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All Journal Medula Jurnal Kreativitas PKM Jurnal Ilmu Kedokteran dan Kesehatan Jurnal Mandala Pharmacon Indonesia JK Unila (Jurnal Kedokteran Universitas Lampung) Jurnal Pengabdian Kepada Masyarakat (JPKM) Tabikpun Buguh: Jurnal Pengabdian Kepada Masyarakat Jurnal Kedokteran Ibnu Nafis JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia JPM (Jurnal Pengabdian Masyarakat) Ruwa Jurai Jurnal Agromedicine Unila: Jurnal Kesehatan dan Agromedicine
Risti Graharti
Bagian Ilmu Patologi Klinik, Fakultas Kedokteran Universitas Lampung
Agriculture, Biological Sciences & Forestry Humanities Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Chemistry Computer Science & IT Dentistry Education Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences

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Challenges and Strategies in Dealing Children with Autism Spectrum Disorder: A Literature Review Nisa, Lutfi Khoirun; Perdani, Roro Rukmi Windi; Graharti, Risti; Wardhani, Dyah Wulan Sumekar Rengganis; Fiana, Dewi Nur; Rahmayani, Fidha
Medula Vol 14 No 10 (2025): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i10.1356

Abstract

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that affects children permanently. The exact cause of GSA is not yet known and affects more men than women with a ratio of 4:1. This autism disorder in children appears from birth or a few months after birth, but is often diagnosed when the child is less than 3 years old. Confirmation of GSA diagnosis can use two screening tools, namely DSM-5 and M-CHAT. The management that can be given to children with GSA can be pharmacological and non-pharmacological treatment. According to the World Health Organization (WHO) in 2022, 1 in 100 children in the world is diagnosed with autism. Children with GSA have many disorders that can affect their daily activities, both verbally and non-verbally. The main symptoms that are often encountered in children with GSA are difficulties in social interaction, problems in communication, including difficulty learning language or abnormalities in speech, and a tendency to be obsessive about maintaining a consistent daily routine and environment. The prognosis of GSA depends on the severity of each individual and the accompanying disease. This of course makes parents who have children with GSA will be faced with specific challenges in raising their children because children with GSA have different characteristics. Effective strategies that can be carried out to improve disorders in GSA children include the use of visual aids, the creation of a structured daily schedule, good interpersonal communication, the application of the Applied Behavior Analysis (ABA) method, integrated sensory therapy, occupational therapy, and play therapy. In addition, to overcome the stress experienced by parents of children with GSA, especially in mothers, it can be done by providing parenting education through psychoeducation.
Tekanan Darah Pada Atlet Al Ghifari, Ghaza Ahmad; Berawi, Khairun Nisa; Graharti, Risti; Kurniati, Intanri
Medula Vol 14 No 10 (2025): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i10.1398

Abstract

Blood pressure in athletes is an important topic in exercise physiology studies, given its influence on performance and long-term health. In general, athletes exhibit lower blood pressure at rest compared to sedentary individuals, as a result of the body's adaptation to regular physical exercise. The purpose of this method is to analyze and collate knowledge relevant to the research topic. In this study, 12 articles from national and international journals published between 2015 and 2023 were used. The articles were obtained from databases such as PubMed and Google Scholar. The collected sources were then analyzed using the systematic literature review method. The result of this study is that blood pressure in athletes can be different compared to individuals who are not involved in intense physical activity, due to the body's adaptation to regular exercise. Blood pressure in athletes is influenced by a variety of factors, including sport type, training pattern, age, gender, as well as genetic and environmental factors. Understanding these blood pressure patterns is important for optimizing performance and maintaining cardiovascular health in athletes.
Gambaran Tingkat Stres Kerja Perawat Di Ruang IGD, ICU, Dan NICU RSUD Dr. H. Abdul Moeloek Bandar Lampung Maulida, Syakira Zahra; Mayasari, Diana; Graharti, Risti; Sutarto, Sutarto
Medula Vol 14 No 10 (2025): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i10.1407

