Medical Profession Journal of Lampung

Monotherapy versus Combination Therapy for Postoperative Pain Management in Pediatric Patients: A Literature Review

Ria Wahyu Januarti, Khadafi Irawan — Sat, 16 May 2026 00:00:00 +0000

Postoperative pain is an acute sensation accompanied by an inflammatory process related to surgical trauma, which decreases as the tissue heals. However, it is often not well managed after surgery in children. Multimodal analgesia is a key principle for managing acute postoperative pain. One form of multimodal analgesia is combining non-opioid analgesics to reduce postoperative pain and opioid use. The latest guidelines recommend a combination of at least paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) for most types of surgery. NSAIDs and paracetamol have different mechanisms of action, so it can be assumed that combining the two will provide better analgesia than either drug alone. This article was written using the literature review method, which involved searching for literature from various national and international journals. Journal articles from 2015 to 2025 were used as the basis for the articles. The literature search references are from the PubMed, NCBI, and Google Scholar databases. The literature was then analyzed using the systematic literature review method, which included activities such as collecting, evaluating, and comparing the efficacy and acute management post-surgery. Hye-Mi et al.'s research found that the combination of NSAIDs with propacetamol is better postoperative analgesia than opioids. Intravenous administration provides a higher maximum plasma concentration (Cmax) and a shorter time to reach Cmax, resulting in faster and more reliable delivery compared to oral or rectal administration.

Laryngopharyngeal Reflux in a 42-Year-Old Male: a Case Report

Farhan Ridho Pangestu, Mukhlis Imanto — Sat, 16 May 2026 00:00:00 +0000

Laryngopharyngeal Reflux (LPR) is an inflammatory condition affecting the mucosa of the larynx and pharynx caused by the retrograde flow of gastroduodenal contents into the upper aerodigestive tract. This condition is frequently underdiagnosed due to its nonspecific symptoms, which often mimic other upper airway disorders. LPR presents with a wide range of clinical manifestations and is commonly managed by multiple medical disciplines without an accurate or standardized diagnostic approach. This case report aims to describe the clinical presentation, risk factors, diagnostic process, and management of LPR in an adult patient. We report the case of a 42-year-old male who presented with recurrent choking sensations, shortness of breath, dry cough, frequent throat clearing, and hoarseness persisting for four months, accompanied by worsening heartburn and epigastric discomfort. The patient had several predisposing factors, including obesity and unhealthy lifestyle habits such as high-fat and acidic food consumption and lying down shortly after meals. The diagnosis of LPR was established based on a Reflux Symptom Index (RSI) score of 14 obtained during anamnesis and a Reflux Finding Score (RFS) of 9 derived from indirect laryngoscopic examination. Management consisted of pharmacological therapy with high-dose proton pump inhibitors and antacids, combined with non-pharmacological interventions including lifestyle and dietary modifications. This integrated approach aims to reduce reflux episodes and mucosal inflammation. This case highlights the clinical importance of RSI and RFS as practical diagnostic tools for LPR and emphasizes the need for comprehensive management strategies to improve patient outcomes and quality of life.

Prevalence of Maternal Mortality Following Caesarean Section at Dr. H. Abdul Moeloek Hospital

Agung Assirri, Risti Graharti, Intan Kusumaningtyas — Sat, 16 May 2026 00:00:00 +0000

Maternal mortality is defined as the number of deaths in women that occur during pregnancy up to 42 days after delivery, caused by conditions directly related to pregnancy or its management, not by accidents or injuries. In Indonesia, the pattern of causes of maternal mortality over time has remained relatively constant, with hemorrhage, preeclampsia-eclampsia, and infection as the dominant factors contributing to high maternal mortality rates. One medical intervention that can help reduce the risk of maternal mortality is delivery by cesarean section (CS), especially in cases where the condition of the mother or fetus does not allow for vaginal delivery. This study aims to identify the prevalence of complications that cause maternal mortality in cesarean section deliveries at Dr. H. Abdul Moeloek Regional General Hospital. The research design used is a descriptive study with a qualitative approach. Secondary data were collected from patient medical records, and the sampling method used was total sampling, so that all 351 cases of C-section deliveries during the study period were analyzed. The results showed that there were 2 cases of maternal mortality out of a total of 351 C-section deliveries, or 0.57%. Both deaths were caused by postpartum hemorrhage (50%) and pre-existing heart disease (50%). These findings indicate that although the maternal mortality rate in CS deliveries at Dr. H. Abdul Moeloek Regional General Hospital is relatively low, risk factors such as hemorrhage and comorbidity still require special attention in delivery management.

Relation Of Black Garlic To White Rats (Rattus Norvegicus) Sprague-Dawley Line With Kidney Histopatology Imaging Induced By Oral Reused Cooking Oil

Dimas Dimas, Putu Ristyaning Ayu Sangging — Sat, 16 May 2026 00:00:00 +0000

Cooking oil consumed orally contains toxic substances that can cause cell damage in the kidneys. Black garlic contains antioxidants that can have an anti-toxic effect on the kidneys. This study is a true experimental study using a posttest only control group design to determine whether there is a relationship between black garlic intake and renal histopathology in Sprague-Dawley strain white rats (Rattus norvegicus) induced by used cooking oil. In this study, there were 25 rat samples divided into 5 groups: a control group with distilled water (K1), a control group with waste oil (K2), a 200mg/kgBW group (P1), a 400mg/kgBW group (P2), and an 800mg/kgBW group from the black garlic dose (P3). Microscopic aspects such as cellular infiltration, edema, and necrosis were assessed to evaluate the histopathology of the kidney. The data obtained were then statistically tested using One-Way ANOVA and PostHoc LSD tests. Based on the results of the One-Way ANOVA statistical test, a p-value of 0.000 was obtained, and group P3 had the lowest renal histopathological damage compared to groups P1 and P2. There was a relationship between black garlic intake and the histopathology of the kidneys of Sprague-Dawley strain white rats (Rattus norvegicus) induced by waste oil, and the group with a black garlic dose of 800 mg/kgBW had the lowest histopathological damage to the kidneys compared to the other treatment groups.

