Medical Profession Journal of Lampung
https://journalofmedula.com/index.php/medula
<p class="PDq2pG_selectionAnchorContainer" data-start="1583" data-end="2216">MEDULA has been committed to providing a high-quality publication platform for researchers, clinicians, healthcare professionals, academics, and students to disseminate scientific advances in medicine and health sciences. The journal is published <strong data-start="2011" data-end="2024">quarterly</strong> and welcomes original research articles, literature reviews, case reports, systematic reviews, meta-analyses, and other scholarly works within its scope.</p> <p data-start="2218" data-end="2630">MEDULA implements a rigorous, transparent, and ethical peer-review process to ensure the quality and integrity of published manuscripts. The journal covers a broad range of topics, including basic medical sciences, clinical medicine, public health, medical education, biomedical sciences, pharmacology, pharmacy, medical laboratory sciences, nutrition, environmental health, and other related health disciplines.</p> <p data-start="2632" data-end="2851">As an open-access journal, MEDULA aims to promote the global dissemination of scientific knowledge, encourage interdisciplinary collaboration, and contribute to evidence-based healthcare practice, education, and policy.</p>CV. Jasa Sukses Abadien-USMedical Profession Journal of Lampung2339-1227Noonan Syndrome in A 6-Month-Old Female Infant: A Case Report
https://journalofmedula.com/index.php/medula/article/view/2035
<p>Noonan syndrome (NS) is an autosomal dominant genetic disorder with significant phenotypic overlap with Turner syndrome (TS). Given these overlapping physical stigmata, accurate diagnosis requires a comprehensive multisystem clinical evaluation and molecular genetic confirmation, particularly when cytogenetic karyotyping yields normal results. A 6-month-old female infant was referred with an initial suspicion of TS, suspected hydrocephalus, and significant gross motor developmental delay. Physical examination revealed characteristic craniofacial and skeletal phenotypic stigmata mimicking TS, including webbed neck, bilateral microtia, low-set ears, hypertelorism, wide-spaced nipples, and bilateral single palmar creases. Echocardiography showed congenital heart disease consisting of mild pulmonary stenosis and a small atrial septal defect. Brain non-contrast CT scan demonstrated Benign Enlargement of the Subarachnoid Space in Infancy (BESS) with mild ventriculomegaly, ruling out obstructive hydrocephalus. Cytogenetic karyotype analysis revealed a normal 46,XX female karyotype, thereby definitively excluding classic TS (45,X). The combination of physical stigmata overlapping with TS, a normal 46,XX karyotype, and the presence of pulmonary stenosis leads to a strong clinical suspicion of Noonan syndrome (strongly suspected Noonan syndrome). However, because molecular genetic testing has not been performed, the diagnosis of NS in this patient remains a clinical diagnosis. This case highlights the importance of a holistic diagnostic approach to differentiate TS and NS phenotypes. Further molecular genetic testing, such as a Targeted Next-Generation Sequencing (NGS) panel for RASopathy genes (PTPN11, SOS1, KRAS, RAF1) or Whole Exome Sequencing (WES), is highly recommended to identify the specific causative gene mutation and achieve a definitive molecular diagnosis.</p>Chindy Setia PutriIsmi Citra IsmailEpriyan Saputra
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2026-07-302026-07-301721810.53089/medula.v17i2.2035Holistic Management of Diabetic Foot Gangrene and Ulcer through Family Medicine Approach
https://journalofmedula.com/index.php/medula/article/view/2040
<p>Diabetic foot ulcers and gangrene are chronic complications of diabetes mellitus and a leading cause of non-traumatic amputation that reduce quality of life, so their management requires a holistic, preventive, and family-based approach. We report a 55-year-old woman with blackening of the second and third right toes and a purulent open wound for one month, with uncontrolled type 2 diabetes mellitus, peripheral artery disease, anaemia, and acute kidney injury on chronic kidney disease. She lived in a functional nuclear family (APGAR score 10). The working diagnosis was gangrene of digits 2 and 3 and a Wagner grade IV diabetic foot ulcer of the right foot. A literature search on PubMed, the