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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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Karsinoma Nasofaring Pada Pasien Pria Usia 51 Tahun Faiq Razaan; 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.v17i1.1942

Abstract

Nasopharyngeal carcinoma is a malignant epithelial tumor arising from the nasopharynx and remains one of the most common head and neck cancers in Indonesia. Its etiology is multifactorial, involving Epstein-Barr virus infection, genetic susceptibility, and environmental exposures such as smoking and consumption of preserved foods. Because early symptoms are often nonspecific, many patients present at an advanced stage. This case report describes the clinical manifestations, risk factors, and diagnostic approach in a 51-year-old man with nasopharyngeal carcinoma and orbital infiltration. The patient presented with a progressively enlarging neck mass for nine months accompanied by hearing loss, tinnitus, epistaxis, diplopia, right-sided facial numbness, nausea, and fatigue. Physical examination revealed cervical lymphadenopathy, right ptosis, anisocoria, multiple cranial nerve deficits, and unilateral hearing impairment. Head computed tomography demonstrated a mass extending to adjacent structures with compression of the optic nerve, while histopathological examination of the nasopharyngeal biopsy revealed keratinizing squamous cell carcinoma, confirming the diagnosis of nasopharyngeal carcinoma with orbital infiltration. The patient had a long history of heavy smoking and frequent consumption of salted fish, both recognized risk factors for this malignancy. Initial management consisted of symptomatic and supportive treatment, followed by referral to a tertiary oncology center for definitive chemoradiotherapy. This case highlights the importance of early recognition of persistent cervical lymphadenopathy and cranial nerve involvement to facilitate timely diagnosis, appropriate staging, and improved clinical outcomes in patients with nasopharyngeal carcinoma.
Penatalaksanaan Herpes Zoster pada Pasien Wanita Usia Produktif : Sebuah Laporan Kasus Arfa Salma Firnandya; Reni Zuraida
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.v17i1.1973

Abstract

Herpes zoster is caused by the reactivation of latent Varicella-zoster virus (VZV) following primary varicella infection. Although it is more common among older adults, it may also occur in productive-age individuals with risk factors such as psychological stress, sleep deprivation, and unhealthy lifestyles. This case report describes the comprehensive management of herpes zoster in a productive-age woman. A 19-year-old woman presented with painful, pruritic, and burning vesicular eruptions on the right posterior lumbar region for four days. Dermatological examination revealed multiple erythematous vesiculobullous lesions with a unilateral dermatomal distribution. The patient had a history of childhood varicella, high academic stress, inadequate sleep, low physical activity, and poor dietary habits. A clinical diagnosis of herpes zoster of the right posterior lumbar region was established. The patient received oral acyclovir 800 mg five times daily, topical acyclovir 5%, paracetamol, cetirizine, and vitamin C for seven days. Non-pharmacological interventions included education regarding the disease, stress management, sleep improvement, physical activity, balanced nutrition, and family support. Follow-up evaluation demonstrated reduced pain, pruritus, and burning sensation, drying of lesions without new eruptions, and improved knowledge and health-related behaviors. A comprehensive approach integrating antiviral therapy, patient education, lifestyle modification, and family support resulted in favorable clinical outcomes and may help prevent complications and recurrence in productive-age patients with herpes zoster.
Perempuan Usia 24 tahun dengan GERD : Laporan Kasus Muhammad Ihsan Fariqy; 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.v17i1.1997

