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The Indonesian Journal of General Medicine
Published by International Medical Journal Corp. Ltd.
ISSN : -     EISSN : 3048104X     DOI : -
Core Subject : Health,
Dentistry Health Professions Medicine & Pharmacology Public Health Veterinary
ims: The Indonesian Journal of General Medicine aims to advance the field of medicine by disseminating high-quality research findings that are accessible to a broad audience of healthcare professionals, researchers, and policymakers. The journal is committed to supporting the development of medical knowledge and practice in Indonesia and globally, fostering innovative research and evidence-based clinical practices. Scope: The journal covers a wide range of topics within the general medical field, including but not limited to: Clinical studies in various medical disciplines Epidemiological research and public health issues Innovations in diagnostic techniques and treatments Reviews on current practices and emerging trends in medicine Case studies and clinical trials Health policy and medical education The Indonesian Journal of General Medicine welcomes submissions from all areas of medicine, particularly those that have significant implications for patient care, public health, and policy-making. The journal encourages submissions that offer new insights, propose novel approaches, or address challenges pertinent to the Indonesian and international medical communities.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 190 Documents
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The Impact of Sleep Disorders on Amyotrophic Lateral Sclerosis: A Systematic Review Bella Sugih Laksono; Nasyifa Nurul Fitriany; Iklima Fauzi Yazidah; Zam Zanariah; Nadia Amrin
The Indonesian Journal of General Medicine Vol. 16 No. 1 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/fdmnvp18

Abstract

Introduction: Amyotrophic Lateral Sclerosis (ALS) is increasingly recognized as a multisystem neurodegenerative disorder where sleep disturbances are highly prevalent and clinically significant. This review aims to systematically evaluate the evidence on the impact of various sleep disorders on the pathophysiology, clinical progression, survival, and quality of life in patients with ALS. Methods: A systematic search of PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library was conducted for observational studies, interventional trials, and meta-analyses published up to September 2024, in accordance with PRISMA guidelines. Studies assessing subjective or objective sleep parameters in ALS patients and their association with clinical outcomes were included. Methodological quality was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for randomized trials. Results: Seventeen studies met the inclusion criteria. The prevalence of poor subjective sleep quality (Pittsburgh Sleep Quality Index > 5) ranged from 50% to 63%. Insomnia, sleep-disordered breathing (SDB), and restless legs syndrome (RLS) were also highly prevalent. Polysomnography (PSG) consistently revealed significant reductions in total sleep time and sleep efficiency, altered sleep architecture with decreased slow-wave and REM sleep, and evidence of nocturnal hypoxemia. Sleep parameters were significantly associated with critical clinical outcomes. Poor sleep quality was linked to a more rapid decline in functional (ALSFRS-R) and respiratory (FVC) status, shorter survival, and reduced quality of life. Specific pathologies, including obstructive sleep apnea (OSA), nocturnal hypoventilation, and periodic limb movements in sleep (PLMS), were independent predictors of mortality. Emerging genetic evidence suggests a potential causal link between OSA and an increased risk of developing ALS. Discussion: The evidence supports a bidirectional model where ALS-related pathophysiology (e.g., respiratory muscle weakness, central neurodegeneration of sleep centers) disrupts sleep, and this sleep disruption, in turn, may accelerate neurodegeneration. Potential mechanisms for the latter include impaired glymphatic clearance of neurotoxic proteins, heightened systemic inflammation, and oxidative stress from intermittent hypoxia. Conclusion: Sleep disorders are an integral and prognostically significant component of ALS, not merely a secondary symptom. Their presence is associated with accelerated disease progression and reduced survival. These findings underscore the critical need for routine sleep assessment, including polysomnography, and proactive management, particularly with non-invasive ventilation (NIV), as a core component of comprehensive ALS care.
The Association of Long-Term Metformin Use with Cancer Risk in Type 2 Diabetes: A Systematic Review of the Evidence and Methodological Controversies Satya Agung Nugroho; Hasnan Habib Affifudin; Rizkyta Audrey Candrasmurti
The Indonesian Journal of General Medicine Vol. 1 No. 1 (2024)
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/vptnkj62

