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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 1,081 Documents
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Peran Edukasi Kesehatan dalam Pencegahan Penyakit Tidak Menular di Masyarakat: Sebuah Tinjauan Pustaka Sekar Feni Widiyastuti; Azelia Nusadewiarti
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.v16i3.1911

Abstract

A Non-communicable diseases (NCDs) are the leading cause of global morbidity and mortality, accounting for approximately 71% of all deaths annually, including among the productive-age population. In Indonesia, the prevalence of NCDs such as hypertension, diabetes mellitus, and cardiovascular diseases continues to show a significant upward trend. The main risk factors for NCDs include unhealthy behaviors such as smoking, unhealthy dietary patterns, physical inactivity, and alcohol consumption. From a clinical perspective, controlling these risk factors through behavioral modification is a key strategy to reduce the incidence, progression, and complications of NCDs. Health education plays a crucial role in improving health literacy, including an individual’s ability to understand medical and numerical information related to their health condition. Improved health literacy is associated with better treatment adherence, improved control of clinical parameters such as blood pressure and blood glucose levels, and a reduced risk of long-term complications. Various forms of educational interventions, including healthcare-based services, community-based programs, and digital health technologies, have been proven effective in promoting healthy lifestyle behaviors. However, their implementation still faces several challenges, including low levels of health literacy, sociocultural influences, limited access to information, and suboptimal health system support. Therefore, comprehensive, sustainable, and context-based educational strategies are needed to enhance the effectiveness of both prevention and clinical management of NCDs.
Peran Uji Imunohistokimia Postmortem Pada Kematian Jantung Mendadak Salma Adinda Hermawan; Susianti; Wiwi Febriani; Waluyo Rudiyanto
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.v16i2.1713

Abstract

Routine forensic examinations often fail to establish a definitive diagnosis, particularly in cases of rapid death where no clear macroscopic or microscopic abnormalities are identified. Immunohistochemistry (IHC) is a laboratory technique used to detect the presence and distribution of specific antigens in tissues through antigen–antibody binding combined with specific staining systems. This narrative review discusses the role of postmortem immunohistochemical testing in the evaluation of sudden cardiac death, including examination principles and procedures, forensic applications, relevant immunohistochemical markers, and the influence of the postmortem interval on result interpretation. A literature search was conducted using the PubMed, ScienceDirect, and Google Scholar databases, covering publications from 2016 to 2025. The reviewed studies indicate that postmortem IHC plays a broad role, particularly in cases involving toxic substances, and assists in establishing diagnoses that cannot be determined through routine examinations. Moreover, markers such as troponin, C5b-9, desmin, H-FABP, and CD68 demonstrate diagnostic value in identifying myocardial injury, tissue necrosis, inflammatory processes, and atherosclerotic plaque formation. However, the reliability of IHC findings is influenced by technical factors, including the interval between death and tissue sampling, tissue fixation methods, and variations in laboratory protocols. Therefore, the use of an integrated immunohistochemical marker panel combined with macroscopic findings, conventional histopathology, and clinical data is recommended within the diagnostic workflow of sudden cardiac death. In Indonesia, the implementation of postmortem IHC remains limited; nevertheless, it holds significant potential as a diagnostic adjunct when applied selectively and in a standardized manner within forensic practice.
Review Article: Pengaruh Durasi Maserasi terhadap Aktivitas Antibakteri Daun Kelor (Moringa oleifera) pada Escherichia coli Nisrina Zalfa Fatin; Tri Umiana Soleha; Shinta Nareswari; Asep Sukohar
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.v16i2.1746