Cochrane Library, and Google Scholar addressed whether family-involved foot care education improves outcomes compared with standard care. A systematic review of ten studies (5,532 patients, including two Indonesian randomised controlled trials) showed that family involvement in foot care education and skills training consistently improved foot care behaviour, diabetes knowledge, wound healing, and HbA1c, with a trend toward fewer amputations. After toe amputation and holistic, family-involved management, the postoperative wound granulated well and glycaemic control improved. Holistic management integrating surgical-vascular treatment, metabolic control, and strengthening of the family role is the most rational strategy to prevent recurrent ulceration and re-amputation.</p>Afrileo Vebi Eka UtamaMarshell Timotius Handoko
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2026-08-102026-08-1017291410.53089/medula.v17i2.2040The Association of Knowledge, Attitudes, Family Role, and Economic Status with Smoking Behavior among Medical Students at the Faculty of Medicine, Universitas Malahayati, in 2025
https://journalofmedula.com/index.php/medula/article/view/2045
<p>Smoking behavior among medical students is an important concern because they are future healthcare professionals who are expected to serve as role models for healthy lifestyles. This study aimed to determine the association between knowledge, attitudes, family roles, and economic status and smoking behavior among medical students at Universitas Malahayati. This quantitative study employed an observational analytical design with a cross-sectional approach. A total of 213 students who met the inclusion criteria were selected using purposive sampling. Data were collected using questionnaires and analyzed using the Chi-square test and multiple logistic regression. Smoking behavior was determined based on smoking status within the previous 30 days; respondents who reported smoking during this period were categorized as smokers, while those who did not smoke were categorized as non-smokers. Most respondents had good knowledge (72.8%), positive attitudes (53.5%), supportive family roles in smoking prevention (69.5%), and high economic status (52.1%). The majority of respondents were non-smokers (56.3%). Bivariate analysis showed significant associations between knowledge (p=0.026; OR=2.09), attitude (p=0.044; OR=1.82), family role (p=0.006; OR=2.38), and economic status (p=0.028; OR=1.92) and smoking behavior. In the multivariate analysis, family role had the strongest association with smoking behavior (p=0.004; OR=2.405; 95% CI: 1.315–4.400). These findings highlight the importance of strengthening family involvement as part of smoking prevention efforts among medical students.</p>Raihandy QodrisSaminoNoviansyahUsatiawaty Cik AyuSutikno
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2026-08-132026-08-13172152110.53089/medula.v17i2.2045Effect of Black Pepper on Blood Glucose Levels and Sperm Analysis in a Hyperglycemic Rat Model
https://journalofmedula.com/index.php/medula/article/view/1449
<p>Black pepper (Piper nigrum) is a widely recognized spice not only for its culinary uses but also for its significant health potential. This study aims to explore the effects of black pepper on blood glucose levels and sperm quality in a hyperglycemic rat model. Black pepper extract, containing the active compound piperine, has been shown to lower blood glucose levels by enhancing insulin sensitivity and reducing fasting blood glucose levels. However, its impact on reproductive health also warrants attention, as the administration of black pepper extract to hyperglycemic male rats resulted in decreased sperm concentration, motility, and an increase in the number of sperm with abnormal morphology. This research highlights the importance of understanding the interactions between black pepper, blood glucose levels, and sperm quality, as well as the need for further studies to explore the clinical applications of black pepper in diabetes management and reproductive health.</p>MayangExsa HadibrataIntan KusumaningtyasEty Apriliana
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2026-08-212026-08-21172222510.53089/medula.v17i2.1449Bihemispheric Infarct Stroke in a 65-Year-Old Elderly Patient with Bilateral Senile Cataract
https://journalofmedula.com/index.php/medula/article/view/2043
