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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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Bronkopneumonia dengan Suspek Tuberkulosis Paru, Trombositopenia ec Dengue Fever, Gizi Kurang, dan Imunisasi Tidak Lengkap pada Bayi Usia 9 Bulan: Sebuah Laporan Kasus Herlingga Nirwana HR; Anselmus Libreya Sinulingga; Lariza Serafina Tobroni; 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.v16i4.1848

Abstract

Bronchopneumonia remains the leading cause of morbidity in infants, especially in developing countries, and can be exacerbated by various comorbid factors such as poor nutritional status, incomplete immunization, and possible chronic infections. This case report aims to describe the clinical course, diagnostic challenges, and management of complex bronchopneumonia in a 9-month-old infant with suspected pulmonary tuberculosis and thrombocytopenia. The method used was a descriptive case report of a 9-month-old male infant who was treated with the main complaints of shortness of breath, chronic cough with phlegm, intermittent fever, and accompanied by weight loss. Data were obtained through anamnesis, physical examination, laboratory and radiological support examinations, and observation during treatment. The results showed that the patient had recurrent bronchopneumonia with findings of respiratory distress, early thrombocytopenia, an increase in LED levels indicating the onset of an inflammatory process, poor nutritional status, and incomplete basic immunization. A pediatric tuberculosis score of 3 led to suspicion of pulmonary TB, although definitive tests had not yet been obtained. Empirical antibiotic therapy, supportive therapy, nebulization, and chest physiotherapy provided gradual clinical improvement. In conclusion, bronchopneumonia in infants with multiple risk factors requires a holistic approach and high alertness to the possibility of chronic infection and comorbidities. A comprehensive evaluation of nutritional status, immunization, and environmental factors is essential to prevent recurrence and improve patient clinical outcomes.
Peran Diagnosis Dini dan Pendekatan Terapi Individual pada Obstructive Sleep Apnea Dewasa Rachel Agustin Inggrid Zefanya; Mukhlis Imanto
Medula Vol 16 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i1.1859

Abstract

Obstructive Sleep Apnea (OSA) is a sleep-related breathing disorder characterized by recurrent upper airway obstruction, leading to intermittent hypoxemia and sleep fragmentation. In adults, OSA is frequently underdiagnosed due to nonspecific symptoms, resulting in an increased risk of cardiovascular and metabolic complications as well as reduced quality of life. Early diagnosis plays a crucial role in preventing disease progression and long-term complications. This article aims to review the role of early diagnosis and the importance of individualized therapeutic approaches in adult patients with OSA based on current literature. This study was conducted as a literature review of scientific publications discussing the pathophysiology, clinical manifestations, diagnostic methods, and management of adult OSA. Diagnosis of OSA requires a comprehensive approach, including clinical history, physical examination, screening tools, and confirmation through polysomnography. Management of adult OSA should be individualized, taking into account disease severity assessed by the apnea–hypopnea index (AHI), upper airway anatomical characteristics, body mass index, presence of comorbidities, as well as patient tolerance and adherence to therapy. Continuous Positive Airway Pressure (CPAP) remains the first-line treatment for moderate to severe OSA, while lifestyle modification, oral appliances, and surgical interventions may be considered in selected cases. In conclusion, the combination of early diagnosis and individualized therapeutic strategies is essential for optimal management of adult OSA, contributing to improved clinical outcomes and patient quality of life.
Asma Onset Dewasa Pada Wanita Berusia 41 Tahun : Laporan Kasus Maulana Idham Lutfi
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.v16i4.1872