Abstract

Job stress is one of the factors that can lead to decreased performance. Occupations with the highest prevalence of work stress are owned by health workers. Nurses are more prone to stress than other health workers because nurses often have heavier workloads. The impact of stress that arises in the form of physiological, psychological and behavioral responses. the most influential factors causing nurses' work stress are individual and work factors. In addition, nurses in the emergency room and intensive care of hospitals are considered to have higher levels of job stress than other units. The purpose of this study was to determine the description of the level of work stress of emergency room, ICU, and NICU nurses at Dr. H. Abdul Moeloek Hospital Bandar Lampung. The type of research used is descriptive quantitative using primary data in the form of Perceived Stress Scale questionnaire. Sampling using proportional sampling technique with a total sample of 75 people consisting of 26 emergency room nurses, 26 ICU nurses, and 23 NICU nurses and the data will be analyzed univariately and then presented in tabular form. Based on the results of the study, 19 nurses (25.3%) were at a mild stress level and 56 nurses (74.7%) were at a moderate stress level. Levels of job stress that are too low or too high can lead to decreased job satisfaction and achievement so that it is necessary.
Cystatin C sebagai Biomarker Fungsi Ginjal: Literature Review Pestalozi, George; Akbar, Fareel Wahyu; Ramadhian, Muhammad Ricky; Graharti, Risti; Lisiswanti, Rika
Medula Vol 14 No 10 (2025): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i10.1410

Abstract

Kidneys are the primary organs responsible for the excretion of metabolic waste products. Glomerular Filtration Rate (GFR) serves as a critical parameter for assessing renal function, with serum creatinine traditionally utilized as the primary biomarker. However, the accuracy of creatinine-based assessments is limited by its susceptibility to external variables, including age, sex, muscle mass, and dietary intake. These factors can lead to variability in results and reduce diagnostic precision. To overcome these limitations, cystatin C (CysC) has gained prominence as a superior alternative biomarker. Unlike creatinine, serum CysC levels are minimally influenced by external factors, offering greater stability and sensitivity in detecting acute kidney injury (AKI), chronic kidney disease (CKD), and other renal impairments such as diabetic nephropathy. Cystatin C provides notable advantages in the reclassification of CKD stages, particularly in cases where GFR measurements are borderline. CysC has demonstrated superior reliability over creatinine in predicting complications such as delayed graft function (DGF), a condition often necessitating hemodialysis. Preoperative measurement of CysC levels is instrumental in predicting long-term renal function and identifying patients at elevated risk for adverse outcomes. Elevated serum CysC concentrations in patients with renal cell carcinoma (RCC) have been correlated with poorer prognoses and an increased likelihood of postoperative renal injury. Despite its clinical advantages, the routine adoption of CysC is constrained by certain limitations. Chief among these is the significantly higher cost of CysC assays compared to traditional creatinine tests, which restricts its widespread application to confirmatory diagnostics or complex clinical scenarios.
Relationship Between Work Duration and Work Experience with the Occurrence of Low Back Pain in Online Motorcycle Drivers Farhah, Putri Dzahabiyyah; Setiorini, Anggi; Graharti, Risti; Saftarina, Fitria
Medula Vol 14 No 10 (2025): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i10.1429

Abstract

Low Back Pain (LBP) is one of the most prevalent musculoskeletal disorders globally and a leading cause of disability. One of the occupational groups at high risk of LBP is online motorcycle taxi drivers, who spend long hours in a static sitting position while riding. The primary factors contributing to LBP among online motorcycle taxi drivers include long working hours and extended work tenure. This study aims to analyze the relationship between working duration and work tenure with the occurrence of LBP among online motorcycle taxi drivers. Based on various studies, it has been found that working more than 8 hours per day can increase the risk of LBP by up to 3.6 times due to excessive muscle strain and spinal load. Additionally, work tenure exceeding 5 years is associated with a higher risk of LBP due to accumulated physical stress, which can reduce muscle performance and deteriorate overall physical condition. Studies conducted in various cities, such as Makassar, Surabaya, and Padang, have demonstrated a significant relationship between working duration, work tenure, and the incidence of LBP among online motorcycle taxi drivers. Implementing proper work time management and ensuring sufficient rest breaks during riding are crucial steps in reducing the risk of LBP among online motorcycle taxi drivers. Additionally, attention to ergonomic factors in riding posture is essential to minimize the negative impact on musculoskeletal health.
Case Report: Tonsilitis Kronik Pada Anak Usia 12 Tahun Retno Mareintika; Graharti, Risti; Hayati, Rina
Medula Vol 15 No 3 (2025): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v15i3.1670

