Journal Of The Indonesian Medical Association

Updates on Autonomic Dysfunction Management in Parkinson's Disease

Priya Nugraha, Vania Ayu Puspamaniar — Mon, 13 Oct 2025 17:28:31 +0700

Since James Parkinson's 1817 initial description of Parkinson's disease (PD), autonomic dysfunction has been identified in PD patients. Parkinson disease (PD) is clinically heterogeneous due to motor and nonmotor symptoms, disease progression, and treatment responses. Autonomic dysfunction can cause a variety of symptoms, such as gastrointestinal, cardiovascular, urogenital, thermoregulatory, irregular pupillary movements, respiratory, and sleep symptoms. The idea that autonomic dysfunction may have a major role in PD patients' mobility, cognition, and health-related quality of life (HRQoL) is supported by several studies. Current management, as determined by the most recent guidelines, is crucial for updating physician expertise. Appropriate care is contingent upon a correct and timely diagnosis which will enhance the quality of life for PD patients. A thorough discussion of the clinical symptoms and current therapy will be provided in this article.

Relation Between Birth Weight and Stunting Nutritional Status among 2-59 Months Old Children

Aulia Yasmin Dewantari , Annisa Annisa, Nurcholid Umam Kurniawan — Mon, 13 Oct 2025 20:27:04 +0700

Introduction: Stunting remains a major global nutritional challenge for children, with a prevalence of 21.3% in 2019. Low birth weight (LBW) has been recognized as one of the risk factors for stunting. Despite various interventions, stunting continues to be a major public health concern because of its long-term impact on child growth and development. This study was conducted to evaluate the association between birth weight and stunting status in children aged 2-59 months, and to describe their characteristics in the working area of Samigaluh 1 Health Center.
Method: This case-control study utilized secondary data obtained from children’ growth monitoring records at the Integrated Healthcare Center and Maternal and Child Health (MCH) handbooks.
Results: Among the 80 subjects, 27 children (67.5%) were stunted at the ages of 2-24 months, and 13 children (32.5%) were stunted at ages 25-59 months. Stunting occurred in 21 boys (52.5%). Bivariate analysis using the Chi-square test revealed a significant relationship between LBW and stunting status (p value = 0.009; OR = 13.000; CI = 1.576-107.228).
Conclusion: The study established a significant association (p less than 0.05) between LBW and stunting status. Children with LBW were at 13-fold increase of stunting than normal birth weight. Stunting was also more prevalent among boys.

Distribution and Prevalence of Opportunistic Infections Among People Living with HIV/AIDS at Gambiran Hospital, Kediri, East Java

Forman Novrindo Sidjabat, Fitria Pratama Lestari Nur Jannah — Mon, 13 Oct 2025 20:31:30 +0700

Introduction: HIV/AIDS remains a global health problem with opportunistic infections (OIs) contributing to increased mortality. As a referral center for HIV/ AIDS services in Kediri City, Gambiran Hospital has reported a rising prevalence of HIV/AIDS and associated OIs. This study aimed to determine the prevalence and distribution of OIs among HIV/AIDS patients at Gambiran Hospital, Kediri, East Java.
Method: This study involved adult patients diagnosed with HIV/AIDS and OIs during the period 2019–2021. Sampling from medical records was performed using a proportional random sampling method. Data were analyzed descriptively.
Results: Of the total subjects (n = 59), the highest proportion of HIV/AIDS patients with OIs was found in group age of 26–45 years (62.7%). Most were male (66.1%), married (71.2%), actively employed (66.1%), and had completed high school (45.8%). The majority of subjects had a single OI (61%), with tuberculosis being the most common (34.9%).
Conclusion: HIV/AIDS patients with OIs at Gambiran Hospital were predominantly aged 26–45 years, male, married, actively employed, and had completed high school, with tuberculosis being the most common OI.

The Importance of Antenatal Care in Puskesmas Pasar Rebo, a Descriptive Cross Sectional Study

Ravi Krista Alya, Ulul Albab, Komarunisa Komarunisa — Mon, 13 Oct 2025 20:35:04 +0700

Introduction: Antenatal care (ANC) is vital for ensuring maternal and fetal health. This study aims to describe the maternal and fetal characteristics of pregnant women attending ANC services at Puskesmas Pasar Rebo from June 2023 to June 2024. Methods: A descriptive cross-sectional study was conducted on 140 pregnant women. Data were collected on maternal sociodemographic characteristics, obstetric history, and fetal parameters.
Results: The average maternal age was 27 ± 5,3 years, with a mean height of 157 ± 5,6 cm, an average body mass index (BMI) of 25.5 ± 4,9 kg/m2. The mean upper arm circumference was 27,47 ± 3,4 cm. Obstetric history showed an average gravida of 2, parity 1, abortus 0. On average, women attended 7,27 ± 3,13 ANC visits. Out of the 140 patients, 27 were referred: 9 cases of previous cesarean section, 2 with hypertension, 5 malpresentations, 2 cases of fetal growth restriction, 2 with placental problems, 2 cases of intrauterine fetal death (IUFD), 4 with hemmorhagic in early pregnancy, and 1 case of gemelli pregnancy. Fetal assessments indicated an average crown-rump length (CRL) of 4.8 ± 1,3 cm in the first trimester, an average fetal heart rate (FHR) of 170 ± 8 bpm in the first trimester, and 142 ± 7 bpm in the third trimester. The estimated fetal weight (EFW) averaged 2293 ± 452 grams, and the average amniotic fluid index (AFI) with a single deepest pocket (SDP) measured 4.5 ± 1,3 cm.
Conclusion: Routine antenatal care visit correlated significant in detecting high risks pregnancy cases needed to be referred to obstetrician. This study highlights the importance of regular ANC visits in detecting maternal and fetal complications in first and third trimester at Puskesmas Pasar Rebo.

