Indonesian Health Journal

Development of an E-Book on Traditional Cosmetics and Beverages for SPA Treatments

Ika Pranita Siregar — 2026-06-25

This study is motivated by the increasing global demand for digital learning media in vocational education, particularly in fields requiring strong practical and visual understanding, such as beauty and spa therapy. Traditional instructional materials are often insufficient to support competency-based learning in courses involving cosmetic formulation and traditional spa treatments. Therefore, this research aims to develop and evaluate an interactive e-book on traditional cosmetics and beverages for spa treatment using the ADDIE model. The study employed a Research and Development (R&D) approach following the ADDIE stages — Analysis, Design, Development, Implementation, and Evaluation. The study involved subject matter experts, media experts, linguists, and 30 vocational students as respondents. Data were collected through questionnaires, interviews, observations, and documentation, and analysed using descriptive quantitative and qualitative methods. The results showed that the developed e-book achieved very high validity and feasibility scores, with expert validation ratings exceeding 95% and an average user response score above 92%. The e-book was considered highly effective in terms of content quality, language clarity, visual design, usability, and accessibility. In conclusion, the interactive e-book on traditional cosmetics and spa treatment is feasible and effective as a learning medium in vocational education. It enhances student engagement, supports independent learning, and bridges theoretical knowledge with practical skills, while integrating local wisdom into digital learning resources.

The Platelet-To-Albumin Ratio and the Mean Platelet Volume-To-Albumin Ratio as Predictors of Disease Severity and Mortality in Pediatric Sepsis Patients

Okky Hudaya — 2026-06-25

Pediatric sepsis remains a critical emergency condition with high morbidity and mortality rates, particularly in low- and middle-income countries. Early identification of patients at risk of severe outcomes is essential to guide timely interventions. This study aimed to evaluate the prognostic value of Platelet-to-Albumin Ratio (PAR) and Mean Platelet Volume-to-Albumin Ratio (MAR) in predicting disease severity and 7-day mortality among pediatric sepsis patients in the emergency room. A retrospective observational study was conducted on 101 pediatric patients admitted to Dr. Soetomo Hospital, Surabaya, from January 2020 to January 2025. PAR and MAR were measured on days 1, 3, and 5, and severity was assessed using PELOD-2 scores. Statistical analyses included ROC curves, Spearman correlations, and Kruskal–Wallis tests. Results demonstrated that MAR consistently showed superior predictive performance compared to PAR, with AUC values improving from 0.711 on day 1 to 0.905 on day 5, and significant correlations with PELOD-2 scores (p<0.001). PAR showed limited and inconsistent predictive ability. The findings indicate that MAR is a reliable and practical biomarker for early risk stratification and monitoring of pediatric sepsis severity. Future research should validate MAR in multicenter prospective studies and explore its integration with clinical scoring systems for enhanced prognostic accuracy.

Dizziness and Cognitive Impairment in Parkinson's Disease Among HIV Patients: Case Report

Lathifatul Fikriyah — 2026-06-11

Parkinsonism affects approximately 5% of individuals with HIV and represents the most common movement disorder in this population. It often coexists with HIV-associated neurocognitive disorder (HAND), opportunistic infections, or neuroleptic use. Accurate diagnosis of HIV-associated dementia (HAD) is crucial, as it is an AIDS-defining condition that may be reversible with antiretroviral therapy (ART). This case report aims to describe a patient with HIV who presented with dizziness, progressive cognitive decline, and parkinsonian features, highlighting the diagnostic challenges and the role of ART in management. A 41-year-old male with known HIV infection presented with progressive memory loss, dizziness, postural instability, bradykinesia, and intention tremors over several months. Neurological examination revealed cognitive impairment (MMSE 22/30) and parkinsonism (UPDRS-III 76/108). Brain MRI showed cerebral atrophy, white matter changes, and an abnormal “swallow tail” sign bilaterally in the substantia nigra, suggestive of Parkinson’s disease. Laboratory tests demonstrated adequate systemic viral suppression (CD4 302 cells/µL). The patient was diagnosed with HIV-associated dementia and Parkinson’s disease. His ART regimen was modified to enhance CNS penetration (zidovudine, lamivudine, dolutegravir). At two-month follow-up, he showed significant improvement in cognitive function and reduced dizziness, enabling return to work and daily activities. HIV-associated neurocognitive disorder and parkinsonism can occur even with well-controlled systemic HIV infection. A high index of suspicion, comprehensive neuropsychological and neuroimaging assessment, and individualized CNS-targeted ART are essential for optimal outcome.

