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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 1,087 Documents
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Noonan Syndrome pada Bayi Perempuan 6 Bulan: Sebuah Laporan Kasus Chindy Setia Putri; Ismi Citra Ismail; Epriyan Saputra
Medula Vol 17 No 2 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i2.2035

Abstract

Noonan syndrome (NS) is an autosomal dominant genetic disorder with significant phenotypic overlap with Turner syndrome (TS). Given these overlapping physical stigmata, accurate diagnosis requires a comprehensive multisystem clinical evaluation and molecular genetic confirmation, particularly when cytogenetic karyotyping yields normal results. A 6-month-old female infant was referred with an initial suspicion of TS, suspected hydrocephalus, and significant gross motor developmental delay. Physical examination revealed characteristic craniofacial and skeletal phenotypic stigmata mimicking TS, including webbed neck, bilateral microtia, low-set ears, hypertelorism, wide-spaced nipples, and bilateral single palmar creases. Echocardiography showed congenital heart disease consisting of mild pulmonary stenosis and a small atrial septal defect. Brain non-contrast CT scan demonstrated Benign Enlargement of the Subarachnoid Space in Infancy (BESS) with mild ventriculomegaly, ruling out obstructive hydrocephalus. Cytogenetic karyotype analysis revealed a normal 46,XX female karyotype, thereby definitively excluding classic TS (45,X). The combination of physical stigmata overlapping with TS, a normal 46,XX karyotype, and the presence of pulmonary stenosis leads to a strong clinical suspicion of Noonan syndrome (strongly suspected Noonan syndrome). However, because molecular genetic testing has not been performed, the diagnosis of NS in this patient remains a clinical diagnosis. This case highlights the importance of a holistic diagnostic approach to differentiate TS and NS phenotypes. Further molecular genetic testing, such as a Targeted Next-Generation Sequencing (NGS) panel for RASopathy genes (PTPN11, SOS1, KRAS, RAF1) or Whole Exome Sequencing (WES), is highly recommended to identify the specific causative gene mutation and achieve a definitive molecular diagnosis.
Hubungan Derajat Hipertensi dan Usia dengan Derajat Volume Prostat pada Pasien Benign Prostatic Hyperplasia di RSUD Dr. H. Abdul Moeloek Provinsi Lampung Smith Imanuel Saputra; Khairun Nisa Berawi; Susianti Susianti; Exsa Hadibrata
Medula Vol 17 No 2 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i2.1977

Abstract

Benign Prostatic Hyperplasia is a benign enlargement of the prostate gland commonly found in older men and may cause lower urinary tract symptoms that negatively affect quality of life. Age and hypertension have been associated with prostate enlargement through hormonal changes, increased sympathetic nervous system activity, and stimulation of prostate cell proliferation. This cross-sectional study aimed to determine the relationship between age and hypertension grade with prostate volume grade among patients with BPH at Dr. H. Abdul Moeloek General Hospital, Lampung Province, during 2019–2021. A total of 53 patients were selected using total sampling. Data were analyzed using Spearman's rank correlation test with a significance level of p<0.05. Of the 53 patients, 21 (39.6%) were aged ≤55 years, 14 (26.4%) were aged 55–65 years, and 18 (34.0%) were aged ≥65 years. Regarding hypertension grade, 24 patients (45.3%) had grade 1 hypertension and 29 (54.7%) had grade 2 hypertension. Prostate volume was classified as grade 1 in 14 patients (26.4%), grade 2 in 20 (37.7%), and grade 3 in 19 (35.8%). Spearman's correlation analysis demonstrated a significant association between age and prostate volume grade (p=0.002) and between hypertension grade and prostate volume grade (p=0.008). Age and hypertension grade were significantly associated with prostate volume grade among patients with BPH at Dr. H. Abdul Moeloek General Hospital, Lampung Province, during 2019–2021.
Diabetes Melitus dengan Dispepsia pada Pasien Usia Pertengahan: Sebuah Laporan Kasus Devira Fitriani Kamal; Winda Trijayanthi Utama
Medula Vol 17 No 2 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i2.2054

