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The Role of Cell Block in Diagnosing Metastatic Adenocarcinoma in Pleural Fluid: A Case Series Salsa Hanisa Anwar; Desi Puspita; Hermin Aminah Usman
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p68-75.2026

Background: Cytological examination of pleural fluid is an important, inexpensive, and simple test for detecting malignancy in patients with clinical pleural effusion who undergo thoracentesis. Adenocarcinoma is the most common tumor type. However, diagnosis using the conventional smear method can be challenging when the typical glandular-like growth patterns are not visible. Cell block preparation from pleural fluid samples preserves tissue architecture and tumor cell genetic material, enabling further tests such as immunohistochemistry (IHC) and PCR. Case presentation: We report a series of four patients with pleural effusion who underwent both conventional smear cytology and cell block examination. Tumor cell growth patterns were identified and descriptively analyzed for each sample. In two of these cases, vague glandular-like growth patterns were observed only in the cell block preparations and were absent in the conventional smears, which directly helped establish the diagnosis of metastatic adenocarcinoma. Conclusion: Differences in tumor cell growth patterns between the conventional smears and the cell block preparations were observed in two cases. The vague glandular-like growth pattern that was present in the cell block but was not identified in the conventional smear aided pathologists in identifying metastatic adenocarcinoma in pleural fluid specimens.

The Relationship Between the Jakarta Cardiovascular Score and Physical Activity: Screening of Cardiovascular Risk Factors in Older Adults Citra Kiki Krevani; Restu Restu; Wahyudi Firmana; Rusdy Kamal; Fikri Satria; Jolatuvel Bahana; Najmi Ilal Hayati; Hajar Nurfa Jirin
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p41-47.2026

Background: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide, including in Indonesia, where low physical activity is a major modifiable risk factor. The Jakarta Cardiovascular Score (JAKVAS) was developed as a local modification of the Framingham Risk Score to better represent Indonesian populations by including physical activity as a variable. However, the quantitative relationship between physical activity level and JAKVAS has not been well established. Methods: This cross-sectional analytical study involved 21 adult participants who took part in a community health screening. Data were collected through structured questionnaires covering JAKVAS components and the International Physical Activity Questionnaire (IPAQ). Physical activity was classified into low–moderate and high categories. Data were analyzed using independent t-test or Mann–Whitney test according to data distribution, with a significance level of p < 0.05. Results: Participants with high physical activity were predominantly male (83.3%; p = 0.003). No significant differences were observed in body mass index, blood pressure, or blood glucose levels. Smoking status (p = 0.003) and menopausal status (p = 0.003) were significantly associated with physical activity, whereas hypertension and diabetes mellitus were not. The median JAKVAS score was higher in the low–light activity group (median = 6; range 0–15) than in the moderate–vigorous group (median = 4; range 1–8; p = 0.066), indicating a trend toward lower cardiovascular risk with higher physical activity levels. Conclusion: Higher physical activity levels tended to correlate with lower cardiovascular risk scores based on JAKVAS, though not statistically significant. Promoting physical activity remains a key preventive strategy against cardiovascular disease in the community.

Shifting Gears in Pediatric Pyeloplasty: A Systematic Review and Meta-Analysis of Robotic vs Conventional Laparoscopic Approaches for Ureteropelvic Junction Obstruction Annisa Ulfa; Gabriel Tandecxi; Prayoga Eko Nuryadi; Cika Joyita Patria
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p1-11.2026

