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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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Peran Pangan Ultra Proses terhadap Peningkatan Risiko Obesitas Anak Cintawan, Ni Made Karenina Rini Dwi; Graharti, Risti; Sitepu, Ricky Rivalino
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.v16i1.1741

Abstract

The problem of obesity in adolescents has developed into a global health crisis, exacerbated by lifestyle changes and the consumption of ultra-processed foods (UPF). Indonesia is predicted to become one of the countries with the highest cases of childhood obesity, marked by a doubling in the prevalence of adolescent obesity between 2013 and 2018. This literature review aims to comprehensively analyze the role of UPF consumption in increasing the risk of obesity in the child and adolescent population. This study uses a literature review method by searching scientific databases to identify and synthesize articles discussing the relationship between UPF intake and childhood obesity. (Note: The literature search section has been adjusted to focus on UPF and Obesity). Obesity in adolescents is defined based on WHO criteria (BMI/A Z-score >+2 SD) and is classified predominantly as primary obesity (multifactorial). High UPF consumption has been shown to have a positive and significant association with overnutrition; studies show a drastically increased risk of obesity (40% - 66%) in UPF consumers. The etiological mechanisms are multifactorial, including: 1) Energy Balance Disruption (high energy density, poor nutrient profile, fiber deficit); 2) Decreased Thermogenic Effect of Food (TEF) by up to 50; 3) Hormonal Metabolic Disturbances (increased insulin, insulin resistance, changes in brain circuitry); and 4) Exposure to Obesogenic Substances (Endocrine Disruptors) from additives and packaging. Consumption of UPF is a major and complex risk factor for the pathogenesis of childhood and adolescent obesity, acting through metabolic, neurological, and toxicological pathways. Food policy interventions are needed to mitigate these health risks.
Efektivitas Kortikosteroid Intranasal vs Antihistamin Oral pada Rhinitis Dwiyanti, Fitri; Ferdiani, Fivien; Imanto, Mukhlis
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.v16i1.1742

Abstract

Allergic Rhinitis (AR) is a chronic inflammatory disorder of the nasal mucosa mediated by immunoglobulin E after exposure to specific allergens. It is characterized by rhinorrhea, nasal obstruction, sneezing, and nasal itching. AR has a high and increasing global prevalence and significantly affects quality of life, sleep quality, cognitive performance, and daily productivity. Effective management is required to control symptoms and prevent complications and comorbidities. This literature review compares the effectiveness of intranasal corticosteroids (INCS) and oral antihistamines (OAH) in the management of allergic rhinitis. A literature search was conducted using the Google Scholar database for studies published between 2017 and 2025, using the keywords “allergic rhinitis”, “allergic rhinitis therapy”, and “intranasal corticosteroids and oral antihistamines”. Included articles were accessible, written in English or Indonesian, and discussed the comparative effectiveness of INCS and OAH. Studies published before 2017 were excluded. The findings show that oral antihistamines effectively relieve early-phase, histamine-mediated symptoms such as sneezing, nasal itching, and rhinorrhea, with a rapid onset of action suitable for intermittent use. In contrast, intranasal corticosteroids are more effective in reducing nasal congestion and controlling persistent inflammation due to their broad anti-inflammatory effects. INCS also improve ocular symptoms and provide greater overall improvement in health-related quality of life compared to antihistamines alone. Overall, intranasal corticosteroids are recommended as first-line therapy for moderate to severe or persistent allergic rhinitis, while oral antihistamines remain useful for mild symptoms or as adjunctive therapy according to individual clinical needs.
Perdarahan Uterus Abnormal Pada Seorang Wanita Berusia 35 Tahun : Sebuah Laporan Kasus Perdana, Azzahra Gadis Junita; Angraini, Dian Isti
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.v16i1.1743

