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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 227 Documents
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A RELATIONSHIP BETWEEN THE HONEYCOMB APPEARANCE ON CT SCAN AND LIFE EXPECTANCY IN PATIENTS WITH SCLERODERMA? A SYSTEMATIC REVIEW Haekal Mahargias; Febrina Mayasari Gunawan; Mutiara Amalia
The Indonesian Journal of General Medicine Vol. 31 No. 1 (2026): 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/mkxj5n20

Abstract

Introduction: Systemic sclerosis (SSc) is a complex autoimmune disease frequently complicated by interstitial lung disease (ILD), a leading cause of mortality. The honeycomb appearance on high-resolution computed tomography (HRCT) represents advanced pulmonary fibrosis, but its prognostic significance in SSc-ILD remains debated. This systematic review aims to evaluate the relationship between honeycomb appearance on CT scan and life expectancy in patients with scleroderma. Methods: A systematic review was conducted following PRISMA guidelines. We screened studies based on predefined criteria: confirmed SSc diagnosis, evaluation of honeycomb pattern on CT, reported survival outcomes, appropriate observational study design, adequate follow-up, and sufficient sample size (>10 patients). Data extraction encompassed study characteristics, CT methodology, honeycomb definition, survival outcomes, and statistical associations. Quality assessment and multivariate analyses were evaluated. Results: Among 198 included studies, sample sizes ranged from 10 to 62,930 patients, with follow-up periods from 12 months to over 20 years. Honeycombing prevalence in SSc-ILD cohorts ranged from 37.2% to 41.9%, with higher frequency in limited cutaneous SSc. Multiple studies demonstrated significant associations between honeycombing and mortality, with hazard ratios ranging from 1.72 (95% CI 1.38-2.14) to 4.64 (95% CI 1.68-12.81). The association persisted after adjusting for age, gender, pulmonary function tests, and scleroderma subtype. Automated quantitative CT methods (CALIPER) showed improved reproducibility compared to visual scoring. Discussion: This review provides robust evidence that honeycomb appearance on CT scan is an independent predictor of reduced life expectancy in SSc-ILD patients. Honeycombing represents irreversible fibrotic damage and consistently outperforms inflammatory features (ground-glass opacities) in prognostic value. Heterogeneity in honeycomb definitions and quantification methods remains a limitation. Conclusion: Honeycomb appearance on HRCT is a critical prognostic marker in SSc-ILD, associated with 2-3 fold increased mortality risk. Standardized CT reporting and incorporation of honeycombing into clinical risk stratification models are recommended. Future research should focus on automated quantitative assessment and validation of honeycombing-specific therapeutic algorithms.
CAN RADIOLOGICAL ASSESSMENT OF THE DEGREE OF CAROTID ARTERY STENOSIS BE USED AS AN INDEPENDENT PREDICTOR FOR THE RISK OF RECURRENT ISCHEMIC STROKE IN PATIENTS WITH PRIOR ISCHEMIC STROKE? A SYSTEMATIC REVIEW Haekal Mahargias; Febrina Mayasari Gunawan; Mutiara Amalia
The Indonesian Journal of General Medicine Vol. 13 No. 5 (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/qy6f6v37

Abstract

Introduction: Recurrent ischemic stroke poses a significant clinical challenge, with carotid artery stenosis traditionally considered a major risk factor. However, whether the degree of stenosis alone independently predicts recurrence remains debated. This systematic review evaluates whether radiological assessment of carotid stenosis degree can serve as an independent predictor for recurrent ischemic stroke in patients with prior stroke. Methods: A systematic review was conducted following standardized screening criteria. Studies were included if they enrolled patients with confirmed prior ischemic stroke, assessed carotid stenosis using radiological methods (CT angiography, MR angiography, duplex ultrasound, or conventional angiography), quantified stenosis degree, and reported recurrent stroke outcomes. Data extraction encompassed study populations, stenosis assessment methods, recurrent stroke outcomes, multivariable analyses, and alternative predictors. Results: Fifty-nine studies were included, comprising 15 randomized controlled trials, 18 systematic reviews, and 26 cohort studies. The association between stenosis degree and recurrent stroke was heterogeneous. Large trials demonstrated significant independent prediction (POINT trial: OR 2.77, 95% CI 1.78-4.31; ENOS trial: OR 1.88, 95% CI 1.44-2.44 for ≥70% stenosis). However, other studies found no significant association (Mingyong Liu et al., 2014: annual risk 3.3% vs 4.7%, P=0.691; NAVIGATE-ESUS: HR 1.11, 95% CI 0.73-1.69). Plaque characteristics, particularly intraplaque hemorrhage, demonstrated stronger predictive value (HR 4.59-11.7) than stenosis degree alone. Cerebrovascular reserve also outperformed stenosis measurement (P=0.003 vs P=0.691). Recurrent events concentrated within the first 7-14 days post-index stroke (58% within 14 days), emphasizing the need for rapid risk stratification. Discussion: The predictive value of stenosis degree varies by clinical context, being most reliable in recently symptomatic severe (≥70%) stenosis but diminishing in moderate stenosis or when plaque vulnerability markers are considered. The pathophysiological basis for these findings relates to stenosis reflecting luminal narrowing without capturing plaque instability or hemodynamic compromise. Conclusion: Radiological assessment of carotid stenosis degree can serve as an independent predictor of recurrent ischemic stroke, but with moderate predictive accuracy (approximately 70%). Its clinical utility is enhanced when combined with plaque vulnerability markers, hemodynamic assessment, and consideration of timing from index event. Future risk stratification should integrate these multidimensional factors.
Gangguan Kecemasan pada Pasien dengan Dyspnea Tanpa Kelainan Organik I Gusti Ngurah Metta Nurcahya; Dian Pritasari Jeger; Edwin Sridana
The Indonesian Journal of General Medicine Vol. 32 No. 1 (2026): 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/ddb1z793

