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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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Carpal Tunnel Syndrome Pada Petani : Tinjauan Pustaka Azzahra, Herina; Utama, 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.v16i1.1755

Abstract

Carpal Tunnel Syndrome (CTS) is a compression neuropathy resulting from increased pressure on the median nerve within the carpal tunnel, characterized by pain, paresthesia, and numbness affecting the thumb to the third finger. CTS represents one of the most common musculoskeletal disorders, particularly among workers engaged in repetitive hand movements, forceful manual tasks, or prolonged non-ergonomic wrist postures. Globally, its prevalence varies across populations and may reach 7–20% among industrial workers. In Indonesia, CTS remains an underreported condition and is often regarded as an iceberg phenomenon due to limited clinical detection and reporting. CTS may be idiopathic or secondary to conditions such as pregnancy, obesity, hypothyroidism, and diabetes mellitus. Diagnosis is primarily clinical, supported by provocative tests such as Phalen’s test, Tinel’s sign, and the wrist extension test, as well as neurophysiological assessments including electromyography and nerve conduction studies. Radiological imaging may assist in excluding other structural causes. Management consists of conservative measures such as activity modification, wrist exercises, splinting, and the use of analgesics or anti-inflammatory agents. In moderate to severe cases, surgical decompression through division of the transverse carpal ligament is required to reduce pressure on the median nerve. Preventive strategies focus on improving workplace ergonomics, controlling comorbid conditions, and providing education regarding safe hand-use practices.
Cushing Syndrome pada Anak Perempuan 5 Tahun: Sebuah Laporan Kasus Daradjat, Muhammad Yazid; Ismail, Ismi Citra
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.v16i2.1756

Abstract

Cushing’s syndrome (CS) is a rare multisystem endocrine disorder characterized by excessive glucocorticoid levels. In children, this condition is uncommon, with a reported global incidence of approximately 1:5,000,000–10,000,000 per year, and may result from endogenous overproduction or prolonged irrational use of exogenous steroids. This case report describes a 5-year-6-month-old girl presenting with fever accompanied by nausea, vomiting, and diarrhea. The patient had a history of recurrent unexplained fever for the past two years and had been repeatedly treated with paracetamol and dexamethasone without medical consultation until symptoms improved. The diagnosis was supported by physical examination findings suggestive of obesity, diastolic blood pressure above the 95th percentile, moon face, buffalo hump, acanthosis nigricans, and abdominal striae. Supporting examinations revealed adrenal ultrasonography within normal limits. Management included gradual tapering off dexamethasone and close observation for signs of adrenal crisis, followed by planned evaluation of cortisol and plasma adrenocorticotropic hormone levels. Long-term use of steroid medications without proper medical supervision remains the most common cause of CS in pediatric patients. This report emphasizes the importance of stricter regulation of over-the-counter steroid distribution by relevant stakeholders and highlights the critical role of clinicians in educating parents regarding the appropriate use of steroid medications to prevent the development of Cushing’s syndrome in children.
Identification of Active Compound and Effectiveness Test of 96% Tithonia diversifolia Ethanol Extract on Mortality of Aedes aegypti Mosquito A.P, Gadila; Mustofa, Syazili; Graharti, Risti; Setyaningrum, Endah
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.v16i1.1758