<p>Bihemispheric infarct stroke is a complex clinical condition that may cause bilateral neurological deficits and increase the risk of recurrent stroke. Senile cataract may contribute to falls in older adults through visual impairment and is hypothesized to be associated with systemic oxidative stress, which also plays a role in atherosclerosis. This case report describes the diagnosis and initial management of bihemispheric infarct stroke in an elderly patient with bilateral senile cataract and discusses the possible association between these conditions. A 65-year-old man presented to the emergency department with right-sided limb weakness, slurred speech, and headache after falling in the bathroom. He had a history of left-sided weakness one year earlier, uncontrolled hypertension, and more than 20 years of smoking. Physical examination revealed bilateral hemiparesis, central-type right facial nerve palsy, and impaired visual acuity of 3/60 in the right eye and 2/60 in the left eye. Ophthalmological examination showed pseudophakia in the right eye and lens opacity in the left eye. Laboratory evaluation revealed elevated total cholesterol and LDL levels. Head CT demonstrated a chronic infarct in the right temporoparietooccipital region and an acute infarct in the left temporal lobe. The patient received supportive therapy, antiplatelet treatment, antihypertensive therapy, statin therapy, and adjuvant treatment. This case emphasizes the importance of comprehensive assessment of vascular risk factors, visual impairment, and previous stroke in elderly patients. In this case, senile cataract should be considered a comorbidity and a possible marker of systemic oxidative stress rather than a direct cause of stroke.</p>Berlyantama AfifaldoIshana Safira Hudi
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2026-08-232026-08-23172263310.53089/medula.v17i2.2043Typhoid Fever with Concomitant Hookworm Infection in A 5-Year-Old Child: A Case Report
https://journalofmedula.com/index.php/medula/article/view/2036
<p>Typhoid fever remains one of the most common infectious diseases affecting children in developing countries, particularly in areas with poor sanitation and hygiene. Meanwhile, hookworm infection continues to be a significant public health problem because it may cause chronic blood loss, iron deficiency anemia, malnutrition, and impaired growth in children. The coexistence of these two infections may aggravate clinical manifestations and requires a comprehensive diagnostic and therapeutic approach. This case report aims to describe the clinical presentation, diagnostic evaluation, and management of typhoid fever accompanied by hookworm infection in a child. A 5-year-11-month-old girl was admitted to the Emergency Department of dr. H. Abdul Moeloek Regional Hospital with a two-week history of fever accompanied by abdominal pain, vomiting, and diarrhea. Physical examination revealed fever, pale conjunctiva, and abdominal distension. Laboratory investigations demonstrated microcytic hypochromic anemia, leukocytosis, thrombocytosis, and hypoalbuminemia. Serological testing for anti-<em>Salmonella</em> IgM (TUBEX) yielded a positive result with a score of 6, while stool examination identified <em>Ancylostoma duodenale</em> eggs. The patient was diagnosed with typhoid fever and hookworm infection and was treated with intravenous antibiotics, an anthelmintic agent, supportive therapy, adequate fluid and nutritional management, and education regarding personal hygiene and sanitation. During hospitalization, the patient's clinical condition gradually improved, as evidenced by the resolution of fever, abdominal pain, vomiting, and diarrhea, along with improved tolerance to oral intake, and she was discharged in good condition. This case highlights the importance of considering coinfection in children presenting with prolonged fever, anemia, and poor sanitation-related risk factors. An integrated approach involving accurate diagnosis, appropriate antimicrobial and anthelmintic therapy, nutritional support, and preventive education is essential to improve clinical outcomes and reduce the risk of complications and reinfection.</p>Muhammad Morsa HabibieOktadoni Saputra
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2026-07-202026-07-20172344310.53089/medula.v17i2.2036Association of Hypertension Severity and Age with Prostate Volume Grade among Patients with Benign Prostatic Hyperplasia at Dr. H. Abdul Moeloek Regional General Hospital, Lampung Province, Indonesia
