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INDONESIA
MEDICINUS
Published by PT Dexa Medica
ISSN : 1979391X     EISSN : 29638399     DOI : 10.56951
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health
Tujuan penerbitan jurnal Medicinus adalah untuk meningkatkan wawasan dan menambah khasanah pengetahuan para praktisi medis dan farmasis di bidang kedokteran dan kefarmasian. Ruang lingkup dari jurnal ilmiah ini adalah publikasi artikel-artikel ilmiah yang bisa disajikan dalam bentuk penelitian (research), laporan kasus (case report), teknologi dan klinis kefarmasian, serta ulasan literatur medis.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 221 Documents
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Abses Tiroid pada Pasien dengan Infeksi HIV: Laporan Kasus Diah Pradnya Paramita; Made Ratna Saraswati
MEDICINUS Vol. 39 No. 5 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/kyr4be95

Abstract

Thyroid abscess is a rare infectious condition as the thyroid gland is completely enclosed by a fibrous capsule, has an iodine-rich environment, an abundant blood supply, and effective lymphatic drainage. Thyroid abscess occurs more frequentlyin patients with pre-existing thyroid anatomical abnormalities or immunocompromised conditions. Underlying thyroid diseases, such as thyroid nodules or thyroid malignancy, represent important predisposing factors. Only approximately 8% of thyroid abscess cases have been reported in the adult population. Case report: A 71-year-old man presented presenting with right-sided neck pain, fever, and odynophagia for seven days prior to admission. Physical examination revealed a 7 × 5 cm mass in the right cervical region with a smooth surface, firm-rubbery consistency, movement with swallowing, and tenderness on palpation. Thyroid ultrasonography demonstrated a cystic lesion with a solid component and internal echoes. Fine-needle aspiration biopsy revealed polymorphonuclear inflammatory cells consisting of neutrophils and lymphocytes. The patient was also newly diagnosed with human immunodeficiency virus (HIV) infection and had subclinical hypothyroidism. A history of thyroid nodules may represent a significant risk factor for the development of thyroid abscess. In this case, the administration of broad-spectrum systemic antibiotics resulted in a favourable clinical response.
Faktor yang Berhubungan dengan Penyebab Admisi dan Kematian Pasien Systemic Lupus Erythematosus (SLE) di RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar Ni Kadek Ariesta Dwijayanthi; Pande Ketut Kurniari
MEDICINUS Vol. 39 No. 5 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/6553mv58

Abstract

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with high mortality. Epidemiological data on SLE related mortality in Indonesia remain limited, therefore, this study was conducted to identify the characteristics of patients with SLE who died. This study used a cross-sectional design with total sampling based on medical record data of SLE patients who died during hospitalization at RSUP Prof. dr. I.G.N.G Ngoerah, Denpasar from August 2022 to October 2024. Data were analyzed using SPSS version 22.The mortality of SLE patients at RSUP Prof. dr. I.G.N.G Ngoerah, Denpasar during this study period were 45 patients. The female-to-male patient ratio was 10:1, with a mean age of 34.96 (±11.50) years, history of hospitalizations of 2,27 (±1.09) times in the last 3 months, and the length of hospitalization of 6.40 (±3.48) days. Approximately 55% of patients died within less than 3 months after the diagnosis of SLE was established. Most patients (73.33%) experienced infections, and40% patients had cardiovascular and 55.55% had renal comorbidities. Vasculitis and neuropsychiatric SLE (NPSLE) were associated with severe disease activity. While worsening SLE activity was a major factor in patient admission, deaths were primarily attributed to infections (19 cases; 42.22%) and comorbid complications (17 cases; 37.78%).Cardiovascular disease was associated with hospital admissions due to comorbid complications (p=0.05) and with increased SLE disease activity at admission (p=0.02). Infection remains the leading cause of mortality in SLE and also a contributing factor to delays in initiating high-dose corticosteroid administration. Cardiovascular disease appears to be a comorbidity that progresses and worsens earlier in SLE patients. Multidisciplinary management of infectious andcardiovascular comorbidities may reduce mortality and morbidity in SLE.
Pendekatan Diagnosis pada Pasien dengan Primary Sclerosing Cholangitis (PSC): Sebuah Laporan Kasus I Putu Aris Govindha Putra; I Ketut Mariadi
MEDICINUS Vol. 39 No. 5 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/pznw5k98

