dosing. The predicted plasma concentration at 0.5 hours postdose (C0.5) was 69.82 mcg/ml. After the fourth dose, the predicted peak concentration (Cmax) reached 183.42 mcg/ml, while the trough concentration (Ctrough) remained elevated at 139.94 mcg/ml. Free drug concentrations remained above the minimum inhibitory concentration (MIC) throughout the dosing interval, resulting in 100% fT>MIC.Supratherapeutic concentrations caused by altered PK/PD may lead to neurotoxicity in critically ill children, whereas even therapeutic dosing may result in microbiome alterations. Conclusion: This case demonstrates that standard meropenemdosing in critically ill pediatric patients with renal impairment may lead to supratherapeutic exposure despite full pharmacodynamic target attainment. PBPK modeling may help anticipate exposure extremes and support individualized dosing when renal function is unstable and therapeutic drug monitoring is unavailable.
Prevalence of Anxiety and Depression in Hemodialysis Patients at RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar: A Descriptive Study Ni Nyoman Ayu Trsinawati; Diah Pritasari Jeger; Yenny Kandarini
MEDICINUS Vol. 39 No. 7 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/4xxj3c60

Abstract

Background: Patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) often experience substantial physical and psychological burdens, including anxiety and depression. These psychological conditions may adversely affect patients’ quality of life and adherence to long-term treatment. Understanding the prevalence of these conditions at RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar is essential to inform appropriate clinical and psychosocial interventions. Objective: This study aimed to describe the prevalence and severity levels of anxiety and depression among patients undergoing hemodialysis at RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar. Methods: This descriptive study included 43 patients receiving hemodialysis at RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar. Data were obtained from medicalrecords and psychological screening using the digitally administered Hospital Anxiety and Depression Scale (HADS). Anxiety and depression levels were categorized as normal (score 0–7), mild (8–10), moderate (11–14), and severe (15–21). Results: Among the 43 patients, symptoms of anxiety and/or depression were identified in 23.26% (n=10). Of these, 11.63% (n=5) had mild symptoms, 6.98% (n=3) had moderate symptoms, and 4.65% (n=2) had severe symptoms. The remaining 76.74% (n=33) of patients showed no symptoms of anxiety or depression. Conclusion: Anxiety and depression are relatively common among patients undergoing hemodialysis at RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar. Routine psychological screening and integration of mental health care into hemodialysis management arestrongly recommended to improve overall patient well-being and quality of life.
Equity, Informed Consent, and Ethical Challenges in Nutrigenetics-Based Precision Nutrition Loury Priskila; Hendi Wicaksono; Amaze Grace Sira; Fenita Renny Dinata; Michael Reskiantio Pabubung
MEDICINUS Vol. 39 No. 7 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/2q83cr67

Abstract

Background: Precision nutrition represents a paradigm shift from generalized dietary recommendations to individualized interventions based on genetic, metabolic, and environmental profiles, offering significant potential for the prevention and management of chronic diseases. Methods: A comprehensive literature search was conducted using PubMed and Google Scholar to evaluate the current landscape of the field. This review analyzed peer-reviewed articles, systematic reviews, and randomized controlled trials published between 2010 and 2025, focusing specifically on the ethical considerations, accessibility, and clinical integration of nutrigenetics. Results: Findings indicate that despite its promise, nutrigeneticsbased precision nutrition faces substantial limitations. Scientific validity remains inconsistent, particularly within direct-toconsumer (DTC) genetic testing. Ethical concerns are prominent regarding informed consent, which is often reduced to complex digital agreements that obscure data use, privacy risks, and issues related to autonomy in vulnerable populations. Furthermore, equity challenges persist; high costs and digital literacy gaps threaten to transform precision nutrition into an exclusive service. This is compounded by algorithmic biases stemming from the underrepresentation of diverse populations in genomic datasets, which risks generating inaccurate recommendations and exacerbating existing health disparities. Conclusion: While nutrigenetics-based precision nutrition offers transformative opportunities for personalized healthcare, its responsible implementation requires strengthened regulatory frameworks, improved genetic literacy among healthcare professionals, transparent consent processes, and inclusive data practices to ensure equitable integration into clinical and public health systems.
Multi-Scale Mechanisms of Phaleria macrocarpa in Liver Fibrosis: From Hepatic Stellate Cell Reprogramming to Systems Pharmacology Insights Fahrul Nurkolis
MEDICINUS Vol. 39 No. 7 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/4bxae078