https://journalofmedula.com/index.php/medula/article/view/1977
<p>Benign Prostatic Hyperplasia is a benign enlargement of the prostate gland commonly found in older men and may cause lower urinary tract symptoms that negatively affect quality of life. Age and hypertension have been associated with prostate enlargement through hormonal changes, increased sympathetic nervous system activity, and stimulation of prostate cell proliferation. This cross-sectional study aimed to determine the relationship between age and hypertension grade with prostate volume grade among patients with BPH at Dr. H. Abdul Moeloek General Hospital, Lampung Province, during 2019–2021. A total of 53 patients were selected using total sampling. Data were analyzed using Spearman's rank correlation test with a significance level of p<0.05. Of the 53 patients, 21 (39.6%) were aged ≤55 years, 14 (26.4%) were aged 55–65 years, and 18 (34.0%) were aged ≥65 years. Regarding hypertension grade, 24 patients (45.3%) had grade 1 hypertension and 29 (54.7%) had grade 2 hypertension. Prostate volume was classified as grade 1 in 14 patients (26.4%), grade 2 in 20 (37.7%), and grade 3 in 19 (35.8%). Spearman's correlation analysis demonstrated a significant association between age and prostate volume grade (p=0.002) and between hypertension grade and prostate volume grade (p=0.008). Age and hypertension grade were significantly associated with prostate volume grade among patients with BPH at Dr. H. Abdul Moeloek General Hospital, Lampung Province, during 2019–2021.</p>Smith Imanuel SaputraKhairun Nisa BerawiSusianti SusiantiExsa Hadibrata
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2026-10-052026-10-05172444910.53089/medula.v17i2.1977Dyspepsia in a Patient with Uncontrolled Type 2 Diabetes Mellitus: a Case Report
https://journalofmedula.com/index.php/medula/article/view/2054
<p>Type 2 diabetes mellitus (DM) and dyspepsia are frequently found together in primary care and share irregular eating patterns as a common factor that can worsen glycemic control while triggering gastrointestinal symptoms. This case report aims to describe the relationship between irregular eating patterns and dyspeptic complaints in a patient with uncontrolled type 2 DM. A 49-year-old woman presented with intermittent epigastric pain and nausea without vomiting for five days, worse when meals were delayed, with similar recurrent complaints over the preceding three months. She had a three-year history of type 2 DM treated with metformin and glimepiride, yet still complained of polyphagia and polyuria. Her diet was poorly controlled, with large portions of rice and carbohydrate-rich snacks, and she had low physical activity. Physical examination revealed epigastric tenderness without alarm features, and a body mass index of 24.2 kg/m² (overweight by Asia-Pacific criteria). Fasting blood glucose (FBG) was 167 mg/dL, up from 129 mg/dL one month earlier. HbA1c testing and endoscopy were not performed, so the condition was classified as uninvestigated dyspepsia and managed empirically on clinical grounds. Treatment consisted of metformin 500 mg twice daily, antacid, omeprazole 20 mg twice daily, and domperidone 10 mg three times daily, together with education, low-carbohydrate dietary modification, and advice on physical activity. At follow-up, epigastric pain and nausea had resolved, polyphagia and polyuria improved, and FBG fell to 135 mg/dL without significant adverse effects. These short-term findings cannot be generalized because of limited data. This case suggests that improving meal regularity may be a relevant point of intervention for both conditions simultaneously.</p>Devira Fitriani KamalWinda Trijayanthi Utama
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2026-10-072026-10-07172505510.53089/medula.v17i2.2054Essential Hypertension in an Elderly Woman: a Case Report
https://journalofmedula.com/index.php/medula/article/view/2055
