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Cermin Dunia Kedokteran
Published by PT. Kalbe Farma Tbk.
ISSN : 0125913X     EISSN : 25032720     DOI : 10.55175
Core Subject : Health,
Health Professions
Cermin Dunia Kedokteran (CDK) is a Medical Journal published since 1974 and affiliated with PT Kalbe Farma Tbk. CDK is intended to help accommodate scientific publications and help increase and disseminate knowledge related to the development of medical science, pharmacy, and public health. CDK covers the disciplines of medicine, pharmacy, and health with several types of articles, namely: 1. Research 2. Literature review 3. Case report 4. Evidence-based case report (EBCR), systematic review 5. Other scientific articles Based on the SK Kemendikbudristek Nomor 152/E/KPT/2023, CDK has obtained Rank 4 (SINTA 4) for Scientific Journals.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 1,384 Documents
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AREDS2 sebagai Strategi Perlindungan Retina Terhadap Penuaan: Tinjauan Pustaka dari Perspektif Gerosains: Tinjauan Pustaka Wilaksono, Bhirau; Elfandari, Enno; Ichsan, Rayhani; Alfiandari, Dhini; Damry, Nurul Muf'idah; Chairul, Andi Makkawaru; Aminuddin, Nurul Mutiah; Nurdin, Novi Safitri; Chandrawati, Aida Ayu; Hammado, Nurussyariah
Cermin Dunia Kedokteran Vol 53 No 08 (2026): Agustus 2026 - CDK 355
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i08.2130

Abstract

Introduction: Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss among the elderly population. The Age-Related Eye Disease Study 2 (AREDS2) supplementation was developed as an evidence-based nutraceutical strategy to slow the progression of AMD. This review aims to evaluate the clinical evidence and potential application of AREDS2 as a geroprotective retinal intervention within the framework of precision geromedicine. Methods: A narrative review of recent AREDS and AREDS2 studies was conducted, integrating concepts from geroscience related to retinal aging. Results: The AREDS2 formulation, which replaced beta-carotene with lutein and zeaxanthin, demonstrated an 18% reduction in AMD progression risk without increasing lung cancer risk among smokers. AREDS2 components target key aging pathways, including oxidative stress, mitochondrial dysfunction, chronic inflammation, and dysregulated autophagy. In addition, potential modulation of mTOR and AMPK signaling suggests a role in extending retinal healthspan. Conclusion: AREDS2 represents a promising nutraceutical approach as a retinal gerotherapy within the paradigm of precision geromedicine. Its clinical implications include preventing AMD progression, optimizing visual function in older adults, and enabling integration into precision-based ophthalmologic practice. Further research is warranted to validate the molecular mechanisms and assess the cross-population effectiveness, thereby strengthening its role in broader age-related ocular health interventions.
Hubungan Kualitas Pelayanan Kesehatan dengan Biaya Total Pasien Apendektomi Terbuka di Rumah Sakit Tipe C dengan Cakupan Asuransi Kesehatan di Indonesia (BPJS Kesehatan): Penelitian Siahaan, Ayesha Melissa Rahmania; Ugut, Gracia Shinta Setyadi
Cermin Dunia Kedokteran Vol 53 No 08 (2026): Agustus 2026 - CDK 355
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i08.2093

Abstract

Introduction: Under BPJS Health, both open and laparoscopic appendectomies, are reimbursed at the same rate despite differences in consumable use. This study aimed to investigate whether open appendectomy provides favorable clinical outcomes at a lower cost and to analyze healthcare costs and service quality in class C private hospitals. Methods: This quantitative study was conducted at a type C hospital in South Jakarta from January 2022 to August 2023. The sample size was calculated using G*Power, the minimum required sample was 70 patients, based on linear multiple regression analysis. Patients included were those with appendicitis undergoing appendectomy under BPJS Kesehatan coverage, selected through purposive sampling. Patients with upgraded insurance or laparoscopic surgery were excluded. Data from medical records were analyzed using logistic regression with a significance level of p < 0.05. Results: Postoperative infection after appendectomy does not significantly influence cost and quality of care, possibly due to other factors. However, length of stay does, as longerpatients require more resources. Cost significantly influences quality of care (p < 0.05). Conclusion: Postoperative infections do not significantlyimpact care costs, suggesting case-mix and illness severity are more influential. Longer stays result in higher costs, especially in advanced services. Hospital management should prioritize controlling complications and infections to improve service and meet accreditation standards.
Characteristics of Pediatric Asthma Patients at the Outpatient Clinic of a General Hospital in Padang, Indonesia: Research Tosman, Farahdilla; Yani, Finny Fitry; Isrona, Laila; -, Russilawati; Rasyid, Roslaili; Rusjdi, Selfi Renita
Cermin Dunia Kedokteran Vol 53 No 09 (2026): September 2026 - CDK 356
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i09.1354

