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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: Gambaran Radiologis Kardiomegali pada Pasien Diabetes Mellitus Tipe 2 Dinda Ananto Prameswari; Ricky Ramadhian
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.v16i3.1986

Abstract

Cardiomegaly is a condition characterized by enlargement of the heart that is often detected only after clinical symptoms develop. Type 2 diabetes mellitus is recognized as a major contributor to cardiovascular disease, including structural and functional cardiac abnormalities. This case report aims to describe the radiological findings of cardiomegaly in a patient with type 2 diabetes mellitus. A 44-year-old male presented with dyspnea that worsened during physical activity. Physical examination revealed a blood pressure of 176/88 mmHg, peripheral edema, and a cardiac murmur. Laboratory investigations showed hyperglycemia, normocytic normochromic anemia, and mild renal dysfunction. An anteroposterior (AP) chest radiograph demonstrated bilateral reticular opacities suggestive of interstitial pulmonary edema, widening of the right peritracheal stripe line suspicious for a vascular etiology, and cardiomegaly. Electrocardiography revealed evidence of left ventricular hypertrophy. The patient was diagnosed with type 2 diabetes mellitus, congestive heart failure (CHF), and normocytic normochromic anemia. Chronic hyperglycemia in diabetes mellitus may increase the production of reactive oxygen species (ROS), leading to oxidative stress, inflammation, myocardial hypertrophy, fibrosis, and cardiac remodeling, all of which contribute to the development of cardiomegaly and heart failure. Coexisting hypertension and chronic anemia may further aggravate these pathological processes. In this case, measurement of the cardiothoracic ratio (CTR) showed a value greater than 0.5, supporting the diagnosis of cardiomegaly. Chest radiography remains a useful initial screening modality for detecting cardiac enlargement in patients with type 2 diabetes mellitus.
Corpus Alienum Esofagus berupa Gigi Palsu pada Pria Dewasa: Laporan Kasus Umniya; 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.v17i1.1987

Abstract

Esophageal foreign body is a medical emergency frequently encountered in ENT-Head and Neck Surgery clinical practice. This condition requires an accurate diagnosis and prompt management to prevent serious complications, such as esophageal perforation, mediastinitis, and even death. Dentures are a type of foreign body with a high risk of causing esophageal impaction due to their irregular shape, relatively large size, and often containing wires or sharp edges that can damage the gastrointestinal mucosa. This case report discusses a 46-year-old man with a chief complaint of a lump in his throat accompanied by pain when swallowing. These symptoms occurred after the patient woke up and realized his dentures were missing. Plain anteroposterior and lateral radiographs of the neck revealed a radiopaque foreign body shadow in the esophageal projection located at the level of the 7th cervical to 1st thoracic vertebrae (C7–T1). Based on these clinical and radiological findings, the patient was immediately scheduled for a rigid esophagoscopy under general anesthesia. Careful extraction of the foreign body using alligator forceps was successful, resulting in the intact removal of the broken piece of denture plate. Post-operatively, a thorough evaluation revealed no mucosal tears or other complications, either during or after the interventional procedure. This case demonstrates that a thorough history, accurate radiological examination, and prompt esophagoscopy are crucial in reducing morbidity in patients with esophageal foreign bodies.
Koinfeksi Bronkopneumonia dan Demam Tifoid pada Anak dengan Status Gizi Kurang: Sebuah Laporan Kasus Fityah Zabrina Hidayat; 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.v17i1.1988