<p>Hypertension is one of the leading risk factors for cardiovascular disease, with a continuously increasing prevalence among the elderly, yet many cases remain undiagnosed or inadequately controlled. A 75-year-old woman presented with headache accompanied by difficulty sleeping for one day prior to examination, with a previously measured elevated blood pressure but no history of antihypertensive treatment. Physical examination revealed a blood pressure of 166/90 mmHg and a body mass index of 25.3 kg/m² (overweight), without signs of target organ damage or clinical findings suggestive of a secondary etiology. Identified risk factors included advanced age, insufficient rest, coffee consumption, a diet high in salt and fat, low physical activity, and a family history of hypertension. Grade 1 essential hypertension was diagnosed based on history and physical examination. Management included amlodipine, education, and dietary sodium restriction combined with increased physical activity. At the following follow-up visit, blood pressure decreased to 140/85 mmHg, accompanied by symptomatic improvement and patient-reported adherence to the recommended dietary and physical activity changes. This case illustrates that acute symptom relief and blood pressure reduction can be achieved through a combination of antihypertensive monotherapy and lifestyle education in an elderly patient, although the target blood pressure of <130/80 mmHg was not yet fully achieved at that evaluation.</p>Fahman GhiffariWinda Trijayanthi Utama
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2026-10-072026-10-07172566310.53089/medula.v17i2.2055Diagnostic Approach and Management of Scabies in an Adolescent: A Case Report
https://journalofmedula.com/index.php/medula/article/view/2063
<p>Scabies is a skin infection caused by Sarcoptes scabiei var. hominis, with transmission closely associated with direct contact and environmental conditions. This case report aims to describe the diagnostic approach and management of scabies in an adolescent with a history of close contact and similar complaints among surrounding contacts. A 16-year-old male adolescent presented with a three-week history of itching affecting both hands and feet, particularly at night and in the interdigital spaces. The symptoms were accompanied by reddish bumps, some of which were reported to contain pus. The patient reported frequent direct contact and clothing exchange with friends, while similar complaints were reported in his younger sibling and close friend. Local examination revealed multiple well-defined erythematous papules and nodules in a linear distribution over the hands, feet, axillae, abdomen, and buttocks. No ancillary diagnostic examinations were performed. Based on the clinical and epidemiological findings, the diagnosis of scabies was established at the clinical level according to the 2020 criteria of the International Alliance for the Control of Scabies (IACS), with the limitation of lacking confirmatory diagnostic testing. The patient was treated with 5% permethrin cream and cetirizine 10 mg once daily, accompanied by education on medication use, personal belongings hygiene, transmission prevention, and the importance of managing close contacts. This case highlights the importance of integrating clinical findings with epidemiological history, transparently reporting diagnostic limitations, and addressing transmission control in scabies management.</p> <p> </p>Amelia Nazwa HanumTutik Ernawati
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2026-10-142026-10-14172647210.53089/medula.v17i2.2063Mild Persistent Asthma with Acute Exacerbation, Bronchitis, and Abdominal Pain in a Child: a Case Report
https://journalofmedula.com/index.php/medula/article/view/2067
<p>Mild persistent asthma in children generally has a favorable clinical course, yet it remains at risk of acute exacerbation, particularly when triggered by respiratory tract infections such as bronchitis. In addition to respiratory symptoms, extrapulmonary manifestations such as abdominal pain may occur and complicate diagnosis because they can mimic an acute abdomen. We report an 11-year-10-month-old girl with a history of asthma since the age of three who presented to the emergency department with shortness of breath that had worsened over the preceding 12 hours, accompanied by productive cough, wheezing, rhinorrhea, and postprandial epigastric pain. There was a family history of atopy, with asthma in the mother and eczema in the father, as well as household exposure to cigarette smoke. Physical examination revealed a respiratory rate of 26 breaths per minute, an oxygen saturation of 93% on room air, and wheezing with minimal rhonchi in both lung fields. Nutritional assessment showed undernutrition, with a weight-for-height of 87%. C-reactive protein, antistreptolysin O, and