Abstract

Asthma is a chronic inflammatory disease of the airways that may first present in adulthood and often exhibits clinical characteristics that differ from those of childhood-onset asthma. Adult-onset asthma tends to be persistent, less responsive to standard therapy, and influenced by environmental and psychosocial factors. This case report aims to describe the management of adult-onset asthma using a holistic family medicine approach in a primary health care setting. The case involves a 41-year-old woman who experienced recurrent episodes of shortness of breath over the past approximately ten years, with no history of asthma or allergic disease during childhood. Her symptoms were triggered by dust, smoke, cold air, fatigue, and stress, and worsened after moving to a home environment with limited ventilation. The diagnosis of asthma was established clinically based on characteristic respiratory symptoms and a favorable response to bronchodilator therapy. Interventions were implemented using patient-centered, family-focused, and community-oriented approaches, including pharmacological therapy, health education, home environmental modification, and promotion of clean and healthy lifestyle behaviors. Evaluation was conducted through monitoring of clinical symptoms, behavioral changes, and pre- and post-intervention knowledge assessments. After three visits, the patient demonstrated a reduced frequency of exacerbations, improved understanding of the disease and adherence to treatment, increased ability to avoid triggering factors, and improved home environmental conditions. A holistic family medicine approach plays an important role in improving symptom control and quality of life in patients with adult-onset asthma.
HERPES ZOSTER PADA ANAK LAKI-LAKI USIA 12 TAHUN DENGAN RIWAYAT VARICELLA: LAPORAN KASUS Lintang Lestari; Tutik Ernawati
Medula Vol 16 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i1.1875

Abstract

Herpes zoster is a disease caused by the reactivation of latent Varicella Zoster Virus (VZV) following primary varicella infection. Although it is more commonly found in older adults, herpes zoster may also occur in children, although relatively rarely. We report the case of a 12-year-old boy who presented with grouped fluid-filled vesicular lesions accompanied by pain, burning sensation, and pruritus on the left posterior thoracic region for three days prior to admission. The patient had a history of varicella infection one year earlier. Physical examination revealed clustered vesicles on an erythematous base distributed unilaterally along the thoracic dermatome, leading to a clinical diagnosis of herpes zoster. The patient was treated with oral acyclovir, topical acyclovir, symptomatic therapy, and education for both the patient and family. Herpes zoster in children is an uncommon manifestation of VZV reactivation, particularly in immunocompetent individuals. Early diagnosis and prompt antiviral therapy play important roles in accelerating lesion healing, reducing symptoms, and preventing complications. In this case, the patient showed good clinical improvement without complications. This case highlights the importance of early recognition and appropriate comprehensive management of herpes zoster in children to achieve optimal clinical outcomes.
Leptospirosis pada Pekerja Pertanian: Sebuah Tinjauan Sistematis Muhammad Ammar Naufal; Risti Graharti; Azelia Nusadewiarti
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.v16i2.1879

Abstract

Leptospirosis remains a significant global public health concern, particularly in tropical and subtropical regions such as Indonesia, where it contributes substantially to morbidity and mortality among individuals of productive age and agricultural workers. This systematic review aimed to analyze the risk factors, transmission mechanisms, and prevention strategies of leptospirosis among agricultural workers. The study reviewed scientific articles published within the last ten years (2016–2026) retrieved from PubMed, Google Scholar, and ScienceDirect using keywords related to leptospirosis, risk factors, agricultural workers, and prevention. A total of ten eligible studies were selected using the PRISMA protocol and synthesized narratively to provide a comprehensive overview of risk factors, transmission mechanisms and pathophysiology, as well as current prevention strategies for leptospirosis. The findings indicate that risk factors can be categorized into occupational factors (agricultural work, contact with livestock, non-compliance with personal protective equipment use), environmental factors (flood exposure, high rainfall, poor drainage and sanitation, and high rodent density), behavioral factors (poor hygiene practices and delayed healthcare seeking), and demographic factors (male sex and productive age). Occupational and environtmental factors were identified as the most prominent determinants of leptospirosis risk. Effective prevention requires a multidimensional One Health approach integrating individual protection, environmental control, occupational health and safety programs, and strengthened national surveillance systems.
Ruptured Pseudoaneurysm of a Brachiocephalic Arteriovenous Fistula: A Case Report Jeffrey Surya; Prasetyo Edi
Medula Vol 16 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i1.1881