Abstract

Introduction: Pediatric asthma is a chronic respiratory disease that may affect daily activities and quality of life. This study aimed to determine the characteristics of pediatric asthma patients attending a general hospital outpatient clinic in Padang, Indonesia. Methods: A retrospective descriptive study was conducted using medical records of pediatric patients diagnosed with asthma from January 2020 to December 2022. Consecutive sampling was used, and 113 eligible medical records were included from 197 records reviewed. We analyzed demographic characteristics, asthma risk factors, disease severity, clinical manifestations, oral medication use, and inhalation device use. Results: Most patients were male (57.5%) and aged 5–11 years (64.6%), resided in Padang (91.2%), had health insurance (81.4%), and attended the pediatric outpatient clinic more than five times (54.9%). Among documented risk factors, a history of atopy was recorded in 46.0% of patients, while cigarette smoke was the most frequently documented allergen (39.8%). Intermittent asthma predominated (88.5%), with cough (97.3%) and shortness of breath (84.1%) as the most common clinical manifestations. Inhalation device use was not documented in 65.5% of patients, and most patients did not receive inhalation therapy. Conclusion: Pediatric asthma mostly affected school-aged boys and was classified as intermittent asthma. These findings show that oral medications were used more frequently than inhalation therapy, and inhalation device use was often not documented.
History, Risk Factors, Etiology, and Pathogenesis of Down Syndrome: Literature Review Zevanya, Evita; Indrarto, FX Wikan
Cermin Dunia Kedokteran Vol 53 No 09 (2026): September 2026 - CDK 356
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i09.1868

Abstract

Down syndrome is a congenital genetic disorder caused by abnormalities in the number, structure, or arrangement of chromosome 21 that cause cognitive impairment, congenital malformation, immune disorder, congenital heart disease, and other disorders. It is the most common chromosomal abnormality worldwide. ‘Down syndrome’ is named in honor of John Langdon Heydon Down, who described its clinical manifestations in an article in 1866. Down syndrome is a congenital genetic disorder caused by abnormalities in the number, structure, or arrangement of chromosome 21 that cause cognitive impairment, congenital malformation, immune disorder, congenital heart disease, and other disorders. It is the most common chromosomal abnormality worldwide. ‘Down syndrome’ is named in honor of John Langdon Haydon Down, who described its clinical manifestations in an article in 1866. Down syndrome may result from classic trisomy 21, Robertsonian translocation, or chromosomal mosaicism. Maternal age is the most common risk factor, as pathogenesis is linked to biological ovarian aging. Biological ovarian aging may increase the risk of chromosome 21 nondisjunction through hormonal imbalance, depletion of the oocyte pool, impaired cohesion function, oxidative stress, and altered elimination of aneuploid embryos. Knowledge of risk factors and their etiopathogenesis may help recommend an ideal maternal age for pregnancy. A better understanding of these mechanisms may support genetic counseling, pregnancy planning, and appropriate prenatal screening.  
Hypokalemia and Hemoperitoneum from Retrograde Menstruation in a Woman with Peritoneal Dialysis – A Case Report: Case Report Sanjaya, Winston; Halim, Hendry; Wibisono, Raden Sony Yusuf; Shian, Davis; Ekaputra, Anthony
Cermin Dunia Kedokteran Vol 53 No 09 (2026): September 2026 - CDK 356
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i09.2123

Abstract

Introduction: Hypokalemia in peritoneal dialysis (PD) can be caused by dialysate potassium loss, low intake of potassium-rich foods, or gastroenteritis. Hemoperitoneum is a non-mechanical complication of peritoneal dialysis, common in menstruating women. Case: A 52-yearold woman with end stage renal disease (ESRD) on PD was admitted to the emergency department with persistent vomiting and bloody dialysate. The patient had a history of type 2 diabetes, controlled with antidiabetic drugs. Her serum potassium was 2.0 mEq/L. Ultrasound showed simple ovarian cysts and uterine myomas. She was diagnosed with severe hypokalemia, hemoperitoneum, type 2 diabetes, and ESRD. The treatment included oral and intravenous potassium chloride, tranexamic acid, and frequent dialysate changes. After a one-month follow-up, no complications were reported. Discussion: The hypokalemia was likely associated with gastrointestinal potassium loss and inadequate intake of potassium-rich foods. The temporal relationship between menstruation and bloody dialysate, together with the absence of cyst rupture or peritonitis, supported retrograde menstruation as the probable cause of hemoperitoneum. Conclusion: Hypokalemia may result from gastrointestinal losses, inadequate potassium intake, while menstruation might cause bloody dialysate in PD.
Keberhasilan Pengobatan Dry Age-Related Macular Degeneration dengan AREDS 2: Tinjauan Pustaka Apriandary, Ni Putu Dian; Howen, Miranda
Cermin Dunia Kedokteran Vol 53 No 09 (2026): September 2026 - CDK 356
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i09.2127