Abstract

Dengue Hemorrhagic Fever (DHF) remains a major public health problem in tropical regions, with Asia accounting for 70% of global cases and Indonesia reporting a massive 90,269 cases in 2024. Vector control is the primary mitigation strategy due to limitations in available therapies and vaccines, yet reliance on chemical insecticides poses ecological toxicity and resistance risks, driving the need for safer bioinsecticide alternatives. Tithonia diversifolia is known to contain active phytochemical constituents with insecticidal potential. This true experimental study used a Post Test Only with Control Group design conducted from August to September 2025 involving 25 Aedes aegypti per group with four replications. Leaf simplicia were extracted using 96% ethanol, followed by alcohol-free verification, qualitative phytochemical screening, and formulation into spray preparations at concentrations of 5%, 10%, 15%, 20%, and 25%. Mortality was assessed over 24 hours, and statistical evaluation included univariate, bivariate, and probit analyses to determine LC50, LC90, LT50, and LT90. Extraction produced a 12.53% yield containing saponins, flavonoids, phenols, tannins, alkaloids, and steroids. Mosquito mortality increased with rising concentrations, with the highest effectiveness observed at 25%. The Kruskal–Wallis test confirmed significant differences between groups, while LC50 and LC90 values were 2.77% and 5.37%, respectively. Although the highest mortality was observed at 25%, the 20% concentration was considered optimal because it met WHO efficacy standards while using a lower extract concentration.
Case Report: Laki-Laki Usia 42 Tahun dengan Laryngopharingeal Refluks Pangestu, Farhan Ridho; Imanto, Mukhlis
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.v16i2.1759

Abstract

Laryngopharyngeal Reflux (LPR) is an inflammatory condition affecting the mucosa of the larynx and pharynx caused by the retrograde flow of gastroduodenal contents into the upper aerodigestive tract. This condition is frequently underdiagnosed due to its nonspecific symptoms, which often mimic other upper airway disorders. LPR presents with a wide range of clinical manifestations and is commonly managed by multiple medical disciplines without an accurate or standardized diagnostic approach. This case report aims to describe the clinical presentation, risk factors, diagnostic process, and management of LPR in an adult patient. We report the case of a 42-year-old male who presented with recurrent choking sensations, shortness of breath, dry cough, frequent throat clearing, and hoarseness persisting for four months, accompanied by worsening heartburn and epigastric discomfort. The patient had several predisposing factors, including obesity and unhealthy lifestyle habits such as high-fat and acidic food consumption and lying down shortly after meals. The diagnosis of LPR was established based on a Reflux Symptom Index (RSI) score of 14 obtained during anamnesis and a Reflux Finding Score (RFS) of 9 derived from indirect laryngoscopic examination. Management consisted of pharmacological therapy with high-dose proton pump inhibitors and antacids, combined with non-pharmacological interventions including lifestyle and dietary modifications. This integrated approach aims to reduce reflux episodes and mucosal inflammation. This case highlights the clinical importance of RSI and RFS as practical diagnostic tools for LPR and emphasizes the need for comprehensive management strategies to improve patient outcomes and quality of life.
Penggunaan Monoterapi Vs Kombinasi Terapi Antinyeri Dalam Manajemen Nyeri Pascaoperasi Pediatri : Literatur Review Januarti, Ria Wahyu; Irawan, Khadafi
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.v16i2.1760

Abstract

Postoperative pain is an acute sensation accompanied by an inflammatory process related to surgical trauma, which decreases as the tissue heals. However, it is often not well managed after surgery in children. Multimodal analgesia is a key principle for managing acute postoperative pain. One form of multimodal analgesia is combining non-opioid analgesics to reduce postoperative pain and opioid use. The latest guidelines recommend a combination of at least paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) for most types of surgery. NSAIDs and paracetamol have different mechanisms of action, so it can be assumed that combining the two will provide better analgesia than either drug alone. This article was written using the literature review method, which involved searching for literature from various national and international journals. Journal articles from 2015 to 2025 were used as the basis for the articles. The literature search references are from the PubMed, NCBI, and Google Scholar databases. The literature was then analyzed using the systematic literature review method, which included activities such as collecting, evaluating, and comparing the efficacy and acute management post-surgery. Hye-Mi et al.'s research found that the combination of NSAIDs with propacetamol is better postoperative analgesia than opioids. Intravenous administration provides a higher maximum plasma concentration (Cmax) and a shorter time to reach Cmax, resulting in faster and more reliable delivery compared to oral or rectal administration.
Prevalensi Komplikasi Kematian Ibu Dengan Persalinan Sectio Caesarea Di RSUD Dr. H. Abdul Moeloek Pada Tahun 2019 Assirri, Agung; Graharti, Risti; Kusumaningtyas, Intan
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.v16i2.1761

