Acta medica Indonesiana最新文献

{"title":"Correlation of Serum FT4 with Serum Uric Acid and Comparison of Uric Acid in Subjects with and without Atrial Fibrillation in Graves' Disease: A Cross-Sectional Study.","authors":"Bella Yunita, Imam Subekti, Birry Karim, Murdani Abdullah, Cleopas Martin Rumende, Dyah Purnamasari, Juferdy Kurniawan, Adityo Susilo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases increase the mortality risk in Graves' disease (GD) patients. Atrial fibrillation (AF) is one of the most prevalent cardiovascular diseases in GD. Hyperthyroidism that occurs in GD may increase uric acid levels, while uric acid levels can also increase the risk of AF in the general population. This study is designed to observe the correlation between free T4 (FT4) and uric acid, and compare the levels of uric acid in subjects with and without AF in GD.</p><p><strong>Methods: </strong>A cross-sectional study was conducted, including GD patients who met research criteria in Dr. Cipto Mangunkusumo Hospital during 2024. We performed history taking, physical examination, laboratory examination, and electrocardiogram for each subject. Data was analyzed using Pearson or Spearman correlation, and bivariate analysis to evaluate the comparison of uric acid in subjects with and without AF.</p><p><strong>Results: </strong>We included 74 subjects, with an average age of 41 years, mostly female (86.5%), and 62.2% had normal FT4 levels. AF occurred only in 4.1% subjects. Mean of uric acid is 4.71 ± 1.2 mg/dl, which is within the normal range. No correlation was found between FT4 and uric acid (r = 0.076; p = 0.520), including after adjustment with subgroup analysis based on thyroid status, gender, and diabetes mellitus. Mean of uric acid is not statistically different between subjects with and without AF (4.9 ± 1.01 mg/dl vs 4.7 ± 1.2 mg/dl; p = 0.785).</p><p><strong>Conclusion: </strong>No significant correlation was found between FT4 and uric acid. Mean of uric acid is not statistically different between subjects with and without AF.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"346-352"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine-assisted Directly Observed Therapy (DOTS) for Tuberculosis: An Evidence-based Case Report.","authors":"Valerie Josephine Dirjayanto, Kieran Pasha Ivan Sini, Aureilia Calista Zahra, Pandya Praharsa, Muhammad Afif Vargas Pramono, Diantha Soemantri","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis is a high-burden infectious disease requiring long-term treatment. Compliance is the key to cure; however, directly observed therapy (DOTS) is not always feasible. Telemedicine use in DOTS offers improved accessibility; however, its effectiveness has not been established. We aimed to investigate the effectiveness of telemedicine-based DOTS on treatment compliance in patients with tuberculosis.</p><p><strong>Methods: </strong>Databases including MEDLINE, Scopus, EMBASE, PubMed, and Cochrane were searched for studies implementing telemedicine-based DOTS until November 2nd, 2023. Studies were appraised for validity, importance, and applicability using the Oxford Centre of Evidence-Based Medicine tool, and the outcomes were graded based on their levels of evidence (LOE).</p><p><strong>Results: </strong>Our search yielded six systematic reviews. Telemedicine-based DOTS yielded favourable effects in improving adherence (LOE: I), treatment completion (LOE: II-III), and cure rates (LOE: II-III). Other outcomes, in terms of bacteriological resolution (LOE: II) and mortality (LOE: IV), were estimated to be non-inferior to those of DOTS. In terms of the telemedicine mode, the VDOTS yielded the highest LOE in improving adherence (LOE: I), followed by short messaging services (LOE: III) and medication monitors (LOE: III), which yielded similar effects. Results for phone reminders were contradictory, with the highest evidence suggesting that it might be ineffective for treatment completion (LOE: I-III) but may increase the cure rate (LOE: III).</p><p><strong>Conclusion: </strong>Telemedicine-based DOTS may improve adherence, treatment completion, and cure rate, and is non-inferior in terms of bacteriological resolution and mortality. Telemedicine-based DOTS can be considered for implementation; however, further high-quality studies in limited-resource settings are needed to strengthen the evidence.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"405-420"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Leptin and Adiponectin Levels and Sarcopenia in Non-Geriatric Type 2 Diabetes Mellitus Patients.","authors":"Khoirul Husam, Purwita Wijaya Laksmi, Robert Sinto, Andhika Rachman, Rudy Hidayat, Sukamto Koesnoe, Noto Dwimartutie, Dyah Purnamasari","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Type 2 Diabetes Mellitus (T2DM) in young adults is associated with an increased risk of early sarcopenia due to insulin resistance and inflammation. This insulin resistance and inflammation can be influenced by leptin and adiponectin, which are key adipocytokines produced by adipose cells. However, no studies have examined the relationship between leptin, adiponectin levels, and sarcopenia in T2DM patients under 60 years old. This study aimed to investigate the relationship between leptin, adiponectin levels, and Leptin-to-Adiponectin ratio (LAR) with sarcopenia in non-geriatric T2DM patients.