Abstract

Abnormal uterine bleeding (PUA) is a gynecological disorder that often occurs in women of reproductive age characterized by menstrual disturbances both in number and duration. The prevalence of PUA worldwide ranges from 3-30% with a higher incidence during menarche and perimenopause. In Indonesia, PUA is estimated to occur in 20% of adolescents and 50% of women aged 40-50 years. Management of PUA requires a holistic approach that includes biomedical, psychosocial and behavioral aspects. The family medicine approach is an effective strategy by considering risk factors, lifestyle, and psychosocial conditions of patients. This study used a qualitative descriptive design with a case study. Data were collected through history taking, physical examination, supporting examination, and in-depth interviews. Interventions included medical therapy, health education, lifestyle modification, and psychosocial support. Patient Mrs. F, 35 years old, had complaints of abnormal bleeding outside the menstrual phase since one month ago. Internal risk factors include lack of knowledge related to PUA, inappropriate diet, and low awareness of routine control. While the patient's external factors include lack of family knowledge about PUA, appropriate contraceptive recommendations for patients and lack of family support. After the intervention, there was an increase in patient and family knowledge, improvement in the patient's diet and physical activity, and increased family attention and support for the patient.
Manajemen Anestesi Perioperatif pada Pasien Obesitas: A Literature Review Nurrahma, Alya Nabila; Rakhman, Andre Kusuma
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.v16i2.1744

Abstract

The prevalence of obesity has continued to rise over the past decades and has become a major concern in clinical practice. Obesity presents specific challenges in perioperative management, particularly in airway management for obese patients undergoing surgical procedures. Anesthesiologists must understand the various risks associated with anatomical and physiological changes, including excessive fat deposition in the neck and thoracic regions, reduced functional residual capacity of the lungs, and increased oxygen demand. In addition, obese patients frequently have comorbid conditions such as diabetes mellitus, hypertension, and obstructive sleep apnea, which further increase the risk of perioperative complications. This article was prepared using a literature review method through a comprehensive search of scientific articles published in various journals. The literature included publications from 2020 to 2025 obtained from PubMed, NCBI, and Google Scholar databases. Selected articles were analyzed using a systematic literature review approach, which involved data collection, assessment of study quality, and synthesis of findings with a focus on perioperative management in obese patients. The results indicate that successful anesthetic management in obese patients strongly depends on thorough preoperative assessment, careful airway strategy planning, and appropriate selection of anesthetic techniques. During the intraoperative phase, close monitoring and adjustment of anesthetic drug dosing are essential to maintain patient safety. Postoperative care also plays a crucial role in preventing respiratory complications, particularly in the early recovery period. A comprehensive and integrated perioperative approach is required to improve patient safety and optimize clinical outcomes in obese individuals undergoing surgery.
Diagnosis & Tatalaksana Nekrosis Avaskular Caput Femur Purwanto, Tito; Utami, Winda Trijayanthi
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.v16i1.1745

Abstract

Avascular necrosis (AVN) of the femoral head is a condition resulting from compromised blood supply, leading to bone tissue death and progressive joint damage. Early diagnosis is challenging because initial radiographic findings are often normal, and most patients present at advanced stages. This narrative review discusses the etiology, diagnosis, classification, and treatment options for AVN based on disease stages, highlighting conservative approaches, biological interventions, and surgical procedures. Causes of AVN include alcohol consumption, corticosteroid use, trauma, anatomical abnormalities, and certain hematologic conditions. MRI is the most sensitive diagnostic modality in early phases, while the Ficat & Arlet classification is used for staging. In the pre-collapse phase, conservative management such as protected weight-bearing, bisphosphonates, anticoagulants, prostaglandin analogs, and hyperbaric oxygen therapy may help preserve the joint. Surgical interventions such as core decompression with or without bone grafting and the addition of biological agents aim to enhance angiogenesis and osteogenesis. In the post-collapse phase, joint preservation is not recommended, and total hip arthroplasty is the preferred treatment, although failure rates are higher than in non-AVN osteoarthritis cases. The prognosis of AVN depends on early detection and stage-appropriate intervention. A multimodal approach in the early phase may maintain joint integrity, while in advanced disease, joint reconstruction through arthroplasty provides the most effective outcome. Further evaluation of biological therapies and optimization of rehabilitation strategies are needed to improve clinical results.
Laporan Kasus : Ulkus Kornea Okuli Sinistra dengan Impending Perforasi Pabiola, Dea Okta; 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.v16i1.1747