Abstract

Type 2 diabetes mellitus (DM) and dyspepsia are frequently found together in primary care and share irregular eating patterns as a common factor that can worsen glycemic control while triggering gastrointestinal symptoms. This case report aims to describe the relationship between irregular eating patterns and dyspeptic complaints in a patient with uncontrolled type 2 DM. A 49-year-old woman presented with intermittent epigastric pain and nausea without vomiting for five days, worse when meals were delayed, with similar recurrent complaints over the preceding three months. She had a three-year history of type 2 DM treated with metformin and glimepiride, yet still complained of polyphagia and polyuria. Her diet was poorly controlled, with large portions of rice and carbohydrate-rich snacks, and she had low physical activity. Physical examination revealed epigastric tenderness without alarm features, and a body mass index of 24.2 kg/m² (overweight by Asia-Pacific criteria). Fasting blood glucose (FBG) was 167 mg/dL, up from 129 mg/dL one month earlier. HbA1c testing and endoscopy were not performed, so the condition was classified as uninvestigated dyspepsia and managed empirically on clinical grounds. Treatment consisted of metformin 500 mg twice daily, antacid, omeprazole 20 mg twice daily, and domperidone 10 mg three times daily, together with education, low-carbohydrate dietary modification, and advice on physical activity. At follow-up, epigastric pain and nausea had resolved, polyphagia and polyuria improved, and FBG fell to 135 mg/dL without significant adverse effects. These short-term findings cannot be generalized because of limited data. This case suggests that improving meal regularity may be a relevant point of intervention for both conditions simultaneously.
Hipertensi Esensial pada Wanita Lanjut Usia: Sebuah Laporan Kasus Fahman Ghiffari; Winda Trijayanthi Utama
Medula Vol 17 No 2 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i2.2055

Abstract

Hypertension is one of the leading risk factors for cardiovascular disease, with a continuously increasing prevalence among the elderly, yet many cases remain undiagnosed or inadequately controlled. A 75-year-old woman presented with headache accompanied by difficulty sleeping for one day prior to examination, with a previously measured elevated blood pressure but no history of antihypertensive treatment. Physical examination revealed a blood pressure of 166/90 mmHg and a body mass index of 25.3 kg/m² (overweight), without signs of target organ damage or clinical findings suggestive of a secondary etiology. Identified risk factors included advanced age, insufficient rest, coffee consumption, a diet high in salt and fat, low physical activity, and a family history of hypertension. Grade 1 essential hypertension was diagnosed based on history and physical examination. Management included amlodipine, education, and dietary sodium restriction combined with increased physical activity. At the following follow-up visit, blood pressure decreased to 140/85 mmHg, accompanied by symptomatic improvement and patient-reported adherence to the recommended dietary and physical activity changes. This case illustrates that acute symptom relief and blood pressure reduction can be achieved through a combination of antihypertensive monotherapy and lifestyle education in an elderly patient, although the target blood pressure of <130/80 mmHg was not yet fully achieved at that evaluation.
Hubungan Risiko Ergonomi dengan Keluhan Musculoskeletal Disorders pada Mahasiswa Kedokteran: A Systematic Review Pande Made Imas Saraswati; Winda Trijayanthi Utama
Medula Vol 17 No 2 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i2.2072

Abstract

Musculoskeletal Disorders (MSDs) are common complaints among medical students, particularly during the clinical phase, which involves clinical activities and non-ergonomic working postures. These issues can impair musculoskeletal function, limit daily activities, and affect both academic and clinical participation. This study aimed to synthesize evidence regarding the association between ergonomic risks and MSDs among medical students in their clinical phase. This systematic review followed the PRISMA 2020 guidelines, with study quality assessed using the JBI Critical Appraisal Checklist. The prevalence of these complaints reached 74.4% in two of the studies, primarily affecting the lower back, neck, and shoulders. Repetitive movements, stooped postures, and the lifting of patients were associated with musculoskeletal complaints. Computer use for more than three hours a day was linked to a higher likelihood of neck pain (OR 1.96), whereas the application of ergonomic principles was associated with a lower likelihood of such complaints (OR 0.48). The number of clinical practice hours did not show a significant association, while stress was also reported as a contributing factor. Due to the heterogeneity of the studies, the results were synthesized narratively. The findings indicate an association between ergonomic risks and MSDs; however, a causal relationship cannot be established, as all included studies utilized a cross-sectional design. From the perspective of medical rehabilitation, early screening, ergonomic education, activity modification, and physical exercise could be considered to support the students' functional capacity and participation. Limitations of the current evidence include the small number of studies, reliance on self-reported data, and a lack of research specifically focused on clinical clerkship students. Longitudinal studies are required to strengthen the evidence base and evaluate the effectiveness of interventions.
Manajemen Anestesi untuk Operasi Miles (Abdominoperineal Resection) pada Pasien Kanker Rektum : Sebuah Laporan Kasus Danang Samudro Wicaksono; Bambang Eko SUbekti; Abigael Ludwina Kalih; Adilla Justisia; Mohammad Haidar Kanzulli; Tiara Dewi Septi; Zien Najwa Hailul Haya
Medula Vol 17 No 3 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i3.2075

