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Kehamilan Ektopik Terganggu: Laporan Kasus dan Tinjauan Pustaka Komprehensif Betti Merdiani Putri; Metti Herliani Putri
The Indonesian Journal of General Medicine Vol. 17 No. 3 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/0zcan335

Abstract

Pendahuluan: Kehamilan ektopik (KE), dan komplikasinya yaitu kehamilan ektopik terganggu (KET), merupakan suatu kegawatdaruratan obstetri yang menjadi penyebab utama mortalitas maternal pada trimester pertama kehamilan. Diagnosis dini yang akurat dan tatalaksana yang cepat merupakan faktor krusial untuk mencegah komplikasi fatal dan mem preservasi fertilitas di masa depan. Laporan kasus ini bertujuan untuk mengilustrasikan pendekatan diagnostik dan tatalaksana komprehensif pada sebuah kasus KET dengan instabilitas hemodinamik. Ilustrasi Kasus: Seorang wanita, 32 tahun, dengan status obstetri G2P1A0, datang ke unit gawat darurat dengan keluhan utama nyeri perut kanan bawah yang timbul mendadak disertai amenorea selama 8 minggu. Pemeriksaan fisik menunjukkan tanda-tanda syok hipovolemik, termasuk hipotensi dan takikardia, serta gambaran abdomen akut. Pemeriksaan laboratorium menunjukkan kadar beta-human chorionic gonadotropin (β-hCG) kuantitatif sebesar 8.500 mIU/mL. Ultrasonografi transvaginal (USG-TV) yang dilakukan segera tidak menunjukkan adanya kantung gestasi di dalam kavum uteri, namun mengidentifikasi adanya massa kompleks di adneksa kanan dan sejumlah besar cairan bebas yang mengindikasikan hemoperitoneum di kavum Douglas. Dengan diagnosis kerja KET, pasien segera menjalani laparotomi eksplorasi. Ditemukan adanya ruptur pada tuba Fallopii kanan dengan perdarahan aktif, yang kemudian ditatalaksana dengan salpingektomi kanan. Pasien menunjukkan pemulihan yang baik tanpa komplikasi pascaoperasi. Diskusi: Kasus ini menegaskan pentingnya indeks kecurigaan yang tinggi terhadap KE pada setiap wanita usia reproduktif yang datang dengan keluhan nyeri abdomen dan riwayat amenorea. Kombinasi antara presentasi klinis, kadar β-hCG yang berada di atas zona diskriminatif, dan temuan USG-TV yang khas merupakan pilar utama dalam penegakan diagnosis. Tatalaksana bedah darurat yang dilakukan pada kasus ini sepenuhnya sesuai dengan pedoman klinis internasional untuk KET dengan instabilitas hemodinamik, di mana tatalaksana medisinal menggunakan metotreksat merupakan suatu kontraindikasi absolut. Kesimpulan: Kehamilan ektopik terganggu adalah kondisi yang mengancam nyawa dan menuntut diagnosis yang cepat serta intervensi segera. Manajemen yang berhasil sangat bergantung pada integrasi yang cermat antara temuan klinis, hasil pemeriksaan biokimia, dan pencitraan diagnostik, serta kesiapan dan keterampilan tim bedah dalam melakukan intervensi penyelamatan nyawa.
A Comprehensive Systematic Review of The Relationship Between Sunscreen Use and Prevention of Photoaging Betti Merdiani Putri; Metti Herliani Putri
The International Journal of Medical Science and Health Research Vol. 29 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/dmhdf292

Abstract

Introduction: Photoaging, the premature aging of skin induced by chronic ultraviolet (UV) radiation exposure, manifests as wrinkles, dyspigmentation, and loss of elasticity. While sunscreen is a cornerstone of photoprotection, the comprehensive evidence linking its use specifically to the prevention of photoaging requires systematic synthesis. This review aims to consolidate the relationship between various photoprotection strategies—including topical sunscreens, oral supplements, antioxidants, and behavioral interventions—and the prevention or amelioration of photoaging. Methods: A systematic review was conducted following predefined screening criteria. Databases were searched for studies involving human participants that investigated sunscreen or photoprotection interventions and reported quantitative outcomes on clinical photoaging measures. Included studies encompassed randomized controlled trials, cohort studies, case-control studies, cross-sectional studies, systematic reviews, and meta-analyses. Data on intervention details, population characteristics, photoaging assessment methods, and outcomes were extracted and analyzed. Results: Sixty-three studies were included. The landmark Nambour trial demonstrated a 24% reduction in skin aging with daily versus discretionary sunscreen use over 4.5 years (Hughes et al., 2013). Shorter-term studies consistently showed significant improvements in wrinkles, pigmentation, and skin texture with regular sunscreen use, with effects evident from 8 to 52 weeks (Randhawa et al., 2016; Sarkar et al., 2019; Du et al., 2020). Enhanced formulations combining UV filters with antioxidants (e.g., vitamin C, bakuchiol), anti-inflammatory agents, or DNA repair enzymes offered superior benefits (Shirata & Maia Campos, 2021; Draelos et al., 2022; Luze et al., 2020). Appearance-based behavioral interventions, such as UV photography and mobile apps, effectively increased sun protection intentions and behaviors, with medium effect sizes (Persson et al., 2018; Brinker et al., 2020). Oral multi-component antioxidant supplements showed promise in increasing minimal erythema dose and improving skin appearance, whereas single-agent β-carotene was ineffective (Stephens et al., 2016; Zhang et al., 2023; Darlington et al., 2003). Discussion: The evidence robustly supports that consistent sunscreen use prevents and can partially reverse signs of photoaging. Efficacy is influenced by formulation, compliance, skin type, and environmental factors. Synergistic effects are observed when UV filtration is combined with agents targeting oxidative stress and inflammation. Behavioral strategies are crucial for fostering long-term adherence. Conclusion: Daily use of broad-spectrum sunscreen, preferably SPF 30 or higher, is a proven, effective strategy for preventing photoaging. Formulations with added antioxidants or anti-inflammatory components provide enhanced protection. Public health initiatives should incorporate appearance-based education to improve sunscreen adherence. Oral antioxidant supplements may serve as adjuncts but not replacements for topical sunscreens.