Abstract

INTRODUCTION: A substantial body of evidence suggests that type 2 diabetes mellitus (T2DM) is a systemic state that promotes carcinogenesis, with chronic hyperinsulinemia identified as a primary biological mechanism. Metformin, a first-line insulin-sensitizing agent for T2DM, has been investigated for potential anti-neoplastic properties due to its ability to reduce circulating insulin levels and exert direct cellular effects. However, the evidence is conflicting, with observational studies suggesting a protective effect while randomized controlled trials (RCTs) show null results. This systematic review synthesizes the evidence on the association between long-term metformin use and cancer risk in patients with T2DM and critically appraises the methodological controversies that complicate its interpretation. METHODS: A systematic review of key observational studies investigating the association between metformin use and cancer risk in T2DM patients was conducted. Included studies were of cohort and case-control design. The methodological quality of selected studies was assessed using the Newcastle-Ottawa Scale (NOS). Findings were synthesized for overall cancer incidence and mortality, site-specific cancer risks, and dose-duration relationships. A critical appraisal of potential biases, including time-related biases and confounding by comparator, was performed to contextualize the discrepancy between observational and RCT evidence. RESULTS: Observational studies and their meta-analyses consistently reported a significant reduction in overall cancer risk, with summary risk reductions of approximately 30-35% for both incidence and mortality. The strongest protective associations were observed for hepatocellular and pancreatic cancers. The evidence for colorectal and breast cancer was inconsistent, while the association with prostate cancer was weak. A clear dose- and duration-response relationship was a common finding, with benefits becoming significant only after several years of continuous use. In stark contrast, meta-analyses of RCTs have consistently found no association between metformin use and cancer incidence (RR 1.07; 95% CI, 0.87–1.31). Critical appraisal of the observational literature revealed a high potential for methodological flaws, particularly immortal time bias and confounding by comparison to potentially harmful agents (e.g., sulfonylureas), which may account for this discrepancy. DISCUSSION: The evidence regarding metformin's chemopreventive effect is defined by a fundamental conflict between a large body of observational data suggesting a strong protective effect and null findings from RCTs. The magnitude of risk reduction in observational studies is likely an overestimation driven by systematic biases. If a true protective effect exists, it is probably far more modest than initially reported and likely mediated by the systemic reduction of hyperinsulinemia, primarily affecting insulin-sensitive tumors. The alternative hypothesis—that metformin appears protective because it is often compared to agents like sulfonylureas that may increase cancer risk—cannot be dismissed. CONCLUSION: Observational studies and their meta-analyses consistently reported a significant reduction in overall cancer risk, with summary risk reductions of approximately 30-35% for both incidence and mortality. The potential for a modest reduction in the risk of certain cancers is a compelling hypothesis, but definitive conclusions await the results of large-scale, long-term RCTs designed with cancer as a primary endpoint.
Hubungan Foodrecall dengan Kejadian Preeklamsia M. Hamsah; Saniska Ayu Kartiniva Iskandar; Wirijanto
The Indonesian Journal of General Medicine Vol. 16 No. 1 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/2q4rys53