Factors Associated with Medical Waste Management at Haji Saeful Anwar General Hospital in Pagaden, Subang Regency, in 2026

Muslimin — 2026-06-22

The results of a preliminary study conducted on February 20, 2026, in the field, including observations and interviews with the sanitation department, revealed dissatisfaction among nurses and sanitation staff regarding medical waste management at Haji Saeful Anwar Pagaden General Hospital, Subang Regency. The purpose of this study was to determine factors related to medical waste management at Haji Saeful Anwar Pagaden General Hospital, Subang Regency, in 2026. The study used a descriptive analytical method with a cross-sectional design. The population in this study consisted of all 74 nurses and sanitation staff at Haji Saeful Anwar Pagaden General Hospital, Subang Regency. The sampling technique employed was total sampling, using bivariate and univariate analysis of the independent and dependent variables, with a questionnaire as the data collection instrument. The results of the study showed that of the 74 respondents, the majority (58 respondents, 78.4%) had good knowledge of medical waste management; the majority (69 respondents, 72.2%) had good attitudes toward medical waste management; the majority (65 respondents, 87.8%) had good infrastructure for medical waste management; the majority (65 respondents) implemented the rules properly for medical waste management; and the majority (55 respondents) had good supervision of medical waste management. Statistically, the relationship between the variables of medical waste management factors and medical waste management implementation showed a significant association, with a Chi-Square test result of 10.503 and ? < 0.05, yielding a P-value of 0.00.

The Effect of Perceived Usefulness, Trust, and Digital Literacy on Acceptance of Clinical Decision Support Systems Among Healthcare Workers

Filipo David Tamara — 2026-06-09

Clinical Decision Support Systems (CDSS) are increasingly used to support clinical reasoning, patient management, and healthcare quality. However, their successful implementation depends not only on technical performance but also on acceptance among healthcare workers. This study aimed to analyze the effect of perceived usefulness, trust, and digital literacy on the acceptance of CDSS among healthcare workers. A quantitative analytical study with a cross-sectional design was conducted among healthcare workers involved in clinical services, including physicians, nurses, and midwives. Data were collected using a structured questionnaire measuring perceived usefulness, trust, digital literacy, and CDSS acceptance. The data were analyzed using univariate analysis and bivariate analysis with Fisher’s Exact Test and odds ratio estimation. The findings showed that most respondents had good perceived usefulness, good digital literacy, and good acceptance of CDSS, while trust was also generally positive but had a larger moderate proportion compared with other variables. Perceived usefulness significantly influenced CDSS acceptance, with respondents who perceived CDSS as useful being more likely to show good acceptance. Trust was also significantly associated with acceptance, as all respondents with good trust demonstrated good acceptance of CDSS. Digital literacy significantly influenced acceptance as well, indicating that healthcare workers with stronger digital capability were more prepared to accept CDSS in clinical practice. These findings suggest that improving CDSS acceptance requires clear practical benefits, reliable and transparent system performance, and adequate digital readiness supported by training and technical assistance.

Atypical Presentation of Thyrotoxic Periodic Paralysis Without Overt Hyperthyroid Symptoms: A Case Report

I Made Satria Wibawa — 2026-06-18

Thyrotoxic Periodic Paralysis is a rare complication of hyperthyroidism characterised by acute muscle weakness due to hypokalemia. This condition is more commonly reported in Asian populations and may be overlooked when classic symptoms of hyperthyroidism are absent, potentially leading to recurrence and serious complications. A 40-year-old man presented with sudden weakness of all four extremities following consumption of a high-carbohydrate meal. The patient did not exhibit typical symptoms of hyperthyroidism. Laboratory evaluation revealed severe hypokalemia with elevated FT? levels and markedly suppressed TSH. The patient was treated with intravenous and oral potassium replacement, along with methimazole and propranolol. Muscle strength improved within 24 hours and recovered completely by the third day of hospitalisation. Thyrotoxic Periodic Paralysis occurs due to an intracellular shift of potassium mediated by increased Na?/K?-ATPase activity in the setting of thyrotoxicosis. Attacks are often triggered by high-carbohydrate intake or physical exertion. Diagnosis can be challenging in patients without overt hyperthyroid manifestations; therefore, thyroid function testing is essential in cases of acute hypokalaemic paralysis. Management includes careful potassium correction and control of thyrotoxicosis to prevent recurrence. Thyrotoxic Periodic Paralysis should be considered in any patient presenting with acute weakness accompanied by hypokalemia, even in the absence of classic hyperthyroid symptoms. Prompt treatment and adequate control of thyrotoxicosis are associated with favourable clinical outcomes.