Background: Ureteropelvic junction obstruction (UPJO) obstructs the flow of urine and can damage the kidney when it is left untreated. Open pyeloplasty (OP) is still the gold standard, yet laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) achieve comparable success rates. This study aimed to evaluate the efficacy and safety of RALP compared with LP in pediatric patients. Methods: A meta-analysis was conducted on studies published after 2010 that were identified from multiple databases. Comparative studies, including randomized controlled trials (RCTs) and non-RCTs (retrospective cohort and retrospective studies), were included. The primary outcomes were operative success rate, operative time, length of hospital stay, intraoperative blood loss, UPJO recurrence, and complications. The analysis was performed in accordance with the PRISMA guidelines. Results: Sixteen studies (15 cohort studies and 1 RCT) involving 4,707 patients, with an overall moderate risk of bias, were included. RALP significantly increased the success rate by 2% (p = 0.03) and reduced the length of hospital stay by 1.71 days (p < 0.0001) compared with LP. In addition, RALP significantly reduced intraoperative blood loss by 4.63 mL (p = 0.04) and postoperative complications by 42% (p = 0.02). No significant differences were observed in operative time or UPJO recurrence between the two groups. Conclusion: RALP provided significant advantages over LP in pediatric UPJO, particularly in reducing hospital stay, blood loss, and complications, which supports its use as a safe and effective alternative wherever robotic facilities are available.

Inpatient Clinical Profile and Mortality Patterns at a Tertiary Referral Hospital in Indonesia: A Descriptive Study at RSUP Dr. M. Djamil Padang Viora Antasya; Dodi Vionanda; Alfitri Alfitri
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p48-59.2026

Background: Hospital electronic medical records contain morbidity and mortality data that can be analyzed to provide a comprehensive picture of health profiles. However, most studies using inpatient data are limited in scope and do not integrate the distribution of diagnoses, mortality patterns, and case fatality rates into a single analytical framework. This study aimed to describe the characteristics of inpatients at Dr. M. Djamil General Hospital in Padang in 2025, including age distribution, gender, diagnosis patterns, mortality rates, and case fatality rates by diagnosis group. Methods: This study employed descriptive analysis of electronic medical record (EMR) data from Dr. M. Djamil General Hospital in Padang for 2025, involving a total of 38,539 inpatients. The variables analyzed were age group, gender, and primary diagnosis. Data were presented in tables and bar charts. Results: Throughout 2025, there were 38,539 inpatients, with the highest number in the 56–60 age group. Males dominated inpatient admissions in nearly all age groups, except for the 21–50 age group, which was dominated by females because of pregnancy complications and gynecological cancers. Of all patients, 4,517 (8.5%) died, with the highest mortality rate occurring in the 61–65 age group. The highest case fatality rates (CFRs) were recorded for diseases of the respiratory system (29.2%); endocrine, nutritional, and metabolic diseases (23.5%); and perinatal conditions (21.0%), surpassing neoplasms and diseases of the circulatory system, which actually recorded the largest absolute numbers of deaths. Disease patterns varied by age group; most notably, admissions among women aged 21–50 were dominated by pregnancy-related conditions and gynecological cancers, whereas those among men over 51 were dominated by diseases of the circulatory system. Conclusion: The patterns of hospital admissions and deaths at Dr. M. Djamil General Hospital in Padang indicated that men and women faced different disease risks at each stage of life. These findings indicate that prevention programs and hospital healthcare services will need to be designed differently according to gender and age group to ensure greater effectiveness.

Effect of Moringa oleifera Leaf Extract on Liver and Kidney Histopathology of Sodium Nitrite-Induced Male Rats (Rattus norvegicus) Niken Ayu Prachelia Putri; Lucya Rahayu Putri; Elsa Yuniarti; Moralita Chatri; Siska Alicia Farma; Yuni Ahda; Yusni Atifah
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p60-67.2026

Background: Sodium nitrite (NaNO2) is a widely used meat preservative that, despite its regulatory approval, can generate reactive oxygen species (ROS) and induce oxidative damage to the liver and kidneys when consumed in excess. This study aimed to determine the effect of Moringa oleifera leaf extract on the liver and kidney histopathology of sodium nitrite-induced male rats (Rattus norvegicus) and to identify the extract dose with the greatest effect. Methods: This experimental study used a completely randomized design with 25 male rats allocated to five groups of five: a negative control (no induction), a positive control induced with sodium nitrite (37.5 mg/kgBW), and three treatment groups given Moringa leaf extract at 200, 400, and 600 mg/kgBW after nitrite induction. Histopathological slides of the liver and kidney were prepared by the paraffin method, stained with hematoxylin-eosin, and examined under a light microscope at 400× magnification. Results: Moringa oleifera leaf extract had a significant effect on the liver and kidney histopathology of the sodium nitrite-induced male rats, and the extent of histological recovery differed across doses. Conclusion: Among the doses tested, 600 mg/kgBW (P3) produced the greatest improvement in the liver and kidney histopathology of the sodium nitrite-induced male rats.

