Abstract Cytomegalovirus (CMV) and Toxoplasma gondii infections are typically associated with immunocompromised individuals, in whom they can cause severe central nervous system (CNS) complications. However, their concurrent manifestation in immunocompetent hosts (IMCh) is exceptionally rare and underreported. We present the case of a 51-year-old immunocompetent male with a three-month history of progressive headache, nausea, and intermittent joint pain, without neurological deficits. Imaging revealed chronic infarcts in the basal ganglia and frontal lobe, as well as multifocal lesions in the periventricular area. Serological testing indicated high-avidity IgG for both CMV and T. gondii, consistent with chronic latent infections. Despite being HIV-negative and without prior immunosuppressive therapy, the patient exhibited hematologic abnormalities, including thrombocytopenia, lymphopenia, and eosinophilia. Treatment with valganciclovir, cotrimoxazole, and clindamycin led to symptomatic improvement. This case underscores the diagnostic challenges of CMV encephalitis and cerebral toxoplasmosis in IMCh, where nonspecific symptoms and overlapping radiological findings may mimic other etiologies such as stroke. Given the neurotropic nature of T. gondii and the hematologic impact of CMV, coinfection—though rare—should be considered in patients with atypical CNS symptoms and hematological abnormalities, even in the absence of immunodeficiency. This report showed the need for heightened clinical suspicion and thorough evaluation to avoid misdiagnosis and ensure timely intervention. Clinicians should recognize that serious manifestations of CMV and toxoplasmosis are possible in IMCh and may present subtly, necessitating comprehensive serologic and imaging workups for accurate diagnosis and management.
CMV ; encephalitis ; cerebral toxoplasmosis ; immunocompetent host

Objectives: This study aimed to estimate the prevalence of loss to follow-up (LTFU) among tuberculosis (TB) patients in Indonesia and to identify associated factors. Methods: This study analyzed data from the 2022 Tuberculosis Information System in Indonesia. A total of 71,665 drug-sensitive TB patients were included in the analysis. Age, sex,employment status, diagnosis type, human immunodeficiency virus (HIV) status, diabetesmellitus, TB type, mode of treatment, treatment standard, referral status, and type of residence.Categorical variables were analyzed using chi-square tests, followed by multivariable logistic regression to identify confounder-adjusted independent predictors of LTFU. Results: The prevalence of LTFU was 18.4%. A higher likelihood of LTFU was observed amongolder adults aged ≥65 years (adjusted-prevalence-odds-ratio [aPOR], 1.862), men (aPOR, 1.187), unemployed individuals (aPOR, 1.136), non-referred patients (aPOR, 1.547), patients with HIV (aPOR, 3.712), and those obtaining TB drugs out of pocket (aPOR, 4.998). The strongest predictorwas receipt of non-standard treatment, which was associated with a markedly increasedlikelihood of LTFU (aPOR, 26.912). In contrast, rural residence demonstrated a protective association (aPOR, 0.610). All associations were statistically significant (p < 0.001). Conclusion This study highlights a substantial burden of LTFU among TB patients in Indonesia,with nearly one in five patients discontinuing treatment. Multiple sociodemographic and clinical factors—particularly non-standard treatment, non-referral status, and HIV co-infection—were strongly associated with LTFU, underscoring gaps in the TB care continuum.These findings emphasize the need for targeted, patient-centered interventions, strengthenedreferral pathways, improved communication, and enhanced care coordination to reduce LTFU in high-risk groups.

Continuous exposure to cigarette smoke causes oxidative stress, leading to diseases in the respiratory tract. Secang (Caesalpinia sappan L.) wood is a popular herbal drink in Indonesia due to its antioxidant properties. To date, the protective effects of Secang on the respiratory system have not been widely studied.Ethanolic extract of Secang was prepared by maceration. An in vivo experiment was conducted on 24 male Wistar rats divided into four groups: Control (K), Negative control (KN), low-dose treatment of the extract (P1, 300 mg/kg), and a high-dose one (P2, 600 mg/kg) for 30 days of treatment. After finishing treatments, rats were sacrificed for histological analysis. Rats' average bodyweight showed a consistent increase, indicating tolerable toxicity of the extract, which does not interfere with rats' general health. Serum glutamic pyruvic transaminase (SGPT) and serum glutamic oxaloacetic transaminase (SGOT) depicted consistent results, where P1 and P2 groups significantly decreased (p < 0.001) compared to KN, indicating hepatoprotective activity of Secang.Histologically, tracheal lumen diameter in P2 significantly (p < 0.05) increased compared to KN, suggesting Secang’s potent antioxidant activity. The number of goblet cells increased in KN compared to K, indicating irritation and inflammatory conditions from cigarette smoke. Secang-treated groups exhibited improvement in the lumen diameter, goblet cells, and ciliated epithelium. The findings suggest protective potential of Secang against cigarette smoke-induced tracheal damage.

