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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 972 Documents
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Hubungan IMT Terhadap Kadar Gula Darah Pada Pasien Diabetes Mellitus Tipe 2: Tinjauan Pustaka Afifah, Ighra; Kurniati, Intanri; Marcellia, Selvi; Ramadhian, Muhammad Ricky
Medula Vol 15 No 4 (2025): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v15i4.1704

Abstract

Type 2 diabetes mellitus is a chronic metabolic disease with a steadily increasing prevalence globally, including in Indonesia. One of the main risk factors contributing to the development and severity of type 2 diabetes is obesity, clinically measured by Body Mass Index (BMI). Increased BMI is closely associated with impaired glucose metabolism and insulin resistance, which play a key role in the pathogenesis of type 2 diabetes. This study used a literature review approach by examining various studies analyzing the relationship between BMI and blood glucose levels. The results showed that increased BMI is positively correlated with fasting blood glucose, random blood glucose, and HbA1c levels. Individuals with a higher BMI tend to experience more severe glycemic control disorders. Pathophysiologically, increased adipose tissue, especially visceral fat, produces various inflammatory mediators such as TNF-α and IL-6, which disrupt the insulin signaling pathway, reduce glucose uptake by muscle tissue, and trigger hyperglycemia. Furthermore, dysfunction of adipokine hormones such as decreased adiponectin and resistance to leptin contribute to worsening insulin sensitivity
HUBUNGAN KADAR HBA1C DENGAN DERAJAT ULKUS DIABETIK MENURUT KLASIFIKASI MEGGITT-WAGNER PADA PASIEN DIABETES MELITUS TIPE 2 DI RSUD DR. H. ABDUL MOELOEK BANDAR LAMPUNG PERIODE JANUARI-JULI 2022 Salsabila, Kamila; Kurniati, Intanri; Wulan, Anggraeni Janar; Wintoko, Risal
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.v16i1.1718

Abstract

Type 2 diabetes mellitus can lead to various complications if they are not managed adequately, including diabetic ulcers. Classification of diabetic ulcers is necessary to describe the lesion and to study the prognosis of the patients. The Meggit-Wagner classification was chosen because it is a classification system that has many advantages. Measurement of glycated hemoglobin (HbA1C) is a glycemic control that is considered good for describing blood sugar levels. High blood glucose levels are one of the reasons why patients have difficulty healing wounds, which can affect the grade of diabetic ulcers. The purpose of this study was to determine the relationship between HbA1C levels and the grade of diabetic ulcers according to the Meggitt-Wagner classification in type 2 diabetes mellitus patients at Dr. H. Abdul Moeloek Hospital Bandar Lampung from January-July 2022. This research is a retrospective observational analytic study with a cross-sectional approach. The research sample was 66 patients. The data used is medical records. Selection of the sample using total sampling technique. Statistical analysis was performed using univariate and bivariate analysis. The results of the bivariate analysis using the chi-square test showed a value of p=0.003 (p <0,05) in HbA1C levels and the grade of diabetic ulcers, which means that there is a significant relationship between the variables. There is a significant relationship between HbA1C levels and the grade of diabetic ulcers according to the Meggitt-Wagner classification in type 2 diabetes mellitus patients at Dr. H. Abdul Moeloek Hospital Bandar Lampung from January-July 2022.
Hubungan antara status kesehatan balita dengan kejadian pneumonia di indonesia (analisis data riskesdas 2018) Howay, Susan Yulia Laura; Sutarto, Sutarto; Larasati, TA; Nareswari, Shinta
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.v16i1.1719