Abstract

Pseudoaneurysm is a vascular abnormality caused by disruption of the arterial wall, resulting in the extraluminal accumulation of blood within a sac-like cavity. This condition may arise from infection, inflammation, trauma, or iatrogenic causes that may progressively enlarge, compress surrounding neurovascular structures, and eventually rupture, leading to active bleeding. Hemorrhage from an arteriovenous fistula is an uncommon but potentially life-threatening emergency. Therefore, prompt surgical management is essential to prevent limb ischemia and reduce mortality. We report the case of a 32-year-old man who presented with acute bleeding, swelling, and pulsatile pain in the left arm two hours prior to admission. The limb had undergone brachiocephalic arteriovenous fistula creation two weeks earlier. Physical examination revealed swelling, purulent discharge, and blood clots at the surgical site, consistent with a ruptured pseudoaneurysm. Initial management in the emergency department included direct compression, intravenous fluid resuscitation, and antifibrinolytic therapy. The patient subsequently underwent emergency vascular reconstruction. Intraoperative findings showed complete rupture of the cephalic vein, which was not salvageable. The brachial artery, however, had a subtotal rupture and was preserved. A side-to-side vein patch plasty using the great saphenous vein was performed. The patient demonstrated clinical improvement postoperatively and was discharged after three days. At the two-week follow-up, no complications were noted, particularly signs of distal limb ischemia.
Case Report: A 6-Year-Old Girl with Bronchopneumonia and Laryngotracheitis Fahmi Ilham Hatimi; Salman Alfarisi; Shinta Nareswari
Medula Vol 16 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i1.1887

Abstract

Acute respiratory infections remain a leading cause of morbidity and mortality among children, particularly in developing countries, with bronchopneumonia representing one of the most common manifestations. Simultaneous involvement of the upper and lower respiratory tract, such as bronchopneumonia accompanied by laryngotracheitis, is uncommon but may result in severe respiratory compromise due to upper airway obstruction and impaired pulmonary gas exchange. This case report describes a six-year-old girl who presented with fever, productive cough, hoarseness, noisy breathing, and progressive dyspnea. Physical examination revealed tachypnea, wheezing that later progressed to bilateral crackles, and signs of upper airway obstruction. Laboratory evaluation demonstrated neutrophilic leukocytosis, while chest radiography showed diffuse patchy infiltrates consistent with bronchopneumonia. Soft tissue neck radiography demonstrated subglottic narrowing (steeple sign), supporting the diagnosis of laryngotracheitis. The patient had predisposing factors including undernutrition and incomplete childhood immunization. Management consisted of intravenous antibiotics, systemic corticosteroids, nebulized epinephrine, oxygen therapy, and supportive care. Gradual clinical improvement was observed from the second to the fifth day of hospitalization without complications or recurrence of symptoms. This case emphasizes the importance of early recognition of concurrent upper and lower respiratory tract involvement, followed by comprehensive diagnostic evaluation and prompt treatment to achieve favorable clinical outcomes. Improvement of nutritional status and completion of routine immunization should also be emphasized as essential preventive strategies to reduce the burden of severe respiratory infections in children.
Diagnosis Komunitas Dan Program Intervensi Dalam Upaya Penurunan Insidens Demam Berdarah Dengue di RT RW Wilayah Kerja Puskesmas Wajo Kota Baubau Sulawesi Tenggara Denny Emilius; R. Wianti Soeryani; Shirley I. Moningkey
Medula Vol 16 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i1.1894