erythrocyte sedimentation rate were within normal limits, chest radiography showed bronchitis without cardiomegaly, and echocardiography was normal. The patient was diagnosed with mild persistent asthma with a mild–moderate acute exacerbation, bronchitis, and abdominal pain. Management consisted of oxygen, nebulized ipratropium bromide–salbutamol and budesonide, systemic methylprednisolone, mucolytics, antihistamines, and gastric therapy, without antibiotics. On the fourth hospital day, the patient was referred to psychiatry because of restlessness, sleep disturbance, and migratory pain, and was diagnosed with acute stress reaction. The patient improved gradually until the fifth hospital day. This case highlights the importance of a holistic approach in evaluating comorbidities, psychosomatic factors, and non-respiratory manifestations in pediatric asthma exacerbations to prevent misdiagnosis and optimize therapeutic outcomes.</p>Isabela PangestuShinta Nareswari
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2026-10-162026-10-16172738010.53089/medula.v17i2.2067Hernia Nucleus Pulposus In A 65-Year-Old Female Patient : a Case Report
https://journalofmedula.com/index.php/medula/article/view/2069
<p>Lumbar herniated nucleus pulposus (HNP) is an intervertebral disc disorder that may cause radicular pain and motor dysfunction due to neural compression. This case report describes the clinical presentation, diagnosis, and response to conservative management in a 65-year-old woman with lumbar HNP. The patient presented with intermittent pain radiating from the right hip to the right foot for one year, worsening over the previous six months. The pain intensified when rising from a seated position and improved when lying down. She had difficulty walking independently and a history of falling onto her buttocks seven years earlier, without bowel or bladder dysfunction. Physical examination revealed pain-limited movement and right lower extremity muscle strength of 4/5, with positive right-sided Lasègue, Patrick, and contra-Patrick tests. Lumbosacral MRI showed posterior disc herniation at L5–S1 compressing the anterior thecal sac and bilateral spinal nerve roots, L4–L5 disc bulging, and L5–S1 degenerative disc changes. Treatment consisted of diclofenac, vitamin B12, a lumbar corset, and activity-modification education. After one month, the Numeric Rating Scale (NRS) pain score decreased from 8/10 to 5/10, while right lower extremity muscle strength remained unchanged. These findings indicate short-term pain improvement without documented motor recovery. Given the single-patient design and short follow-up, the effects of individual interventions and long-term outcomes cannot be established. This case emphasizes the importance of monitoring pain and neurological function during conservative management of lumbar HNP.</p>Shabrina FarhanaWinda Trijayanthi Utama
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2026-10-162026-10-16172818610.53089/medula.v17i2.2069Management of a 65-Year-Old Woman with Low Back Pain in Geriatrics through a Family Medicine Approach at Tanjung Bintang Community Health Center: A Case Report
https://journalofmedula.com/index.php/medula/article/view/2071
<p>Low back pain (LBP) is a musculoskeletal disorder commonly seen in older adults that can limit daily activities and reduce quality of life. This case report aimed to apply a holistic and comprehensive family medicine approach to the management of LBP in a geriatric patient and to identify her internal and external risk factors and clinical problems. Data were collected through autoanamnesis, alloanamnesis, physical examination, home visits, medical records, and the family folder, together with an assessment of family, psychosocial, and environmental aspects. The patient, Mrs. P, was a 65-year-old housewife who presented with low back pain that had persisted for one month, worsened over the previous three days, and radiated to both legs. The pain intensified with physical activity and eased with rest. The identified risk factors were advanced age and a habit of lifting heavy objects with improper posture. Pharmacological and non-pharmacological interventions included patient education about the condition, activity modification, postural correction, and physical exercise, with the family involved in supporting recovery. After 10 days of intervention (three visits, 3–13 March 2025), the Visual Analog Scale (VAS) pain score decreased from 7 to 1, and the patient's knowledge score increased from 40 to 80. Because the patient received multimodal management, the improvement cannot be attributed to a single intervention. A family medicine approach is expected to support sustainable LBP management through the active involvement of the patient and her family.</p>Edward SamosirAzelia Nusadewiarti