Abstract

Primary sclerosing cholangitis (PSC) is a chronic, progressive cholestatic liver disorder of unknown etiology, characterized by inflammation, fibrosis, and narrowing of the intrahepatic and/or extrahepatic bile ducts. The discovery of commonclinical manifestations of cholestasis, whose etiology is difficult to determine, makes PSC cases a challenge for clinicians. We reported the case of a 20-year-old female who presented with the chief complaint of jaundice lasting 6 months.Symptoms included pruritus, tea-colored urine, pale stools, decreased appetite and body weight, and the appearance of bruising without trauma. The patient underwent several examinations, including laboratory tests, ultrasound, CT scan,and magnetic resonance cholangiopancreatography (MRCP), which showed a blockage and narrowing of the bile ducts. The first endoscopic retrograde cholangiopancreatography (ERCP) included biliary stent placement, but the complaints persisted, so a repeat ERCP was performed, revealing a biliary tract stricture. The initial diagnosis was PSC with severe acute cholangitis and coagulopathy. Patient was treated with antibiotics, steroids, and ursodeoxycholic acid (UDCA). In clinical practice, the recognition and confirmation of the diagnosis, as well as the management of PSC remain challenging. This case highlights the importance of early recognition and suspicion as well as comprehensive treatment of PSC to prevent further complications.
Resistensi Insulin sebagai Poros Disfungsi Ovulasi pada Polycystic Ovary Syndrome Raymond R. Tjandrawinata
MEDICINUS Vol. 39 No. 5 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/wnqbb620

Abstract

Insulin resistance in polycystic ovary syndrome (PCOS) is intrinsic in nature and not merely a consequence of obesity. Postreceptorphosphorylation abnormalities, particularly excessive serine phosphorylation of the insulin receptor and insulin receptor substrate, impair the activation of PI3K/Akt pathway, resulting in compensatory hyperinsulinemia. This conditionstimulates CYP17A1 expression in ovarian theca cells, suppresses hepatic synthesis of sex hormone-binding globulin, and creates a hormonal milieu that disrupts follicular maturation, ultimately leading to oligo-anovulation. The improvementin ovulation reported with the use of glucagon-like peptide-1 (GLP-1) receptor agonists is better understood as an indirect consequence of systemic metabolic improvement. The bioactive fraction DLBS3233 acts at a more downstream level,restoring tyrosine phosphorylation and glucose transporter-4 (GLUT-4) expression by modulating peroxisome proliferatoractivated receptor (PPAR)-γ. Positioning insulin resistance as the central pathophysiological axis enables a more precisetherapeutic approach aligned with the physiological mechanisms underlying ovulatory dysfunction in PCOS.
Pentingnya Mendeteksi Hiperammonia Transien pada Bayi Baru Lahir (Transient Hyperammonemia of the Newborn/THAN) Juliani Dewi
MEDICINUS Vol. 39 No. 5 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/me592623

Abstract

Ammonia is a byproduct of nitrogen metabolism. In healthy individuals, ammonia is transported and metabolized under tight regulation to maintain low plasma concentrations. Increased ammonia production or insufficient ammonia detoxificationmay cause hyperammonemia. Transient hyperammonemia of the newborn (THAN) is often underdiagnosed, although it may lead to coma and death, particularly in premature infants. Acute hyperammonemia is an emergency condition thatmay cause cerebral edema, seizures, coma, severe neurological damage, and death. Ammonia levels can be measured using either an automated analyzer or dry slide. With early detection and prompt, appropriate treatment, the prognosis ofTHAN is excellent, without neurological sequelae.
Laporan Kasus Hepatopulmonary Syndrome (HPS) pada Pasien Sirosis Hepatis dengan Penyulit Melena Akut dan Orthodeoxia Yogi Haditya; I Ketut Mariadi
MEDICINUS Vol. 39 No. 6 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/jpeytk40