</p><p><strong>Methods: </strong>This cross-sectional study was conducted from January 2021 to April 2022. The subjects consisted of T2DM patients aged 18-59 years at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Baseline data were sourced from a primary study, while stored serum samples were analyzed for leptin and adiponectin using ELISA. Leptin and adiponectin differences were assessed statistically using the Mann-Whitney U test, and the Kruskal-Wallis test was used for additional analysis.</p><p><strong>Results: </strong>Among 97 subjects, 4 (4.1%) had sarcopenia, while 34 out of 93 non-sarcopenic subjects belonged to the possible sarcopenia category. Bivariate analysis results showed significant differences between leptin levels (p=0.005) and the Leptin-to-Adiponectin Ratio (LAR) (p=0.003) with sarcopenia in non-geriatric T2DM patients. Meanwhile, adiponectin levels (p=0.799) did not show statistical differences. Further analysis was conducted among three groups, namely sarcopenia, possible sarcopenia, and non-sarcopenia. The result showed statistically significant differences in leptin and LAR levels between sarcopenia and possible sarcopenia (leptin p=0.004; LAR p=0.007) as well as sarcopenia and non-sarcopenia (leptin p=0.038; LAR p=0.011).</p><p><strong>Conclusion: </strong>Leptin levels and LAR were associated with sarcopenia in a non-geriatric T2DM population.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"353-360"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Psychotherapy in the Management of Inflammatory Bowel Disease.","authors":"Hamzah Shatri, Rudi Putranto, Edward Faisal, Vinandia Irvianita, Dika Sinulingga, Yanuar Ardani, Dadang Makmun, Muhammad Faisal Prananda, Ayu Suciah Khaerani","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD), consisting of ulcerative colitis (UC) and Crohn's disease (CD), represents one of the debilitating chronic gastrointestinal diseases that affects the physical and psychological aspects of patients, leading to increased morbidity and mortality and affecting patients' quality of life. There is an increased prevalence of depressive disorders and anxiety among IBD patients, with the gut-brain axis as the proposed underlying mechanism. Treatment of psychological issues among patients with IBD enhances long-term management outcomes. Therefore, we provide a comprehensive review of epidemiology, pathomechanism, diagnosis, and treatment modality of psychological issues frequently found among IBD patients.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"421-431"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"p.Gly693Arg Homozygote Mutation in Dubin-Johnson Syndrome with Atypical Liver Biopsy due to Reactivation of Hepatitis B Concomitant with Persistent Loss of Kidney Function.","authors":"Juferdy Kurniawan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Dubin-Johnson syndrome is a rare genetic disease that causes impaired transport of bilirubin. In most cases, there will be no symptoms. However, some people might develop jaundice due to certain conditions. In this case, we would like to present a 54-year-old male patient with Dubin-Johnson syndrome confirmed through genetic analysis showing homozygote mutation of p.Gly693Arg, with no apparent bile deposition in liver biopsy and reactivation of hepatitis B. The Patient had no symptoms since birth and was recently found to have an increased level of direct bilirubin. Further inspection showed a familial pattern of the disease. This is a unique case of homozygote mutation with p.Gly693Arg with atypical presentation of liver biopsy and reactivation of hepatitis B with no clinical manifestation.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"387-395"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Care Quality of Patients with Type 2 Diabetes in Indonesia: A Study of DISCOVER CaReMe Registry Program.","authors":"Rulli Rosandi, Herman Bagus Trianto, Aywar Zamri, Harli Amir, Roy Panusunan Sibarani, Samuel Sulaiman, Achmad Rudijanto Cholil","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) is considered one of the top 3 causes of death in Indonesia. However, the current scenario regarding the management of T2DM in Indonesia remains unclear. Thus, the present study aimed to describe the baseline characteristics, treatment types, and quality of care indicators in T2DM patients under the DISCOVER CaReMe Registry program.</p><p><strong>Methods: </strong>DISCOVER CaReMe Registry program is a multi-centre, prospective, and observational study conducted over 3 years from 2018 to 2021. The data were collected from five different sites across Indonesia.