Allergic Rhinitis in a 25-Year-Old Woman: A Case Report

Muchammad Aqsa Enrico Ricardo, Mukhlis Imanto — Sat, 16 May 2026 00:00:00 +0000

Allergic rhinitis is an immunoglobulin E mediated inflammation of the nasal mucosa characterized by recurrent sneezing, nasal obstruction, rhinorrhea, and ocular symptoms such as itching and tearing. This condition is commonly observed in young adults and is closely associated with environmental allergen exposure and genetic predisposition. This case report describes a 25 year old woman who presented with recurrent nasal obstruction for the past four years. The symptoms were more pronounced in the morning and during exposure to cold air. The patient also reported repetitive sneezing episodes, occurring 10 to 15 times after exposure to dust, accompanied by clear rhinorrhea, nasal and ocular itching, and a habitual nose rubbing behavior. Ocular complaints, including watery and itchy eyes, were consistently reported. Physical examination revealed livid discoloration of the nasal cavity mucosa and septum. The inferior turbinates appeared edematous and hyperemic with clear nasal secretions. No septal deviation or signs of acute infection were observed. Based on the persistence of symptoms for more than four weeks and the characteristic clinical findings, the patient was diagnosed with mild persistent allergic rhinitis. Management included oral antihistamine therapy with cetirizine, a nasal decongestant containing pseudoephedrine hydrochloride, and intranasal corticosteroid therapy with fluticasone furoate. In addition to pharmacological treatment, the patient received education on allergen avoidance, adoption of healthy lifestyle practices, and regular physical activity. This case highlights the importance of recognizing long term symptoms, performing a thorough physical examination, and applying an appropriate combination of pharmacological and non pharmacological interventions to achieve symptom control, improve quality of life, and prevent disease progression in patients with allergic rhinitis.

The Association Between Vitamin D Deficiency and the Risk of Lower Respiratory Tract Infections in Adults

Ashilah Mumtaz Hakim, Chicy Widya Morfi — Sat, 16 May 2026 00:00:00 +0000

Lower respiratory tract infections (LRTIs) remain a major public health problem in adults and contribute substantially to global morbidity and mortality. The risk of LRTIs increases among older adults and individuals with comorbid conditions, making the identification of modifiable risk factors essential. Vitamin D status has gained increasing attention due to its role not only in calcium homeostasis and bone health but also in the regulation of innate and adaptive immune responses. This literature review aims to evaluate the association between vitamin D deficiency and the risk and severity of LRTIs in the adult population. The review includes evidence from meta-analyses, randomized controlled trials, and cohort studies published within the past five years. The findings consistently show that serum 25-hydroxyvitamin D levels below 20 ng/mL are associated with a higher risk of pneumonia, prolonged hospital length of stay, and increased mortality. These associations are supported by biological mechanisms such as reduced production of antimicrobial peptides including cathelicidin, heightened pro-inflammatory immune responses, impaired macrophage and natural killer cell function, and weakened respiratory mucosal defenses. Several interventional studies indicate that vitamin D supplementation provides protective effects in individuals with vitamin D deficiency, particularly by reducing the incidence and severity of LRTIs, whereas the benefits appear limited in individuals with sufficient vitamin D levels. Overall, the evidence suggests that vitamin D screening, targeted supplementation, and comprehensive preventive strategies may play an important role in reducing the burden of LRTIs among adults.

Burnout Among Healthcare Workers: A Literature Review of Contributing Factors and Prevention Strategies

Ni Putu Swastini, Winda Trijayanthi Utama — Sat, 16 May 2026 00:00:00 +0000

Burnout is a common work-related stress syndrome among healthcare workers, characterized by emotional exhaustion, depersonalization, and reduced professional achievement. This condition has a negative impact on service quality, worker health, and patient safety. Factors contributing to burnout include personal characteristics, sociodemographic factors, work environment conditions, high workload, and lack of organizational support. This study aims to review the literature on the factors that trigger burnout in healthcare workers and effective prevention strategies at the individual and organizational levels. The study used a literature review design with a search of articles in the PubMed, ScienceDirect, and Google Scholar databases using the keywords “burnout,” “healthcare workers,” “risk factors,” and “prevention strategies.” The articles included were publications from the last ten years, in Indonesian and English, and relevant to the research objectives. Data were synthesized narratively to identify risk factors and prevention strategies for burnout. Factors contributing to burnout included individual factors (age, gender, personality type), working conditions (high workload, overtime, interaction with patients), and organizational environment (managerial support, work culture). Effective prevention strategies combine individual interventions, such as mindfulness, CBT, and coping training, with organizational interventions, including supportive leadership, flexible policies, open communication, and empowerment of healthcare workers. Preventing burnout in healthcare workers requires a holistic approach that integrates individual and organizational strategies. Management and leadership support that emphasizes employee well-being is key to reducing burnout and improving the quality of healthcare services.

Low Back Pain in Healthcare Workers in The Operating Room: a Literature Review

Poppy Monika Sari, Winda Trijayanthi Utama — Sat, 16 May 2026 00:00:00 +0000

Low Back Pain is one of the most common musculoskeletal complaints among Healthcare Workers, especially nurses, and directly affects quality of life, work performance, and productivity. The high physical demands of healthcare services increase the risk of Low Back Pain through multiple factors. Individual factors include age, body mass index, level of physical activity, and a history of back injury. Occupational factors involve non-ergonomic working postures, patient lifting and transfer activities, repetitive movements, prolonged working hours, and heavy workloads. This study aims to review the literature related to risk factors, impacts, and the effectiveness of preventive interventions for Low Back Pain among Healthcare Workers. The method used is a literature review of scientific articles retrieved from relevant international databases, focusing on Healthcare Workers as the primary population. The review results show that more than half of Healthcare Workers in various countries report experiencing Low Back Pain, with occupational factors identified as the main contributors. Reported impacts include increased absenteeism, decreased work performance, and a higher risk of developing chronic musculoskeletal disorders. Preventive interventions such as workplace ergonomic modifications and posture education demonstrate more consistent effectiveness in reducing the incidence of Low Back Pain compared to physical activity-based interventions or stretching exercises alone. Stretching exercises provide limited benefits when not combined with ergonomic improvements. Therefore, prevention of Low Back Pain among Healthcare Workers requires an integrated approach that combines education, application of ergonomic principles, and systematic workload management to reduce prevalence and mitigate its negative impact.

