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Medula
Published by Universitas Lampung
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Core Subject : Health, Science, Education,
Education Medicine & Pharmacology Neuroscience Public Health
Medical Profession Journal of Lampung didirkan pada tahun 2013. Medula hadir memenuhi kebutuhan publikasi jurnal bagi mahasiswa Fakultas Kedokteran, Dosen ataupun klinisi dan profesi lain dibidang kedokteran. Medula diterbitkan dengan frekuensi 4 kali dalam setahun yang tiap nomornya mencakup 30 jenis artikel ilmiah seperti artikel penelitian, laporan kasus, tinjauan pustaka dan lain-lain. Medula sudah memiliki nomor ISSN media cetak sejak tahun 2013
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 23 Documents
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Search results for , issue "Vol 16 No 2 (2026): Medula" : 23 Documents clear
HIPERTENSI PADA DIABETES MELLITUS: SEBUAH TINJAUAN PUSTAKA Febriyan, Heironimus Billy; Utama, Winda Trijayanthi
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.v16i2.1729

Abstract

Hypertension in patients with diabetes mellitus is a significant clinical problem because it increases the risk of cardiovascular and renal complications. The pathophysiology of this condition involves interactions between insulin resistance, activation of the renin–angiotensin–aldosterone system (RAAS), endothelial dysfunction, and oxidative stress, which trigger vasoconstriction, sodium retention, and increased vascular stiffness. Various clinical guidelines, including those of the American Diabetes Association (ADA), set a blood pressure target of <130/80 mmHg to reduce the risk of long-term complications. Evidence from clinical trials such as ABCD shows that intensive blood pressure control provides benefits in terms of the progression of retinopathy, albuminuria, and stroke risk. This article was compiled using a narrative review approach by examining the latest literature from international journals and clinical guidelines related to hypertension in diabetes. Sources were selected based on relevance, recency, and strength of evidence. The analysis was descriptive to summarize pathophysiology, blood pressure target recommendations, treatment options, and the role of lifestyle changes. Management of hypertension in diabetes requires a combination of pharmacological therapy and lifestyle modifications. ACE inhibitors and ARBs are the first choice due to their renal protective benefits, while calcium antagonists and thiazide diuretics are used as adjunctive therapy. Lifestyle interventions such as salt restriction, increased fruit and vegetable consumption, regular physical activity, weight loss, and alcohol restriction provide moderate blood pressure lowering effects and improve metabolic health. A comprehensive approach encompassing metabolic, pharmacological, and lifestyle management is crucial for reducing morbidity and mortality in patients with diabetes and hypertension.
RESIKO KECELAKAAN KERJA PADA TENAGA KESEHATAN DAN PENCEGAHANNYA: SEBUAH TINJAUAN LITERATUR Pratiwi, Naisya Midary Mutia; Utama, Winda Trijayanthi
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.v16i2.1730

Abstract

Healthcare workers represent an occupational group with a high risk of work related accidents, including biological exposure, injuries caused by sharp objects, exposure to hazardous chemical substances, and musculoskeletal disorders associated with ergonomic hazards. These risks are influenced by high workload, suboptimal use of personal protective equipment, and the incomplete implementation of safety procedures in healthcare settings. This study aims to identify the main types of hazards commonly experienced by healthcare workers and to analyze prevention strategies recommended in previous studies. The method used was a literature review by selecting relevant national and international scientific articles related to occupational accidents, needle stick injuries, chemical hazards, and ergonomic risks among healthcare workers. Selected articles were analyzed using a systematic literature review approach, focusing on key findings, contributing factors, and prevention recommendations reported in each study. The results indicate that needle stick exposure is the most frequently reported occupational accident among healthcare workers. In addition, chemical exposure from substances such as cytotoxic drugs and disinfectants, as well as musculoskeletal complaints caused by non ergonomic working techniques, are also commonly identified. Dominant contributing factors include inadequate occupational safety and health training, inconsistent use of personal protective equipment, weaknesses in healthcare facility risk management, and high workload. In conclusion, occupational accidents among healthcare workers are multifactorial and require comprehensive preventive measures through improved training, provision of safe working facilities, compliance with standard operating procedures, and strengthening of a safety culture in healthcare services.  
LOW BACK PAIN PADA TENAGA KESEHATAN DI RUANG OPERASI: SEBUAH TINJAUAN LITERATUR Poppy Monika Sari; Utama, Winda Trijayanthi
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.v16i2.1732