Abstract

Chronic tonsillitis is one of the most common upper respiratory tract infections in children. This condition is characterized by recurrent inflammation of the tonsils, which can interfere with daily activities, reduce appetite, impair sleep quality, and increase the risk of severe complications such as peritonsillar abscess, parapharyngeal abscess, or sepsis. Appropriate management is essential to prevent recurrence and further complications.This case report describes a 12-year-old female patient who presented with complaints of odynophagia, a foreign body sensation in the throat, halitosis, recurrent fever, and snoring during sleep. Physical examination revealed T3–T3 tonsils with enlarged crypts and the presence of detritus, leading to a diagnosis of chronic tonsillitis or recurrent acute tonsillitis. Initial management included amoxicillin 500 mg three times daily for 10 days, paracetamol 10–15 mg/kgBW as needed for fever, and an antiseptic mouthwash. The patient and her family were also educated on medication adherence, maintaining oral hygiene, and avoiding triggering foods such as spicy meals, cold drinks, and unhygienic snacks.Conservative therapy provided temporary symptomatic improvement; however, considering the recurrent episodes and sleep disturbances, the patient was advised to undergo tonsillectomy as definitive therapy. This case emphasizes that chronic tonsillitis in children requires accurate diagnosis, comprehensive management, and timely intervention. Conservative treatment may alleviate symptoms, but tonsillectomy plays a pivotal role in preventing recurrence, reducing the risk of complications, and improving the patient’s quality of life.
Pengaruh Pemberian Ekstrak Etanol Daun Pucuk Merah (Syzygium myrtifolium Walp) Terhadap Gambaran Sel Hepatosit Tikus Putih Jantan Galur Sprague-Dawley Ruslani, Nada Oktista; Susianti, Susianti; Graharti, Risti; Rudianto, Waluyo
Medula Vol 15 No 3 (2025): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v15i3.1693

Abstract

Syzygium myrtifolium Walp., commonly known as red shoot leaves, is an ornamental plant rich in bioactive compounds such as flavonoids, tannins, and terpenoids, which exhibit antioxidant, anticancer, and antibacterial properties. However, administration at high doses may lead to hepatotoxic effects. The liver plays a central role in drug metabolism and is the first organ exposed to toxic agents, making it highly susceptible to hepatocyte necrosis. This study aimed to evaluate the effect of ethanol extract of Syzygium myrtifolium leaves on liver histopathology in male white rats (Rattus norvegicus). This experimental study employed a post-test only control group design with three groups: control, 2000 mg/kgBW, and 5000 mg/kgBW. The extract was administered orally, and hepatocyte necrosis was assessed using a histopathological scoring system. Statistical analysis included Shapiro-Wilk, Levene’s Test, One Way ANOVA, and post hoc LSD. Histopathological examination revealed normal hepatocytes in the control group, focal necrosis in the 2000 mg/kgBW group, and extensive necrosis in the 5000 mg/kgBW group. Statistical analysis confirmed normally distributed and homogeneous data, while ANOVA indicated significant differences among groups (p=0.001). Post hoc LSD test further demonstrated significant differences between the control and treatment groups as well as between both treatment doses. In conclusion, oral administration of ethanol extract of Syzygium myrtifolium leaves induces hepatocyte necrosis in male white rats, with the severity of liver damage increasing in a dose-dependent manner.
Partus Prematurus Imminens Akibat Penggunaan Obat Uretonika Dosis Tinggi: Sebuah Laporan Kasus Pratiwi, Aulia Sari; Graharti, Risti; Kusumaningtyas, Intan
Medula Vol 16 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Imminent preterm labor is an obstetric condition characterized by uterine contractions accompanied by cervical changes before 37 weeks of gestation, which can lead to preterm delivery. This condition remains the leading cause of perinatal morbidity and mortality in Indonesia. According to the 2018 Basic Health Research (Riskesdas), the prevalence of premature births reached 29.5 per 1,000 live births and contributed to 35% of neonatal deaths. This study aims to report and analyze cases of imminent premature labor due to the use of high-dose urethronics, as well as to review the latest evidence-based management. Data were obtained through anamnesis, physical examination, and review of patient medical records, which were then supplemented with a literature review related to the mechanism of action of uterotonic drugs, the role of prostaglandins, and management guidelines from the WHO, ACOG, and WAPM-PMF. The results of the report showed that patients experienced active uterine contractions with premature rupture of membranes at 29–30 weeks of gestation after repeated consumption of high doses of misoprostol. The use of uretonic drugs caused an increase in contractions due to excessive prostaglandin stimulation. Management included the administration of antenatal corticosteroids to accelerate fetal lung maturation, short-term tocolytics to delay labor, and magnesium sulfate as a neuroprotective agent. It is concluded that the use of uterotonic drugs without medical supervision can be a factor in triggering imminent premature labor. A comprehensive and evidence-based management approach can reduce the risk of neonatal complications and improve pregnancy outcomes, making strict supervision and patient education important steps in preventing similar cases in the future.
Penggunaan High-Sensitivity Troponin dalam Diagnosis Dini Infark Miokard Nuraini, Bianti; Graharti, Risti; Rakhman, Farid
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.v16i1.1733

