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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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Tuberkulosis Paru Anak dengan Hemoptisis dan Resistensi Rifampisin Indeterminate: Laporan Kasus Imtinan Khoirunnisa; 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.v16i4.1968

Abstract

Tuberculosis (TB) in children remains a major contributor to global morbidity and mortality. Although clinical manifestations such as hemoptysis have been increasingly reported in adolescents, the primary diagnostic challenge in this case lies in the Molecular Rapid Test (TCM) GeneXpert result showing indeterminate rifampicin resistance. The patient's chest X-ray showed primary pulmonary TB, consistent with positive Mantoux and lipoarabinomannan (LAM) TB test results. TCM GeneXpert examination confirmed pulmonary TB bacteriologically, with MTB trace detected and indeterminate rifampicin resistance. In addition, Gram staining of sputum showed a mixed flora of bacteria and fungi, reflecting colonization or potential infection in the respiratory tract. The patient was diagnosed with bacteriologically confirmed pulmonary TB with hemoptysis and anemia due to chronic disease, and was well-nourished. Medical interventions included a first-line Anti-Tuberculosis Drug (OAT) regimen and symptomatic therapy. The patient's clinical outcome was excellent, characterized by the immediate cessation of hemoptysis post-tranexamic acid initiation and the achievement of overall clinical improvement during hospitalization.  Overall, indeterminate rifampicin in TCM with a low (trace) bacterial load requires thorough clinical correlation to guide timely therapy.
Karsinoma Nasofaring: Sebuah Laporan Kasus Gatra Hadimuti Wibowo; Ratu Fajaria; Risti Graharti
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.v16i4.1969

Abstract

Nasopharyngeal carcinoma (NPC) is a malignant tumor originating from the nasopharyngeal epithelium and is the fourth most common malignancy in Indonesia, with approximately 13,000 new cases annually. Diagnosis is often delayed due to the concealed location of the nasopharynx. Case presentation: A 40-year-old male presented with left-sided tinnitus, earache radiating to the head, hearing loss, nasal congestion, odynophagia, hoarseness, and a 5-7 kg weight loss over 4 months. He had a history of Bell's palsy 8 months prior with House-Brackmann grade III that partially improved. Physical examination revealed no cervical lymphadenopathy. Nasopharyngeal CT scan showed left nasopharyngeal thickening, narrowing of the Rosenmüller fossa, and a hypodense lesion in the left temporal lobe suggestive of intracranial invasion. Discussion: This case is unique due to the combination of early manifestation as Bell's palsy without cervical lymphadenopathy, which differs from the typical NPC pattern where 70-90% of patients present with cervical metastases. Facial nerve involvement in NPC is rare (incidence <1%) and often overlooked as an early sign of malignancy. MSCT and MRI imaging play a crucial role in early detection of intracranial invasion. Conclusion: NPC should be suspected in adults with persistent ear, nose, and throat symptoms accompanied by weight loss, especially if there is an atypical history of Bell's palsy, even in the absence of cervical lymphadenopathy. Histopathological confirmation through nasopharyngeal biopsy remains essential before definitive management.
Tonsilitis Akut pada Anak : Laporan Kasus Aisyah Lubis; Mukhlis Imanto
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.v17i1.1970

Abstract

Acute tonsillitis is a common ENT disease in children, characterized by sudden inflammation of the tonsils due to viral or bacterial infections. This condition can cause impaired swallowing, breathing, sleep, and reduce children's quality of life if not properly treated. We report a case of a 9-year-old boy with painful swallowing for 5 days, accompanied by fever, cough, runny nose, and snoring. Physical examination revealed T3-T3 tonsillar enlargement, bilateral hyperemia (+/+), no detritus, and no lymphadenopathy. The patient's Centor score was 1, leading to a diagnosis of acute tonsillitis of viral etiology. The patient received symptomatic therapy (paracetamol, rest, hydration, warm salt water gargling, and education) without antibiotics.
Otitis Media Supuratif Kronik Auris Dextra Tipe Aman Fase Aktif Pada Anak Usia 2 Tahun : Sebuah Laporan Kasus Indah Kurnia Putri Waruwu; Mukhlis Imanto
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.v16i4.1971

Abstract

Benign-type chronic suppurative otitis media (CSOM) is a chronic middle ear infection characterized by a central tympanic membrane perforation and persistent otorrhea without cholesteatoma, with inflammation limited to the middle ear mucosa. Benign-type CSOM cases in children under 3 years of age are rarely reported, despite this age group having a high risk of recurrent ear infections due to the immature anatomy of the Eustachian tube, which is shorter, wider, and more horizontal compared to that of adults. We report a case of a 2-year-old boy who presented to the ENT Outpatient Clinic of Dr. H. Abdul Moeloek Regional General Hospital, Lampung Province, with a 2-month history of yellowish-white discharge from the right ear. The complaint was accompanied by hearing loss, indicated by the child not turning his head when called from behind. History-taking revealed six episodes of recurrent upper respiratory tract infection (URTI) within the past year, as well as exposure to cigarette smoke from the patient's father at home. Both conditions were significant risk factors contributing to the development of CSOM. Otoendoscopic examination revealed a subtotal central perforation of the pars tensa of the right tympanic membrane without cholesteatoma, establishing the diagnosis of active benign-type CSOM. The patient received aural toilet with 3% hydrogen peroxide for 3–5 days to clear the discharge, followed by topical ofloxacin 0.3% for 14 days. Parental education was provided regarding proper medication administration, keeping the ear dry, and avoiding cigarette smoke exposure. Accurate diagnosis and appropriate management are essential to prevent hearing impairment and delayed speech and language development in children.
Apnea Periodik akibat Patent Ductus Arteriosus Besar dan Bronkopneumonia pada Bayi Usia 2 Bulan Clara Arta Uli Rahel; 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.v16i4.1972

