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Medula
Published by Universitas Lampung
ISSN : -     EISSN : 97726154     DOI : -
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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LAPORAN KASUS: DIABETES MELITUS TIPE 2, HIPERTENSI, DAN NEUROPATI DIABETIK PADA PASIEN LANJUT USIA Tazkia Vidini Caya; Nanda Fitri Wardani
Medula Vol 16 No 3 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i3.1950

Abstract

Type 2 diabetes mellitus (T2DM) and hypertension are common chronic diseases among older adults and are associated with microvascular complications such as diabetic neuropathy. Comprehensive management is essential to prevent disease progression and improve patients' quality of life. This case report aims to describe the implementation of a holistic approach in managing a geriatric patient with T2DM, hypertension, and diabetic neuropathy at the primary healthcare level. Data were obtained through history taking, physical examination, laboratory findings, and follow-up evaluation. A 62-year-old woman presented with tingling and pain in both feet that had progressively worsened over the previous three months, accompanied by intermittent headaches. Clinical evaluation revealed a blood pressure of 160/95 mmHg, fasting blood glucose of 162 mg/dL, random blood glucose of 348 mg/dL, diminished patellar and Achilles reflexes, and a Douleur Neuropathique 4 (DN4) score of 5. The patient was diagnosed with T2DM, stage II hypertension, and diabetic neuropathy. Management included pharmacological treatment with metformin, amlodipine, and gabapentin, along with education regarding medication adherence, dietary modification, physical activity, and family support. Follow-up after 14 days demonstrated improvement in neuropathic symptoms, reduction of blood pressure to 137/90 mmHg, decreased fasting blood glucose to 149 mg/dL, improved treatment adherence, and healthier lifestyle behaviors. This case highlights that a holistic approach integrating medical therapy, health education, lifestyle modification, and family involvement can contribute to better clinical outcomes and risk factor control in geriatric patients with chronic diseases.
Cataracts in Elderly Patients with Grade 1 Hypertension: Case Reports Elizabeth Mega Sinaga; Winda Trijayanthi Utama
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.v17i1.1955

Abstract

Cataract is one of the leading causes of blindness worldwide, including in Indonesia, particularly among the elderly population. Uncontrolled hypertension is believed to accelerate the development of cataract through mechanisms involving oxidative stress and microvascular dysfunction. This case is reported due to the frequent coexistence of hypertension and cataract in older adults; however, the relationship between systemic risk factor control and visual function preservation is often underemphasized. The aim of this report is to describe the clinical manifestations, risk factors, diagnostic approach, and management of a patient with hypertension and senile cataract. This case report is based on primary data obtained from medical history taking, physical examination, blood pressure measurement, and ophthalmological assessment. A 63-year-old male patient, Mr. H, was diagnosed with grade 1 hypertension and senile cataract, presenting with progressive right eye visual deterioration accompanied by a sensation of haze and glare. Clinical evaluation revealed a blood pressure of 145/93 mmHg, reduced visual acuity, lens opacity, and a positive shadow test, supporting the diagnosis. Management included administration of amlodipine 5 mg, lifestyle modification education such as a low-salt diet, increased physical activity, smoking cessation, and improved medication adherence. The patient was also referred to an ophthalmologist for further evaluation and consideration of phacoemulsification as definitive therapy. This case highlights that early recognition, blood pressure control, and appropriate management play an important role in slowing disease progression and preserving visual function.
Osteoatritis Lutut dengan Hipertensi Derajat 1 pada Pasien Lanjut Usia: Sebuah Laporan Kasus Mentari Putri Maharani; Winda Trijayanthi Utama
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.v17i1.1956

