Cermin Dunia Kedokteran

Effect of Lavender (Lavandula angustifolia) Aromatherapy among Medical Students with Insomnia

Mohammad Bakhriansyah — 2025-10-08

Introduction: The first line of therapy for insomnia disorders is a psychological approach and anti-insomnia drugs. One of the recommended alternative therapies is lavender aromatherapy (Lavandula angustifolia). This study aimed to determine the effect of lavender aromatherapy on insomnia among medical students of the Faculty of Medicine and Health Sciences, Universitas Lambung Mangkurat, Banjarmasin, Indonesia. Methods: The design was a clinical trial with a one-group pretest-posttest design involving 48 students in October 2023. Subjects were selected by consecutive sampling techniques, and data were collected online by Google Form. The Jakarta biological psychiatry study group questionnaire–insomnia rating scale (KSPBJ-IRS) was used to assess the level of insomnia before and after aromatherapy. Data were analyzed using the Wilcoxon signed-rank statistical test with a 95% confidence level. Results: This study showed that before aromatherapy, 50% of subjects experienced mild and severe insomnia. After aromatherapy, 39.6% of subjects did not experience insomnia, while 56.2% and 4.2% experienced mild insomnia and severe insomnia, respectively. This relationship was statistically significant (p = 0.0005). Conclusion: These results indicate that lavender aromatherapy can significantly improve insomnia.

The Effect of Andrographolide on the Histopathological Findings of Liver Cells in Male Wistar Rats (Rattus norvegicus) Induced by Carbon Tetrachloride (CCl4)

Vincent Sanjaya — 2025-10-08

Introduction: Andrographolide is a group of diterpene lactone isolates from the Andrographis paniculata plant with hepatoprotective properties. Andrographolide gives a hydrogen ion to pair with a free electron from a free radical to form a stable chemical compound and thus decrease liver damage. Methods: This experimental research used a post-test only with a control group design. The samples were mouse's liver (Rattus norvegicus).Twenty-four mice (Rattus norvegicus) were divided into 6 groups: a normal group, a curcumin-treated group as a positive control, a carbon tetrachloride-only group as a negative control, and the treatment group with the dose an andrographolide 50 mg/kgBW group, an andrographolide 100 mg/kgBW group, and an andrographolide 200 mg/kgBW group with 4 mice in each group. Mice were induced with carbon tetrachloride on the first day, then treated with curcumin and andrographolide for 7 days. Liver organs were dissected on day 9 to prepare a specimen for assessing hepatocyte damage (necrosis and hydropic degeneration). Results: Andrographolide showed a hepatoprotective effect on hepatocyte damage after induction by CCl₄. The injury score in the normal group is 16.84; the negative control group is 34.36; the positive control group is 11.48; the dose 1 group is 24.92; the dose 2 group is 19.96; and dose 3 is 19.52. In the LSD test, the 50 mg/kgBW and 100 mg/kgBW andrographolide dose groups showed significant differences in hepatocyte damage compared to the normal group. There was no significant difference in liver histopathologic injury score between the normal group and the andrographolide 200 mg/kgBW group (ANOVA, p > 0.05). Conclusion: The best hepatoprotective effect was provided by andrographolide 200 mg/kgBW because the degree of damage is similar to that in the normal group.

Diagnosis and Management of Post-Traumatic Stress Disorder

Wenly Susanto — 2025-10-08

Post-traumatic stress disorder (PTSD) is a stress disorder that can disrupt social life due to cognitive and mood changes. The etiology of PTSD involves a combination of biological, psychological, and social factors, which interact to cause post-traumatic stress disorder. Biological factors such as genetics also play a role. Exposure to traumatic stressors in PTSD needs to be distinguished from ordinary stressors. According to the DSM-V, the diagnostic criteria for PTSD for adults, adolescents, and children over 6 years of age consist of criterion A (stressor), criterion B (intrusive symptoms), criterion C (avoidance symptoms), criterion D (changes in negative cognition and mood), criterion E (changes in reactivity and vigilance), criterion F (symptom duration), and criteria G and H. Diagnosis of PTSD is a challenge in medical practice. PTSD treatment consists of psychotherapy and pharmacotherapy. Psychotherapy is considered more efective but requires a longer time commitment, so maintaining patient engagement is crucial to improving prognosis. Appropriate management can help reduce PTSD symptoms.