Abstract

Bronchopneumonia and typhoid fever remain major causes of childhood morbidity and mortality in developing countries. Coinfection may aggravate the clinical course, particularly in children with malnutrition. This case report describes the clinical presentation, diagnostic evaluation, and management of bronchopneumonia and typhoid fever coinfection in a malnourished child. A 5-year-8-month-old boy was referred with a 9-day history of fever and persistent cough accompanied by shortness of breath, abdominal pain, and abdominal distension. The patient had a history of controlled epilepsy and was undernourished. Physical examination revealed tachypnea, chest wall retractions, bilateral rhonchi, and abdominal distension. Laboratory investigations showed leukopenia (4,600/µL), thrombocytopenia (101,000/µL), and elevated aspartate aminotransferase (160 U/L). Chest radiography demonstrated bilateral perihilar and paracardial infiltrates consistent with bronchopneumonia, while reactive anti-Salmonella IgM serology (score 6) supported the diagnosis of typhoid fever. The patient received oxygen therapy, intravenous fluid resuscitation with Ringer's lactate, intravenous ceftriaxone and gentamicin, salbutamol nebulization, zinc supplementation, and nutritional support. Progressive clinical improvement was observed, with resolution of fever, decreased respiratory rate, and improvement of respiratory symptoms after seven days of hospitalization. This case highlights the importance of considering coinfection in malnourished children presenting with overlapping respiratory and gastrointestinal manifestations. Early diagnosis, appropriate empirical antibiotic therapy, nutritional rehabilitation, and hygiene education are essential to optimize clinical outcomes and reduce the risk of recurrence.
Amenore Sekunder pada Remaja dengan Penyakit Ginjal Kronik yang Menjalani Hemodialisis: Laporan Kasus Muhamad Zaidan Algifari; 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.v17i1.1990

Abstract

Secondary amenorrhea is a reproductive disorder frequently found in female patients with advanced chronic kidney disease (CKD). This condition may be influenced by hormonal dysfunction, malnutrition, anemia, and hemodialysis therapy. We report a 14-year-old female adolescent with stage V CKD who has undergone regular hemodialysis since August 2024 and has experienced secondary amenorrhea for 3 months. She experienced menarche at age 12 and previously had regular menstrual cycles. Physical examination revealed malnutrition (weight 30 kg, height 150 cm). Laboratory examination showed severe anemia with a hemoglobin level of 5.8 g/dL, accompanied by electrolyte disturbances including hyponatremia, hypokalemia, and hypercalcemia. The patient was diagnosed with secondary amenorrhea, stage V CKD, hemodialysis treatment, renal anemia, multiple electrolyte disturbances, and malnutrition. The pathophysiology of amenorrhea in this case is thought to involve a complex interaction between hypothalamic-pituitary-gonadal axis dysfunction induced by uremia, hyperprolactinemia, malnutrition, severe anemia, and the inability of hemodialysis to fully correct neuroendocrine disorders. This case demonstrates the importance of evaluating menstrual disorders in adolescents with advanced CKD. A multidisciplinary approach that includes optimizing dialysis adequacy, improving nutritional status, correcting anemia, and hormonal monitoring is necessary to support reproductive function and improve the patient's quality of life.
Eksaserbasi Asma Berat akibat Pneumonia Komunitas pada Anak dengan Predisposisi Atopik: Sebuah Laporan Kasus Zheva Aprillia Yozevi; 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.v17i1.1993

Abstract

Asthma is a chronic inflammatory airway disease prone to exacerbations triggered by various factors, notably infections. Community-acquired pneumonia (CAP) can exacerbate airway inflammation and trigger severe asthma exacerbations in children. This report discusses a 7-year-and-1-month-old girl presenting with shortness of breath that worsened 7 hours prior to admission, accompanied by wheezing, restlessness, and limited speech. The complaints were preceded by a 3-day cough and a 2-day runny nose. The patient had a history of asthma since age 3, personal atopy, and maternal asthma. Physical examination revealed tachypnea, tachycardia, oxygen saturation of 89% on room air, intercostal retractions, nasal flaring, and bilateral expiratory wheezing. Laboratory findings indicated neutrophilic leukocytosis, eosinophilia (12%), and an increased erythrocyte sedimentation rate (59 mm/hour). Chest radiograph showed right suprahilar consolidation and bilateral paracardial infiltrates, suggestive of right lobe pneumonia and left lung bronchopneumonia. The patient was diagnosed with severe asthma exacerbation on partially controlled mild persistent asthma, accompanied by community-acquired pneumonia. Management included oxygen therapy, inhaled bronchedilators, intravenous antibiotics and aminophylline, and supportive therapy. Evaluation demonstrated clinical improvement characterized by increased oxygen saturation, decreased respiratory rate, and reduced respiratory distress. This case emphasizes that CAP can act as a major trigger for severe asthma exacerbations in children with an atopic predisposition, making early diagnosis and comprehensive management crucial to improve clinical outcomes.
Perempuan Hamil G1P0A0 dengan Preeklamsia Berat : Laporan Kasus Muhammad Rayza Rahmatullah; Ratna Dewi Puspitasari
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.v17i1.1994