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2026-10-162026-10-16172879510.53089/medula.v17i2.2071Laryngomalacia, Gastroesophageal Reflux, and Severe Bronchopneumonia in an Infant: An Aerodigestive Challenge
https://journalofmedula.com/index.php/medula/article/view/2060
<p>Laryngomalacia is a leading cause of congenital stridor in infants; however, concomitant severe lower respiratory infection and feeding difficulties may complicate clinical assessment. This report describes the challenge of distinguishing upper-airway obstruction, bronchopneumonia, and possible aspiration in a male infant younger than two months. The infant had stridor since early life, productive cough, progressive respiratory distress, regurgitation, and choking during feeding. During acute deterioration, the respiratory rate reached 72 breaths/min, oxygen saturation was 82% on room air, and blood gas analysis showed pH 7.28, PaCO₂ 56 mmHg, and PaO₂ 48 mmHg. Chest radiography revealed bilateral infiltrates. Flexible nasopharyngolaryngoscopy demonstrated an omega-shaped epiglottis and dynamic supraglottic collapse, supporting laryngomalacia. Treatment included high-flow nasal cannula at 6 L/min with FiO₂ 40%, antibiotics, and feeding modifications. Oxygen saturation improved to 96–99%; by June 18, 2026, respiratory distress and crackles had resolved, with minimal stridor only during forceful crying. Feeding symptoms raised concern for swallowing dysfunction or aspiration, although objective swallowing assessment and pH-impedance monitoring were not performed. The case highlights that marked hypoxemia in an infant with laryngomalacia should not automatically be attributed to supraglottic obstruction, because concurrent pulmonary infection may contribute substantially. The principal learning points are the need for integrated aerodigestive assessment, careful documentation of respiratory response, and restraint in inferring a causal association between reflux, aspiration, and bronchopneumonia.</p>Muhammad Abrar AdheyasaVelda Felisha SundoroMuhammad Arief CandrasalimRizkia DevintaHerdima Meinardo LimbongBahsyar Afandi Muhammad IrsyadAnindya Dipta Pratita DanardonoAnnisa ZuhrahTubagus Ferdi Fadilah
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2026-10-172026-10-171729610010.53089/medula.v17i2.2060The Impact of Particulate Matter 2.5 (PM2.5) Exposure on the Increased Incidence and Exacerbation of Allergic Rhinitis in the Pediatric Population: A Literature Review
https://journalofmedula.com/index.php/medula/article/view/2065
<p>Air pollution, particularly exposure to Particulate Matter 2.5 (PM2.5), represents a significant threat to global health, with pronounced effects on the respiratory system. Children constitute the most vulnerable population due to anatomical characteristics, elevated respiratory rates, and underdeveloped immune systems. This literature review analyzes and synthesizes recent studies on the impact of PM2.5 exposure on the incidence and exacerbation of allergic rhinitis in children, with a focus on cellular pathomechanisms and management strategies. Evidence indicates that PM2.5 particles can directly compromise the nasal mucosal epithelial barrier and function as adjuvants, initiating inflammatory cascades through the activation of Toll-Like Receptors (TLRs). This activation results in hyperactivation of the T-helper 2 (Th2) pathway, leading to increased production of pro-inflammatory cytokines, Immunoglobulin E (IgE), and leukotrienes. Additionally, PM2.5 impairs anti-viral immune responses, sustains chronic inflammation, and heightens susceptibility to co-infections in children. Largescale cohort studies have demonstrated that prolonged PM2.5 exposure is associated with a higher incidence of new-onset allergic rhinitis and the aggravation of hyperreactivity symptoms, including persistent nasal congestion. In light of the substantial inflammatory burden, effective management of allergic rhinitis in the context of air pollution necessitates comprehensive treatment strategies. Management should extend beyond antihistamine monotherapy to include environmental interventions such as HEPA air purifiers and respiratory masks, mechanical removal of particulates through saline nasal irrigation, and escalation of pharmacotherapy with intranasal corticosteroids to achieve optimal clinical outcomes.</p>Muthiiah Khodista SyakaMukhlis Imanto