Association of Brinkman Index with Airflow Limitation in Active Smokers Using Portable Spirometry at Saketa Primary Health Care Center

Alicia Thessalonica Nata — 2026-06-18

Tobacco-related diseases account for more than seven million deaths globally each year. In Indonesia, approximately 295,043 deaths in 2025 were attributed to tobacco use. Identifying reliable parameters for early detection of pulmonary impairment in smokers, particularly those who are still asymptomatic, is therefore essential. This research aimed to evaluate the association between Brinkman Index score and FEV?% predicted (measured using portable spirometry) among active smokers at Saketa Primary Health Care Center. This cross-sectional study included 40 male active smokers aged ?35 years at Saketa Primary Health Care Center, South Halmahera, selected using a consecutive sampling method. The Brinkman Index score was used as the independent variable, while FEV?% predicted, measured using portable spirometry according to American Thoracic Society standards, was the dependent variable. Data were analysed using Spearman's correlation test. The mean smoking duration was 29.83 ± 8.85 years, with an average cigarette consumption of 17.50 ± 6.88 cigarettes per day. The mean FEV?% predicted was 74.90 ± 5.91%. Analysis using Spearman's correlation showed a strong negative association between Brinkman Index score and FEV?% predicted, which was statistically significant (r = ?0.771; p < 0.001). Scatter plot analysis showed a coefficient of determination of R² = 0.610, indicating that higher Brinkman Index score values were associated with lower FEV?% predicted values among active smokers.

Characteristics of Genetic Susceptibility in Lung Cancer Patients in North Sumatra Population, Indonesia

Putri Aulia Anwar — 2026-06-12

Lung cancer remains a major global health problem and the leading cause of cancer-related mortality worldwide. Although smoking and environmental exposure are the dominant risk factors, genetic susceptibility and family history may also contribute to lung cancer development, particularly among individuals with inherited cancer predisposition. This study aimed to describe the characteristics of genetic susceptibility among lung cancer patients in the North Sumatra population, Indonesia, with emphasis on family history of lung cancer and other cancers. A descriptive observational design was employed, conducted from August to November 2024 at Adam Malik Hospital, Universitas Sumatera Utara Hospital, and Santa Elisabeth Hospital. A total of 240 patients with histopathologically confirmed small-cell lung cancer and non-small-cell lung cancer were included through consecutive sampling. Data were collected from medical records, including sociodemographic characteristics, clinical information, and family cancer history, and were analyzed descriptively using IBM SPSS version 26. The results showed that patients had a mean age of 59.12 ± 13.22 years, were predominantly male, and were mostly of Batak ethnicity. Regarding familial susceptibility, 5.4% had a family history of lung cancer, 34.2% had a family history of other cancers, and 60.4% had no family history of cancer. These findings indicate that family history should be considered in lung cancer risk assessment. Integrating familial cancer evaluation into routine clinical practice may support early screening, prevention, and personalized intervention strategies.

Characteristics of Tumor Marker on Mediastinal Tumors

Novpiodita Pratiwi — 2026-06-12

Mediastinal tumors are rare thoracic malignancies that pose diagnostic and therapeutic challenges due to their anatomical proximity to vital organs and diverse histopathological features. Early detection and accurate characterization are essential for effective management. This study aimed to describe the characteristics of tumor markers and their diagnostic relevance in patients with mediastinal tumors treated at Adam Malik General Hospital, Medan, Indonesia. A descriptive observational study using a case series design was conducted on 43 patients diagnosed with histopathologically confirmed mediastinal tumors from 2020 to 2024. Data on demographics, tumor histopathology, tumor location, and tumor marker levels (LDH, AFP, B-HCG, and CEA) were collected from medical records. Statistical analysis was performed using SPSS 26.0, with categorical variables expressed as frequencies and percentages, and numerical variables as mean ± standard deviation. The results indicated that the majority of patients were male (76.7%), with a mean age of 40.7 ± 15.5 years. Lymphoma (39.5%) and thymoma (37.2%) were the most common tumor types, predominantly located in the anterior mediastinum (76.7%). LDH was elevated in 76.7% of cases, particularly in germ cell tumors and lymphomas, while AFP and B-HCG elevations were mainly observed in germ cell tumors. CEA had limited diagnostic utility. The study concludes that integrating clinical, histopathological, and tumor marker data enhances diagnostic accuracy, and that LDH, AFP, and B-HCG serve as valuable supportive biomarkers for mediastinal tumor evaluation.

