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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 1,081 Documents
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Apendisitis Akut pada Pasien Usia Lanjut: Laporan Kasus Noval Ramadirta; 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.v16i2.1890

Abstract

Acute appendicitis is one of the most common surgical abdominal emergencies and may lead to severe complications such as perforation if not promptly and appropriately managed, particularly in elderly patients who often present with atypical clinical features. This case report aims to describe the diagnostic approach and management of acute appendicitis in an elderly patient using a comprehensive clinical, laboratory, and imaging-based evaluation. A 64-year-old male presented with right lower quadrant abdominal pain preceded by periumbilical pain, accompanied by nausea and vomiting. Physical examination revealed right lower quadrant tenderness with a positive McBurney sign without generalized peritoneal irritation. Laboratory findings showed leukocytosis with neutrophil predominance, while abdominal ultrasonography suggested acute appendicitis with suspected periappendiceal abscess. Based on the Alvarado and RIPASA scores, the patient was classified as high probability for acute appendicitis and underwent appendectomy. Intraoperative findings revealed non-perforated acute appendicitis without abscess formation, establishing the definitive diagnosis of uncomplicated acute appendicitis. The patient received empirical antibiotic therapy, analgesics, and definitive surgical management with favorable postoperative outcomes without complications. This case highlights that the integration of history taking, physical examination, laboratory tests, imaging, and clinical scoring systems is essential for accurate diagnosis of acute appendicitis, especially in elderly patients with variable clinical presentations, and emphasizes the importance of early surgical intervention to prevent disease progression and complications.
Herpes Zoster pada Pasien Dewasa Muda : Laporan Kasus Andra Nabila Fauziani; 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.v16i2.1891

Abstract

Herpes zoster is a reactivation of latent Varicella-zoster virus (VZV) infection that commonly occurs in older adults and immunocompromised individuals, but it may also develop in immunocompetent young adults. This case report aims to describe the clinical manifestation, diagnosis, and management of maxillary branch trigeminal herpes zoster in a young patient without known major risk factors. A 20-year-old woman presented to the Dermatology and Venereology Outpatient Clinic of Dr. H. Abdul Moeloek Hospital with painful vesicular eruptions accompanied by a burning sensation on the left cheek that had appeared four days before presentation. Dermatological examination revealed grouped vesicles on an erythematous base distributed unilaterally along the maxillary branch of the trigeminal nerve without crossing the midline. The diagnosis was established based on history taking and characteristic clinical findings without laboratory confirmation. The patient was treated with oral acyclovir, gabapentin, and supportive therapy. Follow-up evaluation two days after treatment showed no new lesions, gradual crusting of vesicles, and improvement of pain and burning sensation. This case demonstrates that herpes zoster may occur in immunocompetent young adults without identifiable predisposing factors and should therefore remain a differential diagnosis of unilateral vesicular facial eruptions. Accurate clinical diagnosis and timely antiviral therapy are important to promote clinical improvement and prevent complications.
Orchitis Sebagai Komplikasi Infeksi Mumps (Gondongan): A Case Series Rizqiani Astrid Nasution; Oktadoni Saputra
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.v16i2.1896

Abstract

Mumps is a viral infectious disease that is generally self-limiting but may lead to serious complications, including orchitis, which can adversely affect future fertility, particularly in adolescent males. This case series aims to describe the clinical manifestations, diagnostic approach, and management of mumps-associated orchitis in a prepubertal child and an adolescent. Two male patients aged 11 and 15 years who were treated at Dr. H. Abdul Moeloek Hospital in 2024 were diagnosed with mumps orchitis. Both patients initially presented with parotid gland swelling followed by fever, scrotal swelling, and testicular pain several days later. Diagnosis was established through history taking, physical examination, laboratory investigations, and scrotal ultrasonography in one patient. Ultrasonographic findings demonstrated epididymo-orchitis characterized by enlargement of the testis and epididymis with increased vascularity. Both patients received supportive management, including hydration and analgesics, with additional therapies administered according to clinical indications. Clinical improvement was observed in both patients during hospitalization. This report highlights that orchitis may occur as a complication of mumps in both prepubertal and adolescent males, including those with a complete immunization history. Early recognition of orchitis symptoms in patients with mumps is essential to ensure timely diagnosis and appropriate management, thereby reducing the risk of long-term reproductive complications.
Destroyed Lung in Children Undergoing Treatment for Pulmonary Tuberculosis: A Case Report Carissa Aprilia Yusanda; Shinta Nareswari
Medula Vol 16 No 4 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i4.1919