Abstract

Low Back Pain is one of the most common musculoskeletal complaints among Healthcare Workers, especially nurses, and directly affects quality of life, work performance, and productivity. The high physical demands of healthcare services increase the risk of Low Back Pain through multiple factors. Individual factors include age, body mass index, level of physical activity, and a history of back injury. Occupational factors involve non-ergonomic working postures, patient lifting and transfer activities, repetitive movements, prolonged working hours, and heavy workloads. This study aims to review the literature related to risk factors, impacts, and the effectiveness of preventive interventions for Low Back Pain among Healthcare Workers. The method used is a literature review of scientific articles retrieved from relevant international databases, focusing on Healthcare Workers as the primary population. The review results show that more than half of Healthcare Workers in various countries report experiencing Low Back Pain, with occupational factors identified as the main contributors. Reported impacts include increased absenteeism, decreased work performance, and a higher risk of developing chronic musculoskeletal disorders. Preventive interventions such as workplace ergonomic modifications and posture education demonstrate more consistent effectiveness in reducing the incidence of Low Back Pain compared to physical activity-based interventions or stretching exercises alone. Stretching exercises provide limited benefits when not combined with ergonomic improvements. Therefore, prevention of Low Back Pain among Healthcare Workers requires an integrated approach that combines education, application of ergonomic principles, and systematic workload management to reduce prevalence and mitigate its negative impact.
DAMPAK BURNOUT PADA TENAGA KESEHATAN: TINJAUAN LITERATUR TENTANG FAKTOR PENCETUS DAN STRATEGI PENCEGAHAN Ni Putu Swastini; Utama, Winda Trijayanthi
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.v16i2.1737

Abstract

Burnout is a common work-related stress syndrome among healthcare workers, characterized by emotional exhaustion, depersonalization, and reduced professional achievement. This condition has a negative impact on service quality, worker health, and patient safety. Factors contributing to burnout include personal characteristics, sociodemographic factors, work environment conditions, high workload, and lack of organizational support. This study aims to review the literature on the factors that trigger burnout in healthcare workers and effective prevention strategies at the individual and organizational levels. The study used a literature review design with a search of articles in the PubMed, ScienceDirect, and Google Scholar databases using the keywords “burnout,” “healthcare workers,” “risk factors,” and “prevention strategies.” The articles included were publications from the last ten years, in Indonesian and English, and relevant to the research objectives. Data were synthesized narratively to identify risk factors and prevention strategies for burnout. Factors contributing to burnout included individual factors (age, gender, personality type), working conditions (high workload, overtime, interaction with patients), and organizational environment (managerial support, work culture). Effective prevention strategies combine individual interventions, such as mindfulness, CBT, and coping training, with organizational interventions, including supportive leadership, flexible policies, open communication, and empowerment of healthcare workers. Preventing burnout in healthcare workers requires a holistic approach that integrates individual and organizational strategies. Management and leadership support that emphasizes employee well-being is key to reducing burnout and improving the quality of healthcare services.
Manajemen Anestesi Perioperatif pada Pasien Obesitas: A Literature Review Nurrahma, Alya Nabila; Rakhman, Andre Kusuma
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.v16i2.1744