Abstract

Hepatopulmonary syndrome (HPS) is a complication that frequently occurs in patients with end-stage liver disease. It is characterized by a triad of abnormal arterial oxygenation, intrapulmonary vascular dilatations (IPVD), and chronic liverdisease. A 48-year-old man presented with complaints of shortness of breath for about 3 months, which improved when lying down but worsened when sitting or standing. The patient also reported blackish stool since one day prior to admission and had a history of liver cirrhosis since 2020. Vital signs were normal except for peripheral oxygen saturation, which was 86% when lying down and 79% when sitting. Physical examination revealed anemic palpebra, clubbing finger on hands and foots. Laboratory results revealed anemia, with an increased alveolar-arterial (A-a) gradient of 64.7 mmHg on blood gas analysis. A transthoracic contrast echocardiography (TTCE) or “buble study” was performed and the result show more than 20 microbubles in the left chambers of the heart after 5 cardiac cycles, indicating an intrapulmonary shunt caused by IPVD. These findings confirmed the diagnosis of HPS. Management of HPS is supportive, as there is no specific medical therapy available other than liver transplantation.
Gangguan Metabolik pada Sindrom Ovarium Polikistik Nonklasik: Sebuah Laporan Kasus Yogi Haditya; I Made Pande Dwipayana
MEDICINUS Vol. 39 No. 6 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/pkcvxt90

Abstract

Polycystic ovary syndrome (PCOS) is the primary cause of both menstrual irregularity and androgen excess in women. PCOS can be diagnosed when women present with the classic features of hirsutism, irregular menstrual cycles, andpolycystic ovarian morphology on ultrasound. Women with PCOS, as compared with age- and body mass index-matched women without the syndrome, appear to have a higher risk of insulin resistance, hyperinsulinemia, glucose intolerance,dyslipidemia, and an increased prothrombotic state. These factors may result in higher rates of type 2 diabetes mellitus, fatty liver disease, subclinical atherosclerosis, vascular dysfunction, and ultimately cardiovascular disease and mortality. This case report presented a patient with hirsutism and prolonged menstrual cycles despite the absence of polycystic ovary on diagnostic investigation. Laboratory findings showed high cholesterol, triglycserides, and HbA1c level with a normal testosterone level. The primary management for this patient includes metformin to treat the insulin resistance and statin for the management of dyslipidemia.
Management of a Giant Ovarian Mucinous Cyst in Late Pregnancy: A Combined Surgical Approach Arya Ady Nugroho; Yuditiya Purwosunu
MEDICINUS Vol. 39 No. 6 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/m47k9074

Abstract

Background: Adnexal masses complicating pregnancy are relatively rare, with an incidence of 1–5% of all pregnancies. Most are benign and may regress spontaneously; however, large or persistent cysts require careful management because of risks such as torsion, rupture, obstruction of labor, and malignancy. Ovarian mucinous cystadenomas are particularlyuncommon but may grow to giant sizes, causing maternal discomfort and fetal complications, including malpresentation. The optimal timing and mode of surgery depend on gestational age and tumor characteristics. In late pregnancy, concurrent cesarean section and adnexal surgery is considered safe and effective, minimizing the need for repeated laparotomy. Case presentation: We report a 30-year-old gravida 3, para 1, abortus 1 woman at 38 weeks of gestation with a giant right ovarian cyst suspected to be mucinous cystadenoma. The patient presented with a transverse fetal lie without acute complications. Ultrasonography demonstrated a multilocular homogeneous cyst extending to the xiphoidprocess without solid components, classified as O-RADS 3, with a risk of malignancy index (RMI) 39. Tumor markers levels were within benign ranges. At term, the patient underwent spinal anesthesia and Pfannenstiel laparotomy during cesarean section. A healthy male infant weighing 2,720 g was delivered, with Apgar scores of 8 and 9 at 1 and 5 minutes respectively. Right salpingo-oophorectomy was also performed. The estimated blood loss was 600 ml, urine output was 300 ml, with uneventful postoperative recovery. The contralateral adnexa were normal. Conclusions: This case highlightsthe challenges of managing a giant ovarian mucinous cyst during pregnancy. Concurrent cesarean section and salpingooophorectomyat term provided an optimal approach, to ensure maternal and neonatal safety while preventing recurrence risk. Multidisciplinary planning and individualized surgical decisions making remain essential for achieving favorable outcomes in such complex cases.
Diagnostic Challenges in Tuberculous Spondylitis in a Young Adult without Overt Immunodeficiency: A Case Report Ni Putu Nita Wiryandari; I Ketut Agus Somia
MEDICINUS Vol. 39 No. 6 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/dtmzkx63