Abstract

Tuberculosis (TB) is a global health problem, especially in developing countries, with a high prevalence in South Asia and Sub-Saharan Africa. In 2019, there were around 1.2 million new cases of TB in children and 230,000 deaths from TB in children under 15 years of age. In Indonesia, the incidence of TB is very high, with more than 1 million people diagnosed in 2022, and 140,700 deaths from TB in the same year. One of the serious complications of TB is a destroyed lung, which is an advanced stage of pulmonary TB. This condition causes extensive and progressive damage to the lung parenchyma, disrupts lung function, and has the potential to cause respiratory failure, shortness of breath, secondary infections, and other complications. Although symptoms of TB often appear in the early stages, late diagnosis can worsen the prognosis and increase mortality. This case report analyzes a 13-year-old child patient who was referred to the hospital with complaints of cough, greenish sputum, and coughing up blood after recovering from chickenpox. Radiological examination showed atelectasis, bronchiectasis, and indications of destroyed lung. The diagnosis of pulmonary TB with destroyed lung was obtained after physical examination, laboratory, and other supporting examinations. The management includes treatment with antituberculosis drugs (OAT), antibiotics, supportive therapy, and pulmonary rehabilitation. Appropriate management can improve the patient's quality of life even though the prognosis is poor in the long term.
Case Report: Bilateral Sensorineural Hearing Loss Faradhifa Karima Ardianti; Fivien Fedriani
Medula Vol 17 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i1.1921

Abstract

Sensorineural hearing loss (SNHL) is a hearing disorder caused by damage to the cochlea, auditory nerve, or central auditory pathways connecting the ear to the brain. It is the most common type of hearing impairment, affecting more than 5% of the global population, and its prevalence continues to increase with aging. The etiology of SNHL is multifactorial, including age-related degeneration, noise exposure, infection, vascular disorders, and autoimmune diseases. This case report describes a 63-year-old man with a history of Autoimmune Hemolytic Anemia (AIHA) who developed sudden bilateral hearing loss after receiving a transfusion of two units of blood. The hearing loss was preceded by tinnitus and was occasionally accompanied by vertigo without other associated symptoms. Ear, nose, and throat examinations were unremarkable. The whisper test indicated severe hearing loss, while tuning fork tests could not be performed because the patient was unable to perceive the sound. Pure-tone audiometry confirmed severe bilateral sensorineural hearing loss, and the patient was advised to use hearing aids. The diagnosis was established through comprehensive history taking, physical examination, hearing assessment, and audiometric evaluation. The underlying pathophysiology was considered to involve age-related cochlear degeneration aggravated by systemic autoimmune inflammation. Prognosis depends on the severity and underlying etiology of hearing loss. This case highlights the importance of comprehensive clinical evaluation, audiometry, and appropriate management to determine disease severity, improve communication, prevent complications, and optimize the patient's quality of life.
Tonsilitis Kronis Eksaserbasi Akut pada Anak Perempuan Usia 12 Tahun: LAPORAN KASUS Ardian Reza Putra; Fitria Saftarina
Medula Vol 17 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i1.1922