Abstract

The increasing resistance of bacteria to antibiotics has encouraged the use of medicinal plants as a natural alternative antibacterial agent. Moringa leaves (Moringa oleifera) contain bioactive compounds, including flavonoids, tannins, saponins, alkaloids, and terpenoids, which are capable of inhibiting bacterial growth. This review article aims to examine the effect of maceration duration using 96% ethanol as a solvent on the antibacterial activity of Moringa oleifera leaf extracts against Escherichia coli. Literature searches were conducted through PubMed, Google Scholar, and Scopus, using a combination of keywords such as “Moringa oleifera,” “leaf extract,” “ethanol,” “maceration time,” and “antibacterial activity,” with a limitation to publications from the last ten years. Relevant articles were selected based on their focus on ethanol extraction of Moringa oleifera leaves and antibacterial testing against E. coli. Recent studies indicate that variations in maceration duration result in differences in inhibition zone diameters ranging from 9.83 to 27.7 mm. Short-term maceration of 24 hours can achieve high antibacterial activity, whereas longer maceration does not necessarily enhance effectiveness. These differences are influenced by extract concentration, bioactive compound stability, and bacterial testing conditions. These findings highlight that the antibacterial effectiveness of Moringa oleifera leaves depends on an optimal combination of maceration duration, extract concentration, and the stability of active compounds. Determining the appropriate maceration time is crucial for achieving maximum antibacterial activity. Furthermore, these results provide a basis for future research on the utilization of Moringa oleifera leaf extracts as a potential natural antibacterial agent.
Peran Growth Differentiation Factor-15 (GDF-15) sebagai Biomarker Prognostik Gagal Jantung: Literature Review Brian; Iswandi Darwis; Eka Putri Rahmadhani; Intanri Kurniati
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.v16i2.1770

Abstract

Heart failure is a complex clinical syndrome with high morbidity and mortality, contributing to a substantial global health burden, including in Indonesia. Although conventional biomarkers such as BNP and NT-proBNP are well established for diagnosis and risk stratification, they have limitations in capturing the heterogeneous pathophysiology of heart failure. Growth Differentiation Factor-15 (GDF-15), a member of the TGF-β superfamily that increases in response to oxidative stress, inflammation, and myocardial ischemia, has emerged as a more comprehensive prognostic biomarker. This literature review examines clinical studies, prospective and retrospective cohorts, observational research, and meta-analyses evaluating the prognostic value of GDF-15 in acute and chronic heart failure. The synthesized evidence demonstrates that elevated GDF-15 levels consistently correlate with increased risks of mortality, rehospitalization, and disease progression. In addition, serial measurements of GDF-15 reflect therapeutic response, as failure of GDF-15 levels to decline is associated with poorer outcomes. Combining GDF-15 with other biomarkers, such as NT-proBNP, further enhances risk stratification accuracy compared with single-biomarker assessment. Based on current evidence, GDF-15 holds substantial potential as an independent and dynamic prognostic biomarker, supporting more precise risk assessment, disease monitoring, and clinical decision-making in patients with heart failure.
Peran Diet Mediterania terhadap Kadar HbA1c pada Penderita Diabetes Mellitus Tipe 2 (Tinjauan Pustaka) Arron Nathaniel Ginting; Reni Zuraida; Eka Putri Rahmadhani; Dian Isti Angraini
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.v16i2.1802

Abstract

Type 2 diabetes mellitus (DM) is a chronic metabolic disease and global health problem that requires optimal glycemic control to prevent complications. Medical nutrition therapy is a key pillar of management, with the Mediterranean diet recommended due to its nutrient profile rich in unsaturated fats. This review aims to synthesize the latest clinical evidence on the effect of the Mediterranean diet on reducing HbA1c levels in patients with type 2 DM, analyze the underlying biological mechanisms, and evaluate its sustainability compared to other diets. A literature review was conducted using the PubMed database for studies published between 2021 and 2025. Of the 60 articles, 6 clinical studies (RCTs, pilot studies, and prospective interventions) that met the inclusion criteria were analyzed. Data synthesis showed that Mediterranean diet interventions lasting 12 weeks to 12 months consistently reduced HbA1c levels with an absolute reduction range of 0.2% to 2.0% (p < 0.05). Critical interpretation shows that while restrictive diets such as the Ketogenic diet provide more drastic reductions (-9% to -13.5% relative) due to glucose elimination, the Mediterranean diet offers long-term metabolic stability through the restoration of insulin sensitivity. The mechanism of glycemic improvement occurs through anti-inflammatory pathways and modulation of the incretin system, particularly stimulation of the GLP-1 hormone. The Mediterranean diet has been shown to be effective in significantly lowering HbA1c and offers a more sustainable nutritional strategy for patients. Clinical implications suggest the integration of olive oil and plant-based diets as the standard for long-term nutritional therapy.
Depressive-Type Schizoaffective Disorder in a Young Adult Woman: Challenges in Diagnosis and Management, A Case Report Muhammad Akmal Ghani; Tendry Septa; Risti Graharti
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.v16i3.1936

