Cermin Dunia Kedokteran

Evaluation of the Utilization of the e-PPGBM Application for Nutrition Data Entry in South Central Timor Regency, Indonesia

2025-08-05T14:49:48+07:00

Introduction: Management of stunting problems in South Central Timor Regency needs effective health information system, particularly the Electronic-Community-Based Nutrition Recording and Reporting (e-PPGBM) application. This study aims to describe patterns of data entry delays and identify factors that are believed to contribute to data entry delays. Methods: Secondary data analysis based on reports from the South Central Timor Regency Health Office, supplemented with online interviews through the Zoom platform to explore the reasons behind data entry delays. Results: Among the 37 primary health centers, 27 recorded data for the IKG indicator in January, 11 in February, and none in March. For the National Medium-Term Development Plan (RPJMN) indicator, 23 centers entered data in January, 5 in February, and none
in March. The delays were mainly attributed to limited human resources, lack of supervision, and technical difficulties in using the application. Conclusion: Increased supervision, adequate equipment, and continuous assistance from the Health Office are needed to improve the accuracy of data entry. Regular evaluation is expected to improve the effectiveness of e-PPGBM in supporting nutrition interventions in South Central Timor District.

Implementation of the Greeting Program Through the 4 Disciplines of Execution (4DX) Model at Abdhi Famili General Hospital

2025-08-05T14:47:45+07:00

Introduction: One important factor influencing patient satisfaction is the culture of staff friendliness, so an effective execution strategy is necessary to drive service transformation in hospitals. This study aims to evaluate the implementation of the Greeting Program using the 4 Disciplines of Execution (4DX) model at RSU Abdhi Famili and its impact on patient satisfaction. Methods: A mixed-methods approach with a sequential exploratory design, integrating both qualitative and quantitative perspectives. In the qualitative phase, the transformation process toward a culture of hospitality was described through four key disciplines: establishing Wildly Important Goals (WIGs), executing lead measures, displaying performance scoreboards, and maintaining a rhythm of accountability. The quantitative phase studied the relationship between the implementation of the Greeting Program and patient satisfaction with a cross-sectional design, using a questionnaire instrument on 80 inpatients, and analyzed using the Chi-square test. Results: In the qualitative phase, all four disciplines were executed, with final achievement rates in the medical service area: the Polyclinics, Inpatients, and Emergency Department Units each reached 100%, and the Perinatology and Maternity Units each achieved 80%. Medical Support area, Nutrition, and Radiology Units reached 100%, whereas the Admission, Laboratory, and Pharmacy Units attained 89%, 88%, and 75%, respectively. In the quantitative phase, Chi-square analysis indicated
a significant association between the implementation of the Greeting Program and patient satisfaction levels (p < 0.05). Conclusion: These findings confirm that the execution strategy implemented through the 4DX model effectively improves service quality and has a positive
impact on patient satisfaction with health services at RSU Abdhi Famili.

Characteristics of Burn Patients at Ibnu Sina Hospital, Gresik Regency - 2022–2024: A Retrospective Observational Descriptive Study

2025-10-15T20:00:55+07:00

Introduction: Burns are a significant cause of morbidity and mortality, particularly in developing countries with limitations in healthcare systems. This study describes clinical characteristics of burn patients at Ibnu Sina Regional Public Hospital, Gresik Regency, during the
2022−2024 period. Methods: A retrospective observational descriptive study on secondary data from medical records of burn patients admitted through the Emergency Department (ED) within the first 24 hours following injury. Results: Out of a total of 64 patients, the majority
were male and within the productive age group (16−35 years). Most worked as entrepreneurs or factory workers. The most frequent causes of burns were flame exposure and gas explosions, mostly involving 20%−39% of the total body surface area (TBSA). Patients with inhalation
trauma and comorbidities, such as diabetes mellitus or smoking habits, experienced longer hospital stays. Conclusion: Most moderate-tosevere burn injuries in this study occurred among factory workers and entrepreneurs as a result of open flame and gas explosions, indicating
the need to strengthen occupational safety and burn prevention efforts in the workplace.