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2026-10-172026-10-1717210110710.53089/medula.v17i2.2065Pterygium as an Occupational Disease in a 35-Year-Old Woman: A Case Report
https://journalofmedula.com/index.php/medula/article/view/2068
<p>Pterygium is a fibrovascular growth extending from the bulbar conjunctiva toward the cornea, associated with chronic ultraviolet (UV) radiation exposure and potentially related to outdoor occupations. This case report aims to describe the assessment of the relationship between pterygium and occupational exposure, as well as its management, in an oil palm plantation worker. A 35-year-old woman presented to the PTPN Bekri Unit Clinic with a foreign body sensation in both eyes for three months, accompanied by frequent eye redness, mild irritation, and occasional tearing. She had worked in fertilization and weed control for approximately 10 years, spending 6–8 hours per day, 5–6 days per week, in open areas without adequate eye protection. Examination revealed visual acuity of 6/6 in both eyes and triangular fibrovascular tissue on the nasal side of the bulbar conjunctiva extending to, but not beyond, the limbus. The patient was diagnosed with bilateral pterygium, with a strong suspected association with occupational exposure based on the seven-step occupational disease diagnostic approach. Management included education on the use of personal protective equipment (PPE) and eye care, along with the administration of artificial tears. The patient was scheduled for regular follow-up every three months and referral to an ophthalmologist if the condition worsened. This case highlights the importance of occupational exposure history assessment, early detection, and preventive measures to reduce ocular disorders among plantation workers.</p>Madina Ghassan NebraskaWinda Trijayanthi Utama
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2026-10-172026-10-1717210811810.53089/medula.v17i2.2068Analysis of the Demographic and Clinical Characteristics of Tuberculosis Patients to Strengthen Tuberculosis Control Strategies at Way Kandis Primary Health Center, Bandar Lampung City
https://journalofmedula.com/index.php/medula/article/view/2049
<p>Tuberculosis (TB) remains a major public health problem worldwide, including Indonesia. Understanding the epidemiological characteristics of TB cases is essential for planning effective TB control programs. This study aimed to describe the demographic and clinical characteristics of TB patients in the working area of Way Kandis Public Health Center, Bandar Lampung City, Indonesia. This retrospective descriptive study included TB cases recorded from July 2023 to June 2026. Data were obtained from the Tuberculosis Information System (SITB) and TB 03 and TB 06 reporting forms. Variables included age, sex, TB type and classification, anatomical site, occupation, type 2 diabetes mellitus (T2DM), HIV status, rapid molecular test (RMT) results, and residential area. Univariate analysis was performed to determine frequency distributions and percentages. Among 356 TB cases, 59.83% involved patients aged 15–59 years, and 59.83% were male. Clinically diagnosed TB accounted for 54.78% of cases, while bacteriologically confirmed TB accounted for 45.22%. Most cases were new cases (96.91%) and pulmonary TB (90.45%). Unemployment was reported in 67.98% of patients. T2DM and HIV positivity were identified in 4.49% and 1.40% of cases, respectively. All bacteriologically confirmed pulmonary TB cases tested by RMT were rifampicin-susceptible (100%). A total of 20.22% of patients resided in Way Kandis Urban Village. TB cases predominantly affected individuals of productive age, with clinically diagnosed TB, new cases, and pulmonary TB being the most common characteristics. These findings highlight the importance of early case detection, contact investigation, transmission prevention, and treatment outcome monitoring.</p>Arif Yudho PrabowoGiok Pemula
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2026-10-202026-10-2017211913310.53089/medula.v17i2.2049