Abstract

Depressive-type schizoaffective disorder (F25.1) is a psychiatric disorder characterized by the coexistence of psychotic symptoms typical of schizophrenia and prominent depressive symptoms within the same episode of illness. This disorder is thought to involve dysregulation of multiple neurotransmitter systems, particularly dopamine and serotonin, which contribute to the simultaneous manifestation of psychotic and affective symptoms. Establishing the diagnosis remains challenging due to its overlapping clinical features with schizophrenia and major depressive disorder with psychotic features. This case report describes a 26-year-old woman who presented to the Psychiatric Outpatient Clinic of Lampung Provincial Mental Hospital with complaints of talking to herself, auditory hallucinations consisting of voices commenting on her daily activities, insomnia, anxiety, feelings of worthlessness, and suicidal ideation that emerged during the course of her illness. The symptoms developed following psychosocial stressors, including family conflicts and economic difficulties. Mental status examination revealed hypotymic mood, blunted affect, circumstantial thought process, and a history of persistent auditory hallucinations, while cognitive function, orientation, and memory remained intact. Based on psychiatric assessment and the diagnostic criteria of the Indonesian Classification of Mental Disorders (PPDGJ-III), the patient was diagnosed with depressive-type schizoaffective disorder (F25.1). The diagnosis was established due to the simultaneous presence of schizophrenic and depressive symptoms within the same episode of illness. Differential diagnoses considered included paranoid schizophrenia and severe depressive episode with psychotic symptoms. The patient received pharmacological treatment consisting of risperidone, trihexyphenidyl, fluoxetine, lithium carbonate, and clobazam, accompanied by psychoeducation and supportive psychotherapy. Clinical improvement in psychotic symptoms and overall functioning was observed following treatment. Depressive-type schizoaffective disorder requires comprehensive clinical evaluation to distinguish it from other psychotic and affective disorders and necessitates a multidisciplinary approach combining pharmacological and psychosocial interventions to improve patient outcomes.
Korelasi Kadar Feritin dan ALT pada Pasien Talasemia Beta Mayor: Tinjauan Pustaka Mutiara Maharani; Intanri Kurniati; Muhammad Maulana; Susianti
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.v15i4.1696

Abstract

Beta thalassemia major is an autosomal recessive genetic blood disorder caused by mutations in the globin gene, resulting in impaired globin chain synthesis. It represents the most severe form of thalassemia and is characterized by chronic anemia, regular blood transfusions, and a high risk of iron overload. The global prevalence of beta thalassemia major continues to increase, including in Indonesia and the Lampung region. Excess iron is primarily stored as ferritin, which becomes toxic to hepatic tissue at high levels and is reflected by increased alanine transaminase (ALT) levels. This study aimed to analyze the relationship between ferritin and ALT levels in patients with beta thalassemia major through a literature review approach. Relevant scientific publications from reputable databases and accredited national journals were reviewed, focusing on studies that evaluated the association between these two parameters. The results demonstrated a statistically significant positive correlation (p < 0.05), in which elevated ferritin levels were consistently associated with increased ALT levels. These findings indicate a close relationship between iron overload and hepatocellular damage. However, the interpretation of ferritin and ALT levels should consider confounding factors such as inflammation, infection, and other clinical conditions that may influence laboratory results. Pathophysiologically, repeated blood transfusions lead to excessive iron accumulation that exceeds storage capacity, triggering oxidative stress, hepatocyte injury, and subsequent ALT release into circulation. Therefore, regular monitoring of ferritin and ALT levels is essential for early detection and prevention of hepatic complications in patients with beta thalassemia major.
Peran Modalitas Radiologi dalam Deteksi dan Evaluasi Tumor Paru: A Literature Review Fadilah Alwiyah; Muhammad Ricky Ramadhian
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.v16i2.1863