The Relationship Between Maternal Age and Parity and the Incidence of Hypertension in the Third Trimester of Pregnancy at the Maja Community Health Center in 2026

Eva Fauziah — 2026-06-25

Hypertension in pregnancy remains a major global public health problem, contributing significantly to maternal and fetal morbidity and mortality. This condition is influenced by multiple risk factors, including maternal age and parity, which play an important role in determining pregnancy outcomes. The objective of this study was to analyze the relationship between maternal age and parity and the incidence of hypertension in third-trimester pregnancy at the Maja Community Health Center in 2026. This study used an observational analytic design with a cross-sectional approach. The population consisted of third-trimester pregnant women recorded at the Maja Community Health Center, with a total sampling technique. Data were collected from medical records and analyzed using univariate and bivariate analyses with the Chi-Square test and prevalence ratio (RP). The results showed that 10.7% of respondents experienced hypertension in pregnancy. There was a significant relationship between maternal age and hypertension (p = 0.030; RP = 3.146), indicating that women in high-risk age groups had a higher probability of developing hypertension. A significant relationship was also found between parity and hypertension (p = 0.038; RP = 2.759). In conclusion, both maternal age and parity are significant risk factors for hypertension in pregnancy. These findings highlight the importance of early detection and targeted maternal health interventions to reduce complications during pregnancy.

Comparative Effectiveness of Dexmedetomidine Versus Esketamine For Pediatric Procedural Sedation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Dewa Putu Agusta Cahya Udayana — 2026-06-22

Procedural sedation in children is frequently required but still faces challenges regarding safety and efficacy. Dexmedetomidine (DEX) and esketamine (ESK) are two promising sedative agents for the pediatric population. This systematic review aimed to compare the effectiveness and safety of DEX versus ESK for procedural sedation in children. A systematic search was conducted on PubMed, Cochrane CENTRAL, Embase, Scopus, and Web of Science databases up to May 2026. Inclusion criteria were randomized controlled trials (RCTs) in children aged 0–18 years comparing DEX with ESK. Primary outcomes included sedation success rate, onset time, and recovery time. Secondary outcomes included pain score (FLACC), adverse events, and satisfaction. Heterogeneity was assessed using I² statistics with a random-effects model. Six studies with a total of 654 patients were included. Onset time of DEX was significantly longer than that of ESK (MD = +4.82 minutes; 95% CI: 1.93–7.71; I² = 72%). Sedation success rate showed no significant difference between the two groups (RR = 1.08; 95% CI: 0.94–1.24; I² = 58%). DEX was associated with a higher incidence of bradycardia (RR = 2.34), while ESK was associated with a higher incidence of hypertension/tachycardia (RR = 3.12) and agitation/delirium (RR = 1.89). DEX and ESK have comparable sedation effectiveness in children. ESK provides faster onset, while DEX offers a more stable cardiovascular safety profile with lower risk of psychomimetic effects. Agent selection should be based on the specific clinical needs of the patient and procedure.

Digitizing Student Nutritional Status Monitoring through the Development of Anthropometric Applications: Longitudinal Studies of BMI and Abdominal Circumference

Fatmayanti Nawai — 2026-06-29

Student nutritional status is an important indicator in determining the health quality of young adults. Changes in lifestyle during the education period can affect students’ anthropometric conditions, particularly body mass index (BMI) and abdominal circumference. This study aimed to analyze changes in BMI and abdominal circumference among students of the Department of Nutrition over a one-year period without intervention and to develop an Android-based anthropometric application as a tool for monitoring nutritional status. The study used a longitudinal observational design with a paired-sample approach involving 106 students from the Department of Nutrition, consisting of the Diploma III Nutrition Program and the Bachelor of Applied Nutrition and Dietetics Program. Measurements were conducted in 2025 and repeated one year later, including body weight, height, abdominal circumference, and BMI. Data were analyzed using a paired sample test with a 95% confidence level.