Abstract

Dispneu yang terjadi tanpa adanya kelainan organik yang dapat dibuktikan tetap menjadi masalah umum dan seringkali menantang dalam praktik klinis, seringkali dikaitkan dengan faktor psikologis yang mendasarinya, khususnya gangguan kecemasan. Tinjauan ini merangkum bukti terkini tentang sesak napas terkait kecemasan, dengan fokus pada definisi klinisnya, karakteristik epidemiologis, mekanisme etiologis yang mendasarinya, klasifikasi, evaluasi diagnostik termasuk diagnosis banding, dan strategi manajemen berbasis bukti. Dispneu psikogenik biasanya dialami sebagai sensasi subjektif ketidaknyamanan bernapas dan sering disertai dengan gejala panik, pola pernapasan yang tidak adaptif, dan peningkatan kecemasan. Pengenalan dini melalui penilaian biopsikososial yang komprehensif sangat penting untuk mengurangi investigasi diagnostik yang tidak perlu dan untuk memandu pendekatan pengobatan individual, termasuk intervensi kognitif-perilaku dan farmakoterapi bila sesuai. Dispneu yang menetap dengan adanya pemeriksaan fisik dan temuan diagnostik normal harus mendorong dokter untuk mempertimbangkan mekanisme terkait kecemasan dan untuk mengadopsi pendekatan interdisipliner guna mengoptimalkan hasil pasien.
Dermatomyositis: Current Insights into Pathogenesis, Diagnosis, and Dermatologic Management Helen Anastasya; Cut Putri Hazlianda
The Indonesian Journal of General Medicine Vol. 32 No. 1 (2026): 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/g0ffq828