Abstract

Patent Ductus Arteriosus (PDA) is a congenital heart defect resulting from the failure of ductus arteriosus closure after birth. A large PDA may produce a significant left-to-right shunt, leading to pulmonary overcirculation, heart failure, recurrent respiratory infections, growth failure, and apnea. This case report aims to describe the clinical presentation, diagnostic approach, and comprehensive management of an infant with periodic apnea associated with a large PDA complicated by bronchopneumonia. A 2-month-old female infant was admitted with cold extremities, cyanosis, and recurrent episodes of apnea lasting more than 20 seconds, occurring 4 hours before hospitalization. The patient also had a productive cough, respiratory distress, and poor weight gain since birth. Physical examination revealed tachypnea, subcostal and substernal retractions, cold extremities, a continuous cardiac murmur, and undernutrition with a body weight of 2.7 kg. Chest radiography demonstrated right bronchopneumonia, while echocardiography confirmed the presence of a large PDA. The patient was diagnosed with periodic apnea secondary to a large PDA, accompanied by bronchopneumonia, undernutrition, and incomplete basic immunization. Management consisted of oxygen therapy, intravenous antibiotics, bronchodilator nebulization, captopril and furosemide administration, and high-calorie nutritional support. After 10 days of hospitalization, significant clinical improvement was observed, including resolution of apnea and cyanotic episodes, reduced respiratory distress, hemodynamic stabilization, and weight gain to 2.9 kg. This case highlights the importance of considering congenital heart disease in infants presenting with recurrent respiratory symptoms, apnea, and failure to thrive to ensure timely diagnosis and comprehensive management.
Acute Kidney Injury (AKI) et causa Sindrom Nefrotik dengan Komponen Nefritik pada Anak: Laporan Kasus Auriva Renasha Suherman; 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.v16i4.1980

Abstract

Acute Kidney Injury (AKI) is a clinical syndrome characterized by a sudden decline in kidney function, resulting in disturbances of fluid and electrolyte balance and the accumulation of metabolic waste products. In children, AKI may occur secondary to various underlying conditions, including nephrotic syndrome with nephritic components. This case report aims to describe the clinical manifestations, diagnostic evaluation, and management of AKI in a child with nephrotic syndrome accompanied by nephritic features. A 12-year-old girl presented with a 10-day history of fever, accompanied by swelling of the face, lower extremities, and genitalia, abdominal distension and pain, joint pain, oliguria, and reddish, foamy urine. Physical examination revealed stage 2 hypertension, periorbital edema, bilateral lower-extremity edema, labia majora edema, ascites, and anemic conjunctivae. Laboratory findings demonstrated anemia, hypoalbuminemia, elevated blood urea and serum creatinine levels, hyperkalemia, hypocalcemia, and partially compensated metabolic acidosis. Reduced glomerular filtration rate and oliguria supported the diagnosis of stage 2 AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The patient was diagnosed with AKI secondary to nephrotic syndrome with nephritic components and received comprehensive treatment consisting of intravenous fluid therapy, furosemide, captopril, prednisone, antibiotics, and supportive management. Comprehensive treatment and close monitoring were required to improve the patient's clinical condition, prevent complications, and preserve quality of life. This case highlights the importance of early recognition and multidisciplinary management of pediatric AKI associated with nephrotic syndrome and nephritic components to prevent progressive renal impairment.
Prolaps Uteri Derajat III yang Ditatalaksana dengan Sacrohysteropexy pada Wanita Usia 29 Tahun: Laporan Kasus Dorothy Rachel Elisabeth; Rodiani Rodiani
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.v17i1.1981

Abstract

Uterine prolapse is a type of pelvic organ prolapse characterized by the descent of the uterus caused by weakening of the pelvic support structures. Although it is more common in older women, it may also occur in women of reproductive age, particularly in those with obstetric risk factors. We report a 29-year-old multiparous woman (P2A0) presenting with a progressively enlarging vaginal bulge for three years. Gynecological examination revealed cervical descent beyond the hymenal ring with positive Valsalva and cough tests. Based on clinical findings, the patient was diagnosed with grade III uterine prolapse and underwent uterine-preserving sacrohysteropexy. No intraoperative or early postoperative complications were observed. At the six-week follow-up, the vaginal bulge had completely resolved, pelvic pressure symptoms improved, urinary complaints decreased, and the patient resumed normal daily activities. Gynecological examination demonstrated adequate apical support with the cervix located above the hymenal ring and no evidence of recurrence. Sacrohysteropexy provided satisfactory anatomical correction while preserving the uterus, making it a suitable option for young women wishing to maintain reproductive and sexual function.
Wanita 58 Tahun dengan Prolaps Organ Panggul dan Gangguan Berkemih Perbaikan Pasca Operasi : Laporan Kasus Ganesha Rahman Hakim; Rodiani Rodiani
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.v16i4.1982