Abstract

Gastroesophageal Reflux Disease (GERD) is a disorder caused by the reflux of gastric contents into the esophagus and is influenced by biological, behavioral, psychological, and social factors, requiring a comprehensive family medicine approach. We report the case of a 24-year-old woman who presented to Kalirejo Primary Health Center with worsening epigastric pain for two days, accompanied by abdominal fullness, heartburn, nausea, and vomiting. She had experienced similar symptoms for the previous two years, with risk factors including irregular eating habits, frequent consumption of spicy foods, skipping breakfast, overweight, and psychological stress related to family financial problems. The diagnosis was established based on history taking, physical examination, and a GERD-Q score of 11. Management consisted of pharmacological therapy with omeprazole, antacids, and domperidone, combined with non-pharmacological interventions using a patient-centered, family-focused, and community-oriented approach through health education, dietary modification, stress management, and active family involvement. Follow-up after three home visits demonstrated clinical improvement, increased patient and family knowledge (pre-test score 50 to post-test score 80), better treatment adherence, and positive behavioral changes, including regular meal patterns, reduced consumption of trigger foods, and stronger family support. A comprehensive family medicine approach plays an important role in controlling risk factors, improving quality of life, and preventing GERD recurrence.
Persistent Bronchopneumonia in an 8-Month-Old with Down Syndrome and Congenital Heart Disease: A Case Report Mochamad Fauzan Dava; 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.v16i4.1999

Abstract

Children with Down syndrome (DS) are at high risk of persistent pneumonia due to anatomical abnormalities of the airways, ciliary dysfunction, immune dysregulation, congenital heart disease (CHD), malnutrition, and aspiration. This case report describes the diagnostic approach and management of persistent bronchopneumonia in a DS infant with CHD and malnutrition. An 8-month-23-day-old female with DS, a history of anal atresia after anorectoplasty, presented with a 3-day history of severe, productive cough with phlegm, accompanied by fever, tachypnea (52 breaths/minute), chest wall indrawing, and bilateral moist rales. Nutritional status: W/A and W/H < p5 (malnutrition), microcephaly. Chest X-ray showed bilateral infiltrates. Blood gas analysis showed metabolic acidosis and hypoxemia. Sputum culture showed the growth of Enterococcus faecium resistant to ampicillin. Echocardiography showed secundum ASD and PDA (0.1–0.2 cm) with a left-to-right shunt. The patient was treated with oxygen, vancomycin, gentamicin, nebulizer, furosemide, captopril, and chest physiotherapy. Fever normalized on day 1, oxygen saturation normalized on day 4, and the cough persisted until day 6. The patient was discharged on day 7 with a catch-up immunization plan, aspiration education, and referral to cardiology and a nutrition clinic. This case highlights the need for early aspiration detection, sensitivity-guided antibiotics, and multidisciplinary care to prevent recurrence and improve quality of life.
Diagnosis Klinis dan Tatalaksana Rawat Jalan pada Abses Peritonsil Sinistra: Sebuah Laporan Kasus Vania Widyadhari Damayanti; 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.v17i1.2006

Abstract

Peritonsillar abscess is the most common complication of acute tonsillitis and is characterized by the accumulation of pus within the peritonsillar space. If left untreated, it may lead to serious complications, making early recognition and appropriate management essential. In patients with characteristic clinical findings, the diagnosis can often be established based on history taking and physical examination without additional investigations. This case report describes the clinical diagnosis and outpatient management of a left-sided peritonsillar abscess in a 46-year-old man presenting with a two-week history of left neck swelling, progressive sore throat, odynophagia, dysphagia, trismus, hot potato voice, hypersalivation, and fever. Oropharyngeal examination revealed an erythematous and bulging left peritonsillar swelling, causing medial displacement of the left tonsil and rightward deviation of the uvula. A clinical diagnosis of left peritonsillar abscess was established. Although hospitalization was recommended, the patient declined admission and was managed as an outpatient with oral cefixime, metronidazole, methylprednisolone, and paracetamol. Comprehensive education was provided regarding adequate rest, hydration, oral hygiene, smoking cessation, medication adherence, and recognition of warning signs requiring immediate medical attention. Outpatient treatment was considered appropriate because the patient had no evidence of airway compromise, dehydration, sepsis, significant comorbidities, or inability to tolerate oral medication. This case highlights that peritonsillar abscess can be accurately diagnosed clinically and that carefully selected patients may be safely managed on an outpatient basis with appropriate follow-up and patient education to minimize the risk of complications.  
Diabetes Melitus Tipe 2 pada Pasien Neurodermatitis: Laporan Kasus Syahrani Alya Murfi; 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.v17i1.2008