Perioperative Anesthetic Management in Obese Patients: a Literature Review

Alya Nabila Nurrahma, Andre Kusuma Rakhman — Sat, 16 May 2026 00:00:00 +0000

The prevalence of obesity has continued to rise over the past decades and has become a major concern in clinical practice. Obesity presents specific challenges in perioperative management, particularly in airway management for obese patients undergoing surgical procedures. Anesthesiologists must understand the various risks associated with anatomical and physiological changes, including excessive fat deposition in the neck and thoracic regions, reduced functional residual capacity of the lungs, and increased oxygen demand. In addition, obese patients frequently have comorbid conditions such as diabetes mellitus, hypertension, and obstructive sleep apnea, which further increase the risk of perioperative complications. This article was prepared using a literature review method through a comprehensive search of scientific articles published in various journals. The literature included publications from 2020 to 2025 obtained from PubMed, NCBI, and Google Scholar databases. Selected articles were analyzed using a systematic literature review approach, which involved data collection, assessment of study quality, and synthesis of findings with a focus on perioperative management in obese patients. The results indicate that successful anesthetic management in obese patients strongly depends on thorough preoperative assessment, careful airway strategy planning, and appropriate selection of anesthetic techniques. During the intraoperative phase, close monitoring and adjustment of anesthetic drug dosing are essential to maintain patient safety. Postoperative care also plays a crucial role in preventing respiratory complications, particularly in the early recovery period. A comprehensive and integrated perioperative approach is required to improve patient safety and optimize clinical outcomes in obese individuals undergoing surgery.

Hypertension in Patients with Diabetes Mellitus: a Literature Review

Heironimus Billy Febriyan, Winda Trijayanthi Utama — Sat, 16 May 2026 00:00:00 +0000

Hypertension in patients with diabetes mellitus is a significant clinical problem because it increases the risk of cardiovascular and renal complications. The pathophysiology of this condition involves interactions between insulin resistance, activation of the renin–angiotensin–aldosterone system (RAAS), endothelial dysfunction, and oxidative stress, which trigger vasoconstriction, sodium retention, and increased vascular stiffness. Various clinical guidelines, including those of the American Diabetes Association (ADA), set a blood pressure target of <130/80 mmHg to reduce the risk of long-term complications. Evidence from clinical trials such as ABCD shows that intensive blood pressure control provides benefits in terms of the progression of retinopathy, albuminuria, and stroke risk. This article was compiled using a narrative review approach by examining the latest literature from international journals and clinical guidelines related to hypertension in diabetes. Sources were selected based on relevance, recency, and strength of evidence. The analysis was descriptive to summarize pathophysiology, blood pressure target recommendations, treatment options, and the role of lifestyle changes. Management of hypertension in diabetes requires a combination of pharmacological therapy and lifestyle modifications. ACE inhibitors and ARBs are the first choice due to their renal protective benefits, while calcium antagonists and thiazide diuretics are used as adjunctive therapy. Lifestyle interventions such as salt restriction, increased fruit and vegetable consumption, regular physical activity, weight loss, and alcohol restriction provide moderate blood pressure lowering effects and improve metabolic health. A comprehensive approach encompassing metabolic, pharmacological, and lifestyle management is crucial for reducing morbidity and mortality in patients with diabetes and hypertension.

Risk Factor Analysis of Mortality Among Sepsis Patients in the Intensive Care Unit of RSUD Dr. H. Abdul Moeloek, Lampung (2018–2021)

Putri Grace Aiko Purba, Ari Wahyuni, Novita Carolia, Liana Sidharti — Sat, 16 May 2026 00:00:00 +0000

Sepsis is an organ dysfunction due to dysregulation of infection response. It is characterized by cardinal inflammatory signs such as vasodilation, leukocyte accumulation, and increased microvascular permeability in tissues away from the site of infection. Sepsis is identified using clinical criteria, specifically the Sequential (Sepsis-Related) Organ Failure Assessment Score with ≥2 points. Sepsis is a leading cause of mortality in the Intensive Care Unit. Its mortality is triggered by several risk factors, including age, low Glasgow Coma Scale and Mean Arterial Pressure scores, and the presence of comorbidities. This study aims to analyze the relationship between these determinants and mortality among the Intensive Care Unit sepsis patients. This study used an observational analytic method with a cross-sectional approach. The subjects were sepsis patients in the Intensive Care Unit of RSUD DR. H. Abdul Moeloek Lampung in 2018-2021 who met the inclusion and exclusion criteria. The independent variables were age, Glasgow Coma Scale, Mean Arterial Pressure, and comorbidities, while the dependent variable was mortality. Samples were collected using total sampling technique. The results showed that age, Glasgow Coma Scale, Mean Arterial Pressure, and comorbid disease were significantly associated sepsis mortality, with p-values of 0.008, 0.029, 0.040, and 0.013, respectively. Thus, there is a relationship between age, Glasgow Coma Scale, Mean Arterial Pressure, and comorbid disease to the mortality among sepsis patients.

Correlation of NT-proBNP with Ejection Fraction in Heart Failure Patients: a Literature Review

I Wayan Dika Aditia Darma, Putu Ristyaning Ayu Sangging — Sat, 16 May 2026 00:00:00 +0000

Heart failure is a complex clinical syndrome characterized by typical signs and symptoms resulting from structural or functional cardiac abnormalities that impair the ability of the ventricles to fill with or eject blood effectively. It remains a major global health problem with high morbidity and mortality rates. One of the most widely used biomarkers for assessing disease severity and prognosis in heart failure is N terminal pro brain natriuretic peptide or NT proBNP. Elevated NT proBNP levels occur in response to increased ventricular wall stress and volume overload and are closely related to the degree of left ventricular dysfunction, which is commonly assessed by left ventricular ejection fraction or LVEF. Numerous studies have demonstrated a significant negative correlation between NT proBNP levels and ejection fraction, particularly in patients with heart failure with reduced ejection fraction, where higher NT proBNP concentrations are observed as LVEF decreases. In contrast, in patients with heart failure with preserved ejection fraction, this relationship is not consistently linear. This variability is influenced by additional factors such as diastolic dysfunction, the presence of comorbid conditions, increased myocardial stiffness, and structural cardiac remodeling that may not be fully reflected by ejection fraction values alone. This literature review aims to analyze the relationship between NT proBNP levels and ejection fraction in patients with heart failure based on findings from national and international studies published over the past ten years. A clear understanding of this relationship is essential to define the diagnostic and prognostic value of NT proBNP and to support its use in therapeutic monitoring and risk stratification in patients with heart failure.