Abstract

Infark miokard akut (IMA) masih menjadi salah satu penyebab utama morbiditas dan mortalitas di seluruh dunia, sehingga diagnosis yang cepat dan akurat sangat penting untuk meningkatkan luaran pasien serta menurunkan risiko komplikasi fatal. Keterlambatan diagnosis IMA dapat menimbulkan berbagai konsekuensi serius, termasuk gagal jantung, aritmia maligna, dan peningkatan angka kematian, terutama pada pasien dengan manifestasi klinis yang atipikal. Oleh karena itu, evaluasi dini pada pasien dengan dugaan sindrom koroner akut merupakan komponen krusial dalam pelayanan kegawatdaruratan dan kardiovaskular. Biomarker jantung memiliki peran sentral dalam diagnosis IMA, dengan troponin jantung diakui sebagai indikator paling spesifik dan sensitif terhadap cedera miokard apabila dikombinasikan dengan penilaian klinis dan pemeriksaan elektrokardiografi. Namun, pemeriksaan troponin konvensional memiliki keterbatasan sensitivitas pada fase awal setelah onset gejala, sehingga berpotensi menyebabkan keterlambatan atau kegagalan diagnosis. Untuk mengatasi keterbatasan tersebut, dikembangkan pemeriksaan high-sensitivity cardiac troponin (hs-cTn) yang mampu mendeteksi kadar troponin sangat rendah serta perubahan dinamis kecil dalam interval waktu yang singkat. Penggunaan hs-cTn memungkinkan identifikasi cedera miokard lebih dini, bahkan dalam satu hingga tiga jam setelah terjadinya iskemia, serta mendukung penerapan algoritma diagnosis cepat seperti protokol rule-in dan rule-out 0/1 jam dari European Society of Cardiology. Strategi ini terbukti meningkatkan akurasi diagnosis, mempercepat pengambilan keputusan klinis, dan mengoptimalkan pemanfaatan sumber daya di unit gawat darurat. Meskipun demikian, peningkatan kadar hs-cTn juga dapat ditemukan pada kondisi non-iskemik, seperti penyakit ginjal kronik, gagal jantung, sepsis, dan takiaritmia. Oleh karena itu, interpretasi hasil hs-cTn harus dilakukan secara hati-hati dengan mempertimbangkan gambaran klinis, perubahan elektrokardiografi, serta pemeriksaan troponin serial. Tinjauan ini membahas peran, manfaat, keterbatasan, dan implikasi klinis hs-cTn dalam diagnosis dini infark miokard akut.
Hubungan Dua Arah Antara Gastroesophageal Reflux Disease dengan Gangguan Tidur Rahmadani, Tiara Sekar; Graharti, Risti; Septa, Tendry
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.v16i1.1736

