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Osteoarthritis is a progressive degenerative joint disease characterized by cartilage damage, chronic inflammation, and functional limitation. Current treatments mainly focus on symptom relief and mechanical correction, with limited ability to restore the biological environment of the joint. Recently, mesenchymal stem cell derived secretome has emerged as a promising cell free regenerative therapy with anti-inflammatory and tissue-repair potential. This study aimed to systematically review the role of mesenchymal stem cell secretome in osteoarthritis management, both as an intra-articular therapy and as an adjuvant following surgical intervention. A literature review was conducted on relevant preclinical and early clinical studies published over the past decade. The selected articles were analyzed to evaluate therapeutic mechanisms and clinical implications. The findings indicate that intra articular administration of secretome reduces inflammatory mediators, suppresses catabolic enzyme activity, and improves cartilage integrity in various osteoarthritis models. Early clinical evidence also suggests improvements in pain and joint function, especially in patients with mild to moderate disease. Furthermore, secretome shows potential as an adjuvant therapy after surgery by supporting biological recovery of joint tissues. Overall, mesenchymal stem cell secretome represents a promising component of a multimodal strategy for osteoarthritis management, although further clinical trials are required to confirm its efficacy and safety.

Hypertension is a chronic condition that requires long-term management due to its strong association with an increased risk of serious complications when blood pressure is not adequately controlled. One of the key factors influencing the success of hypertension management is patient adherence to antihypertensive medication. However, suboptimal adherence remains a common problem and may lead to poor therapeutic outcomes. This literature review aimed to examine the relationship between adherence to antihypertensive medication and blood pressure control among patients with hypertension. A systematic search of the literature was conducted using the PubMed and Google Scholar databases with relevant keywords combined through Boolean operators. The selected articles were screened based on predefined inclusion and exclusion criteria, including original research articles published within the last ten years, accessible in full text, and addressing the association between medication adherence and blood pressure in hypertensive patients. The findings of the reviewed studies indicate that most articles reported a significant relationship between medication adherence and blood pressure levels. Patients with higher adherence to antihypertensive therapy tended to achieve better blood pressure control compared to those with lower adherence. Although variations in the strength of the reported associations were observed across studies, the overall direction of the relationship was consistent. These results suggest that adherence to antihypertensive medication plays an essential role in achieving optimal blood pressure control. Therefore, this review highlights the importance of continuous efforts to improve patient adherence as part of effective hypertension management strategies aimed at reducing the risk of long-term complications.

The increasing number of malpractice cases in Indonesia, particularly those related to misdiagnosis by medical practitioners, highlights the urgency of law enforcement in the health sector. This study aims to analyze the legal provisions and forms of physician liability for misdiagnosis resulting in patient death. The research employs a normative juridical approach with a library research method, using primary legal materials such as Law Number 17 of 2023 on Health, the Criminal Code (KUHP), and the Civil Code (KUHPerdata), as well as secondary legal materials including literature and legal health journals. The findings indicate that misdiagnosis proven to constitute professional negligence (culpa) may give rise to legal liability in three areas—criminal, civil, and administrative. Criminally, Article 440 of Law Number 17 of 2023 stipulates sanctions for medical personnel whose negligence causes serious injury or death (Republic of Indonesia, 2023). Furthermore, hospitals also bear responsibility under the doctrines of vicarious liability and hospital liability for the actions of medical practitioners under their supervision (Balubun, Simanjuntak, & Ginting, 2018). This research implies the need for a balanced legal protection framework between patients’ rights and the professional rights of medical practitioners, as well as the strengthening of medical supervision systems within healthcare institutions.

Anxiety among family member in the Intensive Care Unit (ICU) is a common psychological issue. This situation arises from the uncertainty about the patient’s condition. Effective therapeutic communication by nurses is one of the key strategies to help reduce anxiety. This study was conducted from June 4 to July 20, 2025. This study aims to analyze the relationship between nurses’ therapeutic communication and the anxiety levels of family members in the ICU of RSUD Meuraxa, Banda Aceh. This research employed a quantitative, correlational design. The population consisted of 66 family members of ICU patients, with a sample of 57 respondents selected using a purposive sampling technique. The results showed that most families received therapeutic communication at a moderate level (50.9%) and a good level (49.1%). The anxiety levels experienced by the families were mostly moderate (54.4%) and mild (45.6%). The analysis revealed a p-value of 0.003, indicating a statistically significant relationship between nurses’ therapeutic communication and the anxiety levels of family member. These findings prove that therapeutic communication given by nurses plays a vital role in influencing the anxiety levels of patients’ families in the ICU. Therefore, the hospital management is encouraged to improve nurses’ therapeutic communication skills and establish supportive communication policies to enhance services and reduce anxiety among the family members in the ICU.

