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All Journal Medula Jurnal Agromedicine Unila: Jurnal Kesehatan dan Agromedicine
Shinta Nareswari
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Dentistry Education Health Professions Medicine & Pharmacology Neuroscience Nursing Public Health

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Eksaserbasi Asma Berat akibat Pneumonia Komunitas pada Anak dengan Predisposisi Atopik: Sebuah Laporan Kasus Zheva Aprillia Yozevi; Shinta Nareswari
Medula Vol 17 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i1.1993

Abstract

Asthma is a chronic inflammatory airway disease prone to exacerbations triggered by various factors, notably infections. Community-acquired pneumonia (CAP) can exacerbate airway inflammation and trigger severe asthma exacerbations in children. This report discusses a 7-year-and-1-month-old girl presenting with shortness of breath that worsened 7 hours prior to admission, accompanied by wheezing, restlessness, and limited speech. The complaints were preceded by a 3-day cough and a 2-day runny nose. The patient had a history of asthma since age 3, personal atopy, and maternal asthma. Physical examination revealed tachypnea, tachycardia, oxygen saturation of 89% on room air, intercostal retractions, nasal flaring, and bilateral expiratory wheezing. Laboratory findings indicated neutrophilic leukocytosis, eosinophilia (12%), and an increased erythrocyte sedimentation rate (59 mm/hour). Chest radiograph showed right suprahilar consolidation and bilateral paracardial infiltrates, suggestive of right lobe pneumonia and left lung bronchopneumonia. The patient was diagnosed with severe asthma exacerbation on partially controlled mild persistent asthma, accompanied by community-acquired pneumonia. Management included oxygen therapy, inhaled bronchedilators, intravenous antibiotics and aminophylline, and supportive therapy. Evaluation demonstrated clinical improvement characterized by increased oxygen saturation, decreased respiratory rate, and reduced respiratory distress. This case emphasizes that CAP can act as a major trigger for severe asthma exacerbations in children with an atopic predisposition, making early diagnosis and comprehensive management crucial to improve clinical outcomes.
Faktor Kecemasan Terhadap Ujian pada Mahasiswa Azzahra Fadhilla Amelia; Oktafany Oktafany; Shinta Nareswari; Oktadoni Saputra
Medula Vol 16 No 2 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i2.1798

Abstract

Test anxiety is a common psychological condition experienced by university students and can negatively affect academic performance and psychological well-being. This study aimed to examine the causes, manifestations, and impacts of test anxiety among students through a literature review approach. Relevant literature was obtained from Google Scholar and national and international scientific databases using the keywords “test anxiety,” “exam anxiety,” “students,” and “academic performance.” A total of 23 articles published between 2010 and 2025 met the inclusion criteria and were analyzed narratively. The findings revealed that test anxiety is influenced by various factors, including academic demands, social pressures, individual characteristics, and learning environment conditions. One of the reviewed studies by Bhuwana (2025) reported that 98.5% of students (197 of 200 respondents) experienced anxiety during the Objective Structured Clinical Examination (OSCE), with the primary causes being limited examination time (21%), the large amount of material to be studied (20.5%), and difficulties maintaining concentration or experiencing forgetfulness during examinations (19.5%). Manifestations of test anxiety include physical, cognitive, and behavioral symptoms such as increased heart rate, excessive worry, negative thoughts, impaired concentration, and procrastination. These symptoms may contribute to lower academic achievement, reduced learning motivation, increased stress levels, and emotional exhaustion. Therefore, effective stress management strategies and institutional support are essential to help students cope with examination-related stress, improve academic performance, and maintain psychological well-being through supportive learning environments and accessible counseling services.
Case Report: A 6-Year-Old Girl with Bronchopneumonia and Laryngotracheitis Fahmi Ilham Hatimi; Salman Alfarisi; Shinta Nareswari
Medula Vol 16 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i1.1887

Abstract

Acute respiratory infections remain a leading cause of morbidity and mortality among children, particularly in developing countries, with bronchopneumonia representing one of the most common manifestations. Simultaneous involvement of the upper and lower respiratory tract, such as bronchopneumonia accompanied by laryngotracheitis, is uncommon but may result in severe respiratory compromise due to upper airway obstruction and impaired pulmonary gas exchange. This case report describes a six-year-old girl who presented with fever, productive cough, hoarseness, noisy breathing, and progressive dyspnea. Physical examination revealed tachypnea, wheezing that later progressed to bilateral crackles, and signs of upper airway obstruction. Laboratory evaluation demonstrated neutrophilic leukocytosis, while chest radiography showed diffuse patchy infiltrates consistent with bronchopneumonia. Soft tissue neck radiography demonstrated subglottic narrowing (steeple sign), supporting the diagnosis of laryngotracheitis. The patient had predisposing factors including undernutrition and incomplete childhood immunization. Management consisted of intravenous antibiotics, systemic corticosteroids, nebulized epinephrine, oxygen therapy, and supportive care. Gradual clinical improvement was observed from the second to the fifth day of hospitalization without complications or recurrence of symptoms. This case emphasizes the importance of early recognition of concurrent upper and lower respiratory tract involvement, followed by comprehensive diagnostic evaluation and prompt treatment to achieve favorable clinical outcomes. Improvement of nutritional status and completion of routine immunization should also be emphasized as essential preventive strategies to reduce the burden of severe respiratory infections in children.
Persistent Bronchopneumonia in an 8-Month-Old with Down Syndrome and Congenital Heart Disease: A Case Report Mochamad Fauzan Dava; Shinta Nareswari
Medula Vol 16 No 4 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i4.1999