Introduction: Insulin resistance and progressive beta-cell dysfunction are key components of the pathophysiology of type 2 diabetes mellitus (T2DM). The triglyceride-to-highdensity lipoprotein cholesterol (TG/HDL) ratio has been widely used as a marker of insulin resistance. In addition, testosterone deficiency has been associated with adverse metabolic profiles and T2DM. However, the relationship between testosterone levels, insulin resistance, and betacell function in patients with T2DM remains incompletely understood. Methodology: A cross-sectional study was conducted involving 25 male patients with T2DM attending the diabetic clinic at Dr. Mohammad Hoesin General Hospital. Serum testosterone, C-peptide, TG, and HDL levels were obtained from routine clinical data. The TG/HDL ratio was calculated as an index of insulin resistance. Normality was assessed using the Shapiro–Wilk test, and due to the non-normal distribution of key variables, Spearman correlation analysis was applied. Results: A strong inverse correlation was observed between testosterone levels and TG/HDL ratio (r = -0.860, p <0.001), indicating that higher insulin resistance was associated with lower testosterone levels. In addition, TG/HDL ratio showed a strong negative correlation with C-peptide levels (r = -0.741, p <0.001), suggesting reduced beta-cell function in the presence of increased insulin resistance. Conclusion In patients with T2DM, increased insulin resistance is strongly associated with lower testosterone levels and reduced beta-cell function. These findings highlight the interaction between metabolic dysfunction and hormonal status in middle-aged and elderly patients with T2DM
Diabetes Mellitus, Type 2 ; Insulin Resistance ; Testosterone

Objectives: The purpose of this study was to develop a valid and reliable instrument for assessing patients’ behavior toward the risk of hypoglycemia through self-assessment. Insufficient education and supervision of type 2 diabetes mellitus (DM) outpatients by healthcare providers is a significant concern, affecting their behavior during the treatment process. Additionally, inappropriate behavior typically increases the risk of hypoglycemia. To mitigate this risk, several studies have recommended evaluating patients’ behavior, necessitating the development of a new instrument. Methods: The study procedures were conducted in 3 stages: instrument development (face and content validity, stage I), construct validity and reliability test (stage II), and criterion validity (stage III). Stage I involved 5 healthcare practitioners, including internal medicine doctors, nurses, dietitians, and pharmacists in hospitals and community health centers. Stage II included 20 respondents using a 1-shot test method. Stage III involved 237 type 2 DM outpatients at Central General Hospital (RSUP) in Jakarta, employing a cross-sectional design and consecutive sampling. Results: The results indicated that the developed instrument was valid and reliable, comprising 9 domains (29 questions). These domains included behavior toward blood glucose monitoring, diet, physical activity, medication, assistance from healthcare providers, hypoglycemia management, self-care, family support, and insulin use. Furthermore, poor behavior was found to increase the risk of hypoglycemia by 2.36 times. Conclusions Based on these results, the developed instrument could be effectively used to evaluate behavior toward hypoglycemia among type 2 DM outpatients, confirming its validity and reliability.

Periodontal Screening, Where Are We Now? A Narrative Review Prevention of diseases begins with screening. An ideal screening tool identifies patients at an early stage to facilitate appropriate treatment modalities with the aim of preventing symptom manifestation, reducing disease severity, and improving health outcomes. Disease screening has been a fundamental component of preventive medicine and dentistry. In the context of periodontal disease, the basic periodontal examination (BPE) is one of the screening tools available. There is a high prevalence of periodontal diseases worldwide, indicating a global issue. Despite the significance of periodontal screening, it remains underutilized both globally and locally. The lack of routine screening contributes to poor assessment and treatment of periodontal disease. This article focuses on the epidemiology of periodontal disease, the associated challenges, current screening practices, and the future directions of periodontal screening. By addressing these issues, early detection and management of periodontal disease can be improved, ultimately enhancing oral health outcomes.