Low-Pressure Cardiac Tamponade: A Systematic Review of Diagnostic Criteria, Hemodynamic Profiles, and Management Challenges

Adam Maulana Yusup — 2026-06-11

Low-Pressure Cardiac Tamponade (LPCT) is a deceptive subset of pericardial compressive syndromes characterized by tamponade physiology occurring at normal or low intracardiac pressures, primarily due to underlying hypovolemia. The absence of classical signs, such as jugular venous distension and pulsus paradoxus, frequently leads to misdiagnosis and mortality. This review aims to synthesize diagnostic criteria, hemodynamic profiles, and evidence-based management strategies for LPCT. A systematic review was conducted following PRISMA 2020 guidelines. Electronic databases (PubMed, Scopus, Embase) were searched through December 2025. Eighteen studies meeting specific hemodynamic criteria for LPCT and subacute presentations were included. Data regarding demographics, echocardiographic findings, and response to volume expansion were synthesized qualitatively. Analysis indicates that LPCT predominantly affects patients with malignancy, renal failure, or chronic inflammation. Hemodynamically, equilibration of diastolic pressures occurs at <12 mmHg due to critical preload reduction. The most consistent diagnostic profile identified is echocardiographic right atrial/ventricular collapse coexisting with a non-plethoric, collapsing inferior vena cava. Physical examination markers, including Beck’s triad, were unreliable. LPCT represents a "pre-tamponade" state masked by hypovolemia. Reliance on physical examination is insufficient; Point-of-Care Ultrasound (POCUS) is mandatory for diagnosis. We recommend a management algorithm centering on a "fluid challenge" (500–1000 mL) to unmask occult tamponade physiology and optimize preload prior to pericardiocentesis, thereby mitigating the risk of Pericardial Decompression Syndrome.

Clinical Spectrum of Adult Henoch-Schönlein Purpura: Diagnostic Challenges and Long-Term Prognostic Considerations

Gede Padmawijaya — 2026-06-18

Immunoglobulin A vasculitis (IgAV) or Henoch–Schönlein purpura (HSP) is an immune complex-mediated systemic vasculitis that primarily affects small blood vessels in the skin, joints, gastrointestinal tract, and kidneys. Although more common in children, IgAV in adults tends to present with more severe symptoms and a higher risk of long-term kidney disease. IgAV is diagnosed based on clinical and histopathological criteria, with emphasis on non-thrombocytopenic palpable purpura, arthralgia/arthritis, abdominal pain, and/or kidney involvement, along with findings of leucocytoclastic vasculitis with IgA deposition on biopsy. Case Illustration: This case report describes a 20-year-old woman with palpable purpura on the lower legs and hands, arthralgia, a history of prior sore throat, and bronchial asthma with markedly elevated IgE. Laboratory findings showed elevated ESR and CRP; urinalysis was negative; skin biopsy revealed leucocytoclastic vasculitis. The patient was taking hormonal medication, methylprednisolone, and loratadine. This case demonstrates a typical presentation of IgAV in young adults, supported by a history of previous upper respiratory tract infection and atopic predisposition (bronchial asthma with high IgE). Clinical manifestations of palpable purpura on the extremities and arthralgia are highly consistent with IgAV. The leucocytoclastic vasculitis findings on skin biopsy are highly suggestive, although confirmation of IgA deposition remains ideal for definitive diagnosis. Management with corticosteroids and antihistamines aims to alleviate skin and joint inflammation. Long-term prognosis depends on close monitoring for potential development of IgAV nephritis.

Understanding Antecedents of Missed Nurse Care in Pediatric Ward Towards Nurse Outcome: A Descriptive Study in Indonesia

Marcella Amadea Widjaja — 2026-06-18

This research aims to examine the relationship between empowering leadership, performance-based evaluation, and resilience on nurse outcomes through self-efficacy, teamwork efficacy, and missed nursing care in paediatric wards, with the moderating role of cognitive empathy. This descriptive research was conducted during October 2024, utilising self-reported questionnaires. The research included 180 paediatric ward nurses, each with at least one year of working experience in paediatric wards where children were admitted. These nurses were selected from four private hospitals in one of the most populous provinces in Indonesia, West Java. The proposed model was tested using partial least squares structural equation modelling. The findings indicate that resilience, empowering leadership, and performance-based evaluation are significantly associated (p < 0.05; 95% CI) with paediatric nurses' outcomes from the nurses' perspective, mediated by nursing profession self-efficacy, nursing teamwork efficacy, and missed nursing care. As a moderating variable, cognitive empathy demonstrated a significant moderating role in the relationship between self-efficacy and missed nursing care (? = ?0.218) but was not significant for teamwork efficacy (? = 0.143). The proposed model demonstrated adequate prediction of paediatric nurse outcomes as the dependent variable (R² = 0.453). This research highlighted the importance of leadership styles that empower paediatric nurses, resilience-building programmes, and initiatives that enhance individual and team efficacy to mitigate missed nursing care in the paediatric ward. Hospital managers should prioritise strategies to improve leadership, resilience, and teamwork to enhance paediatric patient safety, care quality, and paediatric nurse well-being in hospital settings.