Abstract

Pelvic organ prolapse (POP) is a condition characterized by the descent of pelvic structures due to weakness of the supporting pelvic floor tissues, which is commonly found in elderly women and can cause voiding dysfunction, defecation disorders, sexual dysfunction, and decreased quality of life. This case report describes a 58-year-old woman with grade IV uterine prolapse and grade II cystocele accompanied by voiding dysfunction. Total vaginal hysterectomy (TVH) was chosen as the management because the patient was menopausal and no longer desired fertility, allowing uterine removal to correct the apical compartment while eliminating the source of prolapse. Anterior colporrhaphy was selected to repair the anterior vaginal wall defect due to pubocervical fascia weakness and to relieve mechanical obstruction of the urinary tract. The transvaginal approach was chosen due to lower morbidity, less postoperative pain, and faster recovery compared to the abdominal approach. Postoperatively, the patient showed good clinical improvement, with spontaneous voiding without straining on the second day, no major complications, and stable general condition. This case emphasizes the resolution of voiding dysfunction symptoms as the primary functional outcome, confirming that TVH and anterior colporrhaphy provide not only anatomical correction but also restoration of urinary function. Therefore, it can be concluded that appropriate surgical procedure selection based on age, hormonal status, prolapse severity, and involved compartments is essential to achieve optimal functional outcomes in patients with pelvic organ prolapse.
Skizofrenia Paranoid pada Laki-laki Usia 31 Tahun: Laporan Kasus Diva Shaffa Aisyah; High Boy Karmulrubog Hutasoit
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.v17i1.1984

Abstract

Paranoid schizophrenia is a subtype of schizophrenia based on PPDGJ-III classification, characterized by prominent delusions and/or hallucinations, with relatively unobtrusive affective and catatonic symptoms. This condition is often accompanied by medication non-adherence due to poor insight, which contributes to symptom exacerbation and increased risk of rehospitalization. We report a case of a 31-year-old male who presented with agitation, property destruction, and physical assault toward his mother for two days prior to admission. Symptoms first appeared five years earlier, coinciding with the death of his father, presumed to have acted as a significant psychosocial stressor. Mental status examination revealed prominent persecutory delusions alongside grade 1 insight. The patient had a history of medication refusal due to unawareness of his illness and perceived lack of need for treatment. Diagnosis of paranoid schizophrenia (F20.0) was established based on PPDGJ-III criteria. Treatment with risperidone 2x3 mg, trihexyphenidyl 2x2 mg, and valproic acid 2x250 mg alongside psychoeducation for the patient and family resulted in significant clinical improvement during hospitalization. Medication non-adherence due to poor insight was the primary factor worsening the disease course, highlighting the importance of family psychoeducation and medication supervision in long-term management.
Dampak Paparan Asap Rokok (Secondhand Smoke) terhadap Kejadian Bronkopneumonia pada Balita: Sebuah Laporan Kasus Ahmad Fathin Al Farisi; Shinta Nareswari
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.v17i1.1985

Abstract

Bronchopneumonia is a lower respiratory tract infection that remains a major cause of morbidity and mortality among children, particularly toddlers. Exposure to environmental tobacco smoke has been recognized as an important risk factor that increases children's susceptibility to respiratory infections. This case report aims to describe the impact of secondhand smoke exposure on the occurrence of bronchopneumonia in a toddler. A 1.5-year-old boy presented with a six-day history of productive cough with thick green sputum, shortness of breath, and fever. The diagnosis was established based on medical history, physical examination such as takipneu and subcostal retraction, laboratory investigations, and chest radiography, which revealed bilateral patchy perihilar infiltrates. Exposure to cigarette smoke from his father, an active smoker, was identified as the primary risk factor. Management consisted of intravenous Ringer’s lactate fluid therapy, intravenous ampicillin, and oral paracetamol. After five days of treatment, the patient demonstrated significant clinical improvement and was discharged for outpatient follow-up. Secondhand smoke exposure is thought to contribute to the pathogenesis of bronchopneumonia by impairing mucociliary clearance, increasing mucus production, and suppressing local immune responses, thereby facilitating bacterial colonization of the lower respiratory tract. This case highlights that the harmful effects of cigarette smoke exposure may outweigh the protective benefits of good nutritional status, exclusive breastfeeding, and complete immunization. Therefore, education regarding the dangers of secondhand smoke exposure and smoking cessation within the household is essential for preventing recurrent bronchopneumonia in children.

Page 102 of 109 | Total Record : 1081

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