Abstract

Severe preeclampsia is a pregnancy complication that contributes to increased maternal and perinatal morbidity and mortality. Accurate diagnosis and management are essential to prevent more serious complications. This case report aims to describe the clinical manifestations, risk factors, management, and outcomes of a patient with severe preeclampsia. A 29-year-old woman, G1P0A0, at 39 weeks of gestation, presented with uterine contractions and blood-tinged mucous discharge. The patient had a history of elevated blood pressure since 32 weeks of gestation. Physical examination revealed a blood pressure of 152/112 mmHg, while urinalysis demonstrated positive proteinuria. Laboratory findings showed hemoglobin 13.9 g/dL, leukocytes 12,900/µL, and platelets 228,000/µL. Ultrasonography revealed a single live fetus in cephalic presentation with an estimated fetal weight of 3,302 grams. The patient was diagnosed as G1P0A0 at 39 weeks of gestation, in active phase of the first stage of labor, with severe preeclampsia. She received magnesium sulfate as seizure prophylaxis and nifedipine as an antihypertensive agent. During observation, fetal distress was identified, necessitating pregnancy termination via cesarean section. The infant was born weighing 3,200 grams with Apgar scores of 8/9. The mother's postoperative condition was stable, with blood pressure decreasing to 116/83 mmHg. This case demonstrates that severe preeclampsia may present without characteristic symptoms. Early detection, close monitoring, and appropriate management play a crucial role in achieving favorable maternal and neonatal outcomes.
Faktor Higiene dan Lingkungan terhadap Kejadian Tinea Korporis Berulang pada Wanita Usia 41 Tahun dengan Obesitas: Laporan Kasus Alief Gusnirwan Sulaiman; Tutik Ernawati
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.v17i1.1995

Abstract

Tinea corporis is a recurrent superficial dermatophyte infection influenced by personal hygiene, environmental conditions, and patients' knowledge and treatment adherence. A family medicine approach is essential to identify internal and external risk factors and provide comprehensive, continuous management. This case report describes a 41-year-old housewife who presented to the Long Inpatient Health Center with recurrent erythematous, pruritic patches in the right inguinal region that had relapsed three times within three months due to self-discontinuation of treatment after symptom improvement. Physical examination revealed a body mass index of 26 kg/m² (WHO Asian classification: obesity class I) and well-demarcated erythematous plaques with central healing. Home visits identified a damp living environment with inadequate ventilation as a contributing risk factor. Medical treatment consisted of 2% ketoconazole cream, oral ketoconazole 200 mg for 14 days, and cetirizine 10 mg for pruritus. Non-pharmacological interventions were conducted during three home visits using a family medicine framework, including patient education on the disease, risk factors, and medication adherence; family involvement in treatment supervision and environmental improvement; and community-oriented health promotion recommendations through the local health center. At the third follow-up, the patient demonstrated clinical improvement with reduced pruritus and increased knowledge following educational interventions. This case highlights that a holistic, patient-centered, family-focused, and community-oriented approach can improve clinical outcomes, enhance patient knowledge, promote healthier living conditions, and reduce the risk of recurrence in recurrent tinea corporis.
Asymptomatic Congenital Syphilis with Bilateral Metaphysitis in a Term Neonate: A Case Report Daffa Fahreiza; 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.v17i1.2001