Factors Influencing the Occurrence of Ispa Disease in Excavation C Workers in the Work Area of the Gonengganti Health Center

Fitriana Fitriana — 2026-06-15

This study aims to analyze the factors that affect the incidence of ISPA (Infeksi Saluran Pernafasan Atas) in excavation C workers in the working area of the Gonengganti Health Center, Donggala Regency. This study is a quantitative research with a cross-sectional design. The research population is all excavation C workers in the working area of the Gonengganti Health Center, with a total sample of 83 people taken using the total sampling technique. Data were collected through a structured questionnaire that included dust exposure levels, PPE use, duration of dust exposure, and smoking history. Data analysis was carried out univariately, bivariately using chi-square test, and multivariately using logistic regression. The results of the bivariate analysis showed that dust exposure level, PPE use, dust exposure duration, and smoking history had a significant relationship with the incidence of ISPA in excavation C workers (p < 0.05). Multivariate analysis showed that dust exposure level and PPE use were the most dominant factors associated with ISPA incidence, with odds ratio (OR) values > 1, indicating that workers with high dust exposure and not using PPE consistently have a greater risk of experiencing ISPA than other workers. The conclusion of this study shows that the incidence of ISPA in C excavation workers is influenced by work environment factors and worker behavior. Therefore, efforts are needed to control dust exposure, increase compliance with PPE use, regulate work duration, and provide education on the dangers of smoking as preventive measures to reduce the risk of ISPA in excavation C workers.

Screening and Education on Obesity at the Siko Community Health Center in Ternate City

Eko Sudarmo Dahad Prihanto — 2026-06-18

Obesity is a serious global health problem with increasing prevalence, posing risks of metabolic complications such as diabetes mellitus, hypertension, and cardiovascular disease. Delayed diagnosis and lack of public knowledge are common challenges in obesity management. This community service initiative aims to perform early screening for obesity and central obesity among outpatients at the Siko Community Health Center in Ternate City, followed by educational guidance to achieve optimal treatment outcomes and prevent complications. Screening for obesity and central obesity was conducted among 50 outpatients, followed by personalized education using informational leaflets. The results showed that 26 participants (52%) had obesity, and 29 (58%) had central obesity. Metabolic comorbidities associated with obesity were found in 44% of cases, with hypertension being the most prevalent (26%). In conclusion, this community service activity revealed high prevalence rates of obesity and central obesity, and education on obesity management was successfully provided to all participants.

Effectiveness of Phosphodiesterase Type 5 Inhibitors for Erectile Dysfunction After Radical Prostatectomy: A Systematic Review

Maulfi Natsir — 2026-06-17

Erectile dysfunction (ED) is one of the most frequent complications following radical prostatectomy, with substantial implications for quality of life, psychological well-being, and interpersonal relationships. The pathophysiology involves a combination of cavernous nerve injury, vascular insufficiency, and structural alterations such as corporal fibrosis. Phosphodiesterase type 5 inhibitors (PDE5i) are recommended as first-line therapy; however, their effectiveness in post-prostatectomy ED remains variable and influenced by multiple clinical factors. The objective to systematically evaluate the effectiveness of PDE5 inhibitors in improving erectile function in patients with ED following radical prostatectomy. This systematic review was conducted in accordance with PRISMA guidelines. Literature searches were performed in PubMed, Scopus, and Google Scholar for studies published between 2017 and 2025. Randomized controlled trials and observational studies evaluating PDE5 inhibitors (sildenafil, tadalafil, vardenafil) in post-prostatectomy ED were included. Primary outcomes were erectile function scores (International Index of Erectile Function/IIEF) and recovery rates. The results twenty studies met inclusion criteria. PDE5 inhibitors demonstrated consistent improvement in erectile function scores across most studies (1–3). However, treatment outcomes varied significantly depending on nerve-sparing status, baseline erectile function, patient comorbidities, and timing of therapy initiation (4–7). Early initiation as part of penile rehabilitation showed potential benefits in preserving erectile function, although findings were not uniform (6,8). PDE5 inhibitors are effective in improving erectile function after radical prostatectomy, but their effectiveness is influenced by multiple interacting factors. A personalized and multimodal treatment approach is essential to optimize outcomes