Abstract

Pneumonia is a leading cause of under-five mortality in Indonesia. Several risk factors—such as low birth weight, incomplete immunization, lack of exclusive breastfeeding, and poor nutritional status—contribute to the high mortality rate. This study aims to determine the prevalence of pneumonia and the distribution of low birth weight, immunization status, nutritional status, and exclusive breastfeeding among Indonesian children under five, as well as to analyze their associations with pneumonia. This study used secondary data from the 2018 National Basic Health Research (Riskesdas) covering 34 provinces in Indonesia with a cross-sectional design. Samples were selected using probability proportional to size (PPS) with a two-stage sampling method. Data were analyzed using the chi-square test. The results of statistical tests in this study showed that there was a significant relationship between birth weight status and nutritional status with the incidence of pneumonia (p value = 0.000; 95% CI, 1.269-1.996; OR = 1.592) and (p value = 0.029; 95 % CI, 1.023-1.449; OR = 1.218), while the results of statistical tests also showed that there was no significant relationship between immunization status and exclusive breastfeeding status with the incidence of pneumonia (p value = 0.656; 95% CI, 0.808-1.137; OR = 0.958 ) and (p value = 0.803; 95% CI, 0.832-1.153; OR = 0.979). In the conclusion, a significant association was found between birth weight status and nutritional status with the occurrence of pneumonia.
Faktor-Faktor Yang Mempengaruhi Mortalitas Pasien Batu Ginjal yang Menjalani Operasi Nefrolitotomi di RSUD Dr. H. Abdul Moeloek Provinsi Lampung Tahun 2017-2021 Purnamasari, Haninovita; Hadibrata, Exsa; Mayasari, Diana; Wintoko, Risal
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.v16i1.1720

Abstract

This study aims to determine the factors that influence the mortality of kidney stone patients after nephrolithotomy surgery. This study used an descriptive analytic method with a case control approach. The research sample was 84 people, namely 21 cases and 63 controls in the working area of RSUD Dr. H. Abdul Moeloek 2017-2021 and was taken using the consecuetive sampling method. The dependent variable is the mortality of post-nephrolithotomy kidney stone patients. The independent variables were age, sex, Hb levels, decreased kidney function, types of stones, and multiple comorbidities. Statistical analysis using the chi square test. Based on the results of the study the mortality rate for patient with kidney stones after nephrolitotomy surgery was 7,9%. Most of the respondents were aged <60 years (76.2%), male (52.4%), Hb level >10 g/dl (63.1%), creatinine level <1.5 mg/dl (57.1%), non staghorn stones (54.8%), and multiple comorbidities (57.1%). Variables that influence mortality in postoperative kidney stone patients (α=0,05), namely age (p value <0,001),  Hb level (p value=0,003), decreased kidney function (p value=0,001), type of stone (p value=0,043), and multiple comorbidities (p value=0,002). While the unrelated variables is gender (p value=0,207). The factor that has the most dominant influence is Hb levels. Age, Hb level, decreased kidney function, type of stone and multiple comorbidities are influence with mortality in postoperative kidney stone patients at RSUD Dr. H. Abdul Moeloek.
Laporan Kasus : Pasien Wanita 49 tahun dengan Proptosis et causa Thyroid Eye Disease Okuli Sinistra Salsabilah, Nadya; Maulana, Muhammad
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.v16i1.1721

Abstract

Thyroid Eye Disease (TED), also known as Graves’ ophthalmopathy, is an extra-thyroidal manifestation of autoimmune thyroid disorders characterized by chronic inflammation of the orbital tissues. This condition may result in various ocular manifestations, including proptosis, diplopia, dry eyes, photophobia, and decreased visual acuity, significantly affecting patients’ quality of life. The development and progression of TED are influenced by both non-modifiable factors such as age, sex, and genetic predisposition, as well as modifiable factors including uncontrolled thyroid dysfunction, smoking, radioiodine therapy, oxidative stress, elevated TSH receptor antibody levels, and dyslipidemia. This case report describes a 49-year-old woman who presented with a protruding left eye for approximately five years prior to hospital admission. The patient also complained of blurred vision, diplopia, glare, and dry eyes. She had a history of hyperthyroidism diagnosed eight years earlier. Ophthalmologic examination revealed a left visual acuity of 2/20, upper eyelid retraction, and exotropia. Laboratory evaluation demonstrated elevated free thyroxine (T4) levels of 215.53 nmol/L and suppressed thyroid-stimulating hormone (TSHS) levels of <0.005 uIU/mL, consistent with hyperthyroid status. Based on clinical presentation and supporting investigations, the patient was diagnosed with proptosis due to Thyroid Eye Disease in the left eye. This case highlights the importance of early diagnosis, comprehensive assessment, and appropriate management of TED. Timely identification and control of modifiable risk factors, along with individualized therapeutic strategies according to disease severity, are essential to prevent disease progression, minimize complications, and preserve visual function and overall quality of life in patients with Thyroid Eye Disease.
Manajemen Perioperatif pada Pasien dengan Hipertensi: Tinjauan Pustaka Khoirul Basyar, Fragil; Subekti, Bambang Eko
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.v16i1.1725