Abstract

Chronic tonsillitis is a persistent inflammation of the tonsils resulting from recurrent infections and may undergo acute exacerbation, leading to more severe clinical manifestations. This condition is commonly encountered among school-aged children and may negatively affect quality of life, school performance, nutritional intake, and sleep quality. Contributing risk factors include recurrent upper respiratory tract infections, consumption of irritative foods and beverages, exposure to cigarette smoke, and poor oral hygiene. This case report aims to describe the clinical presentation, risk factors, management, and outcome of chronic tonsillitis with acute exacerbation in a pediatric patient. A 12-year-old girl presented with a three-day history of sore throat and odynophagia. The symptoms were accompanied by fever, foreign body sensation in the throat, cough, rhinorrhea, and decreased appetite. She had experienced recurrent episodes over the previous one and a half years, commonly triggered by fried foods, packaged snacks, and cold beverages. Physical examination revealed hyperemic tonsils with T2–T2 enlargement, irregular tonsillar surfaces, widened crypts, and positive detritus. Based on the history and physical findings, a diagnosis of chronic tonsillitis with acute exacerbation was established. The patient received paracetamol, amoxicillin, and dexamethasone, along with education regarding risk-factor modification and improvement of oral hygiene practices. One-month follow-up demonstrated significant clinical improvement without recurrence of symptoms. This case highlights the importance of identifying modifiable risk factors and providing comprehensive patient education as integral components of chronic tonsillitis management to reduce recurrence and improve clinical outcomes in pediatric patients.  
Pertussis and Bronchopneumonia in a One-Month-Old Infant: A Case Report: Pertussis and Bronchopneumonia in a One-Month-Old Infant: A Case Report Virgiansya Alhafiz; Shinta Nareswari
Medula Vol 16 No 4 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i4.1932

Abstract

Pertussis and bronchopneumonia are significant respiratory tract infections that cause high morbidity and mortality in young infants. The combination of these two conditions poses a severe clinical challenge, particularly in patients with an immature immune system who have not yet received immunization. This case report aims to discuss the diagnostic challenges regarding the CDC/WHO criteria for probable pertussis, the importance of intensive monitoring parameters, and the simultaneous management of atypical manifestations in young infants. A 1-month-11-day-old male infant presented with an 8-day history of paroxysmal cough, accompanied by post-tussive cyanosis, dyspnea, and nocturnal fever, with episodes of apnea. The patient had not received the DPT vaccination. Household contact tracing revealed that the patient's father had a history of chronic cough for the past 2 weeks and had not undergone any examination. Physical examination showed an oxygen saturation of 90% on room air and bilateral rhonchi. Laboratory evaluation revealed leukocytosis (14,900/mm³) with predominant relative lymphocytosis (68%) and thrombocytosis (561,000/μL). A chest X-ray demonstrated bilateral perihilar and right paracardiac infiltrates, confirming bronchopneumonia. Based on these findings, the patient was diagnosed with probable pertussis and bronchopneumonia. Therapeutic interventions included intravenous ampicillin-sulbactam, intravenous gentamicin, oral azithromycin, nebulized salbutamol + ipratropium bromide, and oxygen supplementation. The patient showed significant clinical recovery and was discharged on the fourth day of hospitalization. High clinical vigilance for pertussis and bronchopneumonia is vital when evaluating young infants presenting with paroxysmal cough, cyanosis, incomplete immunization status, and a history of close contact with an individual suffering from a chronic cough. The simultaneous administration of empirical macrolides and broad-spectrum antibiotics is effective in ensuring a successful clinical outcome.
Endoftalmitis Okuli Dextra pada Seorang Pekerja Konstruksi : Laporan Kasus Almaina Puteri Jasmine; Risti Graharti; Rani Himayani
Medula Vol 17 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i1.1939