Abstract

Congenital syphilis is a transplacental infection caused by Treponema pallidum that is associated with significant fetal and neonatal morbidity and mortality. Although many infected neonates appear clinically asymptomatic at birth, active infection may only be identified through serological and radiological evaluation. This report describes a 3-day-old full-term female neonate born at 37 weeks of gestation by cesarean section due to cephalopelvic disproportion, premature rupture of membranes, and maternal syphilis. The mother had not undergone antenatal syphilis screening or received treatment during pregnancy despite having a reactive Venereal Disease Research Laboratory (VDRL) test at delivery. The neonate appeared clinically well without dysmorphic features, respiratory distress, or other classic manifestations of congenital syphilis. However, laboratory evaluation revealed leukocytosis and persistently reactive VDRL titers of 1:64 on the first and third days of life. A skeletal survey demonstrated bilateral metaphysitis involving the distal radius, ulna, and first metatarsal base without periostitis or pathological fractures, consistent with early syphilitic osteochondritis. Initial empirical treatment with ampicillin and gentamicin was subsequently changed to benzathine penicillin G after the diagnosis was confirmed. This case highlights that congenital syphilis may present as subclinical skeletal involvement despite an apparently healthy neonate. Routine antenatal screening, prompt neonatal serological assessment, targeted skeletal imaging, and appropriate post-treatment follow-up are essential for early diagnosis, timely management, and prevention of long-term complications, particularly in resource-limited healthcare settings.
Penatalaksanaan Diabetes Mellitus Tipe 2 dengan Komplikasi Selulitis pada Perempuan Usia 50 Tahun: Laporan Kasus Sheilla Amelia Vandela; 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.v17i1.2005

Abstract

Diabetes mellitus (DM) is a chronic metabolic disorder that may lead to various complications, including cellulitis. This case report aimed to implement evidence-based medicine care through a patient-centered and family-oriented approach in a patient with type 2 diabetes mellitus complicated by cellulitis. Data were collected through history taking, physical examination, supporting investigations, and home visits to comprehensively assess the patient's risk factors and overall condition. Interventions included health education, dietary modification, promotion of physical activity, and family involvement in patient care. The results demonstrated improved knowledge among the patient and family members, better adherence to recommended dietary practices, and increased regular physical activity. The family medicine approach was shown to support more comprehensive diabetes management and contribute to complication prevention and improvement of the patient's quality of life.
Tinea Corporis pada Pasien Obese Grade II: Laporan Kasus Sifa’ Syaharani Fairuz Hanan; Tutik Ernawati
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.v17i1.2007

Abstract

Tinea Corporis is a superficial fungal infection caused by dermatophytes affecting the skin, excluding the palms, soles, and groin. Tinea Corporis is a recurrent and potentially spreading disease; therefore, it requires a holistic management approach. Family physicians play an important role in providing comprehensive care by identifying risk factors, clinical problems, and implementing evidence-based management through a patient-centered, family-oriented, and community-oriented approach. This study is a case report. Primary data were obtained through history taking, physical examination, and home visits, while secondary data were collected from the patient’s medical records. Assessment was based on a holistic diagnosis at the beginning, during the process, and at the end of the study using qualitative and quantitative evaluations. A 42-year-old woman presented with erythematous patches accompanied by itching beneath both breasts for six days. Family members had experienced similar complaints. Based on the history and physical examination, the patient was diagnosed with Tinea Corporis. The patient also had grade II obesity, which is a risk factor for dermatophyte infection due to increased skin folds, moisture, and friction that may promote fungal growth and increase the risk of recurrence. Non-pharmacological and pharmacological interventions, including patient and family education regarding the disease, were provided through three home visits. The outcome of this case demonstrated clinical improvement, as indicated by the reduction of symptoms and positive behavioral changes. Family support and involvement remained essential components in the treatment and recovery process.

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