Abstract

Latar Belakang : Kehamilan merupakan proses fisiologis yang terjadi dalam tubuh seorang wanita. Preeklampsi merupakan masalah kedokteran yang serius dan memiliki tingkat kompleksitas yang tinggi Metode food recall 24 jam adalah metode survei konsumsi pangan yang fokusnya pada kemampuan mengingat subjek terhadap seluruh makanan dan minuman yang telah dikonsumsi selama 24 jam terakhir. Metode : Penelitian ini merupakan tinjauan pustaka (narrative review) yang menganalisis tujuh artikel penelitian yang relevan dan diterbitkan dalam sepuluh tahun terakhir. Pencarian literatur dilakukan secara sistematis menggunakan database PubMed, Google Scholar, ClinicalKey, dan ResearchGate dengan kata kunci: ““foodrecall"  dan  "preeklampsia”. Hasil : Hasil tinjauan menunjukkan bahwa food recall dalam konteks kehamilan preeklamsia adalah metode untuk mengumpulkan data tentang asupan nutrisi ibu hamil, dengan tujuan menganalisis hubungan pola makan dengan risiko preeklamsia. Penelitian menunjukkan pola makan preeklamsia lebih tinggi terjadi pada diet yang kaya daging merah olahan, kentang goreng, dan rendah buah-buahan serta sayuran. Kesimpulan : Hubungan food recall terhadap preeklamsia menunjukkan bahwa pola makan dan status gizi yang buruk adalah faktor risiko signifikan untuk terjadinya preeklamsia. Ibu hamil dengan asupan nutrisi yang tidak memadai, terutama defisit kalsium dan protein, serta kebiasaan mengonsumsi makanan tinggi lemak dan garam, memiliki risiko lebih tinggi mengalami peningkatan tekanan darah tinggi yang menjadi ciri preeklamsia. 
Syok Kardiogenik pada Pasien Diabetes Mellitus: A Case Report Putri Saskia Aulya; Andi Salahuddin; Fadillah Maricar
The Indonesian Journal of General Medicine Vol. 16 No. 1 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/qpyxxq20

Abstract

Latar Belakang: Syok kardiogenik merupakan kondisi gawat darurat yang ditandai dengan kegagalan pompa jantung sehingga tidak mampu memenuhi kebutuhan perfusi jaringan. Pasien dengan diabetes mellitus memiliki risiko lebih tinggi mengalami penyakit jantung koroner dan disfungsi miokard, yang dapat memicu terjadinya syok kardiogenik. Kasus: Seorang pasien laki-laki berusia 58 tahun dengan riwayat diabetes mellitus tipe 2 datang ke instalasi gawat darurat dengan keluhan nyeri dada hebat sejak 4 jam sebelum masuk rumah sakit, disertai sesak napas progresif, hipotensi (tekanan darah 78/50 mmHg), dan penurunan kesadaran. Pemeriksaan EKG menunjukkan elevasi segmen ST pada dinding anterior, dan echocardiography mengungkapkan fraksi ejeksi sebesar 25% dengan hipokinesia luas pada ventrikel kiri. Analisis laboratorium menunjukkan hiperglikemia dan peningkatan troponin I. Pasien segera mendapatkan terapi suportif termasuk oksigen, vasopressor, antiplatelet, dan dilakukan primary percutaneous coronary intervention (PCI). Hasil: Setelah intervensi, tekanan darah pasien membaik (104/70 mmHg) dan kesadaran kembali penuh dalam 48 jam. Pasien dirawat selama 10 hari dengan perbaikan hemodinamik dan fungsi ventrikel yang bertahap. Kesimpulan: Syok kardiogenik pada pasien diabetes mellitus sering berkaitan dengan kejadian infark miokard akut yang luas. Diagnosis dan intervensi cepat, termasuk reperfusi dini, sangat penting untuk meningkatkan angka harapan hidup pasien.
The Association of High Body Mass Index with the Risk of Placenta Previa: A Systematic Review Ivandra Septiadi Tama Putra; Penri Fransiskus Manulang; Jansen Renaldi; Lidya Aprilia Sari
The Indonesian Journal of General Medicine Vol. 17 No. 1 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/m9ek0y69