Abstract

Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss. Recent 5-year follow-up findings confirm that AREDS2 formula (vitamins C and E, lutein, zeaxanthin, zinc, copper) significantly reduces the risk of progression from intermediate to advanced AMD. New analyses suggest AREDS2 supplements may slow geographic atrophy (GA) expansion towards the fovea in late-stage dry AMD, potentially preserving central vision. The supplement is recommended for patients with intermediate or advanced AMD, not in early stages. The AREDS2 formula does not prevent the onset of AMD or restore vision that has already been lost. Its main role is to reduce the risk of disease progression in appropriately selected patients. Lutein and zeaxanthin are preferred to β-carotene because β-carotene increases the risk of lung cancer, particularly among current and former smokers. Long-term use should be based on the AMD stage, smoking history, comorbidities, and potential interactions with other medications. Regular ophthalmological monitoring remains necessary to assess disease progression and detect conversion to neovascular AMD.
Secondary Postpartum Haemorrhage due to Retained Intrauterine Blood Clot with Impaired Uterine Outflow Following Caesarean Section: A Case Report: Case Report Risqiyani, Siti Zulaikha; Hapsari, Fikhy Rizky; Alkhairiyah, Annisa
Cermin Dunia Kedokteran Vol 53 No 09 (2026): September 2026 - CDK 356
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i09.2157

Abstract

Introduction: Postpartum hemorrhage (PPH) is the main cause of maternal mortality, ranging from 18%–50% of deaths worldwide. Secondary postpartum hemorrhage (SPPH) is defined as bleeding 24 hours to 12 weeks after delivery. Clinically worrisome uterine hemorrhage develops within 1 to 2 weeks in perhaps 1 percent of women. Such bleeding most often is the result of abnormal involution of the placental site. In some cases, uterine involution is hindered because of infection, retained placental tissue, or other causes. Such subinvolution is accompanied by varied intervals of prolonged lochia as well as irregular or excessive uterine bleeding. Another cause of subinvolution is incompletely remodeled uteroplacental arteries. These noninvoluted vessels are filled with thrombosis and lack an endothelial lining. Perivascular trophoblasts are also identified in the vessel walls, suggesting an aberrant interaction between uterine cells and trophoblasts. Secondary postpartum hemorrhage is most commonly associated with endometritis and retained products of conception, particularly retained placental tissue. However, this case highlights an uncommon mechanism of secondary postpartum hemorrhage associated with a retained intrauterine blood clot, which causes incomplete spiral artery remodeling. Case: A 36-year-old woman with approximately 2,000 mL of bleeding 9 days after elective cesarean delivery. Ultrasonography examination showed a blood clot in the uterus measuring 10.77 x 12.85 cm; a 700 mL blood clot was removed from the uterus by suction curettage. Postoperative ultrasound evaluation found the uterus in good condition without blood clots. Discussion: In this case, the retained blood clot is attributed to obstructed uterine outflow resulting from the lack of prior dilatation of the internal os, rather than to retained placental tissue. Consequently, this case offers an opportunity to discuss retained intrauterine blood clots as a rare and potentially underrecognized mechanism of secondary postpartum hemorrhage following cesarean delivery. Conclusion: In this case, secondary postpartum hemorrhage was caused by uterine subinvolution resulting from the retention of blood clots within the uterus, which prevented complete remodeling of the uteroplacental arteries.
Successful Live Birth in Partial Hydatidiform Mole: A Case Report: Case Report Wardhana, Anggia Mayangsari
Cermin Dunia Kedokteran Vol 53 No 09 (2026): September 2026 - CDK 356
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i09.2207