Abstract

Hypertension is a chronic condition characterized by sustained elevation of blood pressure ≥130/80 mmHg and is one of the major risk factors for morbidity and mortality among patients undergoing elective surgery. Globally, hypertension affects more than 1.13 billion individuals and contributes to approximately 9 million deaths annually. Despite advancements in antihypertensive therapy, hypertension remains a significant clinical challenge in perioperative management. Meta-analyses indicate that hypertension increases the risk of postoperative cardiovascular complications by up to 35%, underscoring the importance of effective perioperative management. Blood pressure regulation involves baroreceptor reflex mechanisms and the Renin–Angiotensin–Aldosterone System (RAAS). Dysregulation of these systems influences hemodynamic responses during anesthesia, in which reduced sympathetic activity and increased RAAS activation may elevate the risk of intraoperative hypotension, particularly in patients receiving specific classes of antihypertensive medications. Perioperative management begins with a comprehensive blood pressure assessment. Surgical delay is recommended only in cases of severe hypertension, defined as diastolic pressure >110 mmHg, or when significant comorbidities are identified. Management of antihypertensive medications plays a crucial role. Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Blockers (ARBs) are generally recommended to be withheld 24 hours prior to surgery to prevent intraoperative hypotension, except in stable heart failure patients. Large cohort studies have demonstrated that discontinuing ACEIs/ARBs before surgery reduces the composite risk of mortality, stroke, and myocardial injury in non-cardiac procedures. In contrast, β-blockers should be continued until the day of surgery, as abrupt discontinuation may induce rebound hypertension, tachycardia, and an increased risk of myocardial ischemia. Meta-analyses show that β-blockers effectively reduce the incidence of postoperative myocardial infarction and arrhythmias. Perioperative management in hypertensive patients requires an individualized approach that considers clinical status, medication profile, and hemodynamic risks associated with anesthesia.
Infeksi Saluran Kemih Rekuren pada Anak Perempuan Usia 7 Tahun: Sebuah Laporan Kasus Wigati, Lucky Indar; Suryati, Elvi
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.v16i1.1726

Abstract

Urinary tract infection (UTI) is one of the most common bacterial infections in children and represents a significant cause of morbidity, particularly among girls. UTIs occur due to the invasion of microorganisms into the urinary tract, triggering local and systemic inflammatory responses. Based on the anatomical location, UTIs are classified into upper and lower urinary tract infections, while according to disease course they are categorized as first episode, recurrent, or complicated UTIs. Recurrent UTIs in children require special attention because of their potential to cause long-term complications, including renal damage. This case report describes a 7-year-old girl presenting with recurrent dysuria accompanied by lower abdominal discomfort and a history of chronic constipation. Physical examination revealed suprapubic tenderness without costovertebral angle tenderness. Urinalysis demonstrated leukocyturia, mild hematuria, positive nitrite, and cloudy urine, while urine culture showed the growth of Escherichia coli at a concentration of 10⁵ CFU/mL. Imaging studies of the kidneys and urinary tract revealed no structural abnormalities. The diagnosis of recurrent UTI was established based on clinical history, physical findings, and supporting investigations. Management included empirical intravenous antibiotic therapy, supportive treatment, and non-pharmacological education focusing on adequate hydration, proper voiding habits, and personal hygiene. This case highlights the significant role of non-anatomical risk factors, such as chronic constipation and habitual urinary retention, in the development of recurrent UTIs in children. A comprehensive management approach addressing both acute infection and predisposing factors is essential to prevent recurrence and preserve long-term renal function.
G2P1A0 Hamil 34 Minggu Belum Inpartu dengan BSC 1x + KPD 6 Jam, JTH Presentasi Kepala Oktarika, Rizqi Fathiani Siti; Adrian, Ronny
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.v16i1.1727