Abstract

Introduction: Placenta previa is a significant cause of maternal and neonatal morbidity, primarily due to antepartum hemorrhage. Concurrently, the global prevalence of maternal obesity is rising, a condition associated with numerous adverse pregnancy outcomes. The direct relationship between high maternal Body Mass Index (BMI) and the risk of developing placenta previa remains contentious, with conflicting evidence from observational studies. This systematic review aims to critically appraise and synthesize the available evidence to clarify this association. Methods: A systematic search of PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library was conducted to identify all relevant cohort and case-control studies published in English. Studies were included if they investigated the association between pre-pregnancy or early-pregnancy BMI (categorized as overweight or obese) and the incidence of placenta previa in pregnant women, compared to those with a normal BMI. Two independent reviewers performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale (NOS). A formal risk of bias assessment was also conducted using the Cochrane Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool. A narrative synthesis of the findings was performed. Results: Seventeen studies, comprising large-scale retrospective cohorts and case-control studies, met the inclusion criteria. The majority of high-quality studies, particularly those with robust adjustment for confounding variables, found no statistically significant direct association between high maternal BMI and the risk of placenta previa. Unadjusted analyses in some studies suggested a weak association, but this effect was consistently attenuated and lost statistical significance after controlling for key confounders, most notably a history of prior cesarean delivery. Analysis of secondary outcomes revealed that high BMI is strongly associated with an increased risk for primary cesarean delivery, gestational diabetes, and preeclampsia. Discussion: The weight of the evidence suggests that high maternal BMI is not an independent, direct risk factor for placenta previa. The association observed in unadjusted analyses is likely an artifact of confounding. A plausible indirect causal pathway is proposed: high BMI increases the risk of a primary cesarean delivery in a woman's first pregnancy, and the resultant uterine scarring is a powerful, established risk factor for placenta previa in a subsequent pregnancy. The pathophysiological mechanisms of obesity, such as systemic inflammation, appear to drive metabolic and hypertensive complications rather than influencing the specific site of placental implantation. Conclusion: The link between high maternal BMI and placenta previa is indirect, mediated primarily through the increased rate of cesarean delivery. Clinical counseling for women with high BMI should emphasize the well-established risks of gestational diabetes, hypertensive disorders, and the increased likelihood of a primary cesarean section, along with the long-term reproductive consequences of that surgery, including a future risk of placenta previa.
A Comparative Analysis of Treatment Strategies for Concurrent ST-Elevation Myocardial Infarction and Infective Endocarditis: A Systematic Review Reiny Laura Ningrum; Tirsa Wehelmina Ivonne Baguna
The Indonesian Journal of General Medicine Vol. 17 No. 1 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/w1tap636