Abstract

Liver fibrosis represents a central pathological process that bridges chronic liver injury to cirrhosis and hepatocellular carcinoma, yet effective therapies across all etiologies remain limited. Phaleria macrocarpa (mahkota dewa), a traditionalIndonesian medicinal plant, has emerged as a promising candidate due to its rich phytochemical diversity and potential polypharmacological effects. This review aims to integrate current evidence at the molecular, cellular, and systems levels to elucidate the anti-fibrotic potential of P. macrocarpa, with particular focus on hepatic stellate cell (HSC) biology. We systematically synthesize findings from phytochemical profiling, in vivo fibrosis models, early clinical observations, and recent systemic pharmacology studies, including data on standardized fractions such as Proliverenol. Available evidence consistently demonstrates that P. macrocarpa attenuates key drivers of fibrosis, including oxidative stress, inflammatory signaling (e.g., NF-κB/TNF-α), and pro-fibrogenic mediators such as TGF-β1, thereby reducing fibrotic burden in experimental models. At the compound level, constituents such as gallic acid and mangiferin provide proof-of-principlefor direct modulation of HSC activation and fibrogenesis-related pathways. However, a critical mechanistic gap remains: current studies primarily support suppression of the fibrogenic microenvironment rather than direct reprogramming of HSCs toward quiescence, apoptosis, or senescence. Recent network pharmacology analyses highlight key regulatoryhubs (e.g., RELA, PTGS2, SIRT1, GSK3B), suggesting that P. macrocarpa operates through multi-target mechanisms intersecting inflammatory, metabolic, and survival pathways. We propose a multi-scale framework that positions P. macrocarpa as a systems-pharmacology-driven anti-fibrotic candidate and emphasize the need for future studies targeting HSC-specific phenotypes, integrating single-cell omics, and providing translational validation. Advancing this plant froma hepatoprotective agent to a fibrosis-focused therapeutic will require direct mechanistic interrogation of stellate cell state transitions and rigorous clinical evaluation.
Insufisiensi Adrenal Tersier pada Penggunaan Steroid Jangka Panjang Ni Kadek Ariesta Dwijayanthi; Wira Gotera
MEDICINUS Vol. 39 No. 7 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/hzmntx72

Abstract

Adrenal insufficiency is a life-threatening condition that may occur as a tertiary effect of long-term use of steroids. Steroid use in patients with gout arthritis is often administered chronically. However, without adequate medical supervision, it can cause a pathogenic loop of adrenal insufficiency through disruption of the cortisol negative feedback mechanism on the hypothalamic-pituitary-adrenal axis. This disruption leads to an inadequate cortisol response, allowing clinical symptoms of adrenal insufficiency to develop, and a fatal adrenal crisis could emerge. In this case, we reported a productive-aged man with underlying disease of gout arthritis who developed adrenal insufficiency. The patient presented with cushingoid clinical features and a secondary immunodeficiency state, with suspected adrenal crisis. Management of the acute condition was carried out, although the diagnostic confirmation of low plasma cortisol levels was only obtained after the patient had been discharged from the hospital. The innapropriate and unsupervised use of steroid remains a medical problem in our society. Inadequate screening related to this issue is still an unmeet obstacle. Early recognition of the clinical signs and symptoms of steroid-induced adrenal insufficiency is essential to ensure timely and appropriate management.
Transformasi Pendekatan Blok Saraf Sensoris sebagai Strategi Prosedur Bebas Nyeri Reno Yonora
MEDICINUS Vol. 39 No. 7 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/dgagey88

Abstract

Pain during medical procedures remains a major challenge in clinical practice, particularly in minor surgery and simple invasive procedures. Conventional local anesthetic infiltration techniques frequently cause additional pain, tissue distortion, and suboptimal anesthetic distribution, highlighting the need of a simpler, more effective, patient-centered approach. The sensory nerve block targets peripheral sensory nerve branches as distal extensions of the central nervous system. Through strategic selection of insertion points, extensive anesthetic coverage can be achieved with only one or two injection points without the need for extensive tissue infiltration. This article discusses the concept, mechanism of action, and clinical applications of sensoric nerve block as a strategy toward minimally painful medical procedures. This technique offers rapid onset, minimal anesthetic requirements, improved patient comfort, as well as greater procedural efficiency. Given these advantages, this approach has the potential to become a new paradigm in modern medical practice, particularly in various minor surgical procedures.
Transformasi Blok Saraf Sensoris untuk Prosedur Bebas Nyeri dengan Levobupivacaine Raymond R. Tjandrawinata
MEDICINUS Vol. 39 No. 7 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/tdphq902