</p><p><strong>Results: </strong>A total of 539 patients with a mean age of 58.98 ± 9.76 were enrolled in the study. Among them, 62% (334/539) of patients were females. Further, the mean glycated haemoglobin (HbA1c) levels were 8.54 ± 2.88%, which was much higher than the American Diabetes Association (ADA) recommended target of 7%. Overall, 69% of the patients had HbA1c levels of >7%. First-line treatment in patients was mostly metformin (26%). As per the quality-of-care indicators, 72.2% of patients use glucose monitoring equipment and receive education about diabetes treatment and management. Furthermore, the knowledge of T2DM among patients was assessed in over 85% of cases, and misconceptions about the condition were clarified by healthcare professionals (HCPs). HCP advised a \"diabetic diet\" to 69.4% of patients.</p><p><strong>Conclusion: </strong>Despite a good knowledge and quality of care indices in patients with T2DM, the proportion of patients with HbA1c levels of >7% is still higher. There is an urgent need for diabetic management programs to prevent such complications in the Indonesian population.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"321-331"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Per-oral Endoscopic Myotomy (Z-POEM): An Effective Treatment for Zenker's Diverticulum with Long-Term Results.","authors":"Achmad Fauzi, Saskia Aziza Nursyirwan, Ari Fahrial Syam","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Zenker's diverticulum (ZD) arises from impaired cricopharyngeal (CP) muscle distensibility during deglutition (swallowing), leading to a clinical presentation characterised by dysphagia, regurgitation, aspiration, cough, and potential weight loss. The definitive treatment for ZD is a CP myotomy. Traditionally, open surgical approaches (transcervical diverticulectomy, diverticulopexy, or diverticular inversion) with or without concomitant CP myotomy and rigid endoscopic techniques utilizing stapling or CO2 laser therapy have been employed. However, these interventions are often associated with significant morbidity and mortality, particularly in the elderly and comorbid ZD patient population. The advent of flexible endoscopic ZD treatment has revolutionized the therapeutic landscape, rapidly becoming the preferred first-line modality for the management of small to moderate-sized diverticula. The past decade has witnessed the emergence of a multitude of novel techniques within the realm of flexible endoscopic ZD treatment. In this medical illustration, we report a woman, 64-years-old with Zenker's diverticulum treated with Z-POEM. She came to our clinic with dysphagia and regurgitation for 6 months prior.  Diagnostic gastroscopy showed ZD of 3 cm, located 18 cm from incisors with a thick septal muscle. A triangle-shaped knife created a 2-cm mucosal incision, and submucosal tunneling was made by spray coagulation. The gastroscope was advanced through the submucosal space of the esophageal lumen and the diverticulum site until the bottom of the diverticulum. The septal muscle was completely cut, immediately allowing the gastroscope to pass through easily, and the mucosal defect was closed with hemoclips. Six months after the treatment, the patient no longer experiences dysphagia and regurgitation. Z-POEM offers a precise approach to treating Zenker's diverticulum by providing a complete visualization of the entire septal muscle. This comprehensive view minimizes the risk of incomplete myotomy, ensuring a more effective treatment.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 3","pages":"403-404"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Diagnostic Utility of Brain Natriuretic Peptide in Heart Failure Patients Presenting with Acute Dyspnea: A Systematic Review and Meta-analysis.","authors":"Mohammad Amin Karimi, Zahra Kazemi Ferezghi, Reza Khademi, Seyed Amirhossein Mazhari, Fatemeh Chichagi, Asma Rasouli, Reyhaneh Alikhani, Anis Sani, Shima Akhavan Rezayat, Nima Shakouri, Seyed Iraj Azimi, Faezeh Jadidian, Golnaz Nikeghbali, Mahfam Edrisian, Alaleh Alizadeh, Niloofar Deravi, Mohadeseh Poudineh, Mahsa Asadi Anar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Patients with heart failure are often diagnosed based on clinical signs and serological markers. Finding biomarkers with greater sensitivity and specificity for heart failure patients who also have episodic dyspnea is a challenge for researchers. Thus, we conducted a systematic review and meta-analysis of previous research to determine the diagnostic value of B-type natriuretic peptide as a potential biomarker in heart failure patients experiencing acute dyspnea.</p><p><strong>Methods: </strong>By searching PubMed/Medline, Scopus, and Google Scholar up to March 2023, all cross-sectional and cohort studies were selected according to the PRISMA guidelines and assessed by the Deeks' funnel plot asymmetry test for bias.</p><p><strong>Results: </strong>A total of thirty-five qualifying studies had their data extracted. In 26 investigations (n=16002), the precision of B-type natriuretic peptide was evaluated. There were significant differences in the reported sensitivity and specificity between trials. One research study yielded the lowest sensitivity of 0.76 (0.68, 0.82), with a prevalence of 46% for heart failure and a BNP level of ≥500 pg/ml. Specificity grew but stayed variable as the threshold rose, whereas sensitivity declined. A diagnostic meta-analysis was carried out on 14 trials (n=6313) to determine the accuracy of N-terminal probrain natriuretic peptide. When the threshold is raised, the pattern in NTproBNP is similar to that of B-type natriuretic peptides, with sensitivity falling and specificity increasing. Following the final analysis, the confidence areas surrounding the pooled sensitivity and specificity for BNP vs NTproBNP showed a distinct overlap. The overlap indicated that there was no statistically significant difference between the tests at the <100 pg/ml and ≤300 pg/ml rule-out levels, respectively (P>0.05).