Abstract

Osteoarthritis (OA) and hypertension are chronic degenerative diseases commonly found in older adults and share interrelated pathophysiological mechanisms that may exacerbate each other through vascular, inflammatory, and functional decline pathways. This case report aims to describe a comprehensive approach in a patient with knee OA and stage 1 hypertension. A 62-year-old woman presented with chronic left knee pain that worsened with activity, accompanied by morning stiffness lasting less than 30 minutes. The patient had a history of uncontrolled hypertension and obesity with a body mass index of 27.6 kg/m². The diagnosis of knee OA and stage 1 hypertension was established based on history taking, physical examination, and clinical investigations. Management was performed comprehensively using pharmacological therapy consisting of sodium diclofenac, omeprazole, and amlodipine, along with non-pharmacological interventions including patient education, lifestyle modification, weight control, increased physical activity, and dietary adjustment. Particular attention was given to NSAID use in patients with cardiometabolic risk factors due to the potential for increased blood pressure and cardiovascular risk, necessitating careful risk–benefit consideration and regular clinical monitoring. Follow-up evaluation demonstrated improvement in blood pressure and reduction in pain, leading to enhanced daily functional capacity. This case highlights the importance of a multidimensional approach in OA with comorbid hypertension, focusing not only on symptom control but also on cardiovascular risk stratification, analgesic safety, and sustained lifestyle interventions to improve therapeutic outcomes and patient quality of life.
Hipertrofi Tonsil Bilateral dengan Rinitis Alergi Intermiten Ringan: Laporan Kasus Vania Christy M. Panjaitan; Mukhlis Imanto
Medula Vol 16 No 4 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

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

Abstract

Tonsillar hypertrophy is an enlargement of the tonsillar tissue that may result from recurrent infections, chronic inflammation, or allergic processes. This condition can lead to upper airway obstruction, dysphagia, sleep disturbances, and alterations in voice resonance. Allergic rhinitis is an inflammatory disorder of the nasal mucosa mediated by immunoglobulin E (IgE) following exposure to allergens. We report the case of a 28-year-old woman who presented to the Otorhinolaryngology Clinic of Dr. H. Abdul Moeloek Regional General Hospital with a lifelong complaint of a nasal voice, accompanied by alternating nasal obstruction, clear rhinorrhea, recurrent sneezing, and mild dyspnea during sleep triggered by dust, cat dander, and cold air. Physical examination revealed grade T4-T4 tonsillar hypertrophy without signs of active infection. Anterior rhinoscopy demonstrated serous nasal discharge and a livid nasal septal mucosa, while nasal endoscopy showed patent nasal cavities with positive secretions. Laboratory findings revealed elevated eosinophil count 4,2% (normal : 2%-4%). Based on the patient's history, physical examination, endoscopic findings, and supporting investigations, a diagnosis of bilateral tonsillar hypertrophy without active infection associated with moderate-severe intermittent allergic rhinitis was established. Management consisted of loratadine as a second-generation antihistamine, fluticasone furoate nasal spray as an intranasal corticosteroid, allergen avoidance education, and environmental control measures. Considering the presence of severe tonsillar hypertrophy causing impaired voice resonance and potential upper airway obstruction, tonsillectomy was planned as definitive treatment; however, no follow-up or postoperative evaluation had been performed at the time this report was written. The patient’s prognosis was considered favorable with appropriate therapy and adequate control of triggering factors.
Demam Tifoid pada Seorang Pasien Usia 21 Tahun: Laporan Kasus Abrila Tamara Putri; Winda Trijayanthi Utama
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.v17i1.1959

Abstract

Typhoid fever is an endemic infectious disease in Indonesia caused by systemic infection with Salmonella typhi and transmitted through the fecal–oral route. This disease has become a significant contributor to morbidity and mortality. Clinical manifestations, diagnostic approaches, comprehensive management, and preventive education are discussed in this case report. A 21-year-old female patient presented to a primary healthcare center with complaints of a step-ladder pattern fever for seven days, accompanied by nausea and vomiting, dry cough, and joint pain. A history of irregular dietary habits and poor hygiene practices, including frequent consumption of street food and inadequate hand hygiene before meals, were identified as major risk factors for fecal–oral transmission. Physical examination revealed a moderately ill general condition, coated tongue, and tenderness in the epigastric region. The diagnosis of acute typhoid fever was established based on serological examination using the Widal test, which demonstrated an elevated Salmonella Typhi O antibody titer of 1:320. Empirical pharmacological management included first-line antibiotic therapy with cefixime for intracellular bacterial eradication, antipyretic treatment with paracetamol, and antiemetic therapy. Non-pharmacological management consisted of strict bed rest to reduce metabolic demands, oral rehydration therapy, and dietary modification with a soft, low-fiber diet. Preventive education focused on modifying environmental and personal risk factors, including proper handwashing with soap, maintaining food sanitation to prevent contamination by fly vectors, and boiling drinking water thoroughly to reduce the risk of recurrent infection and interrupt disease transmission within the community. Early diagnosis and appropriate management are essential to prevent potentially life-threatening complications.
Laporan Kasus : Perempuan 61 tahun dengan Katarak Senilis Imatur Okuli Dekstra et Sinistra Faradhila Azqiah Cahyani; Winda Trijayanthi Utama
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.v17i1.1961