Prevention of Hypotension Following Spinal Anesthesia in Cesarean Section Surgery: A Literature Review

Verra Rachma Indahsari, Khadafi Indrawan — Sat, 16 May 2026 00:00:00 +0000

Spinal anesthesia is widely used for cesarean section, but it often causes hypotension due to sympathetic blockade, making vasopressor prophylaxis necessary. Ephedrine has long been the traditional choice, although several studies have linked it to a higher risk of neonatal acidosis. Phenylephrine is now more commonly recommended because of its effectiveness in maintaining blood pressure, while recent evidence suggests that norepinephrine may provide comparable hemodynamic stability with a lower incidence of maternal bradycardia. Literature searching was performed through PubMed, Google Scholar, and ScienceDirect using keywords related to ephedrine, phenylephrine, norepinephrine, hypotension, and spinal anesthesia for cesarean delivery. Articles discussing vasopressor use for the prevention or management of hypotension were reviewed and summarized narratively. The findings indicate that phenylephrine effectively maintains blood pressure but may cause bradycardia; norepinephrine at doses of 0.05 µg/kg/min offers hemodynamic stability similar to phenylephrine 0.625 µg/kg/min, with no significant differences in neonatal outcomes across several studies; and ephedrine remains useful, especially when maternal bradycardia occurs, although some research reports a higher risk of neonatal acidosis. Overall, the evidence is mixed and does not show clear superiority of one vasopressor over another. Both phenylephrine and norepinephrine can be used for prophylaxis of spinal-induced hypotension in cesarean section, each with its own advantages and limitations, while ephedrine remains relevant in specific situations. Further studies are needed to establish more definitive recommendations regarding the optimal vasopressor choice.

Preoperative, Intraoperative, and Postoperative Anesthetic Considerations in Geriatric Patients: a Literature Review

Putri Puspa Devi, Khadafi Indrawan — Sat, 16 May 2026 00:00:00 +0000

Geriatric patients commonly experience multiple anatomical and physiological changes related to the aging process, involving the cardiovascular, respiratory, metabolic, endocrine, digestive, nervous, and musculoskeletal systems. These changes increase perioperative risks associated with anesthesia and contribute to higher morbidity and mortality rates. This literature review aims to minimize undesirable events and complications that may occur during the preoperative, intraoperative, and postoperative phases in geriatric patients. The method used involved a literature search of studies published between 2015 and 2025 using the NCBI, PubMed, and Google Scholar databases, focusing on anesthetic considerations in geriatric patients across perioperative phases. Selected articles were analyzed using a systematic literature review approach, including data collection, evaluation, and synthesis in accordance with the review objectives. The findings indicate that preoperative preparation in elderly patients should include comprehensive functional assessment to identify cognitive impairment, reduced cardiopulmonary reserve, depression, frailty, nutritional status, polypharmacy, and anticoagulation issues. Intraoperative management involves appropriate selection of anesthetic techniques and pharmacological agents, close monitoring, careful fluid or intravenous transfusion management, adequate pulmonary ventilation, and prevention of hypothermia. Postoperative considerations include effective perioperative analgesia, prevention and early detection of postoperative delirium and cognitive dysfunction, as well as monitoring for other potential complications. A comprehensive and integrated anesthetic approach is essential to improve patient safety and optimize clinical outcomes in the geriatric population undergoing surgical procedures.

Management of Difficult Airway on Adult Patient: a Literature Review

Aditya Gloria Monalisa Sianturi, Khadafi Indrawan — Sat, 16 May 2026 00:00:00 +0000

Difficult airway is a clinical situation in which a healthcare provider who is skilled at airway management encounters difficulty with one or more standard methods of airway management. Difficult airway may obstruct mask ventilation or increase the risk of failed intubation attempts. The purpose of this literature review is to understand the management of difficult airway on adult patient. The method used in this literature review involved searching for literature published between 2018 into 2023 on NCBI, PubMed, and Google Scholar databases, focusing on management of difficult airway on adult patient. Then, literature was analyzed using systematic literature review method, which included data collection and evaluation activities in accordance with the objective of the literature review. There are several indicators of difficult airway, which are face mask ventilation, laryngoscopy, supraglottic airway ventilation, tracheal intubation and extubation, and invasive airway. In addition, there are several predictors as a reference in identifying difficult airway, which are LEMON mnemonic and MOANS mnemonic. After a difficult airway has been identified, there are several interventions that can be apply, which are awake tracheal intubation, anesthetized tracheal intubation, and mixed intubation.

Work Accident Risks Among Healthcare Workers and Their Prevention: A Literature Review

Naisya Midary Mutia Pratiwi, Winda Trijayanthi Utama — Sat, 16 May 2026 00:00:00 +0000

Healthcare workers represent an occupational group with a high risk of work related accidents, including biological exposure, injuries caused by sharp objects, exposure to hazardous chemical substances, and musculoskeletal disorders associated with ergonomic hazards. These risks are influenced by high workload, suboptimal use of personal protective equipment, and the incomplete implementation of safety procedures in healthcare settings. This study aims to identify the main types of hazards commonly experienced by healthcare workers and to analyze prevention strategies recommended in previous studies. The method used was a literature review by selecting relevant national and international scientific articles related to occupational accidents, needle stick injuries, chemical hazards, and ergonomic risks among healthcare workers. Selected articles were analyzed using a systematic literature review approach, focusing on key findings, contributing factors, and prevention recommendations reported in each study. The results indicate that needle stick exposure is the most frequently reported occupational accident among healthcare workers. In addition, chemical exposure from substances such as cytotoxic drugs and disinfectants, as well as musculoskeletal complaints caused by non ergonomic working techniques, are also commonly identified. Dominant contributing factors include inadequate occupational safety and health training, inconsistent use of personal protective equipment, weaknesses in healthcare facility risk management, and high workload. In conclusion, occupational accidents among healthcare workers are multifactorial and require comprehensive preventive measures through improved training, provision of safe working facilities, compliance with standard operating procedures, and strengthening of a safety culture in healthcare services.