Diagnosis and Management of Paradoxical TB-IRIS

Yovita Gotama — 2025-10-08

Tuberculosis (TB) is the most common opportunistic infection in patients with human immunodeficiency virus (HIV). TB-HIV is a global burden, especially in TB endemic countries, such as Indonesia, and increased mortality. Patients with HIV need antiretroviral drugs treatment as early as possible but comorbidity with TB carries a high-risk of immune reconstitution inflammatory syndrome (IRIS), which can worsen clinical condition and increase the mortality rate. TB-IRIS is divided into 2 categories, namely paradoxical TB-IRIS in patients who have previously received TB therapy and unmasking TB-IRIS in patients newly diagnosed with TB after initiation of ARV. Clinical manifestations of TB-IRIS include worsening respiratory and constitutional symptoms, as well as the appearance of new lesions in other organs. The diagnosis of TB-IRIS requires the exclusion of other conditions such as opportunistic infections or TB treatment failure. Prevention strategies include TB screening before ARV initiation, selection of the appropriate timing for ARV administration, and the use of corticosteroids such as prednisone to reduce the risk of worsening. Management of TB-IRIS focuses on supportive therapy, inflammation control, and continuation of ARV and OAT treatment. With early detection, prevention, and appropriate management, morbidity and mortality rates due to TB-IRIS can be significantly reduced.

Diagnosis and Pharmacotherapy of Chronic Obstructive Pulmonary Disease

Johan Indra Lukito — 2025-10-08

Chronic obstructive pulmonary disease (COPD) is a lung disease with chronic respiratory symptoms and exacerbations that can be prevented and treated. COPD is characterized by airfow obstruction that is not fully reversible, generally due to long-term exposure to cigarette smoke, pollution, or other environmental risk factors. Multiaspect COPD assessment after confrmation of COPD diagnosis is needed to guide treatment. The diagnosis is established by spirometry and clinical evaluation, including assessment of symptoms, history of exacerbations, blood eosinophil levels, and the presence of comorbidities. COPD pharmacotherapy aims to reduce symptoms, reduce the risk of exacerbations, and improve the patient’s quality of life. Pharmacotherapy is administered during stable conditions or during exacerbations using bronchodilators alone or in combination, corticosteroids, and other supportive medications according to the patient’s needs, abilities, and condition. Personalized therapy based on symptom severity, history of exacerbations, and patient response. Regular monitoring, proper inhaler technique, and treatment adherence are essential for achieving optimal clinical outcomes.

Nerve Reconstruction with Sural Nerve Graft in Low-Resource Setting

Rabinda Fitriana Tuasikal — 2025-10-08

Introduction: Nerve reconstruction is an essential procedure in the management of nerve damage. When end-to-end primary repair is not possible, an autologous nerve graft is the gold standard for management. The sural nerve is considered the most reliable harvest site. Compared to other reconstructive options, auto graft provides the best similar physiologic nerve environment for axonal regeneration. To achieve an efective neural regeneration, tension-free repair sites should be provided, as they hinder focal neural ischemia caused by disrupted microvascular fow. Case: A 52-year-old woman with a giant schwannoma of the ulnar nerve had a tumor excision surgery followed by sural nerve grafting in a low-resource setting where microsurgery equipment is unavailable. Maluku, with archipelago-type geography, poses signifcant challenges to healthcare professionals in performing guideline-based procedures. Conclusion: Considering the unavoidable risk of nerve damage and signifcant gap, tumor excision followed by nerve reconstruction using autograft was chosen in this case, resulting in a decent outcome.