Objectives: The purpose of this study was to develop a valid and reliable instrument for assessing patients’ behavior toward the risk of hypoglycemia through self-assessment. Insufficient education and supervision of type 2 diabetes mellitus (DM) outpatients by healthcare providers is a significant concern, affecting their behavior during the treatment process. Additionally, inappropriate behavior typically increases the risk of hypoglycemia. To mitigate this risk, several studies have recommended evaluating patients’ behavior, necessitating the development of a new instrument. Methods: The study procedures were conducted in 3 stages: instrument development (face and content validity, stage I), construct validity and reliability test (stage II), and criterion validity (stage III). Stage I involved 5 healthcare practitioners, including internal medicine doctors, nurses, dietitians, and pharmacists in hospitals and community health centers. Stage II included 20 respondents using a 1-shot test method. Stage III involved 237 type 2 DM outpatients at Central General Hospital (RSUP) in Jakarta, employing a cross-sectional design and consecutive sampling. Results: The results indicated that the developed instrument was valid and reliable, comprising 9 domains (29 questions). These domains included behavior toward blood glucose monitoring, diet, physical activity, medication, assistance from healthcare providers, hypoglycemia management, self-care, family support, and insulin use. Furthermore, poor behavior was found to increase the risk of hypoglycemia by 2.36 times. Conclusions Based on these results, the developed instrument could be effectively used to evaluate behavior toward hypoglycemia among type 2 DM outpatients, confirming its validity and reliability.

Objectives: The purpose of this study was to develop a valid and reliable instrument for assessing patients’ behavior toward the risk of hypoglycemia through self-assessment. Insufficient education and supervision of type 2 diabetes mellitus (DM) outpatients by healthcare providers is a significant concern, affecting their behavior during the treatment process. Additionally, inappropriate behavior typically increases the risk of hypoglycemia. To mitigate this risk, several studies have recommended evaluating patients’ behavior, necessitating the development of a new instrument. Methods: The study procedures were conducted in 3 stages: instrument development (face and content validity, stage I), construct validity and reliability test (stage II), and criterion validity (stage III). Stage I involved 5 healthcare practitioners, including internal medicine doctors, nurses, dietitians, and pharmacists in hospitals and community health centers. Stage II included 20 respondents using a 1-shot test method. Stage III involved 237 type 2 DM outpatients at Central General Hospital (RSUP) in Jakarta, employing a cross-sectional design and consecutive sampling. Results: The results indicated that the developed instrument was valid and reliable, comprising 9 domains (29 questions). These domains included behavior toward blood glucose monitoring, diet, physical activity, medication, assistance from healthcare providers, hypoglycemia management, self-care, family support, and insulin use. Furthermore, poor behavior was found to increase the risk of hypoglycemia by 2.36 times. Conclusions Based on these results, the developed instrument could be effectively used to evaluate behavior toward hypoglycemia among type 2 DM outpatients, confirming its validity and reliability.

Orthodontic Treatment of Unilateral Cleft Lip and Palate Associated with Agenesis of Maxillary Lateral Incisors: A Case Report Cleft lip and palate (CLP) is a common congenital condition presenting significant orthodontic challenges due to maxillofacial growth disturbances, associated malocclusions, and dental anomalies. Patients with CLP often have complex dental and skeletal issues, requiring a comprehensive, interdisciplinary approach to address functional and aesthetic concerns. An 11-year-old female presented with unilateral cleft lip, alveolus, and palate (UCLP) associated with dental anomalies, which included a skeletal Class I relationship with Angle Class II malocclusion, bimaxillary retrognathia, bidental retroclination, negative overjet, lower dental midline shifting, anterior crossbite, microdontia #12, agenesis #22, and several malpositioned teeth. The patient was treated with fixed orthodontic appliances, including the extraction of remaining deciduous teeth, mesialisation of the teeth on the upper left side to close the space resulting from agenesis, and space management in the mandible. Significant improvements were observed in overjet, dental alignment, occlusion, and aesthetics after a 17-month treatment period. Following orthodontic treatment, restorative procedures were performed on teeth #12 and #23. Adhering to the prescribed retainer schedule is essential to preserving dental esthetics and the stability of the treatment results. Comprehensive orthodontic treatment with fixed appliances effectively addressed the complex dental and skeletal issues of this patient with UCLP. The treatment led to improved dental function and aesthetics, highlighting the importance of a personalised approach in addressing cleft cases.