Abstract

Introduction : The concurrent presentation of ST-Elevation Myocardial Infarction (STEMI) and Infective Endocarditis (IE) represents a rare but highly lethal clinical challenge. Standard management protocols for atherothrombotic STEMI are often contraindicated or hazardous in the context of septic coronary embolism, the predominant pathophysiology in IE. This creates a significant therapeutic dilemma with no consensus guidelines to direct clinical decision-making. This systematic review aims to synthesize the available evidence on different treatment strategies—medical, percutaneous, and surgical—and their impact on mortality and major complications in this patient population. Methods : A systematic search of PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library was conducted from inception to the present day to identify all relevant studies, including case reports, case series, and observational cohort studies. The search included adult patients with a confirmed dual diagnosis of IE and STEMI. Data on study design, patient characteristics, treatment strategies, and a predefined list of at least 15 clinical outcomes were extracted. The primary outcome was in-hospital all-cause mortality. Due to the heterogeneity of the data and the predominance of case-level evidence, a narrative synthesis was performed. The methodological quality of included studies was assessed using the ROBINS-I tool for observational studies and a modified Joanna Briggs Institute checklist for case series and reports. Results : A total of 18 studies, comprising 91 patients, met the inclusion criteria. The included literature consisted of two observational cohort studies and 16 case reports or small case series. The primary mechanism of STEMI was septic coronary embolism in over 88% of cases (Roux et al., 2017). Three primary treatment strategies were identified: medical management alone, percutaneous coronary intervention (PCI), and definitive cardiac surgery. In-hospital mortality was exceedingly high in patients receiving medical management alone (85.7%, 6/7 patients). PCI-based strategies, particularly stenting, were associated with a significant risk of late complications, most notably mycotic aneurysm formation. An integrated surgical approach, combining valve replacement with coronary revascularization (e.g., coronary artery bypass grafting), was associated with the lowest reported mortality among interventional strategies in selected patient cohorts (10% in one registry's survival group) (Güvenç et al., 2021), although it is subject to significant selection bias. Major complications across all groups included cardiogenic shock, heart failure, and systemic embolic events, particularly ischemic stroke. Discussion : The evidence, though of low quality, suggests a significant divergence in outcomes based on treatment strategy, which is deeply intertwined with the underlying pathophysiology of septic embolism. The high mortality in the medically managed group likely reflects a cohort of patients too unstable for intervention. While PCI can restore acute coronary flow, the implantation of a stent into an infected artery poses a substantial risk of long-term septic complications. A definitive surgical approach that addresses both the valvular source of infection and the coronary occlusion appears to be the most effective strategy but is often precluded by hemodynamic instability or acute neurological injury. Conclusion : Concurrent STEMI and IE is a clinical catastrophe associated with high mortality. The optimal management strategy is highly individualized and necessitates an emergency multidisciplinary 'Endocarditis Heart Team' approach. The available evidence, while limited, supports early definitive surgery in hemodynamically stable patients without prohibitive neurological contraindications. PCI should be used judiciously, primarily as a bridging therapy, with a preference for techniques that minimize vessel trauma and avoid permanent implants. Prospective, multicenter registries are urgently needed to provide higher-quality evidence to guide the management of this devastating condition.
The Association of Vitamin D Deficiency with Disease Activity in Systemic Lupus Erythematosus: A Systematic Review Calista Giovani; Charles Sanjaya Seikka
The Indonesian Journal of General Medicine Vol. 17 No. 2 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/v70g4262

Abstract

Introduction: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease characterized by chronic inflammation and multisystem organ damage. Vitamin D, a potent immunomodulator, has been implicated as a potential environmental factor influencing SLE pathogenesis and activity. A high prevalence of hypovitaminosis D is consistently observed in SLE patients, yet its precise role and the therapeutic benefit of supplementation remain areas of active investigation. This systematic review aims to synthesize the current evidence on the association between vitamin D status and disease activity in SLE and to evaluate the efficacy of vitamin D supplementation as an adjunctive therapy. Methods: A systematic search of medical databases was conducted to identify relevant observational studies and randomized controlled trials (RCTs) published up to 2025. Studies were included if they investigated the relationship between serum 25-hydroxyvitamin D levels and SLE disease activity, or the effects of vitamin D supplementation on clinical and serological outcomes in SLE patients. Data on study design, patient characteristics, interventions, and outcomes were extracted. The quality of included RCTs was assessed using the Cochrane Risk of Bias (RoB 2) tool, while observational studies were evaluated using the Newcastle-Ottawa Scale. Results: A total of 17 studies, comprising 12 observational studies and 5 interventional trials, met the inclusion criteria. Observational studies consistently demonstrated a high prevalence of vitamin D deficiency and insufficiency in SLE cohorts. A statistically significant inverse correlation between serum 25(OH)D levels and global disease activity scores (e.g., SLEDAI) was reported in the majority of these studies. Lower vitamin D levels were also associated with specific organ involvement, particularly lupus nephritis, and adverse serological markers, including higher anti-dsDNA titers and lower complement levels. Interventional studies and meta-analyses showed that vitamin D supplementation significantly, albeit modestly, reduced SLEDAI scores. The most consistent clinical benefit was observed in the improvement of patient-reported fatigue. Discussion: The evidence strongly supports a relationship between low vitamin D status and higher disease activity in SLE. The biological plausibility for this association is robust, grounded in vitamin D's multifaceted immunomodulatory effects on both innate and adaptive immunity. While supplementation appears to be a safe and beneficial adjunctive therapy, particularly for managing fatigue, its effect on global disease activity is modest. Heterogeneity in trial designs, including dosing regimens and study duration, contributes to variability in outcomes and highlights the need for larger, standardized trials. Conclusion: Vitamin D deficiency is a significant and modifiable factor associated with increased disease activity in SLE. Routine screening for and correction of hypovitaminosis D is warranted in all SLE patients, both for its established role in bone health and its potential as a low-cost, adjunctive immunomodulatory therapy. Future research should focus on large-scale, long-term RCTs to define optimal dosing strategies and target serum levels for specific clinical phenotypes.
The Association of Chronic Kidney Disease with Increased Cardiovascular Morbidity and Mortality: A Systematic Review Calista Giovani; Charles Sanjaya Seikka
The Indonesian Journal of General Medicine Vol. 17 No. 2 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/edv76569