Abstract

Preterm premature rupture of membranes (PPROM) remains a clinical challenge due to its association with increased maternal infection, neonatal complications, and the need for carefully timed delivery decisions. This case report describes a 34-week pregnant woman (G2P1A0) who presented with clear vaginal fluid leakage for six hours prior to hospital admission, without uterine contractions. Speculum examination revealed pooling of amniotic fluid with a positive nitrazine test, while ultrasonography demonstrated a live singleton fetus in cephalic presentation with adequate amniotic fluid volume. Laboratory evaluation showed a leukocyte count of 9,900/µL, which is within the physiological range for the third trimester but warrants close monitoring due to the increased risk of ascending infection in PPROM. In the absence of clinical signs of intrauterine infection, short-term expectant management was undertaken, accompanied by antibiotic therapy, tocolytics, and antenatal corticosteroids to maintain maternal–fetal stability and reduce prematurity-related risks. Considering the unripe cervix and a history of one previous cesarean section, elective cesarean delivery was chosen as the safest mode of pregnancy termination. The neonate was delivered in good condition with satisfactory APGAR scores, and the mother experienced an uneventful postoperative recovery. This case highlights that individualized, guideline-based management of PPROM at 34 weeks’ gestation can optimize maternal and neonatal outcomes.
Partus Prematurus Imminens Akibat Penggunaan Obat Uretonika Dosis Tinggi: Sebuah Laporan Kasus Pratiwi, Aulia Sari; Graharti, Risti; Kusumaningtyas, Intan
Medula Vol 16 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Imminent preterm labor is an obstetric condition characterized by uterine contractions accompanied by cervical changes before 37 weeks of gestation, which can lead to preterm delivery. This condition remains the leading cause of perinatal morbidity and mortality in Indonesia. According to the 2018 Basic Health Research (Riskesdas), the prevalence of premature births reached 29.5 per 1,000 live births and contributed to 35% of neonatal deaths. This study aims to report and analyze cases of imminent premature labor due to the use of high-dose urethronics, as well as to review the latest evidence-based management. Data were obtained through anamnesis, physical examination, and review of patient medical records, which were then supplemented with a literature review related to the mechanism of action of uterotonic drugs, the role of prostaglandins, and management guidelines from the WHO, ACOG, and WAPM-PMF. The results of the report showed that patients experienced active uterine contractions with premature rupture of membranes at 29–30 weeks of gestation after repeated consumption of high doses of misoprostol. The use of uretonic drugs caused an increase in contractions due to excessive prostaglandin stimulation. Management included the administration of antenatal corticosteroids to accelerate fetal lung maturation, short-term tocolytics to delay labor, and magnesium sulfate as a neuroprotective agent. It is concluded that the use of uterotonic drugs without medical supervision can be a factor in triggering imminent premature labor. A comprehensive and evidence-based management approach can reduce the risk of neonatal complications and improve pregnancy outcomes, making strict supervision and patient education important steps in preventing similar cases in the future.
HIPERTENSI PADA DIABETES MELLITUS: SEBUAH TINJAUAN PUSTAKA Febriyan, Heironimus Billy; Utama, Winda Trijayanthi
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.v16i2.1729

Abstract

Hypertension in patients with diabetes mellitus is a significant clinical problem because it increases the risk of cardiovascular and renal complications. The pathophysiology of this condition involves interactions between insulin resistance, activation of the renin–angiotensin–aldosterone system (RAAS), endothelial dysfunction, and oxidative stress, which trigger vasoconstriction, sodium retention, and increased vascular stiffness. Various clinical guidelines, including those of the American Diabetes Association (ADA), set a blood pressure target of <130/80 mmHg to reduce the risk of long-term complications. Evidence from clinical trials such as ABCD shows that intensive blood pressure control provides benefits in terms of the progression of retinopathy, albuminuria, and stroke risk. This article was compiled using a narrative review approach by examining the latest literature from international journals and clinical guidelines related to hypertension in diabetes. Sources were selected based on relevance, recency, and strength of evidence. The analysis was descriptive to summarize pathophysiology, blood pressure target recommendations, treatment options, and the role of lifestyle changes. Management of hypertension in diabetes requires a combination of pharmacological therapy and lifestyle modifications. ACE inhibitors and ARBs are the first choice due to their renal protective benefits, while calcium antagonists and thiazide diuretics are used as adjunctive therapy. Lifestyle interventions such as salt restriction, increased fruit and vegetable consumption, regular physical activity, weight loss, and alcohol restriction provide moderate blood pressure lowering effects and improve metabolic health. A comprehensive approach encompassing metabolic, pharmacological, and lifestyle management is crucial for reducing morbidity and mortality in patients with diabetes and hypertension.

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