Factors Associated with Platelet Recovery in Dengue Patients on Fever Day 7 Ghina Shofi Ikrima; Elfira Yusri; Fadrian Fadrian; Efrida Efrida; Mutia Lailani; Yustini Alioes
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p31-40.2026

Background: Thrombocytopenia is a common hematological feature of dengue infection, and platelet recovery is a reliable prognostic indicator. The seventh day of fever typically marks the beginning of the recovery phase, but some patients show delayed platelet recovery. This study aimed to identify the factors affecting platelet recovery in adult dengue patients on fever day 7. Methods: This cross-sectional study was conducted from April 2024 to April 2025 at Universitas Andalas Hospital and involved 35 adult dengue patients selected through total sampling. Retrospective data on clinical and laboratory characteristics were collected. Platelet recovery was defined as an increase in platelet count of more than 20,000/mm³ within 48 hours between fever days 5 and 7. Patients who received platelet transfusion or corticosteroid therapy were excluded. Associations between variables were analyzed using the Chi-square test and Fisher’s Exact Test. Results: A significant association was found between platelet recovery and thrombocytopenia status at admission (p = 0.037). Age, sex, comorbidity, hematocrit level, leukocyte count, and day of fever at admission were not significantly associated with platelet recovery (p > 0.05). Only 10 of the 35 patients (28.6%) showed platelet recovery on fever day 7. Most patients were male (57.1%) and aged ≤40 years (80.0%), while 22.9% had comorbidities. Conclusion: Thrombocytopenia status at hospital admission was significantly associated with platelet recovery in dengue patients. Early recognition of this factor may help identify clinically at-risk patients and enable more effective clinical management.

Effectiveness of Subcutaneous Bupivacaine–Ketamine Wound Infiltration in Reducing Post-Cesarean Section Pain: A Randomized, Double-Blind, Controlled Trial Nadra Septiadi; Riyadh Firdaus; Besthadi Sukmono; Rafidya Indah Septica
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p12-21.2026

Background: Effective postoperative analgesia supports maternal recovery after cesarean delivery, yet subcutaneous local anesthetic infiltration, a simple technique well suited to resource-limited settings, typically provides only 3–6 hours of relief. Ketamine, an NMDA-receptor antagonist with analgesic activity at subanesthetic doses, may extend this window, but evidence in cesarean delivery remains limited.Objective: To determine whether adding subcutaneous ketamine to bupivacaine infiltration reduces rescue opioid requirement after cesarean delivery. Methods: In this randomized, double-blind, controlled trial at Tangerang Regional General Hospital, Indonesia, 60 women undergoing cesarean delivery under spinal anesthesia were allocated 1:1 to subcutaneous infiltration of 0.25% bupivacaine with ketamine 0.9 mg/kg (Group A, n = 30) or 0.25% bupivacaine alone (Group B, n = 30) before wound closure. The primary outcome was total rescue fentanyl requirement in the first 24 postoperative hours. Results: The median 24-hour fentanyl requirement was lower with ketamine (30 [0–90] vs 90 [0–150] mcg; p < 0.001), and fewer participants required rescue fentanyl at all (56.7% vs 76.7%), with a lower cumulative group dose (840 vs 2240 mcg). Group A also had lower pain scores from hour 7 onward, a longer interval to the first rescue request (810 vs 420 min; p = 0.019), and earlier first mobilization (585 vs 810 min; p < 0.001). No serious adverse events occurred in either group. Conclusion: Adding subcutaneous ketamine to bupivacaine infiltration lowered the rescue opioid requirement and supported faster recovery after cesarean delivery, offering a practical, low-cost addition to multimodal analgesia in resource-limited settings.