Abstract

Corneal ulcer is the partial loss of the corneal surface due to the death of corneal tissue, characterized by the presence of a purulent infiltrate accompanied by a corneal defect extending from the epithelium to the stroma. Corneal ulcers can occur due to trauma from foreign objects, tear insufficiency, or diseases that facilitate the entry of bacteria, viruses, or fungi into the cornea. Appropriate medical management to prevent complications such as endophthalmitis, cataracts, secondary glaucoma, and corneal perforation. A man was reported with complaints of blurred vision in his left eye accompanied by pain, itching, and watering since 1 month before admission to the hospital. The complaint is exacerbated by the presence of white spots in the left eye and a sharp decline in vision, with the patient only able to see shadows from a close distance. Examination of the left eye revealed a visual acuity of 1/300, with the eyeball in an orthophoric position. Inspection of the upper and lower eyelids revealed edema, hyperemia, and discharge. The ball movement is good, but the field of view is difficult to assess. The cornea has ulcers that are diffuse, extending from the center to the periphery, 1 mm from the limbus, with irregular, round borders and a size of 5 mm. The anterior chamber, iris, pupil, lens, and fundus examination are difficult to assess. The patient was diagnosed with a left eye corneal ulcer with impending perforation.
The Hubungan Defisiensi Vitamin D dengan Risiko Infeksi Saluran Pernapasan Bawah pada Dewasa Hakim, Ashilah Mumtaz; Morfi, Chicy Widya
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.v16i2.1749

Abstract

Lower respiratory tract infections (LRTIs) remain a major public health problem in adults and contribute substantially to global morbidity and mortality. The risk of LRTIs increases among older adults and individuals with comorbid conditions, making the identification of modifiable risk factors essential. Vitamin D status has gained increasing attention due to its role not only in calcium homeostasis and bone health but also in the regulation of innate and adaptive immune responses. This literature review aims to evaluate the association between vitamin D deficiency and the risk and severity of LRTIs in the adult population. The review includes evidence from meta-analyses, randomized controlled trials, and cohort studies published within the past five years. The findings consistently show that serum 25-hydroxyvitamin D levels below 20 ng/mL are associated with a higher risk of pneumonia, prolonged hospital length of stay, and increased mortality. These associations are supported by biological mechanisms such as reduced production of antimicrobial peptides including cathelicidin, heightened pro-inflammatory immune responses, impaired macrophage and natural killer cell function, and weakened respiratory mucosal defenses. Several interventional studies indicate that vitamin D supplementation provides protective effects in individuals with vitamin D deficiency, particularly by reducing the incidence and severity of LRTIs, whereas the benefits appear limited in individuals with sufficient vitamin D levels. Overall, the evidence suggests that vitamin D screening, targeted supplementation, and comprehensive preventive strategies may play an important role in reducing the burden of LRTIs among adults.
Management of Abdominal Management of abdominal Typhoid in a 22 years old women without regular diet and lack of PHBS knowladge. especially washing hands before eating: Typoid fever, PHBS and Diet Dewi, Tri Agustina; Lisiswanti, Rika
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.v16i2.1750

