Journal Of The Indonesian Medical Association

Renal Denervation: An Adjunctive Therapy for Resistant Hypertension

Sidhi Laksono — 2026-01-15

Hypertension is one of the major risk factors for cardiovascular disease worldwide. Evidence has demonstrated that effective blood pressure control can reduce cardiovascular morbidity and mortality while slowing the progression toward end-stage renal disease. However, blood pressure control rates in the global population remain far from optimal despite the availability of various lifestyle-based and pharmacological treatment options. Recent data indicate that among approximately 120 million adults with hypertension in the United States, only about 23% have successfully achieved the target blood pressure of kess then 130/80 mmHg, whereas nearly 45% continue to have blood pressure levels ≥140/90 mmHg.

The Relationship Between Knowledge and Attitude of Elderly Hajj and Umrah Pilgrims Toward Dehydration Prevention

Firda Amalia — 2026-01-15

Introduction: Hajj and Umrah are Islamic pilgrimages performed in Saudi Arabia, often taking place during the summer season when temperatures may exceed 40°C. Such extreme conditions increase the risk of dehydration, especially among the elderly. Dehydration in older adults can lead to severe complications, even death. Preventive measures can be achieved through adequate knowledge and positive attitudes toward fluid intake.
Methods: This was an observational analytic study with a cross-sectional design. Respondents were selected using purposive sampling, consisting of 50 elderly Hajj and Umrah pilgrims. The study was conducted from February to December 2023 at the NRA Hajj and Umrah Bureau, South Jakarta. Data were analyzed using the chi-square test to assess the relationship between knowledge and attitudes toward dehydration prevention.
Results: The majority of respondents had good knowledge (62%) and moderate attitudes (56%), with most being female aged 60–65 years. Bivariate analysis showed a significant relationship between knowledge and attitudes of elderly Hajj and Umrah pilgrims toward dehydration prevention (p = 0.035).
Conclusion: There is a significant relationship between knowledge and attitudes of elderly Hajj and Umrah pilgrims toward dehydration prevention.

The Impact of Comorbidities on Drug-Resistant Tuberculosis Treatment Success at Dr. Soebandi Hospital Jember 2018-2022

Muhammad Rafi’uddin Hafa — 2026-01-15

Introduction: Drug-resistant tuberculosis (DR-TB) is a major health concern in Indonesia, where treatment success rates remain low. Comorbidities such as diabetes mellitus (DM) and human immunodeficiency virus (HIV) may worsen patient outcomes by complicating disease management and increasing the risk of treatment failure. This study aimed to assess the impact of comorbidities on treatment success among DR-TB patients at dr. Soebandi Hospital Jember.
Method: An analytic observational study was conducted on 228 DR-TB patients at RS dr. Soebandi in 2018-2022 who had completed treatment, selected using total sampling. Data were analysed using bivariate analysis to examine associations between comorbidities and treatment outcomes.
Results: The overall treatment success rate was 36.8%. Comorbidities were present in 37.3% of patients and were associated with a significantly lower success rate compared to those without comorbidities (21.2% vs. 46.2%; p=0.000; OR=3.19). DM (p=0.018; OR=2.17) and HIV (p=0.026; OR=9.31) each significantly reduced treatment success. A combination of DM and hypertension also showed a significant association (p=0.041; OR=9.44).
Conclusion: Hypertension alone, chronic kidney disease, and chronic hepatitis were not statistically related to treatment success. Comorbidities, particularly DM, HIV, and the combination of DM with hypertension, significantly affect DR-TB treatment success. Addressing these conditions could improve patient outcomes and enhance treatment programs.

Comorbid Factors, Metastasis and Their Relationship with Survival of Colorectal Cancer Patients at Nganjuk Regional Hospital and Their Relationship with APC, KRAS and SMAD4 Gene Expression in Cancer Tissue

Pratika Yuhyi Hernanda — 2026-01-15

Introduction: The survival of colorectal cancer patients is significantly influenced by comorbid factors, including age, smoking, obesity, comorbidities, and genetics. The purpose of this study was to analyze factors affecting colorectal cancer survival in Nganjuk Regional General Hospital and to examine the expression of the APC, KRAS, and SMAD4 genes in tumor tissue.
Methods: We analyzed the comorbid factors in 51 colorectal cancer patients and then analyzed their relationship to colorectal cancer survival. Immunohistochemistry (IHC) staining was performed to examine the expression of the KRAS, APC, and SMAD4 genes in colorectal cancer tissue. Data were analyzed using bivariate analysis between variables using the Chi-square test, and survival analysis was performed using Kaplan-Meier statistical analysis.
Results: The data shows that colorectal cancer patients with comorbidities tend to have a lower survival rate than those without comorbidities (P-value 0.054), and patients with metastases also have a lower survival rate (P-value 0.748). APC and SMAD4 gene expression in stromal tissue IHC was more dominant than KRAS gene expression in the stroma. Increased gene expression in the stroma indicates its role in tumor invasion and metastasis.
Conclusion: Comorbidities and the presence of metastases negatively impact the survival rate of colorectal cancer patients. APC and SMAD4 gene expression in the stromal tissue was more dominant than KRAS gene expression in the stroma, suggesting a role for these genes in tumor invasion and metastasis.