Case Report: Occupational Low Back Pain in an Oil Palm Harvester

Salsabila Nurislami, Winda Trijayanthi Utama — Sat, 16 May 2026 00:00:00 +0000

Work-related diseases in the agricultural sector have shown a rising trend in recent years. Heavy physical activities involving non-ergonomic postures, heavy lifting, and repetitive movements increase the risk of injuries and musculoskeletal disorders. Low back pain is one of the most common musculoskeletal complaints among workers in this sector. This case report aims to analyze low back pain in an oil palm harvester using the application of the seven-step occupational diagnostic approach. The seven-step occupational diagnosis was applied to determine the causal relationship between occupational exposure and the patient’s symptoms. Clinical diagnosis and management were conducted in accordance with clinical guidelines.The patient was an oil palm harvester with recurrent episodes of low back pain. Occupational analysis showed that the patient worked in prolonged non-ergonomic postures—standing with neck extension, frequent forward bending, and repetitive heavy lifting—for 15 years, with daily work durations of 8–10 hours. Based on the seven-step occupational diagnostic assessment, the patient’s condition was classified as an occupational disease. Management included pharmacological therapy and ergonomic education. This case highlights that non-ergonomic working postures, the use of non-ergonomic tools, repetitive movements, and heavy lifting significantly contribute to the development of low back pain among agricultural workers. Pharmacological treatment must be accompanied by preventive strategies through ergonomic education. This case report underscores the importance of physicians’ competency in establishing occupational diagnoses and providing comprehensive management for workers with occupational diseases

Cushing Syndrome in a 5-Year-Old Girl: A Case Report

Muhammad Yazid Daradjat, Ismi Citra Ismail — Sat, 16 May 2026 00:00:00 +0000

Cushing’s syndrome (CS) is a rare multisystem endocrine disorder characterized by excessive glucocorticoid levels. In children, this condition is uncommon, with a reported global incidence of approximately 1:5,000,000–10,000,000 per year, and may result from endogenous overproduction or prolonged irrational use of exogenous steroids. This case report describes a 5-year-6-month-old girl presenting with fever accompanied by nausea, vomiting, and diarrhea. The patient had a history of recurrent unexplained fever for the past two years and had been repeatedly treated with paracetamol and dexamethasone without medical consultation until symptoms improved. The diagnosis was supported by physical examination findings suggestive of obesity, diastolic blood pressure above the 95th percentile, moon face, buffalo hump, acanthosis nigricans, and abdominal striae. Supporting examinations revealed adrenal ultrasonography within normal limits. Management included gradual tapering off dexamethasone and close observation for signs of adrenal crisis, followed by planned evaluation of cortisol and plasma adrenocorticotropic hormone levels. Long-term use of steroid medications without proper medical supervision remains the most common cause of CS in pediatric patients. This report emphasizes the importance of stricter regulation of over-the-counter steroid distribution by relevant stakeholders and highlights the critical role of clinicians in educating parents regarding the appropriate use of steroid medications to prevent the development of Cushing’s syndrome in children.

Dry Eye After Cataract Surgery Given Diquafosol Sodium

Natasya Jasmine Azzahra, Muhammad Maulana — Sat, 16 May 2026 00:00:00 +0000

Dry eye is one of the most common complications following cataract surgery, primarily caused by tear film instability, ocular surface epithelial damage, and altered mucin secretion. This condition may reduce visual comfort, delay postoperative recovery, and negatively impact patients’ quality of life. Recent literature from the last five years indicates that 3% Diquafosol sodium, a P2Y₂ receptor agonist, provides substantial therapeutic benefits by promoting tear and mucin secretion, enhancing ocular surface integrity, and supporting epithelial repair after surgical trauma. Multiple studies report that Diquafosol, either as monotherapy or in combination with sodium hyaluronate, significantly improves tear breakup time (TBUT), reduces corneal and conjunctival staining, and enhances Schirmer test scores. Improvements in subjective symptoms, including dryness, irritation, and discomfort, were also noted in many postoperative individuals. Perioperative administration initiated prior to surgery and continued during the healing phase has demonstrated superior outcomes compared to postoperative use alone. However, heterogeneity among study designs, variation in treatment duration, and inconsistent subjective symptom improvement remain limitations in current evidence. Overall, available scientific findings support Diquafosol sodium as an effective and safe therapeutic option for managing postoperative dry eye and suggest its incorporation into standard management protocols, especially for patients with pre-existing dry eye or those at high risk.

Dry Eye Syndrome in Office Workers: a Literature Review

Tyaradhia Ranita Eltidar, Winda Trijayanthi Utama — Sat, 16 May 2026 00:00:00 +0000

An epidemiological study in the United States involving 75,000 adults reported that 5,051 individuals, or 6.73%, were diagnosed with Dry Eye Syndrome (DES), highlighting its growing importance as a public health issue, particularly among office workers with prolonged digital screen exposure. The extensive use of computers, smartphones, and tablets contributes to DES primarily through reduced blink frequency and incomplete blinking, which increase tear evaporation and lead to ocular surface dryness. Prolonged screen exposure may also induce oxidative stress and inflammation on the ocular surface, accelerating DES development. Workplace environmental factors, including air conditioning, artificial lighting, and low humidity, further elevate the risk, while blue light from screens may disrupt circadian rhythms, reduce tear production, and exacerbate symptoms. Poor ergonomic practices, such as improper screen positioning and prolonged near work, add visual strain and worsen Digital Eye Strain. A cross-sectional study in Bangladesh in 2023 found that daily screen time exceeding 8 hours, blink rates below 10 blinks per minute, and air-conditioned work environments significantly increased DES risk among office workers. Similar findings were reported in a 2024 cross-sectional study from India, which also identified screen distances of less than 50 cm and workplace humidity below 30% as risk factors. In addition, a cohort study in the Netherlands showed that professionals in legal, health, business, and administrative sectors had a higher risk of developing DES, which has been shown to reduce work productivity after symptom onset.