Abstract

Distal rectal cancer involving the anal sphincter may require abdominoperineal resection (APR), also known as Miles’ operation. This major surgical procedure requires optimal anesthetic management to maintain hemodynamic stability and minimize perioperative complications. This case report describes the anesthetic management of a patient with rectal cancer undergoing Miles’ operation. A 52-year-old woman with a one-year history of bloody bowel movements and weight loss underwent Miles’ operation following colostomy and four cycles of chemotherapy. Preoperative evaluation revealed stable hemodynamic status, a hemoglobin level of 11.9 g/dL, albumin level of 3.74 g/dL, and normal renal and hepatic function. General anesthesia with endotracheal intubation was induced using fentanyl, propofol, and atracurium, followed by maintenance with sevoflurane, continuous propofol infusion, and continuous atracurium infusion. The operation lasted 2.5 hours, with estimated blood loss of 800 mL and urine output of 500 mL. Intraoperative fluid management included crystalloids, colloids, and 200 mL of packed red blood cells (PRC), administered based on the clinical judgment of the anesthesia and surgical teams. Vital signs were reported as stable in the anesthesia record, although quantitative data were unavailable. Postoperatively, the patient received antibiotics, analgesics, intravenous fluids, and oral nutrition during a two-day hospital stay. She reported pain around the surgical wound but experienced no significant complications and was discharged in good condition. This case highlights the importance of comprehensive preoperative assessment, appropriate anesthetic selection, intraoperative monitoring, and fluid and blood loss management in supporting recovery following major surgery.
Kolik Abdomen dengan Keterlibatan Multisistemik: Laporan Kasus pada Remaja Perempuan dengan Gastritis, ISK, dan Anemia Berat Aditya Hartawan; Shinta Nareswari
Medula Vol 17 No 2 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i2.2076

Abstract

Abdominal pain in children and adolescents requires a thorough evaluation, as it may be associated with gastrointestinal, genitourinary, or hematological disorders. This case report discusses a 13-year-old, 5-month-old girl who presented with intermittent left-sided abdominal pain lasting one week; the pain was described as stabbing, radiating to the back, and accompanied by fever, nausea, vomiting, diarrhea, and weakness. The patient had a history of hospitalization one month prior, with a diagnosis of ascites, suspected tuberculous peritonitis, and anemia. Physical examination revealed pale conjunctivae and mucous membranes, tachycardia, mobile and tender superficial auricular and cervical lymphadenopathy, epigastric tenderness, and hepatomegaly. Laboratory findings showed severe anemia (hemoglobin 5.9 g/dL) with normocytic red blood cell indices, thrombocytopenia (platelet count 31,000/µL), an elevated erythrocyte sedimentation rate, and hypokalemia. Urinalysis indicated microhematuria, with no evidence of leukocyturia, nitrites, or bacteria. An abdominal CT scan revealed hepatomegaly, signs suggestive of cystitis, and suspected duodenitis, with no ascites. The working diagnosis included abdominal colic—with suspected gastritis and a urinary tract infection (UTI)—hypokalemia, and severe anemia accompanied by thrombocytopenia. Management consisted of intravenous fluids, antibiotics, H₂-receptor antagonists, potassium correction, and a transfusion of packed red cells (PRC). Further evaluation is necessary to determine the etiology of the severe anemia and thrombocytopenia, and to confirm the suspected UTI—potentially through a urine culture. This case underscores the importance of a multisystemic diagnostic approach in adolescents presenting with abdominal pain and systemic symptoms, particularly when significant hematological abnormalities are identified.

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