Depressive Disorder in Epilepsy: An Evidence-Based Case Report

Frilya Rachma Putri — 2026-01-15

Introduction: Depression affects approximately 22.9% of people with epilepsy (PWE), substantially higher than the general population. This comorbidity is mediated by complex neurobiological mechanisms including neuroinflammation, GABA-glutamate imbalance, and hypothalamic-pituitary-adrenal (HPA) axis dysregulation, and is further exacerbated by psychosocial stigma.
Case Presentation: We report the case of a 19-year-old woman with epilepsy diagnosed at age 6 who had been treated with phenytoin for 12 years. She developed depressive symptoms following prolonged bullying and social stigma, presenting with persistent sadness, anhedonia, self-harm behaviors, and subsequent psychotic features. Initial management included sertraline and aripiprazole. A drug-drug interactions between sertraline and phenytoin resulted in ataxia and gait imbalance, necessitating a switch in antiepileptic therapy to levetiracetam, carbamazepine, and clobazam.
Methods: A systematic literature review using PubMed, Cochrane, and Google Scholar databases, focusing on studies published between 2018 amd 2023 evaluating antidepressant treatment in PWE.
Result: Selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line treatment for depression in epilepsy (recommendation level B). Venlafaxine reduced Hamilton Depression Rating Scale (HAMD) scores by 7.59 points compared with no treatment (RR 3.25; 95%CI 1.19–8.90; NNT = 4). Paroxetine versus doxepin demonstrated an RR of 1.16 (95%CI 0.88–1.52; NNT = 9), while amitriptyline versus nomifensine showed an RR of 0.55 (95%CI 0.28–1.06; NNT = 3). SSRIs (sertraline or citalopram) reduced Beck Depression Inventory (BDI) scores by 4.90 points compared with cognitive behavioral therapy.
Conclusion: SSRIs are effective to reduce depressive symptoms in PWE, with venlafaxine representing a viable alternative for non-responders. However, clinicians should carefully consider potential drug-drug interactions, particularly CYP450 enzyme inhibition, which may increase antiepileptic drug levels and require dose adjustments and close monitoring.

The Role of Dead-Box Helicase 41(DDX41) Gene Mutation Testing in Hypoplastic Myelodysplastic Syndrome

Budiono Raharjo — 2026-01-15

Introduction: DDX41 gene mutations can occur in hematopoietic malignancies, especially acute myeloid leukemia (AML) and myelodysplastic syndrome. The average incidence of myelodysplastic syndrome (MDS) in the general population is 4.5 out of 100,000 people per year. Myelodysplastic syndrome (MDS) can occur with different genetic mutations and will provide different prognoses and therapy results. Hypoplastic myelodysplastic syndrome (MDS) is often found in 10-15% of MDS patients. There have been no case reports or research studies in Indonesia that have reported a case of hypoplastic myelodysplastic syndrome associated with a mutation in the Dead Box Helicase 41 (DDX41) gene.
Case Report: A 66-year-old man presented with complaints of weakness. The patient had a history of myelodysplastic syndrome diagnosed two years earlier. Bone marrow aspiration revealed cellularity with decreased granulopoiesis and thrombopoiesis, and myeloblasts accounted for 2.0%. Genetic testing using a Next Generation Sequencing (NGS) panel identified DDX41 p.(Pro258Leu) at 47.9%, DDX41 p.(Arg525His) at 1.7%, and ASXL1 p.(Gln977Ter) at 1.6%. The patient was treated with a combination therapy of venetoclax and azacitidine. Follow-up bone marrow aspiration showed improved cellularity, increased erythropoiesis activity, and a reduction in the number of dysplastic cells.
Case Discussion: Mutations in the DDX41 gene can mostly be found in cases of hypoplastic myelodysplastic syndrome, while in normocellular or hypercellular myelodysplastic syndrome, genetic mutations such as SF3B1, TET2, STAG2, ASXL1, and BCOR are mostly found. The DDX41 gene is related to cellular molecules and innate immunity. The DDX41 gene mutation is a determining factor in the administration of chemotherapy. The DDX41 gene mutation is a determining factor in the selection of chemotherapy drugs.
Conclusion: DDX41 genetic testing with NGS method is essential for determining the prognosis and appropriate therapy in the management of hypoplastic myelodysplastic syndrome cases.

The Role of the Pituitary Gland and Neuroendocrine Influence on Human Behavior: A Systematic Literature Review

Siti Nur Asiyah Maskan — 2026-01-15

Human behavior is shaped by the complex interaction between the nervous and endocrine systems. The pituitary gland, as a major component of the endocrine system, plays a crucial role in regulating both physiological and psychological functions through the secretion of various hormones. This study aims to systematically review the role of the pituitary gland and the influence of the neuroendocrine system on human behavior. The research employed a Systematic Literature Review (SLR) method, analyzing eight selected scientific articles published between 2021 and 2025. Articles were sourced from Google Scholar, ScienceDirect, and ResearchGate using relevant keywords, and filtered following PRISMA guidelines. The review revealed that pituitary-secreted hormones such as ACTH, GH, prolactin, LH, FSH, and oxytocin have significant impacts on stress regulation, emotions, social bonding, and cognitive functions. The hypothalamic–pituitary–adrenal (HPA) axis plays a central role in the stress response and is strongly linked to psychological symptoms including anxiety and depression. Additionally, non-pharmacological interventions such as music therapy have been shown to stabilize neuroendocrine activity and effectively reduce anxiety. The pituitary gland functions as a hormonal control center that influences various aspects of human behavior. This review underscores the importance of neuroendocrine understanding within psychological contexts and supports the development of physiological-based interventions for mental well-being.