Abstract

Background: Tuberculous spondylitis accounts for approximately half of all cases of osteoarticular tuberculosis and remains a diagnostic challenge due to its nonspecific clinical manifestations and the variable diagnostic yield of conventionalinvestigations, often leading to delayed diagnosis. Case Presentation: We report a 38-year-old male who presented with chronic nonradiating low back pain for one year, with worsening over one month, followed by paresthesia, urinary incontinence, and progressive bilateral lower limb weakness. The patient had significant weight loss, a close household contact with pulmonary tuberculosis, and lifestyle-related risk factors including smoking and alcohol consumption, but without overt immunodeficiency. Sputum GeneXpert MTB/RIF testing was negative, and histopathological examination of vertebral tissue showed no granulomas or caseous necrosis. However, polymerase chain reaction (PCR) testing of vertebral tissue confirmed the presence of Mycobacterium tuberculosis. Imaging revealed vertebral destruction at T12–L1 withgibbus deformity and a paravertebral soft tissue mass with subligamentous spread on magnetic resonance imaging (MRI). The patient received standard antituberculosis therapy and underwent posterior spinal decompression and stabilizationdue to progressive neurological deficits, resulting in clinical improvement. Conclusion: This case highlights the importance of maintaining a high index of suspicion for tuberculous spondylitis in young adults without classical immunodeficiency and underscores the value of molecular diagnostics when conventional tests are inconclusive.
Patofisiologi dan Tata Laksana Kardiotoksisitas yang Diinduksi Kemoterapi Helen Widiani; Ida Bagus Rangga Wibhuti
MEDICINUS Vol. 39 No. 6 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/3hzabj15

Abstract

According to the European Society of Cardiology (ESC), cardiotoxicity is defined as damage of the function and/or structure of the heart associated with drug exposure, particularly anticancer therapies such as chemotherapy and radiotherapy,as well as damage caused by the cancer itself. Generally, chemotherapy-induced cardiotoxixity is classified into five types, with the two main types most frequently associated with high-risk antineoplastic therapy. Chemotherapy-inducedcardiotoxixity may occur through either direct or indirect mechanisms, with contributing factors including: accumulative dose, drug preparation, formulation, and drug delivery. The management of cardiotoxicity depends on the specific type ofcardiovascular disorder experienced by the patient. In cases of hypertension, angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs), along with dihydropyridine calcium channel blockers, are recommendedtherapeutic options. Anticancer therapy may be continued as long as the QT interval is ≤500 ms and the change in QT interval is <60 ms, and there is no evidence of ventricular arrhythmias or syncope. Management of atrial fibrillation is based on main considerations such as rhythm control and rate control, as well as thromboembolic prophylaxis. Prevention of cardiocicity begins with a comprehensive assessment of cardiovascular risk and predisposing factors. Patients with multiple risk factors, particularly when those are poorly controlled, and/or those with preexisting cardiovascular disease, should be managed as a high-risk patients.

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