Abstract

Children with Down syndrome (DS) are at high risk of persistent pneumonia due to anatomical abnormalities of the airways, ciliary dysfunction, immune dysregulation, congenital heart disease (CHD), malnutrition, and aspiration. This case report describes the diagnostic approach and management of persistent bronchopneumonia in a DS infant with CHD and malnutrition. An 8-month-23-day-old female with DS, a history of anal atresia after anorectoplasty, presented with a 3-day history of severe, productive cough with phlegm, accompanied by fever, tachypnea (52 breaths/minute), chest wall indrawing, and bilateral moist rales. Nutritional status: W/A and W/H < p5 (malnutrition), microcephaly. Chest X-ray showed bilateral infiltrates. Blood gas analysis showed metabolic acidosis and hypoxemia. Sputum culture showed the growth of Enterococcus faecium resistant to ampicillin. Echocardiography showed secundum ASD and PDA (0.1–0.2 cm) with a left-to-right shunt. The patient was treated with oxygen, vancomycin, gentamicin, nebulizer, furosemide, captopril, and chest physiotherapy. Fever normalized on day 1, oxygen saturation normalized on day 4, and the cough persisted until day 6. The patient was discharged on day 7 with a catch-up immunization plan, aspiration education, and referral to cardiology and a nutrition clinic. This case highlights the need for early aspiration detection, sensitivity-guided antibiotics, and multidisciplinary care to prevent recurrence and improve quality of life.
Scurvy in a Child with with Recurrent Lower Extremity Weakness: A Case Report Akhmad Rizki Farhan; Shinta Nareswari
Medula Vol 17 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i1.2016

Abstract

Scurvy is a disease caused by vitamin C deficiency that is still encountered in children with restrictive eating patterns and severe malnutrition. Musculoskeletal manifestations, including lower limb pain, refusal to walk, pseudoparalysis, and joint swelling, often mimic neurological, infectious, or rheumatologic disorders, leading to delayed diagnosis. A 3-year-7-month-old boy presented with recurrent inability to walk accompanied by pain and swelling in both knees. Five months earlier, he had experienced fever followed by bilateral lower limb weakness and inability to stand. At that time, he was diagnosed with scurvy at another hospital and showed improvement after receiving vitamin C supplementation and physiotherapy. Twelve days before admission, similar symptoms recurred, accompanied by oral ulcers. Physical examination revealed severe malnutrition, stunting, microcephaly, tenderness of both knees, and lower extremity weakness. Laboratory evaluation demonstrated leukopenia (3,700/μL). Bilateral genu radiographs showed metaphyseal osteopenia of the femur, a soft tissue lucency at the distal femur suggestive of hematoma, and bilateral Wimberger sign, which is characteristic of scurvy. Dietary history revealed refusal to consume fruits, vegetables, milk, and protein-rich foods, with a preference for packaged snack foods. The patient was treated with intravenous vitamin C at a dose of 300 mg/day for 7 days, followed by oral vitamin C 100 mg/day for 1 month, in addition to nutritional rehabilitation, multivitamin supplementation, and physiotherapy. Rapid clinical improvement following treatment highlights the importance of obtaining a thorough dietary history and recognizing characteristic radiographic findings to establish an early diagnosis and prevent complications.
Co-Authors Ahmad Fathin Al Farisi Akhmad Rizki Farhan Ananda Fitriliani Anniza Agustina Auriva Renasha Suherman Azzahra Fadhilla Amelia Azzahra Gadis Junita Perdana Bayu Anggileo Pramesona Carissa Aprilia Yusanda Clara Arta Uli Rahel Fahmi Ilham Hatimi Imtinan Khoirunnisa Kinanti Rahmadita Mochamad Fauzan Dava Muhamad Zaidan Algifari Oktadoni Saputra Oktafany Oktafany Salman Alfarisi Virgiansya Alhafiz Zheva Aprillia Yozevi