Abstract

INTRODUCTION: Chronic Kidney Disease (CKD) represents a global public health crisis, affecting over 10% of the world's population. It is now unequivocally recognized not merely as a renal condition but as a systemic state of exceptionally high cardiovascular risk, where patients are more likely to die from cardiovascular complications than to progress to end-stage kidney disease. This review systematically synthesizes the evidence quantifying this profound risk. METHODS: A systematic review of prospective cohort studies and meta-analyses published between January 2000 and September 2024 was conducted using PubMed, EMBASE, and the Cochrane Library. Studies were included if they reported on the association between CKD, defined by estimated glomerular filtration rate (eGFR) or albuminuria, and specific cardiovascular morbidity or mortality outcomes in adult populations. The risk of bias in included non-randomised studies was systematically assessed using the Cochrane ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool. RESULTS: A total of 18 prospective cohort studies and 3 meta-analyses, encompassing a collective population of over 5 million participants, met the inclusion criteria. The evidence demonstrates a strong, independent, and graded association between declining eGFR and increasing albuminuria with heightened risks for all-cause and cardiovascular mortality. Significant associations were confirmed for over 15 distinct outcomes. Compared to preserved renal function, CKD was associated with substantially increased risks for myocardial infarction (Hazard Ratio up to 1.90), ischemic and hemorrhagic stroke (HR up to 2.19), incident heart failure (HR >2.0 for severe CKD), atrial fibrillation (HR up to 4.04 in stage 4 CKD), peripheral artery disease (HR >6.0 for associated complications), and sudden cardiac death, for which CKD confers a risk 4 to 20 times greater than that of the general population. DISCUSSION: The profound cardiovascular risk in CKD is driven by a synergistic interplay of highly prevalent traditional risk factors (e.g., hypertension, diabetes) and potent, non-traditional uremia-specific pathways. These include chronic inflammation, oxidative stress, sympathetic overactivity, anemia, and CKD-Mineral and Bone Disorder (CKD-MBD), which leads to accelerated and extensive vascular calcification. This unique pathophysiology renders general population risk scores inadequate and necessitates an integrated, cardiorenal-metabolic approach to patient management, as advocated by modern clinical practice guidelines. CONCLUSION: The evidence is overwhelming and definitive: CKD is a potent and independent risk multiplier for a wide spectrum of fatal and non-fatal cardiovascular events. Aggressive risk stratification using both eGFR and albuminuria, coupled with intensive management of both traditional and CKD-specific risk factors, is imperative to mitigate this substantial burden of disease.
The Association of Chemotherapy-Induced Neutropenia with the Risk of Febrile Neutropenia and Infections: A Systematic Review Calista Giovani; Charles Sanjaya Seikka
The Indonesian Journal of General Medicine Vol. 17 No. 2 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/73fmrg57