Abstract

Typhoid fever is a potentially fatal multisystem infectious disease that remains a significant public health problem in Indonesia, particularly in areas with poor sanitation and inadequate implementation of clean and healthy living behavior (PHBS). We report a case of a 22-year-old woman who presented with continuous fever for approximately three days prior to admission, worsening in the afternoon and evening, accompanied by chills, headache, dizziness, nausea, vomiting, epigastric pain, and constipation. The patient had a history of irregular dietary habits, frequent consumption of street food, and poor hand hygiene practices, especially failure to wash hands before meals. Physical examination revealed a coated tongue and epigastric tenderness, while laboratory findings showed a Widal O titer of 1/320 supporting the diagnosis of abdominal typhoid fever. The patient was managed with chloramphenicol, antipyretics, intravenous fluids, bed rest, and a low-fiber diet, along with comprehensive education regarding PHBS implementation, particularly proper handwashing and regular dietary patterns. This case highlights that irregular eating habits and inadequate knowledge and practice of PHBS play an important role in the occurrence of abdominal typhoid fever, emphasizing the need for comprehensive management combining medical therapy and health behavior education to prevent recurrence and disease transmission.
Laporan Kasus: Nyeri Punggung Bawah Akibat Kerja pada Pekerja Pemanen Sawit Salsabila Nurislami; 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.v16i2.1751

Abstract

Work-related diseases in the agricultural sector have shown a rising trend in recent years. Heavy physical activities involving non-ergonomic postures, heavy lifting, and repetitive movements increase the risk of injuries and musculoskeletal disorders. Low back pain is one of the most common musculoskeletal complaints among workers in this sector. This case report aims to analyze low back pain in an oil palm harvester using the application of the seven-step occupational diagnostic approach. The seven-step occupational diagnosis was applied to determine the causal relationship between occupational exposure and the patient’s symptoms. Clinical diagnosis and management were conducted in accordance with clinical guidelines.The patient was an oil palm harvester with recurrent episodes of low back pain. Occupational analysis showed that the patient worked in prolonged non-ergonomic postures—standing with neck extension, frequent forward bending, and repetitive heavy lifting—for 15 years, with daily work durations of 8–10 hours. Based on the seven-step occupational diagnostic assessment, the patient’s condition was classified as an occupational disease. Management included pharmacological therapy and ergonomic education. This case highlights that non-ergonomic working postures, the use of non-ergonomic tools, repetitive movements, and heavy lifting significantly contribute to the development of low back pain among agricultural workers. Pharmacological treatment must be accompanied by preventive strategies through ergonomic education. This case report underscores the importance of physicians’ competency in establishing occupational diagnoses and providing comprehensive management for workers with occupational diseases
Hubungan Jenis Kelamin, Usia, dan Pekerjaan dengan Kejadian Anemia pada Pasien Tuberkulosis Paru di Rumah Sakit Umum Daerah Abdul Moeloek Bandar Lampung pada Bulan Januari - Agustus 2022 Fathunnisa, Ridha Riano; Sangging, Putu Ristyaning Ayu; Utami, Winda Trijayanthi; Soleha, Tri Umiana
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.v16i1.1754

Abstract

Pulmonary tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and is classified as a chronic multisystem infection with diverse clinical manifestations. Hematological abnormalities are frequently observed in tuberculosis patients and are generally associated with non-immunological mechanisms. Anemia is one of the most common abnormalities. All chronic infections, including tuberculosis, can induce anemia through various pathogenic pathways. However, most studies indicate that suppression of erythropoiesis mediated by inflammatory factors plays a major role in the development of anemia in tuberculosis patients. This study aimed to describe the characteristics of anemia and identify factors associated with its occurrence in patients with pulmonary tuberculosis. An observational analytic study with a cross-sectional design was conducted. Data were obtained from the medical records of pulmonary tuberculosis patients with anemia at the Medical Records Unit of RSUD Dr. H. Abdul Moeloek Bandar Lampung from January to December 2022. A total of 85 patients who met the inclusion criteria were included and analyzed using univariate and bivariate analyses with the Chi-Square test. Univariate analysis showed that most patients had normocytic normochromic anemia, accounting for 66 patients or 77.6%, while microcytic hypochromic anemia was observed in 19 patients or 22.4%. Anemia was more common in male patients, with a proportion of 74.1%. Bivariate analysis demonstrated a significant association between age and anemia occurrence, with a p value of 0.024. No significant association was found between occupation and anemia or between sex and anemia. This study concludes that age is the only factor associated with anemia among pulmonary tuberculosis patients at RSUD Dr. H. Abdul Moeloek Bandar Lampung.

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