BACKGROUND The prevalence of autonomic nervous system disorders is increasing due to the complications of chronic illnesses that become more severe with age. The Composite Autonomic Symptom Score-31 (COMPASS-31) is a questionnaire that assesses autonomic function and has been utilized globally. This study aimed to conduct cultural adaptation and validation of the COMPASS-31 in Indonesia, particularly for the elderly. METHODS This cross-sectional study involved elderly individuals aged 60 years and older. The process included translation, cultural adaptation, back-translation, and reliability tests. The COMPASS-31 questionnaire was translated from English to Indonesian by a certified translator, a native Indonesian speaker without medical background. A panel of experts comprising a neurologist, a gerontologist, and a physiologist discussed the translated questionnaire and made cultural adaptations. Facial and content validity tests were conducted on 11 elderly individuals. The inputs for revision are discussed by the expert panel. The questionnaire was then back-translated into English by a native English speaker, professional translator, without a medical background. The questionnaire was checked for reliability in 52 elderly subjects. Reliability testing was conducted separately for the binomial and polynomial questions of the COMPASS-31 questionnaire. RESULTS The reliability test yielded a Cronbach’s alpha of 0.729 for the binomial questions and 0.722 for the polynomial questions, indicating high reliability. CONCLUSIONS The Indonesian version of COMPASS-31 questionnaire is a valid and reliable symptom assessment tool for use in the elderly.
BACKGROUND Delirium is common in geriatric inpatients and may increase hospital burden. This study aimed to analyze the association of length of stay (LOS), in-hospital mortality, and 30-day readmission among geriatric inpatients at a secondary hospital in Jakarta. METHODS A retrospective study was conducted using secondary data from geriatric inpatients assessed with the comprehensive geriatric assessment (CGA) at Atma Jaya Hospital (March 2024–February 2025). Demographic, functional, nutritional, frailty, and comorbidity variables and clinical outcomes (LOS, mortality, and readmission) were analyzed using t-tests, Fisher’s exact tests, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS Of 425 patients, delirium was identified in 7.8% of patients. Compared with non-delirium groups, the delirium groups had poorer clinical characteristics, including lower activities of daily living, malnutrition, higher frailty, and greater comorbidity burden. Delirium groups had longer LOS (13.88 [9.24] versus 6.36 [5.25] days; p<0.001) and higher 30-day readmission (15.2% versus 3.6%; aOR: 4.821, 95% CI: 1.62–14.353; p = 0.011), while in-hospital mortality was higher but not statistically significant (p = 0.322). CONCLUSIONS Delirium in geriatric inpatients is associated with prolonged LOS and increased risk of readmission. These findings underscore the importance of early detection and CGA-guided interdisciplinary management to reduce hospital burden and improve clinical outcomes for older adults.
The increasing prevalence of vascular cognitive impairment (VCI) underscores the critical need for innovative non-pharmacological strategies. This retrospective comparative case series evaluated the effects of classical music therapy, Qur’anic recitation, and their combination on cognitive function and religious engagement in 7 patients with VCI due to rare disorders, including vasculitis related to systemic lupus erythematosus and Balint syndrome. Assessments included brain magnetic resonance imaging, the Indonesian version of the Montreal Cognitive Assessment, the dementia solat score, and C-reactive protein levels. Patients who received only Qur’anic recitation demonstrated the most significant improvement in cognitive function and religious engagement. The findings suggest that Qur’anic recitation therapy has yielded superior results despite potential sound wave conflicts. Future studies with larger samples are required to validate these findings and explore further non-pharmacological interventions for VCI.
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that impacts several organ systems. Regulatory T cells (Tregs) are essential for maintaining immunological tolerance, and their dysregulation has been found linked to the pathogenesis of SLE. This study aimed to evaluate the correlation between CD4⁺CD25⁺FOXP3⁺ Treg levels and disease activity, as measured by the MEX-SLEDAI score, in patients with SLE. METHODS A cross-sectional study was conducted involving 40 SLE patients treated in the Allergy and Immunology outpatient clinic and inpatient ward of Mohammad Hoesin Hospital from June 1, 2024 to August 31, 2024. Inclusion criteria were adults (≥18 years) diagnosed with SLE who provided informed consent. Exclusion criteria included other history autoimmune or immunocompromised conditions, pregnancy or lactation, hormonal contraceptive use, and active severe infection. CD4⁺CD25⁺FOXP3⁺ Treg cell levels were measured by flow cytometry. Disease activity was assessed using the MEX-SLEDAI score. Spearman’s correlation test was used to analyze the association between Treg levels and disease activity. RESULTS Of 40 enrolled subjects (39 women, 1 man), 75% were aged 20–44 years. Mucocutaneous manifestations were the most common clinical feature (95%). Nephritis and hematologic involvement were most frequently observed in patients with severe disease activity. A strong negative correlation was identified between CD4⁺CD25⁺FOXP3⁺ Treg cell levels and MEX-SLEDAI scores (R = –0.72, p<0.001), indicating that lower Treg levels were associated with higher disease activity. CONCLUSIONS CD4⁺CD25⁺FOXP3⁺ Treg levels show a significant negative correlation with MEX-SLEDAI disease activity in SLE. Lower Treg cell levels reflect more severe disease activity.
Bulbar urethral ischemic necrosis (BUIN) is an unfortunate complication of urethroplasties. This is a result of previous unsalvageable strictures resulting from previous repairs. Here, we present the first case of entero-urethroplasty performed using a sigmoid flap. A 27-year-old man visited the urology clinic with a complaint of urine retention on cystostomy 1 year prior. He had a motor vehicle accident that injured the urethra. He had previously undergone excision and primary anastomosis (EPA) urethroplasty and redo EPA; however, the results were unsatisfactory. Entero-urethroplasty was performed using a sigmoid colon flap harvested carefully from the patient's sigmoid colon, and reconstructive options are limited to BUIN. The sigmoid flap reconstruction appears for treating BUN. This study's limitation is the short follow-up period. Therefore, further studies and long-term follow-up should be performed to assess the effectiveness of this technique.
