Background: Frailty is common among hospitalized elderly patients, with prevalence rates ranging from 27% to 80%. Frail individuals have a higher risk of mortality than non-frail individuals do. The Clinical Frailty Scale (CFS), developed by the Canadian Study of Health and Aging (CSHA), is a widely used tool for assessing frailty and clinical outcomes in older adults. This study aimed to evaluate the prognostic performance of the CFS in predicting 30-day mortality among elderly inpatients. Methods: This prospective cohort study included patients aged ≥ 60 years admitted to the Haji Adam Malik Central General Hospital in Medan, Indonesia. Discrimination and calibration of the CFS were evaluated using the ROC curve and Hosmer-Lemeshow tests, while logistic regression identified factors independently associated with mortality. Discrimination and calibration of the CFS were evaluated using the ROC curve and Hosmer-Lemeshow tests, while logistic regression identified factors independently associated with mortality. Results: Among 120 patients, the 30-day mortality rate was 43.3%. The Hosmer–Lemeshow test indicated good calibration (p = 0.661), and ROC curve analysis showed good discrimination (AUC = 83.2%, 95% CI 76%–90.4%). Multivariate analysis identified the C-reactive protein level, CFS score, and nutritional status as independent predictors of 30-day mortality. Conclusion: Clinical Frailty Scale (CFS) demonstrates good prognostic performance for predicting 30-day mortality among elderly inpatients, with elevated CRP, higher CFS scores, and malnutrition serving as independent predictors of death.
Background: Internal medicine specialists have always been one of the pillars that support the health of Indonesian people. Currently, there is no available survey regarding the socio-demography, lifestyle, and income of any medical specialist in Indonesia. This study aims to report this gap in knowledge amongst internists across Indonesia. Methods: This study was a nationwide cross-sectional study and was conducted via online questionnaires by The Indonesian Society of Internal Medicine Specialists (INASIM) between December 2023 and March 2024. Participants from the existing 39 INASIM branches were selected using cluster random sampling, with a target of 20% of registered internists per branch. Of 1,568 internists invited, 1,082 (69.0%) completed the questionnaire and were included. Results: A total of 1,082 internists participated in this study, mostly male (57.7%), aged 35-49 years (57.7%), non-academic staff (64.3%), practicing as general internists (76.3%) in 3 locations (70.9%). Distribution discrepancy was observed with 58.0% of general internists and 71.5% of subspecialists practicing in urban areas only. Income analyses showed significant positive correlations with age, working years, working hours, and number of practices. Male internists had higher income than their counterparts, indicating a gender-related income gap. The location of practice did not affect income significantly. Amongst internists, there were approximately 11.1% with a history of smoking, 55.9% with daily coffee consumption, 62.9% with sleep deprivation, and more time spent being sedentary. Conclusion: This study identified distribution discrepancy, a gender-related income gap, and unhealthy lifestyle patterns among Indonesian internists, which are issues that warrant targeted policy responses. Nevertheless, these findings may support future policies on equitable workforce distribution, appropriate incentive systems, and physician wellness programs in Indonesia.
Background: Patients with end-stage renal disease (ESRD) undergoing chronic hemodialysis often experience reduced quality of life and autonomic dysregulation. Group supportive psychotherapy may improve psychological well-being through biopsychosocial mechanisms. This study evaluated the effects of group supportive psychotherapy on quality of life and its association with heart rate variability (HRV) and blood serotonin levels. Methods: This randomized, parallel-group, single-blind controlled trial was conducted at the Hemodialysis Unit of Dr. Cipto Mangunkusumo National General Hospital, Jakarta, from November 2024 to January 2025. Fifty-two eligible patients were randomly assigned to an intervention group receiving group supportive psychotherapy plus standard care (n = 26) or a control group receiving standard care alone (n = 26). Outcomes were assessed at baseline and post-intervention using Kidney Disease Quality of Life-36 (KDQOL-36), HRV measured by standard deviation of normal-to-normal intervals (SDNN), and plasma serotonin levels measured using enzyme-linked immunosorbent assay (ELISA). Statistical analyses included an independent t-test or Mann-Whitney test, with effect size calculation and ANCOVA adjustment for baseline values. Results: The intervention group demonstrated significantly greater improvement in KDQOL-36 scores compared with control (mean change 8.46-16.92 vs 0.27-11.36; p=0.046). After adjustment, the between-group difference remained statistically significant (p<0.001), with a large effect size (Cohen’s d = 1.16). Plasma serotonin levels were significantly higher in the intervention at post-intervention (p=0.028; r=0.30). However, no significant differences were observed in HRV (SDNN) either between groups (p=0.805) or within groups over time (p>0.05). Conclusion: Group supportive psychotherapy significantly improves quality of life and is associated with higher plasma serotonin levels in ESRD patients undergoing chronic hemodialysis. However, no significant autonomic modulation, as measured by HRV, was demonstrated.
Obscure gastrointestinal bleeding (OGIB) accounts for approximately 5% of all gastrointestinal bleeding cases, with the small intestine being the most common source of origin. Primary small-bowel lymphoma is a rare malignancy that can present as intestinal bleeding in 2% to 22% of cases. A 67-year-old male presented with a four-day history of diarrhea and melena, accompanied by severe anemia with a hemoglobin level of 5 g/dL. While a colonoscopy only revealed internal hemorrhoids and an ascending colon polyp, a subsequent non-contrast whole-abdomen CT scan demonstrated a 6-cm segmental small bowel wall thickening involving the proximal and distal ileum, accompanied by mesenteric fat stranding and aggressive aneurysmal dilatation. Further evaluation using antegrade enteroscopy identified a mass with central ulceration in the proximal ileum. Histopathological analysis of the ileal biopsy specimens revealed small intestinal mucosa heavily infiltrated by a diffuse, highly cellular tumor with small-to-medium neoplastic cells, confirming a malignant round cell neoplasm highly suspicious for non-Hodgkin lymphoma. This case highlights the critical clinical challenge of managing OGIB and underscores the importance of early diagnostic interventions. Utilizing CT imaging alongside device-assisted enteroscopy is vital for the prompt recognition of hidden small bowel disorders like lymphoma, enabling timely treatment, preventing life-threatening hemorrhagic complications, and improving the overall patient prognosis.
Cardiac tamponade is a critical condition that can result from complications during invasive cardiac procedures. This case report describes a 67-year-old male who developed right ventricular perforation leading to cardiac tamponade following elective complex percutaneous coronary intervention with rotational atherectomy and temporary pacemaker placement. By performing emergent pericardiocentesis and using a pigtail catheter with sustained negative pressure, we successfully managed a massive pericardial effusion of 2,600 cc. The patient stabilized without requiring surgical intervention, demonstrating favorable outcomes. This case underscores the importance of timely recognition and personalized management strategies in the conservative treatment of cardiac tamponade secondary to right ventricular perforation.