The Relationship Between Depression and Anxiety With Caregiver Burden of Cancer Patients Receiving Chemotherapy

Titis Hadiati, Natalia Kus Setiarini, Hang Gunawan Asikin — Wed, 15 Oct 2025 08:45:51 +0700

Introduction: Cancer causes a significant physical and emotional burden, not only for patients, but also for caregivers. Caregiver’s burden is associated with caring for a chronically ill family member, which would increase if role tensions and concerns related to cancer are high and/or if they are in poor physical and emotional health, such as depression or anxiety. This study aims to determine the relationship between depression and anxiety with the burden of caregivers of cancer patients receiving chemotherapy.
Method: A cross-sectional study with consecutive sampling involving caregiver of cancer patients who met the inclusion and exclusion criteria. The sample filled out the DASS-21 and ZBI questionnaires to determine the degree of depression, anxiety, and caregiving burden. The relationship between variables was obtained using the Spearman test.
Results: From 30 caregivers of cancer patients who received chemotherapy, 3 experienced mild depression, 1 experienced moderate depression, 7 experienced severe depression, and 2 experienced very severe depression. While 5 experienced mild anxiety, 3 experienced moderate anxiety, 4 experienced severe anxiety, and 5 experienced very severe anxiety. ZBI showed 18 with little or no burden, 3 with mild to moderate burden, 4 with moderate to severe burden, and 5 with severe burden. There is a significant correlation between the degree of depression and anxiety with the burden of caring for cancer patients who receive chemotherapy (p less than 0,001).
Conclusion: Depression and anxiety are associated with the burden of caring for cancer patients who receive chemotherapy due to the tension and worry related to cancer with various symptoms and chemotherapy side effects.

Evidence Based Case Report: Can the Mentzer Index Guide Diagnosis of Microcytic Anemia in Rural Indonesia?

Angelica Diana Vita, Mario Bernardinus Realino Nara — Wed, 15 Oct 2025 09:02:32 +0700

Introduction: Indonesia, part of the “Thalassemia Belt,” carries a significant burden of hemoglobinopathies, with β-thalassemia trait (BTT) affecting up to 10% of the population. In rural settings with limited access to advanced diagnostics, distinguishing between BTT and iron deficiency anemia (IDA) using clinical and hematologic indices such as the Mentzer Index may aid early management.
Method: A structured literature search was conducted in MEDLINE and EBSCO to identify diagnostic or cross-sectional studies comparing red blood cell indices, particularly the Mentzer Index, in differentiating IDA from BTT. Studies were selected based on inclusion and exclusion criteria, and full texts were critically appraised by three reviewers using criteria of validity, importance, and applicability.
Results: Six studies with Level 4 evidence were included. The Mentzer Index was evaluated in all studies, with sensitivity ranging from 66% to 100% and specificity from 47.1% to 100%. Rashwan et al. and Jasim et al. reported perfect or near-perfect accuracy, while Indrasari et al., an Indonesian study, found more modest results (sensitivity 66%, specificity 62.5%). Variability in diagnostic performance may be influenced by population genetics, disease spectrum, and laboratory techniques.
Conclusion: The Mentzer Index demonstrates promising diagnostic value, particularly in settings where advanced testing is unavailable. However, variability in its accuracy across populations suggests that clinical judgment remains essential. The Mentzer Index can be a useful preliminary tool but should not replace confirmatory tests when available.

Eosinophilic Pneumonia: An Update Of Pathophysiology, Diagnosis And Management

Miraz Radhea Bagaskoro, Fariz Nurwidya — Wed, 15 Oct 2025 10:51:34 +0700

Eosinophilic pneumonia is a rare and heterogeneous group of lung diseases, comprising two main subtypes: acute eosinophilic pneumonia (AEP) and chronic eosinophilic pneumonia (CEP). Both are marked by eosinophilic infiltration into lung tissue and alveolar spaces, sharing similar pathophysiology but differing in clinical presentation and etiology. AEP is often linked to recent smoking or relapse in former smokers, while CEP commonly occurs in individuals with a history of atopy, such as asthma or allergic rhinitis. Diagnosis involves imaging and confirmation through bronchoscopy with bronchoalveolar lavage. Corticosteroids are the primary treatment, though relapses may occur, requiring long-term therapy. Biologic agents, particularly monoclonal antibodies, are being explored as alternative therapies. This review aims to summarize current knowledge on the clinical features, pathophysiology, diagnosis, and management of eosinophilic pneumonia.