Abstract

The prevalence of obesity has continued to rise over the past decades and has become a major concern in clinical practice. Obesity presents specific challenges in perioperative management, particularly in airway management for obese patients undergoing surgical procedures. Anesthesiologists must understand the various risks associated with anatomical and physiological changes, including excessive fat deposition in the neck and thoracic regions, reduced functional residual capacity of the lungs, and increased oxygen demand. In addition, obese patients frequently have comorbid conditions such as diabetes mellitus, hypertension, and obstructive sleep apnea, which further increase the risk of perioperative complications. This article was prepared using a literature review method through a comprehensive search of scientific articles published in various journals. The literature included publications from 2020 to 2025 obtained from PubMed, NCBI, and Google Scholar databases. Selected articles were analyzed using a systematic literature review approach, which involved data collection, assessment of study quality, and synthesis of findings with a focus on perioperative management in obese patients. The results indicate that successful anesthetic management in obese patients strongly depends on thorough preoperative assessment, careful airway strategy planning, and appropriate selection of anesthetic techniques. During the intraoperative phase, close monitoring and adjustment of anesthetic drug dosing are essential to maintain patient safety. Postoperative care also plays a crucial role in preventing respiratory complications, particularly in the early recovery period. A comprehensive and integrated perioperative approach is required to improve patient safety and optimize clinical outcomes in obese individuals undergoing surgery.
The Hubungan Defisiensi Vitamin D dengan Risiko Infeksi Saluran Pernapasan Bawah pada Dewasa Hakim, Ashilah Mumtaz; Morfi, Chicy Widya
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.v16i2.1749

Abstract

Lower respiratory tract infections (LRTIs) remain a major public health problem in adults and contribute substantially to global morbidity and mortality. The risk of LRTIs increases among older adults and individuals with comorbid conditions, making the identification of modifiable risk factors essential. Vitamin D status has gained increasing attention due to its role not only in calcium homeostasis and bone health but also in the regulation of innate and adaptive immune responses. This literature review aims to evaluate the association between vitamin D deficiency and the risk and severity of LRTIs in the adult population. The review includes evidence from meta-analyses, randomized controlled trials, and cohort studies published within the past five years. The findings consistently show that serum 25-hydroxyvitamin D levels below 20 ng/mL are associated with a higher risk of pneumonia, prolonged hospital length of stay, and increased mortality. These associations are supported by biological mechanisms such as reduced production of antimicrobial peptides including cathelicidin, heightened pro-inflammatory immune responses, impaired macrophage and natural killer cell function, and weakened respiratory mucosal defenses. Several interventional studies indicate that vitamin D supplementation provides protective effects in individuals with vitamin D deficiency, particularly by reducing the incidence and severity of LRTIs, whereas the benefits appear limited in individuals with sufficient vitamin D levels. Overall, the evidence suggests that vitamin D screening, targeted supplementation, and comprehensive preventive strategies may play an important role in reducing the burden of LRTIs among adults.
Management of Abdominal Management of abdominal Typhoid in a 22 years old women without regular diet and lack of PHBS knowladge. especially washing hands before eating: Typoid fever, PHBS and Diet Dewi, Tri Agustina; Lisiswanti, Rika
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.v16i2.1750

Abstract

Typhoid fever is a potentially fatal multisystem infectious disease that remains a significant public health problem in Indonesia, particularly in areas with poor sanitation and inadequate implementation of clean and healthy living behavior (PHBS). We report a case of a 22-year-old woman who presented with continuous fever for approximately three days prior to admission, worsening in the afternoon and evening, accompanied by chills, headache, dizziness, nausea, vomiting, epigastric pain, and constipation. The patient had a history of irregular dietary habits, frequent consumption of street food, and poor hand hygiene practices, especially failure to wash hands before meals. Physical examination revealed a coated tongue and epigastric tenderness, while laboratory findings showed a Widal O titer of 1/320 supporting the diagnosis of abdominal typhoid fever. The patient was managed with chloramphenicol, antipyretics, intravenous fluids, bed rest, and a low-fiber diet, along with comprehensive education regarding PHBS implementation, particularly proper handwashing and regular dietary patterns. This case highlights that irregular eating habits and inadequate knowledge and practice of PHBS play an important role in the occurrence of abdominal typhoid fever, emphasizing the need for comprehensive management combining medical therapy and health behavior education to prevent recurrence and disease transmission.
Laporan Kasus: Nyeri Punggung Bawah Akibat Kerja pada Pekerja Pemanen Sawit Salsabila Nurislami; Winda Trijayanthi Utama
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.v16i2.1751