Abstract

INTRODUCTION: Dermatomyositis (DM) is a rare, heterogeneous, systemic autoimmune myopathy characterized by hallmark cutaneous manifestations and, typically, symmetric proximal muscle weakness. It’s clinical significance is profound, extending beyond the skin and muscle to involve systemic complications such as interstitial lung disease (ILD) and a strong association with internal malignancy, both of which confer significant morbidity and mortality. The field is currently undergoing a paradigm shift, moving from a monolithic clinical diagnosis to a "clinico-serological" classification based on myositis-specific autoantibodies (MSAs). This modern approach is essential for accurate prognosis and the selection of targeted therapies. METHODS: This article presents a comprehensive narrative literature review based on a targeted search of scientific databases, including PubMed/MEDLINE, Google Scholar, and Scopus. The search prioritized literature published between 2020 and 2024 to capture the most current insights. Key search terms included "Dermatomyositis," "pathogenesis," "diagnosis," "treatment," "myositis-specific autoantibodies," "Type I interferon," "Janus Kinase inhibitors," "malignancy screening," and "interstitial lung disease." Selected foundational articles were included for essential context, and all literature was synthesized to build an integrated framework. LITERATURE REVIEW: Recent advances have solidified the central role of the Type I interferon (IFN-I) pathway in DM pathogenesis, creating a "Type I IFN signature" in affected skin, muscle, and blood. This discovery provides a direct mechanistic rationale for emerging targeted therapies. The identification of MSAs has revolutionized the diagnostic and prognostic landscape. These autoantibodies define distinct, clinically relevant phenotypes, such as anti-MDA5-positive DM, which is associated with rapidly progressive ILD (RP-ILD) (Lu, Peng and Wang, 2024), and anti-TIF1-γ-positive DM, which carries a very high risk of concurrent malignancy. Diagnosis now integrates clinical findings, serological profiling, and imaging, with new 2024 IMACS guidelines providing a risk-stratified, MSA-driven protocol for malignancy screening. Dermatologic management follows a stepwise algorithm, beginning with foundational photoprotection and antimalarials, escalating to conventional immunosuppressants (e.g., mycophenolate mofetil, methotrexate), and advancing to intravenous immunoglobulin (IVIG) and rituximab for refractory disease. Janus kinase (JAK) inhibitors represent the most promising emerging therapy, as they directly target the pathogenic IFN-STAT signaling pathway. CONCLUSION: The modern management of DM is a multidisciplinary, personalized endeavor guided by a patient's specific clinico-serological profile. This approach enables vital risk stratification for ILD and malignancy, guiding both screening and therapeutic selection. While significant therapeutic gaps remain, particularly for anti-MDA5+ RP-ILD and refractory cutaneous disease, the development of pathway-specific therapies like JAK inhibitors heralds a new, more targeted era for DM treatment. Future research must focus on validating these new therapies in randomized controlled trials and refining classification criteria to include skin-predominant disease.
Penatalaksanaan Anestesi pada Operasi Splenektomi Ruptur Lien dengan ORIF Humerus Sinsitra Naftali Novian Kristianto
The Indonesian Journal of General Medicine Vol. 32 No. 1 (2026): 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/kaw92y95

Abstract

Latar Belakang Syok hipovolemik (hemoragik) yang tidak terkontrol merupakan penyebab mortalitas yang paling sering terjadi pada pasien dengan multipel trauma. Diperkirakan 25% kematian akibat trauma dapat dicegah dengan onset penanganan trauma yang tepat dan intervensi yang tepat untuk menghentikan perdarahan. Laporan Kasus Dilaporkan seorang pasien laki-laki usia 31 tahun, mengalami kecelakaan lalu lintas, terdiagnosis ruptur lien derajat V disertai fraktur humerus sinistra. Pasien dilakukan Tindakan operasi cito splenektomi dan ORIF humerus. Anestesi dilakukan dengan general anesthesia (GA). Operasi berlangsung selama 3.5 jam dengan lama anestesi 4 jam. Durante operasi hemodinamik relatif stabil, dengan perdarahan 1500 mL dan urine output 400 mL. Post operasi pasien dirawat di ICU. Kesimpulan Manajemen perioperatif, yang meliputi: pemilihan farmakologi sebelum operasi, kombinasi terapi cairan, tranfusi darah dan penggunaan vasopresor sangat penting dalam tatalaksana anestesi operasi splenektomi ruptur lien dengan ORIF humerus.
Is Bacterial Vaginosis Associated with an Increased Risk of Pelvic Organ Prolapse in Women? : A Comprehensive Systematic Review Petra Damiana Anindita; Elvantie; Galih Dwi Endrianto; Namira
The Indonesian Journal of General Medicine Vol. 33 No. 1 (2026): 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/xgbgg912

Abstract

Introduction: Bacterial vaginosis (BV) is the most common vaginal infection in reproductive-aged women, characterized by depletion of protective Lactobacillus species and overgrowth of anaerobic bacteria. Pelvic organ prolapse (POP) is a prevalent pelvic floor disorder with significant morbidity. Although both conditions share common risk factors such as aging, parity, and estrogen decline, whether BV independently increases POP risk remains unclear. This systematic review aims to synthesize available evidence on the association between BV and POP. Methods: A comprehensive systematic review was conducted using predefined screening criteria. Studies were included if they involved adult non-pregnant women, assessed BV as an exposure, measured POP as an outcome, provided clear diagnostic criteria for both conditions, and employed observational designs. Data extraction encompassed study characteristics, BV and POP assessment methods, effect measures, confounders, and temporal relationships. Results: Twenty-two sources were reviewed, including primary studies, systematic reviews, and narrative reviews. Only one primary study (Cheng et al., 2022) directly examined the BV-POP association in 358 postpartum women, finding significantly higher BV incidence in the pelvic floor dysfunction group (p<0.05), but BV was not an independent risk factor on logistic regression. Kaminskyi et al. (2020) observed vaginal biocenosis disorders in women with early genital prolapse but reported no statistical analysis. Indirect evidence from Yu et al. (2023) demonstrated associations between vaginal microenvironment factors (lactobacilli depletion, leukorrhea cleanliness) and pelvic dysfunction. Balaouras et al. (2024) identified Gardnerella among species associated with pelvic floor dysfunction. Alnaif et al. (2001) found smoking independently associated with both severe prolapse and BV, suggesting shared environmental risk factors. Wojtas et al. (2024) reported that up to 30% of pessary users develop BV, indicating possible reverse causation. Discussion: The current evidence does not support BV as an independent risk factor for POP. The observed co-occurrence is more plausibly explained by shared risk factors (age, menopause, estrogen decline, smoking) and reverse causation whereby anatomical changes of prolapse or pessary use promote dysbiosis. Broader vaginal microecological disturbances—particularly Lactobacillus depletion—may be more relevant than BV per se. Mechanistic pathways involving inflammation and collagen degradation remain speculative. Conclusion: Bacterial vaginosis is not established as an independent risk factor for pelvic organ prolapse. Well-designed prospective cohort studies with long-term follow-up, adequate confounder control, and standardized diagnostic criteria are needed to clarify this relationship.
Association of Pre-existing Hypertension to The Development of Superimposed Preeclamsia Andi Muh. Ariansyah Nazaruddin; Yusran Antonius
The Indonesian Journal of General Medicine Vol. 33 No. 1 (2026): 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/prnp3669