Abstract

Maternal mortality is defined as the number of deaths in women that occur during pregnancy up to 42 days after delivery, caused by conditions directly related to pregnancy or its management, not by accidents or injuries. In Indonesia, the pattern of causes of maternal mortality over time has remained relatively constant, with hemorrhage, preeclampsia-eclampsia, and infection as the dominant factors contributing to high maternal mortality rates. One medical intervention that can help reduce the risk of maternal mortality is delivery by cesarean section (CS), especially in cases where the condition of the mother or fetus does not allow for vaginal delivery. This study aims to identify the prevalence of complications that cause maternal mortality in cesarean section deliveries at Dr. H. Abdul Moeloek Regional General Hospital. The research design used is a descriptive study with a qualitative approach. Secondary data were collected from patient medical records, and the sampling method used was total sampling, so that all 351 cases of C-section deliveries during the study period were analyzed. The results showed that there were 2 cases of maternal mortality out of a total of 351 C-section deliveries, or 0.57%. Both deaths were caused by postpartum hemorrhage (50%) and pre-existing heart disease (50%). These findings indicate that although the maternal mortality rate in CS deliveries at Dr. H. Abdul Moeloek Regional General Hospital is relatively low, risk factors such as hemorrhage and comorbidity still require special attention in delivery management.
Perbandingan Absolute Lymphocyte Count (ALC) Antara Pasien Terkonfirmasi Dengan Probable Covid 19 Di RSUD Pesawaran Kurniawan, Denny Andika; Utama, Winda Trijayanthi
Medula Vol 16 No 3 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i3.1763

Abstract

Coronavirus Disease 2019 (COVID-19) is a broad group of viruses known to cause diseases with a diverse clinical spectrum, ranging from mild symptoms to severe disorders in humans. These viruses are zoonotic, meaning they can be transmitted from animals to humans, posing a major challenge in infection control efforts. In addition, variations in immune responses in each individual cause the clinical picture of Covid-19 to vary greatly, including changes in laboratory parameters such as absolute lymphocyte count (ALC). This study was conducted to analyze the differences in ALC values in patients with a confirmed diagnosis of Covid-19 compared to patients categorized as probable Covid-19 at the Pesawaran Regional General Hospital. The study design used an observational analytical method with a cross-sectional approach. Data processing and analysis were performed using an independent t-test to assess the difference in means between the two groups. The total sample consisted of 45 patients, namely 20 patients with confirmed Covid-19 and 25 patients with probable Covid-19. The results showed that the mean ALC value in the confirmed group was 1,241.5/µL, while in the probable group it reached 1,812.59/µL. These findings indicate a statistically significant difference between the mean ALC of the two groups, with a p-value of 0.0001. This difference also supports the findings of previous studies that lymphopenia is more commonly found in patients with verified Covid-19 infection. Thus, this study confirms that Covid-19 confirmation status is associated with changes in ALC, which can be a supporting clinical parameter in the evaluation and monitoring of patient conditions.
Perbandingan, Monoterapi, Double Terapi, Triple Kombinasi Terapi Pada Pasien Glaukoma Primer Sudut Terbuka Di Rumah Sakit Mata Lampung Eye Center Zaiva, Syalsa; Karima, Nisa
Medula Vol 16 No 3 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i3.1764