Abstract

Neurodermatitis is a cutaneous manifestation that may exacerbate the clinical course of type 2 diabetes mellitus (T2DM); however, reports on the comprehensive management of these coexisting conditions in the primary healthcare setting remain limited. This case report aims to describe the successful implementation of an integrated management approach in a 55-year-old male patient with T2DM accompanied by neurodermatitis. The patient presented with paresthesia in both lower extremities, polyuria, polydipsia, and a chronic pruritic lesion with lichenification on the left upper arm. Random blood glucose measurement of 240 mg/dL supported the diagnosis of T2DM accompanied by neurodermatitis. Management included metformin therapy, appropriate topical treatment, intensive education on T2DM dietary management, lifestyle modification, increased physical activity, and family involvement to enhance treatment adherence. During follow-up evaluation, the patient's paresthesia, hyperglycemic symptoms, and cutaneous pruritus improved, fasting blood glucose decreased to 117 mg/dL, and the knowledge scores of both the patient and family increased from a pre-test score of 70 to a post-test score of 100. This case demonstrates that optimal glycemic control, accompanied by appropriate neurodermatitis management and family-based education, can lead to clinical improvement and enhance patient adherence to treatment. A comprehensive approach in the primary healthcare setting is essential for controlling cutaneous manifestations while preventing the progression of complications associated with T2DM.
Osteogenesis Imperfecta in A Neonate with A Positive Family History: A Case Report Bryantdary Arrafif Nasution; 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.v17i1.2010

Abstract

Osteogenesis Imperfecta (OI) is a rare genetic disorder characterized by bone fragility due to impaired type 1 collagen synthesis. This condition is generally caused by mutations in the COL1A1 and COL1A2 genes, which are inherited in an autosomal dominant or recessive manner, and are clinically heterogeneous. This report presents a case of a 5-day-old male neonate, born by cesarean section at 37 weeks of gestation, with a birth weight of 2,200 grams, who was referred to Dr. H. Abdul Moeloek Regional General Hospital, Bandar Lampung, with complaints of inactive right leg movement since 4 days of age. There was a positive family history, namely an older sibling who had been diagnosed with OI. Physical examination revealed bilateral blue sclerae, asymmetry in the lengths of the lower extremities, and pain with mobilization of the right leg. Radiological examination in the form of a right femur x-ray and bone survey showed a complete proximal fracture of the right femur, bowing of the left femur, and decreased bone density, which supports the diagnosis of OI. Serum Alkaline Phospatase (ALP) levels were within normal limits, distinguishing them from rickets or hypophosphatasia. Management included splinting immobilization, closed reduction, hip spica placement, prophylactic antibiotics and analgesics, and phototherapy for hyperbilirubinemia. The prognosis for this patient was quo ad vitam (dubia ad bonam), while quo ad functionam and quo ad sanationam (dubia ad malam) were quo ad functionam. This case report aims to raise clinical awareness of OI in the neonatal period, especially in cases with a confirmed family history.
Faktor Maternal yang Berhubungan dengan Kejadian Sindrom HELLP pada Pasien Preeklamsia di RSUD Dr. H. Abdul Moeloek Bandar Lampung Keyla Aisya Putri; Reni Zuraida; Selvi Marcellia; Efriyan Imantika
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.v17i1.2013

Abstract

HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count) is a severe complication of preeclampsia that increases maternal and perinatal morbidity and mortality. Maternal factors such as age, parity, and nutritional status are thought to be associated with the occurrence of HELLP syndrome. This study aimed to analyze the association between maternal age, parity, and nutritional status and the incidence of HELLP syndrome among preeclamptic patients at Dr. H. Abdul Moeloek Regional General Hospital, Bandar Lampung. This analytic observational study used a case-control design based on medical records of preeclamptic patients from 2023 to 2025. The sample consisted of 50 respondents, comprising 25 preeclamptic patients with HELLP syndrome as cases and 25 preeclamptic patients without HELLP syndrome as controls, selected using purposive sampling according to inclusion and exclusion criteria. Data were analyzed using univariate and bivariate Chi-Square tests, with Odds Ratios (OR) and 95% confidence intervals (CI) calculated to assess the strength of association. The results showed significant associations between maternal age and HELLP syndrome (p=0.045; OR=3.27; 95% CI 1.01–10.62) and between nutritional status and HELLP syndrome (p<0.001; OR=51.00; 95% CI 5.82–446.56). No significant association was found between parity and HELLP syndrome (p=0.544; OR=1.45; 95% CI 0.44–4.78). In conclusion, maternal age and nutritional status were associated with HELLP syndrome among preeclamptic patients, whereas parity showed no significant association. Early identification of these maternal factors during the antenatal period is important to support early detection in high-risk pregnancies.
Scurvy in a Child with with Recurrent Lower Extremity Weakness: A Case Report Akhmad Rizki Farhan; 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.v17i1.2016