Abstract

Endophthalmitis is a severe intraocular infection involving the aqueous and/or vitreous humor and is considered an ophthalmic emergency due to its potential to cause irreversible vision loss if not treated promptly. Globally, most cases of endophthalmitis are associated with ocular surgery and ocular trauma. Exogenous endophthalmitis is the most common form and may be caused by Gram-positive bacteria, Gram-negative bacteria, or fungi. Ocular trauma is one of the major risk factors for the development of exogenous endophthalmitis. This report describes a 49-year-old construction worker presenting with right eye redness, pain radiating to the head, swelling, and progressive visual deterioration leading to loss of light perception. Ophthalmologic examination revealed no light perception in the right eye, eyelid edema and hyperemia, mucoserous discharge, conjunctival injection, corneal opacity, and hypopyon involving up to three-quarters of the cornea. The patient was diagnosed with right eye endophthalmitis and treated with topical levofloxacin, ceftriaxone, methylprednisolone, and ketorolac. After two days of treatment, no clinical improvement was observed. The patient was subsequently scheduled for surgical evisceration. This case highlights that endophthalmitis may present with severe clinical manifestations and poor outcomes in advanced stages. Prompt diagnosis and appropriate management are essential to preserve visual function and prevent further complications.
Penatalaksanaan Holistik Pasien Perempuan Usia 56 Tahun dengan Ulkus Peptikum: Laporan Kasus Tamadar Hilmi; Fitria Saftarina
Medula Vol 17 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i1.1945

Abstract

Peptic ulcer disease remains one of the most common upper gastrointestinal disorders encountered in primary healthcare settings and may lead to serious complications if not managed appropriately, including gastrointestinal bleeding, decreased quality of life, and recurrence. This case report describes a 56-year-old woman presenting with chronic epigastric pain accompanied by nausea, vomiting, abdominal fullness, and a history of gastrointestinal bleeding. Data were collected through autoanamnesis, physical examination, home visits, and medical record review. Case assessment was conducted using a holistic diagnostic approach to identify internal and external factors contributing to the patient’s condition. Internal risk factors included irregular eating habits, frequent consumption of spicy foods on an empty stomach, inadequate stress management, and limited knowledge regarding the disease and its prevention. External factors included a family healthcare-seeking pattern that remained predominantly curative and insufficient family support for health behavior modification. Interventions consisted of pharmacological therapy according to clinical indications, education regarding dietary modification and healthy lifestyle practices, stress management counseling, and family involvement in the care process. Evaluation demonstrated improvement in clinical symptoms, increased patient knowledge, and positive changes in health behavior. A   holistic, patient-centered, and community medicine approach contributed to successful management of peptic ulcer disease and prevention of recurrence in primary care settings.
Penatalaksanaan Secara Holistik pada pasien 67 Tahun dengan Ulkus Kaki Diabetikum: Laporan Kasus Nimas Shifa Azzahra; Aila Karyus
Medula Vol 16 No 4 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i4.1948

Abstract

Diabetic foot ulcers are a chronic complication of diabetes mellitus that has a high prevalence globally, including in Indonesia. This condition can lead to a decreased quality of life and increase the risk of infection and amputation. This study discusses the case of a 67-year-old woman with a diabetic foot ulcer who was managed through a comprehensive approach based on EBM to improve the healing process and prevent complications. This study is structured as a case report, with primary data collected through anamnesis, physical examination, and home visits. Secondary data sources were obtained from the patient's medical records at the community health center. The evaluation was conducted using a holistic diagnostic approach, both quantitatively and qualitatively, covering the initial stages, implementation process, and final results of the study. Patient Mrs. H, 67, complained of a wound that had not healed for three months. Additional complaints included frequent hunger, frequent thirst, and frequent urination. In this study, diagnosis and management were carried out in accordance with current guidelines and literature, including glycemic control, wound care, health education, and regular monitoring. After a five-day holistic intervention, there was a decrease in fasting blood glucose from 262 mg/dL to 210 mg/dL (19.8% decrease), improvement in nutritional adequacy figures through food recall obtained data on energy reduction from 60.86% to 33.9%, with details of carbohydrates from 280% to 122.8%, protein 152.9% to 143.2%, and fat from 434% to 325.8% and an increase in patient knowledge scores from 50 to 80 (scale 0-100).

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