The Effects of Hypoxia in Patients with Atrial Septal Defect (ASD) and Eisenmenger Syndrome: A Case Report

Dyah Rachmasari — 2026-06-09

Background: Atrial septal defect (ASD) is a congenital heart disease characterized by an opening in the interatrial septum, allowing abnormal blood flow between the atria. In untreated cases, long-standing left-to-right shunting may progress to pulmonary arterial hypertension and eventually Eisenmenger syndrome, a severe condition associated with chronic hypoxemia, cyanosis, secondary erythrocytosis, and multiorgan complications. Case Presentation: A 46-year-old female patient was referred to Kudungga Regional Hospital with intermittent shortness of breath that worsened over four days, bluish discoloration of the fingers and toes, chest pain, palpitations, tremors, edema, and productive cough. Physical examination revealed cyanosis, clubbing fingers, periorbital edema, oxygen saturation of 74%, cardiomegaly, systolic murmur, and pulmonary rales. Supporting examinations showed biatrial enlargement and right ventricular dilation on electrocardiography, cardiomegaly and pulmonary hypertension on chest X-ray, elevated hemoglobin and hematocrit levels, thrombocytopenia, and severe pulmonary arterial hypertension on echocardiography. Echocardiography also revealed a secundum ASD with bidirectional shunt, right atrial and ventricular dilatation, right ventricular hypertrophy, severe tricuspid regurgitation, and preserved ejection fraction. The patient was diagnosed with secundum ASD bidirectional shunt, severe pulmonary arterial hypertension, Eisenmenger syndrome, bronchopneumonia, and hypoxia-induced tremor. Management included oxygen therapy, fluid restriction, diuretics, antibiotics, mucolytics, sildenafil, digoxin, antiplatelet therapy, and symptomatic treatment. After eight days of hospitalization, the patient showed clinical improvement and was discharged for outpatient follow-up. Conclusion: This case highlights the significant impact of hypoxia in ASD patients with Eisenmenger syndrome, particularly in causing cyanosis, secondary erythrocytosis, hyperviscosity symptoms, and neurological manifestations such as tremor.

Severe Generalized Tetanus in a Child with a History of a Nail Puncture Wound and Chronic Dental Infection: A Case Report

ST. Miftahayatun — 2026-06-22

Tetanus is an acute infectious disease caused by the toxin of Clostridium tetani, which affects the nervous system and results in progressive muscle rigidity and spasms. Although immunisation is available and effective, tetanus cases continue to occur in developing countries, often associated with inadequately treated open wounds and incomplete immunisation. This case report describes a rare presentation of severe generalised tetanus in a 13-year-old boy with suspected multiple portals of entry. The patient presented with progressive stiffness and pain in the abdomen, back, neck, and jaw. He had a history of a nail puncture wound one month prior to admission, without having received post-exposure tetanus immunisation. Oral examination revealed chronic apical periodontitis of tooth 16 and a habit of self-inflicted needle trauma to the teeth. The patient was admitted to the intensive care unit under isolation and received antitetanus serum, combination antibiotic therapy, and prolonged sedation. This case highlights the importance of clinical vigilance for tetanus, the critical role of immunisation, and the need for adequate wound management and treatment of chronic infections to prevent severe complications. The possibility of more than one portal of entry — including chronic oral cavity infections — should be considered in the clinical evaluation of tetanus patients, particularly in paediatric populations with incomplete immunisation status.

Formulation and Antioxidant Activity Test of Hand Cream Extzract of Kumis Kucing Leaf (Orthosiphon Stamineus) Using DPPH (2,2- Diphenyl-1-Picrylhydrazyl) Methods