Schizophrenia is a chronic mental disorder that requires long-term medication adherence to prevent relapse and improve patients’ quality of life. Caregivers play a crucial role in encouraging medication adherence through emotional, informational, instrumental, and supervisory support. This descriptive quantitative study with a cross-sectional design aimed to describe caregiver support and medication adherence among schizophrenia patients at the South Denpasar Public Health Center. A total of 100 respondents, who were family members or caregivers of schizophrenia patients, were selected using a consecutive sampling technique. Data were collected through structured interviews using questionnaires and analyzed descriptively. The results showed that most caregivers provided good support (63%), particularly in accompanying patients during medication intake, actively interacting with them, and following health workers’ recommendations. Furthermore, patients’ medication adherence was mostly in the moderate (45%) and good (35%) categories. These findings indicate that caregiver support plays a significant role in improving medication adherence among schizophrenia patients. Strengthening caregiver knowledge and optimizing health education by healthcare workers are essential to further enhance adherence.

Background: Hypertension remains a major public health problem, particularly in primary health care settings. The coexistence of diabetes mellitus may contribute to increased hypertension severity; however, evidence from primary care data in Indonesia remains limited. Objective: This study aimed to examine the association between diabetes mellitus and hypertension severity among patients attending a primary health care center in Indonesia. Methods: A cross-sectional study was conducted using secondary data obtained from medical records at a primary health care center in 2025. A total of 84 patients with hypertension were included using total sampling. Hypertension severity was classified into stage 1 and stage 2. Bivariate analysis was performed using the Chi-square test or Fisher’s exact test as appropriate, with statistical significance set at p < 0.05. Data were analyzed using SPSS version 26. Results: Of the 84 participants, 33.3% had diabetes mellitus. Stage 2 hypertension was more prevalent than stage 1 hypertension. Diabetes mellitus was significantly associated with hypertension severity (p = 0.029), with a higher proportion of patients with diabetes mellitus presenting with stage 2 hypertension. Conclusion: Diabetes mellitus was significantly associated with greater hypertension severity in a primary health care setting. These findings highlight the importance of integrated management of diabetes mellitus in patients with hypertension at the prizary care level.

Background: Hypertension remains a major public health problem, particularly in primary health care settings. The coexistence of diabetes mellitus may contribute to increased hypertension severity; however, evidence from primary care data in Indonesia remains limited. Objective: This study aimed to examine the association between diabetes mellitus and hypertension severity among patients attending a primary health care center in Indonesia. Methods: A cross-sectional study was conducted using secondary data obtained from medical records at a primary health care center in 2025. A total of 84 patients with hypertension were included using total sampling. Hypertension severity was classified into stage 1 and stage 2. Bivariate analysis was performed using the Chi-square test or Fisher’s exact test as appropriate, with statistical significance set at p < 0.05. Data were analyzed using SPSS version 26. Results: Of the 84 participants, 33.3% had diabetes mellitus. Stage 2 hypertension was more prevalent than stage 1 hypertension. Diabetes mellitus was significantly associated with hypertension severity (p = 0.029), with a higher proportion of patients with diabetes mellitus presenting with stage 2 hypertension. Conclusion: Diabetes mellitus was significantly associated with greater hypertension severity in a primary health care setting. These findings highlight the importance of integrated management.

Permanent tooth loss is a common oral health problem experienced by patients. This condition can be caused by pathological conditions such as tooth decay, leading to tooth extraction. Rehabilitation treatment for partial posterior tooth loss aims to restore masticatory function, maintain occlusal relationships and periodontal health, and improve aesthetics. A 34-year-old man came with a complaint that his lower right posterior tooth had been extracted and wanted a permanent dentures to replace his missing tooth. The intraoral and periapical radiograph examination revealed that 46 was missing, and 47 had enamel caries. The diagnosis for 46 was determined to be partial edentulous. The treatment plan was a PFM fixed-fixed bridge with a sanitary pontic for 46, a rigid connector, and a full crown retainer for 45 and 47. In this case, the choice of PFM bridge is based on several considerations, i.e., high chewing loads, relatively low cost, and high long-term success. The PFM bridge has been the primary choice for posterior tooth rehabilitation, due to its durability and cost-effectiveness.