A Little of Everything, Just In Time: Multimodal Opioid-Sparing Anesthesia for a Twin Pregnancy in Decompensated Heart Failure Caused by Severe Mitral Stenosis Muhammad Imam Mulia; Arief Cahyadi
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p76-85.2026

Background: Rheumatic heart disease remains a leading cause of valvular heart disease among women of reproductive age in low- and middle-income countries. Severe mitral stenosis complicating pregnancy substantially increases the risk of acute cardiac decompensation because of the hemodynamic load imposed by gestation, and anesthetic management becomes considerably more complex when it is combined with atrial fibrillation with a rapid ventricular response and a multifetal pregnancy. Reports describing general anesthesia for cesarean delivery in a twin pregnancy complicated by both severe mitral stenosis and atrial fibrillation remain scarce, which limits the guidance available to clinicians who face this specific combination. Case Presentation: A 43-year-old woman, gravida 5 para 4 abortus 0, with a twin pregnancy at 32 weeks’ gestation was referred for emergency cesarean delivery because of acute decompensated heart failure secondary to rheumatic heart disease, with atrial fibrillation with a rapid ventricular response (AF-RVR) and severe mitral stenosis. Severe dyspnea that improved only marginally with upright positioning, together with an ongoing therapeutic heparin infusion, precluded neuraxial anesthesia. General anesthesia was therefore planned using a modified, opioid-sparing induction that combined low-dose propofol, ketamine, and dexmedetomidine under invasive hemodynamic monitoring. Two live infants were delivered; postpartum ventricular rate control was achieved with intravenous digoxin followed by amiodarone, alongside vasopressor and diuretic support. The patient was extubated on postoperative day 1 without further cardiopulmonary complications. Discussion: The anesthetic strategy in mitral stenosis with AF-RVR must be directed toward avoiding tachycardia, preserving preload, and maintaining hemodynamic stability. These goals are difficult to reconcile with the sympathetic blockade produced by neuraxial techniques when these are otherwise contraindicated. A multimodal, opioid-sparing approach that layered dexmedetomidine and ketamine preserved maternal hemodynamics and respiratory drive while limiting opioid exposure before delivery to a single low dose of fentanyl given at induction; definitive antiarrhythmic therapy was deferred until after both infants had been born. Conclusion: General anesthesia with a multimodal opioid-sparing strategy is a feasible and effective approach for high-risk parturients with stenotic valvular disease and arrhythmia when neuraxial techniques are contraindicated, provided that care is delivered through close multidisciplinary collaboration. The principal lesson is that sequencing several low-dose non-opioid agents, rather than avoiding opioids altogether, can preserve both maternal hemodynamic stability and fetal well-being in this setting.

Research Trends and Perspectives on Psychiatric Nursing: A Decade of Progress and Challenges Veolina Irman; Helena Patricia; Dwi Christina Rahayuningrum Rahayuningrum; Emira Apriyeni
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p94-109.2026

Background: Psychiatric nursing continues to evolve in response to changing clinical, social, and professional demands, and the volume of research in this field has grown rapidly. This study aimed to analyse research trends and perspectives in psychiatric nursing over the last decade using bibliometric mapping and a thematic review. Methods: A bibliometric analysis was conducted using the Scopus database for publications indexed between 2015 and 2025, limited to English-language journal articles. Data were analysed with Scopus built-in tools and VOSviewer to identify publication trends, productive countries, institutions, journals, co-authorship networks, and keyword patterns. In addition, the 100 most-cited articles were reviewed to explore major thematic areas in psychiatric nursing. Results: The search initially retrieved 510 publications; after screening and duplicate removal, 236 articles were included in the final analysis. Publication output peaked in 2022, and the United States emerged as the leading contributor, followed by Australia and Iran. Key productive institutions included King’s College London and Turun yliopisto, while the Journal of Psychiatric and Mental Health Nursing was the most active journal. Thematic findings showed that recent psychiatric nursing research focused on interventions and patient outcomes, education and professional development, nurse–patient relationships and communication, technology integration, care for specific populations, and nursing theory in mental health. Conclusion: Psychiatric nursing research has expanded substantially and has become more interdisciplinary and patient-centred. However, persistent challenges remained, particularly in workforce preparedness, therapeutic communication, technological implementation, and support for nurses’ well-being. These findings provide a useful foundation for future research, education, policy, and psychiatric nursing practice.

