Cermin Dunia Kedokteran

Comparison of Immature Platelet Fraction (IPF) and Procalcitonin (PCT) as Biomarkers of Infection Severity in Relation to NS1 Antigen in Patients with Dengue Hemorrhagic Fever (DHF)

2025-08-29T17:55:35+07:00

Background: Dengue hemorrhagic fever (DHF) is an infectious disease caused by the dengue virus (DENV) and transmitted by the Aedes aegypti and Aedes albopictus mosquito vectors. This disease remains a major global health problem, particularly in tropical regions such as Indonesia. Clinical indicators of DHF severity include thrombocytopenia and shock, which are associated with high viremia levels and an increase in dengue NS1 antigen in the vascular system. This study compares immature platelet fraction (IPF) and procalcitonin (PCT) levels as biomarkers of infection severity in relation to DENV NS1 antigen positivity. Methods: This study included 35 patients with DHF and 35 healthy controls. IPF values and PCT levels were measured. Differences between the two groups were analyzed using an independent t-test. Results: p-values for both IPF and PCT were < 0.05, indicating statistically significant differences between DHF patients and healthy controls. These findings suggest that higher IPF values are associated with thrombocytopenia, whereas elevated PCT levels may reflect more severe infection, including dengue shock syndrome. Conclusion: There are significant differences in IPF and PCT levels between DHF patients and controls, depending on dengue NS1 antigen positivity. IPF may serve as an indicator of thrombocytopenia, while PCT may be a marker of infection severity, including dengue shock syndrome, in patients with dengue hemorrhagic fever.

An Exploration of Stress Levels and Coping Strategies Among Final-Year Medical Students Experiencing Stagnation in the Writing of Their Theses: A Qualitative Study at the Faculty of Medicine, Tanjungpura University

2025-07-09T16:22:44+07:00

Introduction: Final-year medical students often face significant academic pressure during the thesis-writing process, which can lead to stress and stagnation in academic progress. This stagnation reflects the tension between academic demands, internal pressures, and environmental factors that affect students’ psychological balance. Unmanaged stress may cause emotional, physical, and cognitive strain, as well as the use of maladaptive coping strategies that hinder academic productivity. This study aims to explore the levels of stress, stress responses, the nature of stress, and coping strategies among final-year medical students experiencing stagnation in thesis completion. Method: This research employed a qualitative, phenomenological approach to understand the subjective experiences and meanings of academic stress among medical students. Participants were selected through purposive sampling, comprising 10 final-year medical students who met the criteria for thesis stagnation. Data were collected through semi-structured in-depth interviews and analyzed using thematic analysis to identify patterns in stress experiences and coping mechanisms. Results: The findings indicate that most participants experienced moderate to severe stress, reflected in emotional responses (anxiety, frustration, and loss of motivation), physical symptoms (fatigue, sleep disturbance, and psychosomatic complaints), and cognitive impacts (difficulty concentrating, overthinking, and procrastination). The nature of stress varied between positive stress (eustress), which enhanced motivation, and negative stress (distress), which hindered progress. Coping strategies were classified as adaptive (seeking social support, prayer, and time management) and maladaptive (avoidance, withdrawal, and delay). Institutional barriers, including bureaucratic constraints, academic hierarchy, and limited psychosocial support, were found to exacerbate thesis stagnation. Conclusion: High stress levels among final-year medical students are associated with complex stress responses and a tendency toward maladaptive coping when academic and emotional support is lacking. Therefore, medical institutions need to implement time and stress management training, psychosocial mentoring, and an early academic warning system to foster a supportive learning environment and prevent stress from escalating during the thesis-writing process.

Differences in Skin Moisture Before and After the Administration of Collagen Supplements to Female Medical Students in Jakarta

2026-03-05T10:45:51+07:00

Introduction: Adequate nutrition, including collagen supplements and the use of moisturizers, can improve skin hydration. This study aims to determine the effects of collagen supplements and several factors such as history of keratosis and atopic dermatitis, sun exposure, bathing habits, and water intake on skin moisture. Methods: This is a descriptive-analytical study with consecutive sampling involving 29 female students aged 19–21 years who met the inclusion and exclusion criteria. The participants were given collagen supplements for 12 weeks, and skin moisture was measured at weeks 0, 4, 8, and 12 using the skin analyzer SK-8 on the upper left arm. Results: This study showed that the average skin moisture level was 32.02% before supplementation and 68.37% after supplementation, indicating a significant difference (p < 0.001). Factors such as history of keratosis and atopic dermatitis, sun exposure, bathing habits, and water intake were not related to skin moisture. Conclusion: These findings suggest that collagen supplementation may contribute to improved skin hydration under the studied conditions.