Cold compresses or cryotherapy are one of the non-pharmacological therapies often used in nursing practice to help reduce pain, especially in patients with fractures. Fractures are often accompanied by acute pain that can inhibit mobilization, prolong recovery time, and reduce patient comfort. Therefore, a safe, effective, and easy-to-use pain management method is needed. This article was compiled with the aim of identifying and mapping scientific evidence regarding the effectiveness of cold compresses in reducing pain intensity in fracture patients. This study used the Arksey and O'Malley model in conducting the analysis, with articles searched through PubMed, ScienceDirect, and Google Scholar for the 2021–2025 publication period. The article selection process followed the PRISMA flow. A review of ten articles showed that most studies used quantitative designs, both experimental and quasi-experimental. The results of the analysis of 11 articles consisted of 8 quantitative articles with experimental and quasi-experimental designs, while 2 articles were case studies. These articles generally discuss the effectiveness of cold compresses in reducing pain intensity in fracture patients using various measurement instruments, such as NRS, VAS, Wong-Baker Faces Scale, and Bourbanis Pain Scale. In addition to reducing pain, several studies also reported that cold compresses can reduce edema, increase mobility, and improve patient comfort. However, variations in the duration, frequency, and method of cold compress application were still found, so there is a need to develop a more standardized protocol in nursing practice.

Urinary tract infection (UTI) is a common bacterial infection that requires appropriate antibiotic management to prevent complications and antimicrobial resistance. Ceftriaxone and ciprofloxacin are commonly used antibiotics with different clinical indications in UTI treatment. This literature review aims to compare the role of ceftriaxone and ciprofloxacin in the management of urinary tract infections. A narrative literature review was conducted using articles published within the last ten years from PubMed, ScienceDirect, and Google Scholar databases. The review focuses on clinical effectiveness, resistance patterns, and therapeutic considerations. The findings indicate that ceftriaxone is primarily used in moderate to severe or complicated UTIs, particularly in hospitalized patients, whereas ciprofloxacin is more frequently used in uncomplicated UTIs in outpatient settings. However, increasing bacterial resistance and safety concerns limit the empirical use of ciprofloxacin. These findings emphasize the importance of rational antibiotic selection based on clinical conditions and local resistance patterns.  

Hypertension and diabetes mellitus are two highly prevalent non-communicable diseases that often coexist as comorbidities, significantly increasing the risk of cardiovascular complications. The coexistence of these conditions accelerates the onset of atherosclerosis, diabetic nephropathy, and kidney failure, thereby requiring more comprehensive clinical management. One of the key parameters in diabetes management is fasting blood glucose (FBG), which reflects the balance of glucose metabolism after a fasting period. Chronic hyperglycemia is known to contribute to endothelial dysfunction, increased peripheral vascular resistance, and activation of the sympathetic nervous system and renin-angiotensin-aldosterone system, ultimately leading to elevated blood pressure. This study employed a systematic literature review approach, analyzing articles published between 2021 and 2025. Narrative synthesis was conducted across various study designs, including cross-sectional, cohort, and meta-analysis studies. The findings indicate that most studies support a significant association between FBG levels and blood pressure, although some reported varying results. Cohort studies provide stronger evidence that elevated FBG increases the risk of new-onset hypertension. Age, treatment adherence, and lifestyle factors were also identified as confounding variables influencing outcomes. Overall, the evidence highlights that glycemic control through FBG monitoring is essential in managing hypertension among diabetic patients. Multidisciplinary strategies, patient education, and strengthening of primary healthcare services are required to reduce cardiovascular risks. Longitudinal studies are recommended to deepen the understanding of the relationship between FBG and blood pressure and to reinforce the scientific basis for evidence-based clinical interventions.

Postoperative pain is a common clinical condition experienced by patients after surgical procedures and may hinder the recovery process if not properly managed. In addition to pharmacological therapy, safe and effective non-pharmacological interventions are needed, one of which is early mobilization. This study aimed to analyze the effect of early mobilization on pain reduction in postoperative surgical patients. A scoping review method was conducted based on the Arksey and O’Malley framework. Literature searches were performed using ScienceDirect, PubMed, and Google Scholar databases with a PICO strategy, including articles published within the last five years. From a total of 167,948 identified articles, 10 studies met the inclusion criteria and were included in the analysis. The results showed that early mobilization performed gradually and according to patients’ clinical conditions had a significant effect on reducing postoperative pain intensity. In addition, early mobilization was associated with improved comfort, enhanced functional recovery, and faster postoperative rehabilitation without increasing the risk of complications. Although variations were found in the timing and type of mobilization across studies, overall evidence supports that early mobilization is safe and effective. In conclusion, early mobilization can be recommended as an evidence-based nursing intervention for postoperative pain management.