Superficial Circumflex Iliac Perforator (SCIP) Free Flap for Lower Extremity Reconstruction in Malignancy Case

Ade Putra — 2025-10-08

Background: Synovial sarcoma, a rare tumor primarily afecting the lower extremities, often requires surgical excision to ensure tumor removal and limb preservation. This case highlights the importance of reconstructive options in achieving optimal functional and aesthetic outcomes for patients with large surgical defects. Case: A 51-year-old female with left foot synovial sarcoma (T2N0M0) underwent Chopart amputation to achieve clear surgical margins. The resulting defect was extensive, involving both skin and deeper soft tissues, making primary closure impossible. Reconstruction was performed using the Superfcial Circumfex Iliac Perforator (SCIP) free fap harvested from the groin region, which provided robust soft tissue coverage and minimized donor site morbidity. The patient’s postoperative course was uneventful, with no complications such as fap necrosis or infection. Early rehabilitation was initiated to restore limb function, and long-term follow-up showed no evidence of recurrence or functional impairment. Conclusion: Chopart amputation with SCIP fap is an efective option for foot synovial sarcoma management, ensuring both tumor clearance and limb function preservation.This case demonstrates the value of microsurgical reconstruction in complex oncologic cases and underscores the importance of multidisciplinary care in achieving favorable outcomes.

Successful Non-Operative Management of Idiopathic Acute Limb Ischemia in a Pediatric Patient

Charolina Simatupang — 2025-10-08

Introduction: Acute limb ischemia (ALI) is a rare occurrence in children, predominantly associated with trauma or iatrogenic causes. Acute limb ischemia can result in the loss of limbs and lifelong complications. The ideal treatment is not yet established. Case: A 10-month-old boy was referred with darkening of the extremities, accompanied by fever and seizures. The patient had a continuous fever for the past four days and experienced four generalized seizures, 1-2 minutes each. During treatment at the previous hospital, the nose and fingers of all extremities became dark blue since one day before referral. Upon arrival, examination revealed bluish-purple extremities, a harder texture, and cold acral areas. Pulses in the extremities were weak. Complete laboratory tests showed D-dimer >20,000 ng/mL, CRP 21.6 mg/dL. Head MRI was within normal limits. Doppler ultrasound of the extremities did not reveal thrombosis in the leg veins, and echocardiography also did not show the presence of thrombus. The patient was treated with antibiotics and anticoagulants for 10 days. During hospitalization, the patient showed clinical and laboratory improvement. Discussion: Acute limb ischemia in pediatric patients is uncommon, typically associated with trauma or iatrogenic factors. In this pediatric case, the etiology of acute limb ischemia (ALI) remained unclear, as no embolic source or thrombotic occlusion was detected on Doppler ultrasound or echocardiography. This highlights the limitation of the initial diagnostic work-up, since advanced imaging such as CT angiography would be required to further delineate potential underlying vascular abnormalities or occult causes that might not be evident on standard modalities.

The Use of Collagen Stimulators in Aesthetics

Della Mahendro — 2025-10-08

Aging is a life cycle stages accompanied by physiological and anatomical changes as biological aging process. Various methods of prevention and management are used to reduce the appearance of facial aging, among others is minimally invasive procedure. Dermal fillers or soft tissue fillers are one of the minimally invasive procedures aimed at restoring facial volume and augmenting specifc areas. Dermal fillers are divided into two categories, non-biodegradable and biodegradable. Biodegradable fillers are known as collagen stimulators.The use of collagen stimulators such as polycaprolactone (PCL), calcium hydroxylapatite (CaHa), and poly-L-lactic acid (PLLA) is increasingly popular due to their ability to stimulate natural collagen production, resulting in long-lasting and natural-looking outcomes. Each type has unique characteristics, indications, and injection techniques, making product and method selection important for optimal patient results. Side efects such as edema, nodules, or infammatory reactions can be minimized with proper technique and administration by trained medical professionals. With advances in technology and improved understanding, collagen stimulators have become an efective solution for soft tissue rejuvenation and augmentation in aesthetic practice.