The Effect of Vitamin D in Reducing C-reactive Protein Levels in Ulcerative Colitis: Evidence-based Case Report

2026-05-05T10:55:42+07:00

Introduction: Ulcerative colitis (UC) is a chronic gastrointestinal inflammatory disease characterized by immune dysregulation. C-reactive protein (CRP) is used as a marker of inflammation and disease severity. Vitamin D has an immunomodulatory role, and low serum levels are associated with increased disease activity in UC. However, the effect of vitamin D supplementation on inflammatory markers in UC remains unclear. This study aims to evaluate the effect of vitamin D supplementation on CRP levels in patients with UC. Methods: A systematic literature search was conducted across three databases: PubMed, Scopus, and the Cochrane Library. The search strategy was developed based on the PICO approach, with filters for randomized controlled trials and meta-analyses. Duplicates were removed, and selection was carried out based on titles, abstracts, and full texts. The selected studies were critically appraised using the validity, significance, and applicability approach from the Centre for Evidence-Based Medicine. Results: Two studies met the criteria, one systematic review and meta-analysis, and one meta-analysis. Although both studies showed a significant reduction in CRP levels after vitamin D administration, the validity of these studies remains doubtful. Conclusion: Current evidence is insufficient to support a definitive recommendation for the use of vitamin D supplementation in patients with ulcerative colitis. High-quality randomized controlled trials are needed.

Multiple Cerebral Dolichoectasia as a Potential Contributor to Intracranial and Intraventricular Hemorrhage During Hypertensive Crisis: A Case Report

2026-05-08T10:12:46+07:00

Introduction: Dolichoectasia (DE) represents an uncommon vascular anomaly of the brain, characterized by abnormal dilation and elongation of cerebral blood vessels. Its occurrence is relatively rare, with an estimated prevalence ranging from 0.05% to 0.06%. Although predominantly observed within the vertebrobasilar system, cases involving the anterior cerebral circulation have also been documented. Patients with DE are susceptible to intracranial and intraventricular hemorrhage. Case: A 54-year-old male with sudden extremity weakness, hypertensive crisis, and hyperlipidemia. CT imaging showed intracranial hemorrhage in the left thalamic and intraventricular hemorrhage in the posterior horn of the left ventricle with enlargement and tortuosity of the intracerebral artery and vertebrobasilar artery. These imaging findings led to a diagnosis of multiple cerebral dolichoectasia. The patient underwent conservative management with antihypertension and decompression therapy, leading to a gradual alleviation of symptoms. Discussion: Hypertension is considered the major risk factor for intracranial hemorrhage in this patient, while dolichoectasia may represent an associated vascular abnormality that potentially increases vessel wall vulnerability. Structural alterations in dolichoectatic vessels, including disruption of elastic fibers and remodeling of the tunica media, may contribute to reduced vascular integrity under severe hemodynamic stress. The coexistence of hypertensive crisis and multiple dolichoectasia may therefore increase susceptibility to hemorrhagic complications. Conclusion: CT imaging is essential for the diagnosis of dolichoectasia and the detection of associated complications, including intracranial and intraventricular hemorrhage. Early and accurate diagnosis may improve patient outcomes by enabling appropriate therapy.

Moyamoya Disease Suzuki Stage III in Adult: Diagnosis and Conservative Management - A Case Report