Analysis of Sociodemographic and Behavioral Determinants Related to Cervicitis Incidence in Pregnancy

2026-03-04T16:42:39+07:00

Introduction: Cervicitis is an inflammation of the cervix that can lead to serious complications during pregnancy. The objective of this article is to identify risk factors associated with the incidence of cervicitis in pregnant women. Methods: Literature review with narrative analysis. Article searches were conducted on the ScienceDirect, Sage, Google Scholar, and Garuda databases using predetermined keywords. A total of 2,009 articles were obtained from the 4 databases. After the screening process based on the inclusion and exclusion criteria, 15 articles were obtained for analysis. Results: Analysis of 15 articles showed that the incidence of cervicitis in pregnant women is influenced by several risk factors, including: (1) Demographic characteristics such as age and ethnicity; (2) Behavior and lifestyle including sexual intercourse and smoking patterns; (3) Obstetric and gynecological health history; (4) Socio-economic factors; (5) Living environment; and (6) Personal hygiene. The most consistently reported factors were poor personal hygiene, low socioeconomic status, and risky sexual behavior. Conclusion: Cervicitis in pregnant women is associated with complex and multidimensional risk factors. Identification of these factors is important for developing prevention and early detection strategies, thereby reducing the incidence of cervicitis and preventing serious pregnancy complications.

Subarachnoid Block Regional Anesthesia for Cesarean Section in Triplet Pregnancy with Premature Rupture of Membranes in the Region - A Case Report

2026-03-17T13:28:10+07:00

Introduction: Triplet pregnancy is a high-risk pregnancy for both mother and baby, the risk of complications increases with the number of fetuses and maternal age. Cesarean section is the recommended for triplet or more. Spinal anesthesia with hyperbaric bupivacaine and an opioid adjuvant is the most popular neuraxial anesthesia for cesarean section and has been used safely in twin, triplet, and quadruplet deliveries. Case: A woman, 34 years old, G5P4A0 gravida preterm triplet result of insemination, and premature rupture of membranes. Weight 70 kg, height 160 cm, Mallampati 2, blood pressure 135/84 mmHg, pulse rate 140 x/minute, temperature 38.80C, SpO2 100% with binasal cannula. The patient underwent cesarean section with subarachnoid block regional anesthesia using hyperbaric bupivacaine and opioid adjuvant. Discussion: This case demonstrates that preterm premature rupture of membranes is a high-risk condition requiring comprehensive management, including the administration of antibiotics and corticosteroids, as well as the selection of an anesthetic technique that is safe for both the mother and the fetus. The use of spinal anesthesia with a combination of bupivacaine, morphine, and fentanyl provides effective analgesia, although vigilance regarding hypotension and opioid side effects remains necessary. Conclusion: Overall, appropriate management resulted in stable maternal outcomes with good neonatal conditions, as evidenced by satisfactory APGAR scores, despite the low birth weight.

Neonatal Dengue – A Case Report

2026-03-04T17:08:56+07:00

Introduction: Neonatal dengue is a rare but potentially lethal infectious disease, infected through maternal vertical transmission during pregnancy or via mosquito bites. Case: A 3-day-old, 3120-gram female neonate was admitted to the neonatal intensive care unit with fever and jaundice. Her mother was re-admitted for dengue infection 24 hours postpartum. The patient was hemodynamically stable, with
no thrombocytopenia, and underwent phototherapy to treat jaundice (total bilirubin 15,7 mg/dL, indirect bilirubin 14,8 mg/dL). Neonatal dengue was diagnosed on the third day of admission since her temperature rose to 38,8oC and the NS1 antigen was reactive. The platelet count dropped from 257,000/mm3 to the lowest count of 15,000/mm3 on the sixth day of admission with the appearance of petechiae on her face, chest, back, and abdomen. No active bleeding was observed. Adequate treatment and close hemodynamic monitoring would lead to better outcomes. Discussion: Neonatal dengue is a rare condition that can occur through vertical transmission from the mother or
horizontal transmission via mosquito vectors, with diagnosis supported by tests such as the NS1 antigen or RT-PCR. Clinical manifestations in newborns vary widely, ranging from mild fever to severe complications such as thrombocytopenia, shock, and liver dysfunction. Conclusion: Neonatal dengue is a potentially lethal infectious disease. Early diagnosis and prompt treatment are needed, especially in endemic regions.