Abstract

Procedural pain is a biological consequence arises from the activation of peripheral nociceptors, the transmission of impulse through sensory nerve fibers, spinal processing, and cortical integration that transforms tissue injury into a conscious pain experience. Modern clinical practice increasingly recognizes that pain-free procedures should not belimited to postprocedural analgesia, but should involve precise interventions targeting pain transmission pathways before nociceptive impulses evolve into a systemic responses and psychological burden. Sensory nerve block represents an important clinical approach because it acts directly on peripheral transmission structures, aiming to inhibit pain impulse conduction without inducing extensive depression of consciousness. Levobupivacaine, a long-acting amino-amide localanesthetic and the S-enantiomer of bupivacaine, provides a pharmacologically relevant option for this transformation. By inhibiting voltage-gated sodium channels on neuronal membranes and stabilizing their inactive state, levobupivacainereduces neuronal excitability and reversibly interrupts the sensory transmission pathway. This medical perspective frames sensory nerve block not merely as a regional anesthetic technique, but as part of a broader shift toward procedures thatare more targeted, mechanism-based, anatomically precise, patient-centered care, more humane, and align with the physiology of pain. The challenges associated with this approach include appropriate patient selection, comprehensive anatomical understanding, technical precision, toxicity awareness, and the integration of sensory nerve blocks into rational perioperative pain management.
Catheter-Related Bloodstream Infection (CRBSI) akibat Methicillin-Resistant Staphylococcus aureus (MRSA) pada Pasien Hemodialisis: Laporan Kasus Yogi Haditya
MEDICINUS Vol. 39 No. 8 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/v2ysqz52

Abstract

Among dialysis patients, infection is the second leading cause of death. The use of central venous catheters (CVC) for hemodialysis (HD) is associated with increased infection rates compared with other types of vascular access. The use of CVC is associated with a 2–3 fold higher risk of infection compared with arteriovenous fistula (AVF). CVC is associated with a spectrum of infections that includes catheter-related bloodstream infections (CRBSI) at the exit site, tunnel, and catheter. CRBSI is the most clinically significant infection due to its potential for progression to sepsis and death, and represents a major complication. We reported a 40-year-old man, with CRBSI caused by methicillin-resistant Staphylococcus aureus. The patient presented with a history of fever during HD sessions that resolved upon completion of HD. The vascular access used was a temporary CVC that had been in place for 2 months prior. On physical examination, the skin surrounding the catheter double lumen (CDL) was hyperemic with remaining blood clots. Cultures obtained from the exit-site swab, blood from the tip of CVC, and peripheral blood all identified with the same result: methicillin-resistant Staphylococcus aureus. Intravenous vancomycin 1,000 mg twice daily (BID) was administered for 14 days, and source control including catheter replacement was carried out. Repeat blood culture obtained after 14 days of antibiotic therapy was negative for bacteremia,and the patient showed clinical improvement.
Pharmacogenomics and Precision Pharmacotherapy in Heart Failure: A Narrative Review Andika Yusuf Ramadhan
MEDICINUS Vol. 39 No. 8 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/51m6s534

Abstract

Heart failure is a life-threatening condition affecting approximately 1% of the global population, with its prevalence continuing to rise. Genetic factors, including pathogenic variants in sarcomere, cytoskeletal, and ion channel genes, contribute to disease progression, often following Mendelian inheritance patterns. However, most interindividual variability in disease course and therapeutic response arises from polygenic, non Mendelian patterns, particularly single nucleotide polymorphisms (SNPs). SNPs can modestly influence gene expression, protein function, and downstream signaling pathways, thereby affecting the pharmacokinetics and pharmacodynamics of cardiovascular drugs. Variants in genes such as CYP2D6, ACE, AGT, CYP11B2, ADRB1/2, SLC5A2, and UGT2B4 have been associated with differential responses to β-blockers, SGLT2-inhibitors, and ACE inhibitors. The clinical application of genomic approaches remains limited due to small study sizes, interpatient variability, and the lack of standardized biomarkers. Nevertheless, integrating genetic, epigenetic, and phenotypic data offers a promising strategy to guide more effective and individualized heart failure pharmacotherapy.

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