2026-05-08T10:25:55+07:00

Introduction: Moyamoya disease (MMD) is a rare, progressive cerebrovascular condition, predisposing patients to ischemic or hemorrhagic strokes—particularly among Asian populations. Case: A 38-year-old male with a prior ischemic stroke in 2023 presented with acute left lower limb weakness lasting two days. MRI showed an acute and chronic ischemic lesion, and an acute lacunar infarct in the right superior frontal gyrus. MRA and cerebral angiography confirmed Suzuki stage III MMD, with A1 right anterior cerebral artery (ACA) occlusion and collateral flow from the left posterior cerebral artery (PCA). Cerebral angiography revealed occlusion of the proximal A1 segment of the right ACA and a characteristic “puff of smoke” appearance from abnormal collateral vessels in the distal branches of the right middle cerebral artery (MCA). The patient was managed conservatively with cilostazol, rosuvastatin, and antiplatelet therapy, alongside physical rehabilitation, resulting in functional improvement. Discussion: MMD is a progressive vasculopathy that may cause recurrent cerebrovascular events due to impaired cerebral perfusion. Cerebral angiography remains essential for diagnosis and Suzuki staging. Although revascularization surgery is the standard treatment to improve cerebral blood flow and reduce stroke risk, conservative management may be considered in selected patients based on clinical stability, collateral circulation, and treatment indications. In this case, conservative therapy combined with rehabilitation was associated with clinical improvement, although continuous monitoring is required due to the progressive nature of the disease. Conclusion: Early diagnosis of MMD through advanced neuroimaging is crucial for preventing recurrent stroke and guiding treatment decisions. This case highlights that individualized conservative management may provide clinical benefits in adult Suzuki stage III MMD when surgical intervention is not immediately performed, while long-term follow-up remains essential.

Management of Acute Myeloid Leukemia in Young Adult in the Peripheral Area: A Case Report

2026-05-20T17:19:51+07:00

Introduction: Acute myeloid leukemia (AML) is an aggressive and rapidly progressing hematopoietic malignancy that originates from myeloid stem cells in the bone marrow. Case: An 18-year-old male presented with nausea and vomiting for 5 days, preceded by frequent fatigue and weight loss over the past month. Vital signs were within normal limits. Physical examination revealed anemic conjunctivae and palpable enlargement of the liver and spleen. Laboratory examination revealed extreme leucocytosis, severe anemia, and thrombocytopenia. The patient was diagnosed with acute myeloid leukemia. Management was symptomatic with blood transfusion, and referred for further treatment. Discussion: AML is generally characterized by nonspecific symptoms such as anemia, fever, bleeding, hepatosplenomegaly, as well as hematological abnormalities including leukocytosis, anemia, and thrombocytopenia. The diagnosis is made by examining peripheral blood and bone marrow, while the prognosis is influenced by the patient's age, subtype, and cytogenetic abnormalities. Conclusion: AML in young adults may present with nonspecific symptoms such as fatigue, nausea, vomiting, and weight loss, which can delay diagnosis. Marked hematologic abnormalities, including extreme leukocytosis, severe anemia, and thrombocytopenia, should raise suspicion for AML. Early recognition, appropriate supportive management, and timely referral from peripheral healthcare facilities are essential to improve patient outcomes and survival.

Delayed Diagnosis of Myocarditis After Blunt Abdominal Trauma: A Rare Case Report

2026-05-18T13:18:56+07:00

Introduction: Myocarditis is an inflammation of the myocardium that can lead to impaired heart function and sudden death. Most cases are caused by viral infections and are very rarely reported as a post-traumatic complication. Case: A 54-year-old male developed abdominal pain and vomiting after blunt abdominal trauma. The patient was initially diagnosed with colonic rupture and underwent exploratory laparotomy. Despite initial improvement, the patient experienced hemodynamic deterioration. Electrocardiography, cardiac biomarkers,
and echocardiography evaluation revealed myocarditis with decreased ejection fraction. Despite supportive and pharmacological therapy, the patient fell into cardiogenic shock and passed away. Discussion: This case demonstrates that the diagnosis of myocarditis can be
significantly delayed in patients with atypical presentations and no obvious cardiac symptoms. Abdominal trauma accompanied by systemic infection, such as colonic rupture, may potentially cause secondary myocardial inflammation. Clinicians need to consider the possibility of myocarditis in patients with postoperative hemodynamic instability, even without a history of cardiac disease. Conclusion: This report highlights the urgency of improving diagnostic awareness of myocarditis and access to support facilities.

Diagnostic Challenges in Acute Leukemia: A Case Report of Inconclusive Bone Marrow with Blasts in Peripheral Smear