Abstract

Introduction: Superimposed preeclampsia (SPE), the development of preeclampsia in women with pre-existing chronic hypertension (CH), represents a high-risk obstetric condition associated with significant maternal and perinatal morbidity and mortality. Understanding the magnitude of this risk and the effectiveness of preventive interventions is critical for improving outcomes in this vulnerable population. Methods: This systematic review synthesized evidence from 40 studies, published between 2005 and 2025. Studies were screened and included if they examined pregnant women with CH, reported on SPE as an outcome, provided quantitative data on the association, and had appropriate study designs. Data were extracted on study characteristics, population demographics, definitions of CH and SPE, incidence rates, risk factors, effectiveness of preventive interventions (e.g., low-dose aspirin, antihypertensives, metformin), predictive markers, and secondary maternal/perinatal outcomes. Results: The pooled incidence of SPE among women with CH was 25.9% (95% CI: 21.0-31.5%), representing a 5- to 8-fold increased risk compared to normotensive women (Bramham et al., 2014; Al Khalaf et al., 2019). Risk was significantly modified by renal dysfunction (even mild elevations in serum creatinine or proteinuria), uncontrolled blood pressure, and newly diagnosed CH during pregnancy (Kawakita et al., 2022; Heimberger et al., 2020; Nie et al., 2024). Meta-analyses of RCTs found low-dose aspirin (typically 60-150 mg) did not significantly reduce the risk of SPE (OR 0.83, 95% CI: 0.55-1.25), with subgroup analysis from the ASPRE trial showing a significant interaction suggesting no benefit in women with CH (Poon et al., 2017; Richards et al., 2023). However, aspirin reduced preterm birth and composite adverse neonatal outcomes. Antihypertensive treatment effectively reduced severe hypertension (RR 0.33) but had no significant impact on SPE incidence (RR 0.74, 95% CI: 0.49-1.11) (Webster et al., 2017). Promising predictive markers included the sFlt-1/PlGF ratio (particularly after 27 weeks) and second-trimester cerebrovascular hemodynamics (Scalia et al., 2024; Riskin-Mashiah & Belfort, 2005). Women with SPE had worse maternal and neonatal outcomes compared to those with preeclampsia alone. Discussion: The strong association between CH and SPE is well-established, but significant heterogeneity in incidence stems from variations in population risk profiles, diagnostic criteria, and blood pressure control. The apparent "aspirin paradox"—where aspirin is highly effective in preventing preeclampsia in other high-risk groups but not in women with CH—may indicate a distinct pathophysiology in this group, involving pre-existing endothelial and vascular damage less responsive to antiplatelet therapy. The primary benefit of antihypertensive therapy is in preventing severe maternal hypertension, not SPE. Accurate risk stratification using renal markers and achieving tight BP control are crucial management pillars. Conclusion: Chronic hypertension confers a substantially elevated risk for superimposed preeclampsia, with incidence influenced by renal function and BP control. Current evidence does not support low-dose aspirin for primary prevention of SPE in this population, though it retains benefit for reducing preterm birth. Management should focus on stringent blood pressure control, early risk stratification using renal parameters, and vigilant monitoring for predictive biomarkers. Future research should prioritize large RCTs targeting women with CH, exploring alternative preventive agents like metformin, and refining predictive models.

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