Abstract

Introduction: Partial hydatidiform mole (PHM) is a rare form of gestational trophoblastic disease characterized by abnormal trophoblastic proliferation accompanied by the presence of a fetus. Most cases end in miscarriage, while live births are extremely uncommon. Case: A 22-year-old primigravida diagnosed with PHM, intrauterine growth restriction (IUGR), and oligohydramnios underwent cesarean delivery at 35–37 weeks of gestation, resulting in a live female infant (1,750 g; Apgar scores 8/9). The enlarged placenta (1,180 g) was histopathologically confirmed as PHM. The newborn developed hypoglycemia, thrombocytopenia, and hyperbilirubinemia requiring intensive care, while the mother recovered uneventfully with declining β-hCG levels. Discussion: This case is remarkable as such an occurrence is extremely rare, as most PHM pregnancies end in spontaneous abortion during the first or second trimester due to chromosomal abnormalities and placental insufficiency. Postpartum follow-up revealed a gradual decline in β-hCG levels until they returned to normal, indicating the absence of persistent gestational trophoblastic disease. Conclusion: Pregnancies complicated by PHM require multidisciplinary care and close monitoring, including vigilance during the antenatal period, postpartum evaluation, and appropriate neonatal management to prevent and manage potential complications. Although rare and often associated with poor outcomes, PHM with live birth can achieve favorable results.
Efficacy of Doxycycline Prophylaxis for Prevention of Bacterial Sexually Transmitted Infections Among People with or Without HIV: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Systematic Review Prakoeswa, Flora Ramona Sigit; Dzikri, Dykall; Anggita, Vinka Dwi
Cermin Dunia Kedokteran Vol 53 No 09 (2026): September 2026 - CDK 356
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i09.2210

Abstract

Introduction: Bacterial sexually transmitted infections (STIs) remain a significant burden among populations at high risk, including people living with HIV (PLWH) and HIV-negative individuals receiving HIV pre-exposure prophylaxis (PrEP). This study evaluated the efficacy and safety of doxycycline pre- and post-exposure prophylaxis for preventing bacterial STIs among people with or without HIV. Methods: This systematic review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251171815). We conducted comprehensive searches in PubMed, Embase, and Cochrane CENTRAL through October 2025. We included randomized controlled trials evaluating doxycycline prophylaxis versus standard care. Meta-analysis was performed using random-effects models in RevMan 5.4. Results: Seven randomized controlled trials (2,091 participants) were included. Doxycycline prophylaxis significantly reduced bacterial STI incidence by 57% (pooled RR 0.43, 95% CI 0.35–0.53; p < 0.00001; I² = 42%). In the subgroup analysis of HIV-positive participants, doxycycline achieved a 62% reduction (RR 0.38; 95% CI 0.28–0.52). Pathogen-specific analysis showed a 72% reduction for chlamydia (RR 0.28), a 72% reduction for syphilis (RR 0.28), and a 44% reduction for gonorrhea (RR 0.56). Safety outcomes were summarized descriptively, with gastrointestinal symptoms most frequently reported; no pooled adverse-event or discontinuation estimate was calculated. The number needed to treat calculated from pooled event counts was approximately 4. Conclusion: Doxycycline prophylaxis reduced bacterial STI incidence in high-risk populations with and without HIV. These findings support considering doxycycline prophylaxis as a prevention strategy, while emphasizing limitations in regimen-specific evidence and the need for ongoing safety and antimicrobial-resistance monitoring.
Delayed Detection of Sperm in the Ejaculate Following Failed Microdissection Testicular Sperm Extraction in a Man With Azoospermia: A Case Report: Case Report Taher, Mukhlis Akmal; Silalahi, Esther Syalomia; Azzahra, Fathimah; Ariiq, Favian; Achmadsyah, Armand; Atmoko, Widi; Rasyid, Nur; Birowo, Ponco
Cermin Dunia Kedokteran Vol 53 No 09 (2026): September 2026 - CDK 356
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i09.2239

Abstract

Introduction: Non-obstructive azoospermia (NOA) affects 10%–15% of infertile males, posing a significant challenge in fertility management. Microdissection testicular sperm extraction (mTESE) is regarded as the gold standard for sperm retrieval for NOA. However, even when mTESE fails to retrieve sperm, unexpected postoperative findings may still occur. Case: A 31-year-old male with primary infertility and azoospermia underwent two surgical sperm retrieval procedures: percutaneous epididymal sperm aspiration (PESA) and mTESE. Hormonal and genetic evaluations revealed no abnormalities, but no sperm were retrieved during either procedure. Remarkably, six days after surgery, a self-ejaculated sample yielded five motile spermatozoa, which were immediately cryopreserved for intracytoplasmic sperm injection. Histopathology indicated moderate spermatogenesis with Johnsen scores of 6.0 and 7.0 for the right and left testes, respectively, highlighting residual spermatogenic activity. Discussion: The postoperative appearance of spermatozoa may reflect focal or intermittent spermatogenesis that was not detected during surgical sampling. The histopathological findings support the presence of limited residual sperm production despite unsuccessful PESA and mTESE. Conclusion: The detection of motile spermatozoa after failed mTESE highlights the importance of postoperative for follow-up, repeated semen analysis, and timely cryopreservation in the fertility management of patients with NOA.

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