Abstract

Gastroesophageal Reflux Disease (GERD) is a common chronic gastrointestinal disorder characterized by recurrent reflux of gastric contents into the esophagus, causing symptoms such as heartburn, chest pain, chronic cough, and nocturnal discomfort. The global prevalence of GERD continues to increase and is closely associated with lifestyle factors, including high body mass index, excessive caffeine and alcohol consumption, psychological stress, and poor sleep patterns. In Asia, GERD prevalence has risen markedly over the past two decades, with intercountry differences reflecting variations in socioeconomic status and health behaviors. Nocturnal GERD symptoms frequently disrupt sleep quality, most commonly through insomnia and obstructive sleep apnea (OSA). These sleep disorders can physiologically worsen reflux by altering intrathoracic pressure and reducing lower esophageal sphincter tone. Recent evidence suggests a bidirectional relationship between GERD and sleep disorders, in which nocturnal reflux leads to sleep fragmentation, while sleep disturbances increase the frequency and severity of reflux episodes. Other contributing factors include stress, high-fat dietary intake, impaired esophageal motility, and reduced nocturnal acid clearance. This literature review summarizes current evidence regarding the physiological links between GERD and sleep disorders, associated risk factors, and available management strategies. Therapeutic approaches include pharmacological treatments such as proton pump inhibitors (PPIs) and potassium-competitive acid blockers (P-CABs), along with non-pharmacological interventions, including sleeping in the left lateral position, which has been shown to reduce nocturnal reflux events. This review highlights the importance of a multidisciplinary management approach and the need for further research to improve GERD symptoms and sleep quality.
Co-Authors A.P, Gadila Ade Yonata, Ade Adrifianie, Femmy aflika happy, terza Agatha Catherine Agustyas Tjiptaningrum Airlangga Damara Akbar, Fareel Wahyu Al Ghifari, Ghaza Ahmad Ali, Nur Fitriana Muhammad Andika, Gede Agus Andrifianie, Femmy Angga Wijaya, Angga Anggraeni, Ranesya Eka Annisa Fath Ari Wahyuni Arif Yudho Prabowo Arnida Rahman Asep Sukohar Assirri, Agung Aulia Berliana Avisa Jinan Azura Ayu, Putu Ristyaning Bayu Anggileo Pramesona Benny Syahputra Gumay betta kurniawan Betta Kurniawan, Betta Boy K.H, High Cintawan, Ni Made Karenina Rini Dwi Daffa, Meysha Nur Devya Aulia Dewi Nur Fiana Diaru Fauzan Farizy Disaputera, Alfafa Tsalaatsa Djausal, Anisa Nuraisa Dorisman, Hari Dwiki WIjaya Rahman Endah Setyaningrum, Endah Evi Kurniawati Fardiansyah, Ahmad Irzal Farhah, Putri Dzahabiyyah Farid Rakhman Fatmasari, Dina Fitria Saftarina George Pestalozi Gigaramadan Sema Hadibrata, Exsa Hafizh, Ahmad Fauzan Happy, Terza Aflika Helmi Ismunandar Hendra Tarigan Sibero Idris, Mohamad Indri Windarti Indriyani, Reni Intan Kusumaningtyas Intanri Kurniati Iswandi Darwis Izdihar, Adinda Fairuz Jati, Pandu Kumaya Khairun Nisa Khairunnisa, Aulia Kurniawaty, Evi Kusumaningrum, Desy Liana Sidharti, Liana Maharani, Atifah Fadilah Mallarangeng, Andi Nafisah Tendri Adjeng Maulida, Syakira Zahra Mayasari, Diana Muhammad Ihsan Fariqy Muhammad Maulana Muhammad Ricky Ramadhian Ningrum, Kurnia Nisa, Lutfi Khoirun Novita Carolia Nuraini, Bianti Nurul Utami Oktoba, Zulpakor Prameswari, Putu Arya Indira Pratiwi, Aulia Sari Prayogi, Norbertus Marcell Purnama Sari, Faraztya Putri, Syalika Dianisa Putu Ristyaning Ayu Rachman Aziz Rahmadani, Tiara Sekar Rahmat, Aprin Nabila Rahmayani, Fidha Rani Himayani Rasmi Zakiah Oktarlina Ratna Dewi Puspita Sari Reni Indriyani Retno Mareintika Ricky Rivalino Sitepu, Ricky Rivalino Rika Lisiswanti Rina Hayati Risal Wintoko rizki_novtarina21 Rodiani Roro Rukmi Windi Roro Rukmi Windi Perdani, Roro Rukmi Rudianto, Waluyo Ruslani, Nada Oktista Sangging, Putu Ristyaning Ayu Sany Setiawan Sema Gigaramadan Septa, Tendry Septiani, Linda Setiawan, Putri Ayundari Setiorini, Anggi Sheira Indah Anjani Soemarwoto, Retno Ariza Soeprihatini Sofyan Musyabiq Wijaya Suharmanto Sulthan Alam Yasyfa Susianti, Susianti Sutarto Sutarto Sutarto Sutarto Syahrul Hamidi Nasution Syazili Mustofa TA Larasati Tri Umiana Soleha Wardhani, Dyah Wulan Sumekar Rengganis Wardhani, Oktiva Risma Widjaja, Jovan Winda Trijayanthi Utama, Winda Trijayanthi