Abstract

Scurvy is a disease caused by vitamin C deficiency that is still encountered in children with restrictive eating patterns and severe malnutrition. Musculoskeletal manifestations, including lower limb pain, refusal to walk, pseudoparalysis, and joint swelling, often mimic neurological, infectious, or rheumatologic disorders, leading to delayed diagnosis. A 3-year-7-month-old boy presented with recurrent inability to walk accompanied by pain and swelling in both knees. Five months earlier, he had experienced fever followed by bilateral lower limb weakness and inability to stand. At that time, he was diagnosed with scurvy at another hospital and showed improvement after receiving vitamin C supplementation and physiotherapy. Twelve days before admission, similar symptoms recurred, accompanied by oral ulcers. Physical examination revealed severe malnutrition, stunting, microcephaly, tenderness of both knees, and lower extremity weakness. Laboratory evaluation demonstrated leukopenia (3,700/μL). Bilateral genu radiographs showed metaphyseal osteopenia of the femur, a soft tissue lucency at the distal femur suggestive of hematoma, and bilateral Wimberger sign, which is characteristic of scurvy. Dietary history revealed refusal to consume fruits, vegetables, milk, and protein-rich foods, with a preference for packaged snack foods. The patient was treated with intravenous vitamin C at a dose of 300 mg/day for 7 days, followed by oral vitamin C 100 mg/day for 1 month, in addition to nutritional rehabilitation, multivitamin supplementation, and physiotherapy. Rapid clinical improvement following treatment highlights the importance of obtaining a thorough dietary history and recognizing characteristic radiographic findings to establish an early diagnosis and prevent complications.
Sindrom Beckwith-Wiedemann dengan Presentasi Trias Klasik pada Bayi: Sebuah Laporan Kasus Yogi Arvendo; Ismi Citra Ismail
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.v17i1.2017

Abstract

Beckwith-Wiedemann syndrome (BWS) is a rare congenital overgrowth disorder and genetic imprinting disorder caused by dysregulation of chromosome 11p15.5. This disorder increases the risk of embryonal tumors, making early diagnosis crucial. This case report aims to present the clinical diagnosis of BWS based on the international consensus scoring system in an infant with a classic clinical triad. A 2-month-14-day-old male infant was admitted with a large tongue and a history of omphalocele since birth. The patient was born via cesarean section at 37 weeks of gestation with a birth weight of 3,800 grams (>90th percentile on the Lubchenco curve). The omphalocele was reported to have closed spontaneously at 1 month of age. The patient had experienced neonatal hypoglycemia following NICU care, which required glucose infusion. Physical examination revealed macroglossia, a scalp hemangioma, and right upper extremity hemihyperplasia. Laboratory examination showed an alpha-fetoprotein (AFP) level within the normal range for age (587.98 ng/mL; reference range 10–1,359 ng/mL), while echocardiography detected a small atrial septal defect (ASD). Based on the 2018 international consensus, the cumulative clinical findings yielded a score of 8, confirming a clinical diagnosis of Classic BWS. The clinical diagnosis of BWS in this patient could be strongly established using the scoring system, even though molecular genetic testing was not available or had not been performed. Given the high risk of embryonal malignancy, long-term management must include a rigorous periodic tumor surveillance protocol comprising abdominal ultrasonography and serum AFP monitoring every 3 months, along with multidisciplinary supportive care to optimize the child's growth and development. 

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