Abstract

INTRODUCTION Chemotherapy-induced neutropenia (CIN) is a primary dose-limiting toxicity of myelosuppressive cancer therapy. It significantly increases a patient's susceptibility to febrile neutropenia (FN), an oncologic emergency associated with severe infections, substantial morbidity, and mortality. This systematic review synthesizes the evidence linking CIN to the risk of FN and subsequent infectious complications. METHODS A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted for studies published from January 2010 onwards, following PRISMA guidelines. Observational studies and clinical trials involving cancer patients receiving chemotherapy and reporting on neutropenic complications were included. Data on over 15 distinct clinical, microbiological, and treatment-related outcomes were extracted. The methodological quality of included studies was appraised using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. RESULTS Twenty studies, encompassing prospective and retrospective cohorts, cross-sectional analyses, and validation studies, met the inclusion criteria. The evidence confirms that CIN is a direct precursor to FN, with an incidence of up to 16.8% per chemotherapy course, and a peak risk during the first treatment cycle. FN frequently necessitates hospitalization, with a mean duration of approximately 8 days, and is associated with significant in-hospital mortality rates ranging from 2.6% to over 25% in high-risk, culture-positive cohorts. Bloodstream infections are the most common severe documented complication. The microbiological landscape is evolving, with a resurgence of Gram-negative pathogens, including multidrug-resistant organisms, challenging standard empiric antibiotic regimens. Neutropenic events directly impact oncologic care, leading to frequent chemotherapy dose reductions and delays, which can compromise treatment efficacy. DISCUSSION The synthesized evidence underscores the profound clinical and economic burden of neutropenic complications. A critical gap exists between guideline recommendations for risk stratification and the poor predictive performance of existing clinical tools like the MASCC and CISNE scores. An episode of FN serves not only as an acute event but also as a sentinel marker of patient vulnerability, predicting a significantly increased long-term risk of subsequent infections. CONCLUSION CIN is unequivocally associated with an elevated risk of FN and life-threatening infections. This relationship drives significant morbidity, mortality, and disruptions to cancer treatment. Future efforts must prioritize the development of dynamic, data-driven risk prediction models and surveillance-informed antimicrobial stewardship to optimize patient management and improve oncologic outcomes.
Tinjauan Literatur: Peran Gaya Pengasuhan terhadap Terjadinya Gangguan Anxietas Sosial Masa Kanak Maria Leony Rahajeng Firstyani; Andy Soemara
The Indonesian Journal of General Medicine Vol. 17 No. 3 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/3gnjt982

Abstract

Gangguan Anxietas Sosial Masa Kanak merupakan salah satu kondisi kesehatan mental yang paling umum dan melemahkan, yang secara signifikan mengganggu fungsi akademik, sosial, dan keluarga anak. Lingkungan keluarga, khususnya gaya pengasuhan yang diterapkan orang tua, diakui sebagai faktor fundamental dalam perkembangan psikososial anak. Tinjauan literatur ini bertujuan untuk menganalisis secara sistematis hubungan antara berbagai gaya pengasuhan dengan etiologi dan perkembangan Gangguan Anxietas Sosial Masa Kanak. Pembahasan didasarkan pada kerangka teoretis tipologi gaya pengasuhan Baumrind yang diperluas oleh Maccoby dan Martin, serta kriteria diagnostik untuk Gangguan Anxietas Sosial Masa Kanak (F.93.2) menurut International Classification of Diseases, 10th Revision (ICD-10) yang menjadi acuan bagi Pedoman Penggolongan dan Diagnosis Gangguan Jiwa di Indonesia (PPDGJ-III). Sintesis bukti-bukti dari berbagai tinjauan sistematis dan meta-analisis secara konsisten menunjukkan bahwa gaya pengasuhan otoriter dan mengabaikan, yang ditandai oleh tingginya kontrol psikologis dan rendahnya kehangatan, secara signifikan meningkatkan risiko terjadinya anxietas sosial. Sebaliknya, gaya pengasuhan otoritatif, yang menyeimbangkan tuntutan dengan responsivitas, berfungsi sebagai faktor protektif yang kuat. Temuan ini menegaskan pentingnya intervensi klinis yang berfokus pada keluarga dan menyoroti perlunya penelitian lebih lanjut yang mempertimbangkan moderasi budaya dan kontribusi diferensial dari ibu dan ayah dalam dinamika ini.

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