The Role of Glucosamine and Chondroitin Supplementation in the Management of Osteoarthritis

M.Kaisar Febriantara, George Pestalozi, Helmi Ismunandar — Sat, 16 May 2026 00:00:00 +0000

Osteoarthritis (OA) is a chronic degenerative disease characterized by progressive damage to articular cartilage and surrounding joint tissues, clinically manifesting as pain, deformity, and disability. The main risk factors include aging, joint injury or overuse, and obesity. According to the Global Burden of Disease Study in 2020, approximately 595 million people worldwide were living with osteoarthritis. In Indonesia, data from the 2018 Basic Health Research report indicated that osteoarthritis affected about 55 million individuals, with the highest prevalence among those aged over 61 years, accounting for 65%. Pathophysiologically, osteoarthritis develops due to cartilage thinning, leading to biomechanical changes, reduced synovial fluid, and increased inflammatory processes associated with aging. Inflammatory cells, particularly macrophages, release mediators that accelerate cartilage degradation and exacerbate joint pain. Radiological assessment of osteoarthritis severity is commonly performed using the Kellgren–Lawrence classification. Management of osteoarthritis frequently involves nonsteroidal anti inflammatory drugs, although long term use is associated with adverse effects. Therefore, adjunctive therapies such as glucosamine and chondroitin have been widely studied. Glucosamine and chondroitin exhibit anti inflammatory and chondroprotective effects and play roles in inhibiting cartilage degradation while supporting anabolic processes in cartilage tissue. Several studies have demonstrated that supplementation with glucosamine and chondroitin improves pain scores, slows joint space narrowing, and enhances joint function in patients with osteoarthritis. These findings suggest that glucosamine and chondroitin may serve as beneficial adjunctive therapies in the management of osteoarthritis.

Ectopic Pregnancy in a G3P1A1 29-Year-Old Woman: a Case Report

Hasta Hendarto, Rasmi Zakiah Oktarlina, Intan Kusumaningtyas — Sat, 16 May 2026 00:00:00 +0000

Ectopic pregnancy is a condition in which the gestational sac is located outside the uterine cavity, representing the most common life-threatening emergency during the first trimester of pregnancy. Implantation in ectopic pregnancy frequently occurs in the fallopian tube. The clinical manifestations are typically characterized by amenorrhea, followed by vaginal bleeding and sudden onset abdominal pain. In this case, a 29-year-old woman, G3P1A1, presented at 6–7 weeks of gestation with severe lower abdominal pain accompanied by vaginal bleeding, along with a risk factor of a previous history of ectopic pregnancy. Data were obtained through anamnesis, general physical examination, obstetric assessment, ultrasonography, and both medical and non-medical management. Physical examination revealed conjunctival pallor, abdominal distension with muscular defense, tenderness in the lower abdomen, and a non-palpable uterine fundus. Pelvic examination demonstrated cervical motion tenderness and bulging in the pouch of Douglas. Ultrasonography findings were highly suggestive of ectopic pregnancy. The diagnosis was established as gravida 3 para 1 abortus 1, 6–7 weeks of gestation, with a complicated ectopic pregnancy. The patient underwent exploratory laparotomy with left salpingectomy due to rupture of the left ampullary segment of the fallopian tube. Methotrexate therapy was not administered, as the patient did not meet the eligibility criteria for medical management, given that tubal rupture had already occurred.

Management of Abdominal Management of Abdominal Typhoid Fever in a 22-Year-Old Woman with Poor Dietary Habits and Limited Knowledge of Clean and Healthy Living Behavior: a Case Report

Tri Agustina Dewi, Rika Lisiswanti — Sat, 16 May 2026 00:00:00 +0000

Typhoid fever is a potentially fatal multisystem infectious disease that remains a significant public health problem in Indonesia, particularly in areas with poor sanitation and inadequate implementation of clean and healthy living behavior (PHBS). We report a case of a 22-year-old woman who presented with continuous fever for approximately three days prior to admission, worsening in the afternoon and evening, accompanied by chills, headache, dizziness, nausea, vomiting, epigastric pain, and constipation. The patient had a history of irregular dietary habits, frequent consumption of street food, and poor hand hygiene practices, especially failure to wash hands before meals. Physical examination revealed a coated tongue and epigastric tenderness, while laboratory findings showed a Widal O titer of 1/320 supporting the diagnosis of abdominal typhoid fever. The patient was managed with chloramphenicol, antipyretics, intravenous fluids, bed rest, and a low-fiber diet, along with comprehensive education regarding PHBS implementation, particularly proper handwashing and regular dietary patterns. This case highlights that irregular eating habits and inadequate knowledge and practice of PHBS play an important role in the occurrence of abdominal typhoid fever, emphasizing the need for comprehensive management combining medical therapy and health behavior education to prevent recurrence and disease transmission.

Impact of Maceration Duration on the Antibacterial Activity of Moringa oleifera Leaves Against Escherichia coli : Article Review

Nisrina Zalfa Fatin, Tri Umiana Soleha, Shinta Nareswari, Asep Sukohar — Sat, 16 May 2026 00:00:00 +0000

The increasing resistance of bacteria to antibiotics has encouraged the use of medicinal plants as a natural alternative antibacterial agent. Moringa leaves (Moringa oleifera) contain bioactive compounds, including flavonoids, tannins, saponins, alkaloids, and terpenoids, which are capable of inhibiting bacterial growth. This review article aims to examine the effect of maceration duration using 96% ethanol as a solvent on the antibacterial activity of Moringa oleifera leaf extracts against Escherichia coli. Literature searches were conducted through PubMed, Google Scholar, and Scopus, using a combination of keywords such as “Moringa oleifera,” “leaf extract,” “ethanol,” “maceration time,” and “antibacterial activity,” with a limitation to publications from the last ten years. Relevant articles were selected based on their focus on ethanol extraction of Moringa oleifera leaves and antibacterial testing against E. coli. Recent studies indicate that variations in maceration duration result in differences in inhibition zone diameters ranging from 9.83 to 27.7 mm. Short-term maceration of 24 hours can achieve high antibacterial activity, whereas longer maceration does not necessarily enhance effectiveness. These differences are influenced by extract concentration, bioactive compound stability, and bacterial testing conditions. These findings highlight that the antibacterial effectiveness of Moringa oleifera leaves depends on an optimal combination of maceration duration, extract concentration, and the stability of active compounds. Determining the appropriate maceration time is crucial for achieving maximum antibacterial activity. Furthermore, these results provide a basis for future research on the utilization of Moringa oleifera leaf extracts as a potential natural antibacterial agent.