Abstract

Work-related diseases in the agricultural sector have shown a rising trend in recent years. Heavy physical activities involving non-ergonomic postures, heavy lifting, and repetitive movements increase the risk of injuries and musculoskeletal disorders. Low back pain is one of the most common musculoskeletal complaints among workers in this sector. This case report aims to analyze low back pain in an oil palm harvester using the application of the seven-step occupational diagnostic approach. The seven-step occupational diagnosis was applied to determine the causal relationship between occupational exposure and the patient’s symptoms. Clinical diagnosis and management were conducted in accordance with clinical guidelines.The patient was an oil palm harvester with recurrent episodes of low back pain. Occupational analysis showed that the patient worked in prolonged non-ergonomic postures—standing with neck extension, frequent forward bending, and repetitive heavy lifting—for 15 years, with daily work durations of 8–10 hours. Based on the seven-step occupational diagnostic assessment, the patient’s condition was classified as an occupational disease. Management included pharmacological therapy and ergonomic education. This case highlights that non-ergonomic working postures, the use of non-ergonomic tools, repetitive movements, and heavy lifting significantly contribute to the development of low back pain among agricultural workers. Pharmacological treatment must be accompanied by preventive strategies through ergonomic education. This case report underscores the importance of physicians’ competency in establishing occupational diagnoses and providing comprehensive management for workers with occupational diseases
Cushing Syndrome pada Anak Perempuan 5 Tahun: Sebuah Laporan Kasus Daradjat, Muhammad Yazid; Ismail, Ismi Citra
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.v16i2.1756

Abstract

Cushing’s syndrome (CS) is a rare multisystem endocrine disorder characterized by excessive glucocorticoid levels. In children, this condition is uncommon, with a reported global incidence of approximately 1:5,000,000–10,000,000 per year, and may result from endogenous overproduction or prolonged irrational use of exogenous steroids. This case report describes a 5-year-6-month-old girl presenting with fever accompanied by nausea, vomiting, and diarrhea. The patient had a history of recurrent unexplained fever for the past two years and had been repeatedly treated with paracetamol and dexamethasone without medical consultation until symptoms improved. The diagnosis was supported by physical examination findings suggestive of obesity, diastolic blood pressure above the 95th percentile, moon face, buffalo hump, acanthosis nigricans, and abdominal striae. Supporting examinations revealed adrenal ultrasonography within normal limits. Management included gradual tapering off dexamethasone and close observation for signs of adrenal crisis, followed by planned evaluation of cortisol and plasma adrenocorticotropic hormone levels. Long-term use of steroid medications without proper medical supervision remains the most common cause of CS in pediatric patients. This report emphasizes the importance of stricter regulation of over-the-counter steroid distribution by relevant stakeholders and highlights the critical role of clinicians in educating parents regarding the appropriate use of steroid medications to prevent the development of Cushing’s syndrome in children.
Case Report: Laki-Laki Usia 42 Tahun dengan Laryngopharingeal Refluks Pangestu, Farhan Ridho; Imanto, Mukhlis
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.v16i2.1759

Abstract

Laryngopharyngeal Reflux (LPR) is an inflammatory condition affecting the mucosa of the larynx and pharynx caused by the retrograde flow of gastroduodenal contents into the upper aerodigestive tract. This condition is frequently underdiagnosed due to its nonspecific symptoms, which often mimic other upper airway disorders. LPR presents with a wide range of clinical manifestations and is commonly managed by multiple medical disciplines without an accurate or standardized diagnostic approach. This case report aims to describe the clinical presentation, risk factors, diagnostic process, and management of LPR in an adult patient. We report the case of a 42-year-old male who presented with recurrent choking sensations, shortness of breath, dry cough, frequent throat clearing, and hoarseness persisting for four months, accompanied by worsening heartburn and epigastric discomfort. The patient had several predisposing factors, including obesity and unhealthy lifestyle habits such as high-fat and acidic food consumption and lying down shortly after meals. The diagnosis of LPR was established based on a Reflux Symptom Index (RSI) score of 14 obtained during anamnesis and a Reflux Finding Score (RFS) of 9 derived from indirect laryngoscopic examination. Management consisted of pharmacological therapy with high-dose proton pump inhibitors and antacids, combined with non-pharmacological interventions including lifestyle and dietary modifications. This integrated approach aims to reduce reflux episodes and mucosal inflammation. This case highlights the clinical importance of RSI and RFS as practical diagnostic tools for LPR and emphasizes the need for comprehensive management strategies to improve patient outcomes and quality of life.

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