Diagnosis of Sarcopenia in Geriatrics using Actigraph wGT3XBT Accelerometer: A Narrative Review

Gembong Satria Mahardhika — 2025-10-08

Sarcopenia is a degenerative condition of age-related decline in muscle mass and strength. The worldwide occurrence of sarcopenia varied from 8% to 36% in those under the age of 60, and from 10% to 27% in those aged 60 and above. There is 9.92% or around 26.82 million, elderly people in Indonesia. Several studies have stated that in 2020, the incidence of sarcopenia in Indonesia ranged from 9.1% to 59%. Various studies have shown that accelerometers can provide a quantitative measurement of physical activity, positively correlated with muscle mass and strength in the elderly. Accelerometers, particularly the Actigraph wGT3X-BT, offer an objective approach to measuring physical activity and provide important insights into sarcopenia. Accelerometers offer an unbiased method for quantifying physical activity, offering valuable information on sarcopenia, and serving as a clinical diagnostic tool for this disorder characterized by reduced muscle mass and function. Literature review suggests that the Actigraph wGT3X-BT accelerometer has great potential for early detection and diagnosis of sarcopenia. The integrated use of this technology is expected to improve the accuracy of diagnosis and enable more effective interventions, thereby improving the quality of life of the elderly in Indonesia.

Bibliometric Analysis of Nutritional Benefits in Sarcopenia

Citra Pratiwi — 2025-10-08

Introduction: The benefits of nutrition in sarcopenia include maintaining muscle mass and improving physical condition. The bibliometric analysis aims to visualize future trends and opportunities for nutritional research in sarcopenia. Methods: Data was gathered from the Scopus database. The BIBLIO checklist is used as a guideline for quantitative analysis of bibliographic data using keywords “diet”, “nutritional approach,” and “sarcopenia”, on literature published between 2015 and 2025. Selection of types, articles, reviews, and conference papers in English, with final or in-press publication status. Studies involving “nonhuman” subjects were excluded. Analysis was conducted using the R and VOSviewer to visualize author networks, keywords, and publication trends. Results: A total of 1,337 documents were found, with 57,860 citations, ranging from 117 to 13,203 document citations per year. H-index is 109. The top three journals were Clinical Nutrition (60 articles), Journal of Nutrition, Health and Aging (44 articles), and Frontiers in Nutrition (33 articles). Publications have increased over the past 10 years. The majority of publications were original articles (60.1%), followed by reviews (38.3%), and conference papers (1.5%). There are 5 clusters of co-occurrence topics from keywords. Conclusion: Research trends focus on sarcopenia prevention. Future studies could explore the effects of vitamin D and the mediterranean diet on sarcopenia.

The Effect of Vitamin D on the Immune System of Leprosy Patients

Florentina Ranni Eka Rovanza — 2025-10-08

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Vitamin D is a fat-soluble vitamin that plays an important role in bone metabolism with an anti-inflammatory and immune-modulating properties. Recent studies show a role of vitamin D on the immune system of leprosy patients. Vitamin D in its active form (1,25 (OH)2 D binds to the vitamin D receptor on macrophages. Vitamin D stimulates the production of cathelicidin and defesin, antimicrobial peptides that can kill Mycobacterium leprae. Vitamin D enhances the Th1 immune response by producing IL12, which is important against intracellular bacteria. Vitamin D suppresses excessive TH2 immune response to prevent disease progression. Vitamin D deficiency has a strong negative correlation with increased levels of pro inflammatory cytokines such as TNF -α. TNF-α, an inflammatory modulator, has been found to be significantly elevated in skin lesions of leprosy patients experiencing type 2 leprosy reactions. High levels of TNF-α play a direct role in myelin sheath damage, bone resorption stimulation, and inhibition of bone collagen synthesis. These factors likely explain clinical symptoms such as neurological disorders and disability in leprosy patients. Based on the above findings, vitamin D has effects on the immune system of leprosy patients.