The Role of Growth Differentiation Factor-15 (GDF-15) as a Prognostic Biomarker in Heart Failure: A Literature Review

Brian, Iswandi Darwis, Eka Putri Rahmadhani, Intanri Kurniati — Sat, 16 May 2026 00:00:00 +0000

Heart failure is a complex clinical syndrome with high morbidity and mortality, contributing to a substantial global health burden, including in Indonesia. Although conventional biomarkers such as BNP and NT-proBNP are well established for diagnosis and risk stratification, they have limitations in capturing the heterogeneous pathophysiology of heart failure. Growth Differentiation Factor-15 (GDF-15), a member of the TGF-β superfamily that increases in response to oxidative stress, inflammation, and myocardial ischemia, has emerged as a more comprehensive prognostic biomarker. This literature review examines clinical studies, prospective and retrospective cohorts, observational research, and meta-analyses evaluating the prognostic value of GDF-15 in acute and chronic heart failure. The synthesized evidence demonstrates that elevated GDF-15 levels consistently correlate with increased risks of mortality, rehospitalization, and disease progression. In addition, serial measurements of GDF-15 reflect therapeutic response, as failure of GDF-15 levels to decline is associated with poorer outcomes. Combining GDF-15 with other biomarkers, such as NT-proBNP, further enhances risk stratification accuracy compared with single-biomarker assessment. Based on current evidence, GDF-15 holds substantial potential as an independent and dynamic prognostic biomarker, supporting more precise risk assessment, disease monitoring, and clinical decision-making in patients with heart failure.

The Role of Postmortem Immunohistochemistry Test in Sudden Cardiac Death

Salma Adinda Hermawan, Susianti, Wiwi Febriani, Waluyo Rudiyanto — Sat, 16 May 2026 00:00:00 +0000

Routine forensic examinations often fail to establish a definitive diagnosis, particularly in cases of rapid death where no clear macroscopic or microscopic abnormalities are identified. Immunohistochemistry (IHC) is a laboratory technique used to detect the presence and distribution of specific antigens in tissues through antigen–antibody binding combined with specific staining systems. This narrative review discusses the role of postmortem immunohistochemical testing in the evaluation of sudden cardiac death, including examination principles and procedures, forensic applications, relevant immunohistochemical markers, and the influence of the postmortem interval on result interpretation. A literature search was conducted using the PubMed, ScienceDirect, and Google Scholar databases, covering publications from 2016 to 2025. The reviewed studies indicate that postmortem IHC plays a broad role, particularly in cases involving toxic substances, and assists in establishing diagnoses that cannot be determined through routine examinations. Moreover, markers such as troponin, C5b-9, desmin, H-FABP, and CD68 demonstrate diagnostic value in identifying myocardial injury, tissue necrosis, inflammatory processes, and atherosclerotic plaque formation. However, the reliability of IHC findings is influenced by technical factors, including the interval between death and tissue sampling, tissue fixation methods, and variations in laboratory protocols. Therefore, the use of an integrated immunohistochemical marker panel combined with macroscopic findings, conventional histopathology, and clinical data is recommended within the diagnostic workflow of sudden cardiac death. In Indonesia, the implementation of postmortem IHC remains limited; nevertheless, it holds significant potential as a diagnostic adjunct when applied selectively and in a standardized manner within forensic practice.

Distribution of Body Mass Index Among Fourth-Year Female Medical Students at The University of Lampung

Rio Sanjaya, Anggi Setiorini, Eka Putri Rahmadhani, Waluyo Rudiyanto — Sat, 16 May 2026 00:00:00 +0000

Students in early adulthood are vulnerable to lifestyle changes associated with academic demands and the university environment, which may ultimately affect their nutritional status. One commonly used indicator for assessing nutritional status is Body Mass Index (BMI). Changes in dietary patterns, irregular physical activity, and suboptimal sleep quality may increase the risk of nutritional imbalance among students. This study aimed to determine the distribution of Body Mass Index among female medical students of the 2022 cohort at the Faculty of Medicine, University of Lampung. This study employed an observational design with a cross-sectional approach and involved 175 female students as research participants. Data were collected through anthropometric measurements, including body weight on a digital scale and height on a microtoise. BMI values were calculated as body weight divided by height squared and then classified according to standard anthropometric criteria. The results showed that the majority of respondents had normal nutritional status based on BMI, with 123 students (70.3%). Meanwhile, 23 students (13.1%) were classified as underweight, 11 students (6.3%) as overweight, and 18 students (10.3%) as obese. These findings are consistent with previous studies reporting a predominance of normal BMI among student populations. However, the presence of nearly one-third of respondents with abnormal BMI indicates the influence of lifestyle-related factors, such as dietary habits, physical activity levels, sleep quality, and daily behaviors. Therefore, promotive and preventive efforts through nutritional education and the adoption of healthy lifestyle practices are necessary to maintain optimal nutritional status among students.