Abstract

The eye is one of the sensory organs that functions as the organ of vision. Various ocular disorders can cause visual impairment, one of which is cataract. Cataract is a condition characterized by opacification of the lens, which can lead to impaired visual function. Cataracts can be classified into several types, one of which is senile cataract. Senile cataract is a type of cataract associated with the aging process. It can cause visual disturbances that significantly affect the quality of life of affected individuals. We report the case of a 61-year-old woman who presented to the Ophthalmology Clinic of Dr. A. Dadi Tjokrodipo Hospital with complaints of blurred vision for one year prior to admission, which had progressively worsened over the past month. The patient also complained of cloudy vision, glare, and a foreign body sensation in the eye. Ophthalmological examination revealed visual acuity of 1/60 in both the right and left eyes, with a positive shadow test on physical examination. Based on the clinical findings, the patient was diagnosed with senile cataract. Accurate diagnosis through thorough history taking and comprehensive ophthalmological examination is essential to determine disease severity and appropriate therapeutic management. Adequate treatment can improve visual function, enhance quality of life, and significantly influence the patient's prognosis. This case report aims to discuss the clinical presentation, diagnostic approach, and management of senile cataract in an elderly patient.
Tantangan Pengendalian Diabetes Melitus dan Hipertensi pada Lansia: Sebuah Laporan Kasus Fayza Syachrani; Dian Isti Anggraini
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.v17i1.1962

Abstract

Diabetes mellitus (DM) and hypertension are common chronic diseases among older adults and frequently coexist, increasing the risk of cardiovascular and microvascular complications. Successful disease management depends not only on pharmacological treatment but also on dietary habits, physical activity, and medication adherence. This case report describes a 60-year-old woman with a 15-year history of DM and hypertension who attended a routine evaluation at an elderly community health service. Her initial assessment revealed a blood pressure of 168/96 mmHg, a random blood glucose level of 263 mg/dL, and a body mass index of 21 kg/m². The patient reported a high-sodium diet, frequent consumption of fried foods, low-fiber carbohydrate intake, limited physical activity, and poor medication adherence due to forgetfulness and limited access to healthcare services. She received education regarding medication adherence, balanced nutrition, sodium and fat restriction, increased physical activity, and the importance of regular follow-up. Three weeks later, her blood pressure decreased to 160/90 mmHg and her random blood glucose level improved to 190 mg/dL, although therapeutic targets had not yet been achieved. This case highlights that inappropriate dietary habits and poor medication adherence contribute to suboptimal control of DM and hypertension in older adults. A comprehensive approach involving continuous education, lifestyle modification, adherence assessment, and regular monitoring is essential to improve long-term therapeutic outcomes and prevent disease-related complications.
Hubungan Psychological Well-Being dengan Prokrastinasi Akademik pada Mahasiswa Tingkat Akhir Program Studi Pendidikan Dokter Universitas Lampung Rizqi Hidayat; Rasmi Zakiah Oktarlina; Ari Irawan Romulya
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.v17i1.1963