Abstract

Lung cancer remains one of the leading causes of cancer-related mortality worldwide, making early detection and accurate diagnosis essential for appropriate management. Radiological imaging plays a crucial role in the detection, characterization, and staging of pulmonary tumors. This case report describes the role of radiological modalities in a patient with pulmonary squamous cell carcinoma. A 52-year-old female non-smoker with a history of chronic secondhand smoke exposure for more than 20 years presented with chronic dyspnea, intermittent cough, and significant weight loss. Chest radiography in posteroanterior (PA) and lateral projections revealed a pulmonary mass associated with right upper lobe atelectasis. Further evaluation using contrast-enhanced chest computed tomography (CT) demonstrated a 56.6 × 35.3 mm mass in the apical segment of the right upper lobe, right paratracheal lymphadenopathy, localized right pleural effusion, and findings suggestive of advanced-stage disease. Histopathological examination of tissue biopsy confirmed the diagnosis of right lung squamous cell carcinoma. The patient was subsequently scheduled for chemotherapy with periodic follow-up using chest CT imaging. This case highlights the importance of a multimodal radiological approach in the evaluation of pulmonary malignancies. Chest radiography serves as an effective initial screening and detection tool, whereas contrast-enhanced CT provides superior anatomical detail for lesion characterization, disease staging, biopsy planning, and treatment monitoring. The integration of radiological modalities contributes significantly to comprehensive and accurate management of lung cancer.
HIPERTENSI PADA PASIEN PEREMPUAN: LAPORAN KASUS Rahmi Zuraida; Dian Isti Angraini
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.v16i4.1866

Abstract

Hypertension is a chronic non-communicable disease and a major risk factor for cardiovascular complications. Poor treatment adherence and unhealthy lifestyle behaviors frequently contribute to inadequate blood pressure control. This case report aims to describe the comprehensive management of grade 2 hypertension in a 55-year-old female patient at a primary healthcare facility. Data were collected through history taking, physical examination, medical record review, and a three-week follow-up evaluation. The patient presented with intermittent headaches, numbness, and tingling sensations in both lower extremities. Physical examination revealed a blood pressure of 160/92 mmHg and a body mass index of 24.69 kg/m², classified as overweight. The patient had a five-year history of hypertension, poor medication adherence, a high-sodium diet, and insufficient physical activity. Based on clinical findings, the patient was diagnosed with uncontrolled grade 2 hypertension. Pharmacological treatment consisted of amlodipine 10 mg once daily and captopril 12.5 mg twice daily. Non-pharmacological interventions included health education regarding hypertension, medication adherence, sodium restriction, dietary improvement, increased physical activity, and regular blood pressure monitoring. Follow-up after three weeks demonstrated improvement in clinical symptoms, better treatment adherence, healthier lifestyle behaviors, and a reduction in blood pressure to 130/88 mmHg. This case highlights that a combination of pharmacological therapy, health education, and lifestyle modification plays an important role in achieving blood pressure targets and preventing long-term complications in patients with hypertension.
Penerapan Pendekatan “Beyond Calories”: Rehabilitasi Nutrisi pada Kasus Gizi Buruk Berat dengan Komorbiditas Kompleks Maria Devi; Arief Rahman
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.v16i4.1876

Abstract

Severe acute malnutrition in children with congenital and chronic comorbidities presents a significant challenge in both diagnosis and management. Children with Down syndrome have increased nutritional requirements and are more susceptible to gastrointestinal disturbances; therefore, nutritional strategies should extend beyond merely meeting caloric demands and should consider the patient’s nutritional tolerance and absorptive capacity. This case report describes a 12-month-old male infant with Down syndrome, a history of multiple surgical interventions for anorectal malformation (anal atresia), a cow’s milk protein allergy, and hypothyroidism, who presented with chronic diarrhea, failure to thrive, and severe wasting. Anthropometric assessment revealed a body weight of 4.2 kg, a body length of 62 cm, and a mid-upper arm circumference of 6.5 cm, consistent with a diagnosis of marasmic severe acute malnutrition according to WHO criteria. Nutritional rehabilitation was initiated using an amino acid based elemental formula, intravenous fluid therapy, empirical antibiotic treatment (cefotaxime), zinc supplementation, and levothyroxine. Clinical improvement was observed during the initial stabilization phase; however, progression into the rehabilitation phase was complicated by oral feeding intolerance, recurrent vomiting, and persistent diarrhea, necessitating reassessment of the nutritional management strategy and close monitoring for formula intolerance. The use of an elemental formula contributed to overcoming challenges related to nutrient absorption and immunological tolerance in this patient. This case highlights the importance of a comprehensive, individualized, and multidisciplinary nutritional approach, accompanied by family education and intensive clinical monitoring to support successful long-term recovery.

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