The Role of Mediterranean Diet on Glycated Hemoglobin (HbA1c) in Type 2 Diabetes Mellitus (Literature Review)

Fri, 12 Jun 2026 00:00:00 +0000

Type 2 diabetes mellitus (DM) is a chronic metabolic disease and global health problem that requires optimal glycemic control to prevent complications. Medical nutrition therapy is a key pillar of management, with the Mediterranean diet recommended due to its nutrient profile rich in unsaturated fats. This review aims to synthesize the latest clinical evidence on the effect of the Mediterranean diet on reducing HbA1c levels in patients with type 2 DM, analyze the underlying biological mechanisms, and evaluate its sustainability compared to other diets. A literature review was conducted using the PubMed database for studies published between 2021 and 2025. Of the 60 articles, 6 clinical studies (RCTs, pilot studies, and prospective interventions) that met the inclusion criteria were analyzed. Data synthesis showed that Mediterranean diet interventions lasting 12 weeks to 12 months consistently reduced HbA1c levels with an absolute reduction range of 0.2% to 2.0% (p < 0.05). Critical interpretation shows that while restrictive diets such as the Ketogenic diet provide more drastic reductions (-9% to -13.5% relative) due to glucose elimination, the Mediterranean diet offers long-term metabolic stability through the restoration of insulin sensitivity. The mechanism of glycemic improvement occurs through anti-inflammatory pathways and modulation of the incretin system, particularly stimulation of the GLP-1 hormone. The Mediterranean diet has been shown to be effective in significantly lowering HbA1c and offers a more sustainable nutritional strategy for patients. Clinical implications suggest the integration of olive oil and plant-based diets as the standard for long-term nutritional therapy.

The Role of Radiology in Establishing the Diagnosis of Ileus in a Patient with Chronic Kidney Disease Presenting with Abdominal Pain, Constipation, and Anemia of Chronic Disease: A Case Report

Divia Denisa Sitinjak, Ricky Ramadhan — Thu, 18 Jun 2026 00:00:00 +0000

Ileus often presents as mechanical bowel obstruction, thereby posing a significant diagnostic challenge in patients with advanced chronic kidney disease (CKD). This is because the symptoms of uraemia overlap with those of acute abdominal conditions. The use of contrast-enhanced computed tomography (CT) is generally avoided due to the risk of nephropathy, making non-contrast multimodal imaging crucial. This case report analyses the role of integrating plain abdominal radiographs and ultrasound (US) in distinguishing between obstructive and paralytic ileus. A 72-year-old male patient with stage 5 CKD presented with acute abdominal pain, persistent vomiting, distension and total constipation. Assessment confirmed normocytic normochromic anaemia, severe uraemia, hyponatraemia and hyperkalaemia. A plain abdominal X-ray showed dilated small bowel with a herringbone pattern and the absence of rectal gas, which was initially interpreted as high-site mechanical obstruction. However, dynamic abdominal ultrasound revealed markedly hypoperistaltic dilated bowel loops with wall thickening, leading to a diagnosis of secondary paralytic ileus due to uraemic enteropathy. The patient refused dialysis and surgical intervention but showed partial improvement through conservative management comprising decompression, prokinetic therapy and electrolyte correction. This case underscores that a combination of static and dynamic non-contrast imaging is essential in reconciling conventional pseudo-mechanical findings with functional dysmotility. Furthermore, the comorbidity of anaemia in PGK reduces physiological tolerance to intestinal ischaemia and requires a higher level of clinical vigilance.

The Role of Radiological Modalities in the Detection and Evaluation of Pulmonary Tumors : A Case Report

Fadilah Alwiyah, Muhammad Ricky Ramadhian — Fri, 19 Jun 2026 00:00:00 +0000

Lung cancer remains one of the leading causes of cancer-related mortality worldwide, making early detection and accurate diagnosis essential for appropriate management. Radiological imaging plays a crucial role in the detection, characterization, and staging of pulmonary tumors. This case report describes the role of radiological modalities in a patient with pulmonary squamous cell carcinoma. A 52-year-old female non-smoker with a history of chronic secondhand smoke exposure for more than 20 years presented with chronic dyspnea, intermittent cough, and significant weight loss. Chest radiography in posteroanterior (PA) and lateral projections revealed a pulmonary mass associated with right upper lobe atelectasis. Further evaluation using contrast-enhanced chest computed tomography (CT) demonstrated a 56.6 × 35.3 mm mass in the apical segment of the right upper lobe, right paratracheal lymphadenopathy, localized right pleural effusion, and findings suggestive of advanced-stage disease. Histopathological examination of tissue biopsy confirmed the diagnosis of right lung squamous cell carcinoma. The patient was subsequently scheduled for chemotherapy with periodic follow-up using chest CT imaging. This case highlights the importance of a multimodal radiological approach in the evaluation of pulmonary malignancies. Chest radiography serves as an effective initial screening and detection tool, whereas contrast-enhanced CT provides superior anatomical detail for lesion characterization, disease staging, biopsy planning, and treatment monitoring. The integration of radiological modalities contributes significantly to comprehensive and accurate management of lung cancer.

Herpes Zoster in a Young Adult Patient: ACase Report

Andra Nabila Fauziani, Winda Trijayanthi Utama — Fri, 19 Jun 2026 00:00:00 +0000

Herpes zoster is a reactivation of latent Varicella-zoster virus (VZV) infection that commonly occurs in older adults and immunocompromised individuals, but it may also develop in immunocompetent young adults. This case report aims to describe the clinical manifestation, diagnosis, and management of maxillary branch trigeminal herpes zoster in a young patient without known major risk factors. A 20-year-old woman presented to the Dermatology and Venereology Outpatient Clinic of Dr. H. Abdul Moeloek Hospital with painful vesicular eruptions accompanied by a burning sensation on the left cheek that had appeared four days before presentation. Dermatological examination revealed grouped vesicles on an erythematous base distributed unilaterally along the maxillary branch of the trigeminal nerve without crossing the midline. The diagnosis was established based on history taking and characteristic clinical findings without laboratory confirmation. The patient was treated with oral acyclovir, gabapentin, and supportive therapy. Follow-up evaluation two days after treatment showed no new lesions, gradual crusting of vesicles, and improvement of pain and burning sensation. This case demonstrates that herpes zoster may occur in immunocompetent young adults without identifiable predisposing factors and should therefore remain a differential diagnosis of unilateral vesicular facial eruptions. Accurate clinical diagnosis and timely antiviral therapy are important to promote clinical improvement and prevent complications.