2025-05-08T08:31:41+07:00

Introduction: Acute leukemia is a hematologic malignancy characterized by the proliferation of immature leukocytes that disrupt normal hematopoiesis, leading to cytopenias and systemic symptoms. Diagnosis typically relies on bone marrow evaluation. Peripheral blood findings may be critical when marrow results are inconclusive. Case: A 23-year-old male with melena, severe anemia, generalized weakness, and a two-week history of back pain. Physical examination revealed pallor and splenomegaly. Initial laboratory findings showed severe macrocytic anemia, leukocytosis, and thrombocytopenia. A peripheral blood smear revealed 63% blasts with a high nuclear-to-cytoplasmic ratio and prominent nucleoli. Despite these findings, the diagnosis of acute leukemia, bone marrow aspiration was inconclusive. Elevated lactate dehydrogenase indicated a high tumor burden. Discussion: Peripheral smear evaluation, supported by cytogenetic and flow cytometry studies, is vital for early diagnosis. Acute leukemia must remain a differential consideration even in the absence of definitive bone marrow findings. Conclusion: This case highlights the diagnostic challenge of acute leukemia with inconclusive initial bone marrow findings. Peripheral blood smear detection of circulating blasts was crucial in establishing the diagnosis. Early recognition through integrated diagnostic evaluation remains essential for the timely initiation of treatment.

Indications for CT Scans in the Management of Head Trauma in Children

2025-05-19T21:35:15+07:00

Head injury is an emergency case, including in the pediatric population. Pediatric head injury is a common cause of mortality and morbidity in the pediatric population. Head computed tomography (CT) scan is used as the gold standard in traumatic brain injury diagnosis, allowing for fast and accurate diagnosis. However, there are often constraints like limited facilities, uncooperative children, and risk of malignancy due to radiation exposure. Moreover, most pediatric head trauma cases are mild and only < 10% require neurosurgical intervention. Several algorithms and clinical decision protocols have been formulated to assist clinicians in determining the need for performing a CT scan, especially for children with minor head injury. The three most frequently used clinical decision rules are PECARN (Pediatric Emergency Care Applied Research Network), CATCH (Canadian Assessment of Tomography for Childhood Head Injury), and CHALICE (Children's Head Injury Algorithm for the Prediction of Important Clinical Events). Implementing these clinical decision rules may reduce unnecessary CT scans and minimize radiation exposure in children. Furthermore, these predictive algorithms can support faster, more effective, and safer clinical decision-making in the emergency management of pediatric head trauma.

Malignant Hyperthermia: A Literature Review

2024-12-06T11:28:32+07:00

Malignant hyperthermia (MH) is a life-threatening syndrome triggered by inhaled anesthetics and depolarizing muscle relaxants like succinylcholine, leading to uncontrolled skeletal muscle hypermetabolism. This condition is marked by massive calcium release from the endoplasmic reticulum, causing muscle rigidity, increased temperature, and metabolic disturbances. The genetic basis of MH is linked to mutations in the CACNA1S gene, which encodes a subunit of the dihydropyridine receptor (DHPR), which is essential to muscle calcium regulation. The condition is often triggered during surgeries requiring general or regional anesthesia, particularly in individuals with a family history of MH. Clinical manifestations may include hypercapnia, tachycardia, acidosis, rhabdomyolysis, and multi-organ dysfunction. Early diagnosis remains challenging because MH may resemble other hypermetabolic conditions and can progress rapidly if left untreated. Treatment involves the administration of dantrolene, a post-synaptic muscle relaxant that reduces excitation-contraction coupling (ECC) and mitigates hypermetabolism. Early recognition and prompt dantrolene administration are vital for successful management.

Clinical Approach to Takotsubo Syndrome

2024-06-03T16:10:07+07:00

Takotsubo syndrome (TTS) or cardiomyopathy due to stress is defined as a syndrome of acute systolic and diastolic dysfunction of the left ventricle, usually associated with emotional or profound physical stress. The incidence of Takotsubo syndrome has increased dramatically during the COVID-19 pandemic, which is closely related to psychological stressors such as social isolation, financial problems, and anxiety. Increased sympathetic stimulation with massive catecholamine release plays a major role in the pathogenesis of Takotsubo cardiomyopathy. An accurate history of the emotional and physical events preceding the onset of symptoms is the most important diagnostic tool. In the acute phase, most complaints are typical chest pain similar to myocardial infarction, while others come with symptoms of heart failure, such as dyspnea, orthopnea and/or acute pulmonary edema or syncope. An important clinical marker of Takotsubo cardiomyopathy is an increase in N-terminal prohormone of brain natriuretic peptide (NT proBNP), which has been shown to be directly related to elevated blood catecholamine concentrations, a marker of sympathetic overreaction, and the severity of left ventricular dysfunction with associated systemic complications, such as pulmonary edema. Supportive and symptomatic treatment should be provided in the acute phase. Patients with Takotsubo cardiomyopathy have a good prognosis, with left ventricular function recovering within days and fully recovering within 3–4 weeks.