Chronic liver disease is a significant health problem and places a significant burden on healthcare services. Deaths from complications of chronic liver disease (cirrhosis and cancer) account for approximately 3.5% of all deaths worldwide each year. Hepatocellular carcinoma (HCC) is a primary liver tumor, accounting for 90% of all liver tumors. Due to limitations in liver transplantation, liver resection is considered the treatment of choice for HCC patients with a single tumor and sufficient liver function reserve. Liver resection and transplantation are the only curative treatment options available for HCC patients. Surgical procedures require anesthesia. General anesthesia is the preferred method for liver tumor resection. There are five main classes of anesthetic agents: intravenous (IV) anesthetics, inhalational anesthetics, IV sedatives, synthetic opioids, and neuromuscular blocking agents. Estimated health risks depend on the extent or severity of liver disease, the nature and timing of surgery, the type of anesthesia, and other comorbidities.

Postoperative nausea and vomiting (PONV) is one of the most common complications following surgery under general anesthesia, with an incidence of 20–70% in the general population and exceeding 80% in high-risk patients. PONV can reduce patient comfort, delay recovery, and increase the risk of dehydration, electrolyte imbalance, and surgical wound dehiscence. This article aims to analyze the effectiveness of single antiemetic therapy compared with combination antiemetic therapy in reducing the incidence of PONV in adult patients after general anesthesia, based on evidence from randomized controlled trials (RCTs). This study applied the Arksey and O’Malley framework for analysis. Literature was obtained from ScienceDirect, PubMed, and the Cochrane Library, published between 2020 and 2025. Identification and selection of studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009). A total of 10 articles were included and analyzed, focusing on outcomes such as the incidence of nausea and vomiting, complete response rates, and the need for rescue antiemetic therapy. The findings indicate that single antiemetic therapy remains effective in low-risk patients, whereas combination antiemetic therapy with multiple mechanisms of action provides more optimal protection, particularly in high-risk patients. These results provide an evidence-based foundation for healthcare professionals in selecting the most effective PONV prevention strategies according to individual patient risk and clinical conditions.

Diabetes mellitus (DM) is a global health problem characterized by increased blood glucose levels. Type 2 diabetes mellitus (T2DM) accounts for 90-95% of all diabetes cases and is characterized by insulin resistance. Persistent hyperglycemia in patients with T2DM increases the risk of various complications, including renal dysfunction. Therefore, monitoring HbA1c levels is important for assessing long-term glycemic control and preventing complications, one of which is impaired kidney function that can be detected through increased blood creatinine levels. To analyze the relationship between HbA1c levels and blood creatinine levels in type 2 diabetes mellitus patients at RSUD ODSK North Sulawesi Province. This study used an observational analytic design with a cross-sectional approach. This study was retrospective using secondary data in the form of medical record data for the period February 2024-August 2025. This study used a total sampling method with 71 patients who met the inclusion criteria. The findings showed that the majority of patients had HbA1c levels >6,5%, while most blood creatinine levels were within the normal range. Based on the results of the Spearman-Rank correlation test, a significance value of 0.040 (p-value <0.05) was obtained. There is a significant relationship between HbA1c levels and blood creatinine levels, with a negative correlation strength in patients with type 2 diabetes mellitus at RSUD ODSK North Sulawesi Province.

Chronic kidney disease (CKD) is a global health problem with continuously increasing prevalence and mortality. This condition is characterized by a progressive and irreversible decline in kidney function, which is clinically assessed using the estimated glomerular filtration rate (eGFR) as one of the main parameters for staging and monitoring disease progression. Red blood cell distribution width (RDW) is a hematological parameter that reflects the degree of variation in erythrocyte size. In patients with CKD, elevated RDW levels are often associated with oxidative stress and chronic inflammation, which may accelerate kidney damage and increase mortality risk. To analyze the correlation between RDW and eGFR values in patients with chronic kidney disease at ODSK Hospital, North Sulawesi Province. This study used an analytical observational design with a cross‑sectional approach. It was conducted retrospectively using secondary data from the medical records of CKD patients at ODSK Hospital, North Sulawesi Province, from February 2024 to August 2025. This study used a total sampling method with 189 CKD patients who met the inclusion and exclusion criteria.  Based on Spearman-rank correlation analysis, the p‑value obtained was 0.129 (>0.05). There was no significant relationship between RDW and eGFR values in CKD patients at ODSK Hospital, North Sulawesi.Province.