Abstract

The eye is an essential sensory organ that delivers visual information to the brain. Glaucoma is a progressive optic neuropathy that can disrupt this process and lead to irreversible blindness. Primary open angle glaucoma is the most common type and is characterized by a gradual increase in intraocular pressure with minimal early symptoms. Glaucoma treatment is usually initiated with single drug therapy or monotherapy. If monotherapy is insufficient to control intraocular pressure, combination therapy using two or more medications is required, including double therapy and triple combination therapy. This study aimed to compare the effectiveness of monotherapy, double therapy, and triple combination therapy in reducing intraocular pressure in patients with primary open angle glaucoma at Lampung Eye Center Eye Hospital. An observational analytic method with a cross sectional design was used. Data on intraocular pressure and treatment regimens were obtained from medical records. Bivariate analysis was performed using the Kruskal Wallis test. The results showed that most subjects were male, with 23 patients or 53.5%, and the most common age group was 40 to 60 years, accounting for 41.9% of participants. Of the 43 patients included, 20.9% (9 patients) received monotherapy, 60.5% (26 patients) received double therapy, and 8 patients or 18.6% received triple combination therapy. Bivariate analysis demonstrated a statistically significant reduction in intraocular pressure in patients receiving triple combination therapy, with a p value less than 0.05. These findings indicate that triple combination therapy provides the most significant intraocular pressure reduction in patients with primary open angle glaucoma.
Pencegahan Hipotensi Pasca Anestesi Spinal pada Operasi Sectio Caesarea: Literature Review Indahsari, Verra Rachma; Indrawan, Khadafi
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.v16i2.1766

Abstract

Spinal anesthesia is widely used for cesarean section, but it often causes hypotension due to sympathetic blockade, making vasopressor prophylaxis necessary. Ephedrine has long been the traditional choice, although several studies have linked it to a higher risk of neonatal acidosis. Phenylephrine is now more commonly recommended because of its effectiveness in maintaining blood pressure, while recent evidence suggests that norepinephrine may provide comparable hemodynamic stability with a lower incidence of maternal bradycardia. Literature searching was performed through PubMed, Google Scholar, and ScienceDirect using keywords related to ephedrine, phenylephrine, norepinephrine, hypotension, and spinal anesthesia for cesarean delivery. Articles discussing vasopressor use for the prevention or management of hypotension were reviewed and summarized narratively. The findings indicate that phenylephrine effectively maintains blood pressure but may cause bradycardia; norepinephrine at doses of 0.05 µg/kg/min offers hemodynamic stability similar to phenylephrine 0.625 µg/kg/min, with no significant differences in neonatal outcomes across several studies; and ephedrine remains useful, especially when maternal bradycardia occurs, although some research reports a higher risk of neonatal acidosis. Overall, the evidence is mixed and does not show clear superiority of one vasopressor over another. Both phenylephrine and norepinephrine can be used for prophylaxis of spinal-induced hypotension in cesarean section, each with its own advantages and limitations, while ephedrine remains relevant in specific situations. Further studies are needed to establish more definitive recommendations regarding the optimal vasopressor choice.
Manajemen Jalan Napas Sulit pada Pasien Dewasa: Literature Review Sianturi, Aditya Gloria Monalisa; Indrawan, Khadafi
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.v16i2.1767

Abstract

Difficult airway is a clinical situation in which a healthcare provider who is skilled at airway management encounters difficulty with one or more standard methods of airway management. Difficult airway may obstruct mask ventilation or increase the risk of failed intubation attempts. The purpose of this literature review is to understand the management of difficult airway on adult patient. The method used in this literature review involved searching for literature published between 2018 into 2023 on NCBI, PubMed, and Google Scholar databases, focusing on management of difficult airway on adult patient. Then, literature was analyzed using systematic literature review method, which included data collection and evaluation activities in accordance with the objective of the literature review. There are several indicators of difficult airway, which are face mask ventilation, laryngoscopy, supraglottic airway ventilation, tracheal intubation and extubation, and invasive airway. In addition, there are several predictors as a reference in identifying difficult airway, which are LEMON mnemonic  and MOANS mnemonic. After a difficult airway has been identified, there are several interventions that can be apply, which are awake tracheal intubation, anesthetized tracheal intubation, and mixed intubation.

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