Acute Myocardial Infarction Suspected of being Triggered by Hospital-Acquired Pneumoia in Elderly – A Case Report

2026-03-04T17:06:47+07:00

Introduction: Pneumonia can trigger acute cardiovascular events (CVE) in elderly. Risk for subsequent CVE can occur even years after pneumonia. Case: A 75-year-old male was hospitalized with chief complaint of diarrhea. During hospitalization, he complained of black stools, accompanied by cough with white phlegm, fever, and shortness of breath. As he developed into Hospital-Acquired pneumonia (HAP), he was also diagnosed as atypical angina. His electrocardiography (ECG) underwent evolution into ST elevation at lead II, III, and aVF, as well as the increasing cardiac biomarker level. The patient was diagnosed with inferior ST elevation myocardial infarction (STEMI) Killip III, intestinal amoebiasis, melena suspected caused by peptic ulcer dd/ colitis amoebiasis, moderate normochromic normocytic anemia, late onset hospital-acquired pneumonia (HAP), and acute kidney injury (AKI) stage II dd/ prerenal acute on chronic kidney disease (ACKD) caused by suspected chronic pyelonephritis dd/ nephrosclerosis. Discussion: The suspicion of pneumonia as a trigger for STEMI can be seen from the clinical manifestation of infection and the presence of significant increase in leucocytes as a marker of infection. After
several days of treatment He was treated in an intensive cardiac care unit with antiplatelet and anti- angina therapy, the patient’s condition improved. Conclusion: The mechanisms underlying cardiovascular events triggered by pneumonia remain unclear. Adequate therapy plays
a crucial role in the management of pneumonia.

Bronchiectasis and Emphysema in a Non-Smoking Patient with Prior TB Infection - A Case Report

2026-03-04T17:10:12+07:00

Background: Bronchiectasis is a chronic lung disease characterized by permanent bronchial dilation and is commonly associated with previous respiratory infections. Structural airway damage may persist even after the primary infection has resolved, leading to chronic respiratory symptoms and progressive lung impairment. Tuberculosis (TB) is recognized as one of the major causes of post-infectious bronchiectasis, particularly in regions with a high prevalence of TB. Case: A 66-year-old female with a long history of tuberculosis presented with yellow sputum for two months. Chest CT scan showed fibrotic lines in both lungs, signs of bronchiectasis in the form of tram lines, and pulmonary emphysema. Previous chest x-rays revealed peribronchial and parenchymal infiltrates with a flattened diaphragm and emphysematous lung appearance. Discussion: Bronchiectasis with emphysema or chronic obstructive pulmonary disease (COPD) often occurs in the elderly population. A history of TB is a major risk factor for bronchiectasis occurring concurrently with COPD. Chronic inflammation due to TB infection can trigger further parenchymal damage manifesting as bronchiectasis and emphysema. Conclusion: This case report highlights the importance of radiological imaging in evaluating chronic respiratory symptoms in patients with a previous history of TB.

Hyperbaric Oxygen Therapy (HBOT) for Sudden Deafness – A Case Report

2026-03-04T17:12:30+07:00

Introduction: Sudden deafness or sudden sensorineural hearing loss (SSNHL) is defined as sensorineural hearing loss of more than 30 dB at three consecutive frequencies occurring within 3 days. The condition is usually unilateral and often idiopathic. The etiology is still not known. Early diagnosis and prompt treatment are essential to improve hearing recovery. Case: A 62-year-old Balinese male presented with sudden decreased hearing for approximately one week accompanied by tinnitus. The patient denied previous history of cough, cold, vomiting, allergies, sinusitis, autoimmune disease, anemia, or other systemic diseases. There was no history of trauma or rhinoplasty. Pure tone audiometry showed severe mixed hearing loss in the right ear and moderate sensorineural hearing loss in the left ear. The patient received combination therapy consisting of methylprednisolone, mecobalamin, and hyperbaric oxygen therapy (HBOT). Discussion: HBOT increases oxygen delivery to the inner ear and may enhance cochlear metabolism and microcirculation. Several studies have reported improved outcomes when HBOT therapy is combined with corticosteroid therapy. Conclusion: This case demonstrats that HBOT therapy combined with corticosteroids may provide significant hearing improvement in patients with sudden deafness.