Postoperative pain is a common physiological response following surgical procedures, and its suboptimal management can have physiological and psychological effects, including sleep disturbances, decreased functional capacity, increased anxiety, and deterioration in quality of life. This scoping review aims to describe the empirical evidence regarding the effectiveness of music therapy in reducing the intensity of postoperative pain in surgical patients. A systematic search was conducted through four major databases (ScienceDirect, PubMed, Neliti, and Google Scholar) using Boolean operators and keywords such as ‘postoperative pain,’ ‘music therapy,’ and ‘pain scale.’ Inclusion criteria included articles published in the last decade, in English or Indonesian, and available in full text format. In accordance with PRISMA-ScR guidelines, this review analysed 10 articles. The synthesis of results showed that music therapy consistently reduced pain intensity, anxiety, and analgesic requirements through mechanisms such as increased endorphin secretion, decreased stress hormone levels, and activation of the gate control theory. Typically administered for 15–30 minutes, music therapy is a safe, cost-effective, and patient-acceptable non-pharmacological modality. This intervention is recommended as an adjunct component in perioperative pain management in nursing practice, although further standardised research is needed to improve consistency.

Pulmonary tuberculosis (TB) remains a major public health problem in Indonesia. Despite the implementation of national TB control programs through the Directly Observed Treatment Shortcourse (DOTS) strategy, treatment success continues to face significant challenges, particularly related to patient adherence to anti-tuberculosis drug (ATD) therapy. Non-adherence to TB treatment can lead to treatment failure, disease relapse, and the development of drug-resistant tuberculosis, thereby increasing the overall burden of the disease.Treatment adherence in TB patients is influenced not only by medical factors but also by social and behavioral determinants. Family support plays a crucial role in encouraging patients to comply with treatment regimens by providing motivation, reminding medication schedules, and offering emotional support throughout the long duration of therapy. Patients who receive adequate family support tend to demonstrate higher levels of treatment adherence compared to those with limited support.In addition, the use of herbal medicine as a preventive and supportive health measure is common among the Indonesian population. Herbal medicine is often utilized to enhance immune function, reduce medication side effects, and improve patient comfort during TB treatment. However, the use of herbal remedies without proper medical guidance may lead to misconceptions regarding standard TB therapy.Therefore, it is important to examine the relationship between family support and the use of herbal medicine as preventive measures with treatment adherence among pulmonary TB patients in primary healthcare settings. Such evidence is expected to support a comprehensive family medicine approach and strengthen TB control programs in primary care services.

Non-communicable diseases (NCDs) are chronic health conditions that affect not only physical but also psychological well-being, including increased anxiety. Untreated anxiety can reduce quality of life and treatment adherence. Acupressure, as a form of complementary therapy, offers a safe and non-invasive approach to managing anxiety. This narrative review aims to evaluate the effectiveness of acupressure in reducing anxiety among patients with NCDs. Articles were searched using Google Scholar with keywords such as "acupressure", "anxiety", and various chronic diseases. Six studies with experimental and quasi-experimental designs were selected based on inclusion criteria, involving patients with cancer, chronic kidney disease, and osteoarthritis. The findings consistently demonstrated that acupressure reduced anxiety levels, whether performed by a therapist or self-administered, with commonly used points including ST36, LI4, and PC6. This review concludes that acupressure is an effective complementary therapy that can be incorporated into holistic care strategies for anxiety management in patients with NCDs.

This study investigates the levels of asprosin and irisin in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN), and evaluates their relationships with insulin resistance, glycemic control, and renal function. Additionally, it explores their diagnostic performance as potential non-invasive biomarkers for the early detection of DN using ROC curve analysis. A controlled prospective study was conducted involving 130 participants, categorized into healthy controls, T2DM patients, and T2DM with DN. Serum asprosin, irisin, and insulin levels were measured using ELISA, while biochemical and renal parameters such as fasting blood glucose, HbA1c, creatinine, urea, and eGFR were assessed using standard spectrophotometric techniques. ROC analysis was employed to assess the diagnostic accuracy of asprosin and irisin. Asprosin levels were significantly elevated, while irisin levels were markedly reduced in DN patients compared to T2DM and control groups (p < 0.001). Moreover, DN patients exhibited higher levels of fasting glucose, HbA1c, HOMA-IR, creatinine, and urea, with lower eGFR, indicating substantial renal dysfunction. ROC analysis revealed that asprosin had an AUC of 0.910 (95% CI: 0.839–0.981), with 90.0% sensitivity and 88.9% specificity at a cutoff value of 11.27 ng/mL. Irisin showed an AUC of 0.886 (95% CI: 0.812–0.960), with 95.0% sensitivity and 71.1% specificity at a 158.25 ng/mL cutoff. Asprosin and irisin are strongly associated with insulin resistance and renal impairment in patients with T2DM and DN. Their high diagnostic performance supports their utility as promising non-invasive biomarkers for the early detection and monitoring of diabetic nephropathy progression.