Effect of Preoperative Lactobacillus acidophilus Supplementation on Postoperative Gastric Residual Volume after Lower Digestive Laparotomy: A Randomized, Double-Blind, Controlled Trial Christophorus Simadibrata; Rudyanto Sedono; Sidharta Kusuma Manggala; Wifanto Saditya Jeo
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p22-30.2026

Background: Gastrointestinal dysmotility is among the most common complications after abdominal surgery and is reflected clinically by an elevated gastric residual volume (GRV), which increases the risk of aspiration and delays enteral feeding. Lactobacillus acidophilus is thought to improve gut motility through luminal acidification, competitive exclusion of pathogens, and direct stimulation of smooth-muscle contractility, but whether this translates into a lower GRV after digestive laparotomy has not been tested. Objective: To determine whether preoperative Lactobacillus acidophilus supplementation reduces postoperative GRV after lower digestive laparotomy. Methods: In this randomized, double-blind, placebo-controlled trial at Dr. Cipto Mangunkusumo National General Hospital, Indonesia, adults scheduled for elective laparotomy of the jejunum, ileum, colon, or rectum received oral Lactobacillus acidophilus 10⁹ CFU or an identical placebo capsule three times daily for three days before surgery. A nasogastric tube inserted during surgery was aspirated every 6 hours after ICU admission; GRV was categorized as normal (<250 mL/24h) or increased (≥250 mL/24h) at 24 and 48 hours. Results: Fifty-five participants were randomized (27 probiotic, 28 placebo); one placebo-group participant was withdrawn because of sepsis, leaving 54 participants analyzed per protocol. GRV was increased in 4/27 (14.8%) probiotic recipients versus 2/27 (7.4%) placebo recipients at 24 hours (p = 0.669; risk ratio for normal GRV 0.92, 95% CI 0.76–1.11) and in 1/27 versus 0/27 at 48 hours (p = 1.000). Stratified analysis identified age, neurological comorbidity, obesity, vasopressor use, opioid exposure, hypercapnia, and hyperglycemia as confounders that shifted the crude risk estimate by more than 10%; opioid and vasopressor exposure were also unevenly distributed between groups at baseline (p = 0.006 and p = 0.026, respectively). Conclusion: A 3-day preoperative course of Lactobacillus acidophilus did not significantly reduce postoperative GRV after lower digestive laparotomy. The trial was underpowered relative to its planned sample size, and an uneven distribution of opioid and vasopressor exposure between groups may have obscured a true effect.

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Zulda Musyarifah

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Journal Mail Official
admin@frontiersonhealthcare.org

Editorial Address
Jalan Perintis Kemerdekaan Sawahan Timur Padang West Sumatra

Location
Kota padang,

Sumatera barat

INDONESIA

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Home Page

OAI Link

Editorial Team

Contact

Reviewer

Google Scholar

Contact Name Zulda Musyarifah

Contact Email penelitian.diklit@gmail.com

Phone +627518956666

Journal Mail Official admin@frontiersonhealthcare.org

Editorial Address Jalan Perintis Kemerdekaan Sawahan Timur Padang West Sumatra

Location Kota padang, Sumatera barat INDONESIA

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Contact Name
Zulda Musyarifah

Contact Email
penelitian.diklit@gmail.com

Phone
+627518956666

Journal Mail Official
admin@frontiersonhealthcare.org

Editorial Address
Jalan Perintis Kemerdekaan Sawahan Timur Padang West Sumatra

Location
Kota padang,

Sumatera barat

INDONESIA