The Role of Lutein and Zeaxanthin in AREDS 2 Formulation: Protective Mechanisms and Clinical Implementation in Age-related Macular Degeneration

2025-09-03T16:25:24+07:00

Lutein and zeaxanthin are carotenoids that serve as key components in the Age-Related Eye Disease Study 2 (AREDS 2) formulation, replacing beta-carotene from the original formulation due to safety concerns. These carotenoids exhibit dual protective mechanisms as blue light filters and antioxidants within the macula. This literature review aims to analyze the specific roles of lutein and zeaxanthin in AREDS 2, their molecular protective mechanisms, and their optimal clinical implementation in age-related macular degeneration (AMD). Literature searches were conducted through PubMed, Cochrane Library, and Google Scholar using the keywords "lutein", "zeaxanthin", "AREDS 2",
"macular pigment", and "photoprotection". Lutein and zeaxanthin selectively accumulate in the macula, forming macular pigment optical density (MPOD), which functions as blue light filter (400–500 nm) and free radical scavenger. Supplementation with lutein 10 mg and zeaxanthin 2 mg in AREDS 2 has been proven to increase MPOD and reduce the risk of age-related macular degeneration (AMD) progression by 10%–26%. Clinical implementation requires baseline MPOD evaluation, individualized response monitoring, and dose optimization based on nutritional status and patient-specific risk factors.

Diagnosis and Management of Acanthosis Nigricans

2024-10-19T19:08:27+07:00

Acanthosis nigricans (AN) is a skin disorder characterized by hyperpigmented, thickened, and velvety lesions, primarily affecting intertriginous areas. This condition is commonly associated with insulin resistance, diabetes mellitus, obesity, endocrine disorders, and the use of certain medications, and in some cases may serve as a marker of underlying internal malignancy. Individuals with darker skin are more prone to developing AN. Although it can be present at birth, AN is more commonly observed in adults. This literature review aims to discuss the etiology, pathomechanism, clinical manifestations, diagnostic approach, and management of acanthosis nigricans, with emphasis on its role as an indicator of underlying systemic disease. Literature was obtained from various relevant scientific sources, including review articles, case reports, and clinical studies. The pathogenesis of AN is primarily associated with hyperinsulinemia, which stimulates keratinocyte and fibroblast proliferation through the insulin-like growth factor-1 (IGF-1) pathway. Diagnosis is generally established clinically, although laboratory and histopathological evaluations may be required in certain cases. Management focuses on treating the underlying condition, such as weight reduction, improvement of insulin resistance, and management of malignancy when present, along with topical or procedural therapies to improve skin lesions and patients’ quality of life.

Diagnosis and Management of Chronic Urticaria.

2024-07-28T07:11:45+07:00

Chronic urticaria is an inflammatory skin condition characterized by urticarial skin lesions, angioedema, or both, occurring continuously or sporadically for 6 weeks or more, and may be spontaneous or induced by specific factors. The impact of chronic urticaria significantly
includes physical discomfort as well as mental health disturbances (particularly anxiety and depression), sexual dysfunction, impaired interpersonal relationships, and limitations in daily activities including work and school. Diagnosis is established based on clinical history
and physical examination, with additional investigations performed in selected cases to exclude secondary causes. Management includes antihistamines as first-line therapy, with treatment escalation based on patient response. This individualized therapeutic approach follows a step-up or step-down principle based on the level of disease control. The treatment target is disease remission, indicated by a sustained urticaria activity score (UAS) of 0, controlled disease with a urticaria control test (UCT) score of 16, and normalization of quality of life. A good understanding of this condition along with proper patient education is essential to help control symptoms and improve overall quality of life.