Abstract

The massive academic and clinical burden on final-year medical students is highly prone to triggering stress that leads to increased academic procrastination, a phenomenon that can be mitigated through the optimization of psychological well-being (PWB). This study aims to identify the relationship between PWB and academic procrastination among final-year students of the Medical Education Study Program at the University of Lampung. The research design employed an observational analytic method with a cross-sectional approach. Out of a target population of 146 students from the 2020 cohort, a final sample of 141 respondents was selected using the total sampling technique, while 5 students were excluded due to being academically inactive or declining to participate. Primary data collection relied on validated and reliable Indonesian versions of the Psychological Well-Being Scale (PWBS) and Academic Procrastination Scale (APS), which were subsequently analyzed using the non-parametric Rank Spearman correlation test. The univariate analysis results showed that respondents' PWB levels were dominated by the moderate category with 92 students (65.3%), and procrastination levels were also predominantly moderate with 110 students (78%). Furthermore, the bivariate analysis confirmed a significant but weak negative correlation between psychological well-being and academic task deferral behavior (p=0.01; r=−0.216). This finding demonstrates an inverse trend; the enhancement of students' psychological emotional states is accompanied by a decrease in procrastination intensity. In conclusion, a psychologically healthy mental state is proven to serve as an effective internal protective factor that minimizes academic procrastination behavior among final-year medical students.
Stroke Iskemik dengan Hemiparesis Sinistra pada Pasien Laki-Laki Usia 54 Tahun : Laporan Kasus Ditya Ananda Safira; Winda Trijayanthi Utama
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.v17i1.1964

Abstract

Ischemic stroke is an acute neurological condition requiring rapid onset-time assessment because reperfusion therapy is only beneficial in selected patients within a specific therapeutic window. This case report discusses ischemic stroke with left hemiparesis in a 54-year-old male patient presenting outside the reperfusion therapy window. The patient arrived at the emergency department on September 1, 2024, at 13:31 Western Indonesian Time with left arm and leg weakness, dysarthria, left tongue deviation, and swallowing difficulty. Symptoms began on August 30, 2024, at approximately 09:00, resulting in an estimated onset-to-door time of 52 hours and 31 minutes. Blood pressure on arrival was 157/108 mmHg. A non-contrast head CT scan showed a hypodense lesion in the right temporal lobe, supporting ischemic stroke. Reperfusion therapy was not performed because the patient presented beyond the therapeutic window. Management included antiplatelet therapy, antihypertensive therapy, dysphagia screening using the water swallow test, inpatient physiotherapy, and home exercise education. After seven days of hospitalization, the patient was discharged in stable condition with compos mentis consciousness, GCS 15, left-sided motor strength of 5/5, improved dysarthria, improved tongue deviation and swallowing ability, and independent ambulation. Discharge medications included amlodipine 10 mg once daily and aspirin 80 mg once daily. This case emphasizes the importance of onset documentation, swallowing assessment, early rehabilitation, and secondary prevention in ischemic stroke.
Deteksi Dini Atresia Bilier dan Tatalaksana Kolangitis Pasca Hepatoportoenterostomi di Fasilitas Terbatas: Laporan Kasus Zahra Qori Azizza; Mohammad Taufik Perwira Wicaksono
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.v16i4.1966

Abstract

Biliary atresia is the most common cause of extrahepatic cholestasis in infants, with an incidence of approximately 1 in 8,000–18,000 live births. Delayed diagnosis can decrease the success rate of hepatoportoenterostomy and increase the risk of cirrhosis and end-stage liver failure. Early detection of biliary atresia can be achieved through the identification of three characteristic signs: pale or tarry stools, elevated gamma-glutamyltransferase (GGT) levels >250 IU/L, and ultrasound findings suggestive of biliary atresia. Hepatoportoenterostomy is the definitive treatment to restore bile flow from the remaining patent intrahepatic bile ducts to the intestinal tract. However, this procedure often has complications, including cholangitis due to ascending bacterial infection through the hepatoportoenterostomy anastomosis. This article reports a case of a male infant who began experiencing persistent jaundice and tarry stools at two weeks of age. At 40 days of age, an increase in direct bilirubin and a GGT level of 606 IU/L were found, suggesting biliary atresia, although other differential diagnoses still needed to be ruled out. Limited diagnostic facilities in the area required referral for intraoperative cholangiography, which confirmed the diagnosis of biliary atresia and was followed by hepatoportoenterostomy. At five months of age, the patient returned with fever, jaundice, and tarry stools, suggesting postoperative cholangitis. Initial antibiotic therapy did not improve clinically, but the patient's condition improved after seven days of meropenem. This case highlights the importance of early detection of biliary atresia, awareness of post-hepatoportoenterostomy cholangitis, and the challenges of diagnosis and management in resource-limited healthcare facilities.

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