</p><p><strong>Conclusion: </strong>The meta-analysis reveals a substantial degree of congruity in the sensitivity and specificity between the levels of BNP and NTproBNP as biomarkers. Nevertheless, it's worth noting that, in the end, there exists a potential for overlooking heart failure diagnoses. Larger future studies, overcoming past limitations, could likely establish a consensus.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 2","pages":"175-199"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Shock Liver in Inferior ST-Segment Elevation Myocardial infarct with Total Atrioventricular block: A Case Report.","authors":"Mochamad Rizky Hendiperdana, Sumardjo Sumardjo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Liver dysfunction frequently accompanies heart diseases, especially in hemodynamically unstable acute heart failure or cardiogenic shock. This condition is marked by significant elevation of liver transaminases and brings high morbidity and mortality for > 50 % of cases. Despite the high mortality rate, early recognition with prompt management results in the recovery of liver function. A 53-year-old man presented with late-onset non-reperfused inferior STEMI. The patient presented with persistent chest pain and shortness of breath. The electrocardiogram showed atrioventricular (AV) block grade III and ST-segment elevation evolution in the inferior lead. The patient was diagnosed with a late-onset inferior STEMI with cardiogenic shock and total AV block complication, acute shock liver, lactic acidosis, and acute renal failure. We administered inotropic and chronotropic support drugs as well as post-MI anti-remodelling therapy to treat heart failure (HF) and left ventricular (LV) systolic dysfunction, such as angiotensin-converting enzyme inhibitor and aldosterone antagonist, after systemic perfusion improved. Anti-ischemic therapy, such as antithrombotics, was also administered. Renal and liver function test evaluation after a week of patient discharge showed normalization of these parameters. There is no definite treatment strategy for shock liver. The management strategy is directed at the treatment of underlying causes. Hemodynamic insult is the mainstay therapeutic target. Recovery of liver transaminases was demonstrated after the underlying insult had been eliminated.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 2","pages":"257-263"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144606987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging Palliative Care and HIV/AIDS: A Call for Integrated Approaches.","authors":"Rudi Putranto","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS) remain significant global health challenges. Beyond the physical manifestations, individuals living with HIV/AIDS often grapple with psychological burdens, notably anxiety, which can adversely affect their quality of life (QoL) and physiological stress markers, such as cortisol levels. Palliative care, traditionally associated with end-of-life support, has evolved to address the multifaceted needs of chronic illness patients, including those with HIV/AIDS.  In the world, 1.89 million individuals require palliative care due to pain, and around 2.7 million people have HIV. This editorial explores the role of palliative care in enhancing QoL and modulating cortisol levels among HIV/AIDS patients experiencing anxiety. Palliative care is holistic, addressing physical, emotional, social, and spiritual needs. In the context of HIV/AIDS, palliative interventions have demonstrated efficacy in alleviating symptoms, reducing psychological distress, and improving overall well-being. A systematic review highlighted that home-based palliative care and inpatient hospice services significantly improved patient outcomes in pain management, symptom control, anxiety reduction, and spiritual well-being. Palliative care emerges as a vital component in the comprehensive management of HIV/AIDS, particularly for patients grappling with anxiety. By enhancing quality of life and potentially modulating stress-induced hormonal imbalances, palliative interventions offer a holistic approach that addresses both psychological and physiological aspects of the disease. Future research should focus on elucidating the mechanisms by which palliative care influences cortisol levels and exploring its long-term benefits on disease progression and patient well-being.</p>","PeriodicalId":6889,"journal":{"name":"Acta medica Indonesiana","volume":"57 2","pages":"151-152"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144606988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}