Abstract

Dengue Hemorrhagic Fever (DHF) is a viral infection transmitted to humans through the bite of Aedes aegypti mosquitoes. According to World Health Organization (WHO) data in 2024, approximately 5.2 million dengue cases were reported worldwide. In Southeast Asia, 648,301 dengue cases were recorded in 2019. In Indonesia, 73,518 dengue cases were reported in 2021. Meanwhile, in Baubau City, 122 dengue cases with two deaths were reported in 2025. In the working area of Wajo Primary Health Center, an increase in dengue cases was reported in January 2026, with a total of 39 cases. A mini-survey conducted at Wajo Primary Health Center revealed that community knowledge regarding dengue and its prevention through the 3M Plus strategy remains low. This activity aimed to analyze the factors contributing to the high incidence of dengue fever and to implement effective community-based interventions to reduce its incidence. This activity was conducted using a community diagnosis approach. Problem identification was carried out using the Blum health paradigm. Problem prioritization was determined through a USG method, while root cause analysis was performed using a fishbone (Ishikawa) diagram. Intervention planning was developed based on the identified root causes. The intervention consisted of health education on dengue fever and its prevention using the 3M Plus strategy. Data were collected through pre-test and post-test questionnaires, and activity evaluation was conducted using a systems approach. The health education activity, which involved 30 participants, demonstrated an increase in the mean knowledge score from 79.47 before the intervention to 96.94 after the intervention, with all participants (100%) showing improved understanding. The results of this community diagnosis activity indicate an increase in community knowledge in Lamangga Subdistrict regarding dengue fever and 3M Plus prevention. The intervention program was considered effective in enhancing community awareness and motivating preventive actions against dengue fever.
Peran Radiologi dalam Menegakkan Diagnosis Ileus pada Pasien CKD dengan Nyeri Abdomen, Konstipasi, dan Anemia Penyakit Kronik: Laporan Kasus Divia Denisa Sitinjak; Ricky Ramadhan
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.v16i2.1902

Abstract

Ileus often presents as mechanical bowel obstruction, thereby posing a significant diagnostic challenge in patients with advanced chronic kidney disease (CKD). This is because the symptoms of uraemia overlap with those of acute abdominal conditions. The use of contrast-enhanced computed tomography (CT) is generally avoided due to the risk of nephropathy, making non-contrast multimodal imaging crucial. This case report analyses the role of integrating plain abdominal radiographs and ultrasound (US) in distinguishing between obstructive and paralytic ileus. A 72-year-old male patient with stage 5 CKD presented with acute abdominal pain, persistent vomiting, distension and total constipation. Assessment confirmed normocytic normochromic anaemia, severe uraemia, hyponatraemia and hyperkalaemia. A plain abdominal X-ray showed dilated small bowel with a herringbone pattern and the absence of rectal gas, which was initially interpreted as high-site mechanical obstruction. However, dynamic abdominal ultrasound revealed markedly hypoperistaltic dilated bowel loops with wall thickening, leading to a diagnosis of secondary paralytic ileus due to uraemic enteropathy. The patient refused dialysis and surgical intervention but showed partial improvement through conservative management comprising decompression, prokinetic therapy and electrolyte correction. This case underscores that a combination of static and dynamic non-contrast imaging is essential in reconciling conventional pseudo-mechanical findings with functional dysmotility. Furthermore, the comorbidity of anaemia in PGK reduces physiological tolerance to intestinal ischaemia and requires a higher level of clinical vigilance.
Dermatitis Kontak Iritan Kronik Pada Pekerja Penyadap Karet: Laporan Kasus Ni Komang Devi Wiratningrum; 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.v16i2.1903

Abstract

Irritant contact dermatitis (ICD) is one of the most common occupational skin diseases and is caused by direct and repeated exposure to irritant substances. Workers in the rubber plantation sector are at high risk of developing ICD due to exposure to natural rubber latex and chemicals such as ammonia solution used in the latex processing process. This case report aims to describe a case of chronic irritant contact dermatitis in a rubber tapper. A 50-year-old male presented with a burning sensation on both palms for the past three months, accompanied by erythema, pruritus, dry skin, and scaling. The patient had been working as a rubber tapper for 10 years and was frequently exposed to latex and ammonia solution without using personal protective equipment. Dermatological examination revealed erythematous plaques with diffuse hyperpigmentation and ill-defined borders on the bilateral palmar and plantar regions, accompanied by xerosis, coarse scales, fissures, lichenification, and hyperkeratosis. Based on the history, occupational exposure to irritants, and clinical findings, the patient was diagnosed with chronic irritant contact dermatitis. Management included topical therapy and patient education to avoid irritant exposure and to use personal protective equipment while working. This case highlights the importance of identifying occupational risk factors in establishing the diagnosis and emphasizes preventive measures to reduce irritant exposure in order to prevent disease recurrence.

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