Indah Zahara — 2026-06-22

Extract of kumis kucing leaves (Orthosiphon stamineus) contains secondary metabolites, namely flavonoids, tannins, saponins, and phenolics. This study conducted an antioxidant activity test on the extract and its formulations. The aim of this research is to determine the antioxidant activity of the kumis kucing leaf extract and formulations, and to formulate it into a hand cream preparation at concentrations of 5 g, 10 g, and 15 g. The antioxidant activity of the extract and formulations was measured using UV-Vis spectrophotometry. The results of this study show that the IC₅₀ value of the kumis kucing leaf extract (Orthosiphon stamineus) is 74 ppm. For the formulations, the IC?? values are as follows: Formulation 0 has an IC₅₀ value of 257 ppm, Formulation 1 has an IC₅₀ value of 108 ppm, Formulation 2 has an IC₅₀ value of 91 ppm, and Formulation 3 has an IC₅₀ value of 84 ppm. The hand cream preparations present as white, green, dark green, and dark greenish-black in colour respectively, with a characteristic scent of kumis kucing leaves, in cream form, with a pH range of 5–7, a spreadability range of 5–7 cm, an adhesion range of 4–8 seconds, and a viscosity range of 4,000–36,000 cps. The results confirm antioxidant activity in both the kumis kucing leaf extract and the formulations. The best formulation was Formulation 3, with an IC₅₀ value of 84 ppm, while Formulations 1, 2, and 3 all meet the requirements for a good cosmetic preparation.

The Effect of Academic Anxiety and Stress on The Risk of Functional Dyspepsia Among Pre-Clinical Medical Students: A Literature Review

Meisya Devi Ardhana — 2026-06-30

Functional dyspepsia is a functional gastrointestinal disorder commonly found in the productive-age population, including medical students. This condition is characterized by symptoms such as epigastric pain, postprandial fullness, early satiety, nausea, bloating, and a burning sensation in the upper abdomen (heartburn), without any identifiable organic abnormalities. Various studies have shown that psychological factors, particularly anxiety and academic stress, contribute to the occurrence of functional dyspepsia through the brain–gut axis mechanism. This literature review aimed to analyze the relationship between anxiety and academic stress and the incidence of functional dyspepsia among medical students. The method used was a literature review based on a systematic search of scientific databases, primarily PubMed, as well as relevant international journals. The articles included were published between 2016 and 2026. A total of 11 articles that met the inclusion criteria were analyzed using a narrative synthesis approach.

An Overview of Occupational Health Protection in the Informal Sector Among Female Traditional Textile Artisans in Karangasem, Bali

Adi Saputra — 2026-06-15

Female workers in the informal sector, such as traditional weavers, are vulnerable to occupational health and safety risks due to the lack of implementation of occupational health and safety (OHS), unsuitable working environments, and limited access to social security. Weak regulations and low participation of BPJS employment insurance have exacerbate this situation, so requiring a special attention to improve occupational health protection in the informal sector. This study aims to describe occupational health protection in the informal sector of traditional weavers in Karangasem, Bali. This was a descriptive study with a quantitative research method that involving 65 samples that selected by accidental sampling. The result showed that OSH aspects have not been optimally implemented, as evidenced by the lack of occupational safety and health training, the use of PPE, and noisy and non-ergonomic work environments. In addition, social protection is still lacking, as indicated by the low enrollment in BPJS employment insurance and insufficient concern for occupational health at the workplace. This study concludes that occupational health protection among the informal sector for female traditional weavers in Karangasem, Bali is still low, so that making the workers more vulnerable to occupational accidents and diseases. Therefore, it is recommended that workers be more proactive in understanding occupational risks and the importance of social protection. The owner, the government, and the agency of BPJS employment insurance need to collaborate in implementing OSH and expanding social security coverage for the informal workers.

Conjunctival Inclusion Cyst Following Closed-Globe Blunt Ocular Trauma: A Rare Complication with Spontaneous Resolution - A Case Report

Sekar Rahadisiwi — 2026-06-11

Secondary conjunctival inclusion cyst is most commonly caused by ocular surgery, inflammation, and penetrating trauma. Its occurrence following closed globe blunt injury remains rarely reported. This case report aims to describe a rare presentation of a secondary conjunctival inclusion cyst developing after closed-globe blunt trauma and its successful non?surgical management with corticosteroids. A 75-year-old female on antiplatelet therapy presented with blurred vision following blunt ocular trauma from a bicycle handlebar. Examination revealed grade I traumatic hyphema, severe subconjunctival haemorrhage, and intraocular pressure of 7.6 mmHg with a negative Seidel test. Two weeks later, a 9 × 6 mm translucent cystic nodule appeared at the superior bulbar conjunctiva. Secondary conjunctival inclusion cyst was diagnosed based on clinical morphology and temporal relationship to the trauma. Complete resolution of the cyst was achieved with systemic and topical corticosteroids alone, without surgical intervention. Conjunctival inclusion cyst is a rare but possible complication of closed-globe blunt trauma. In the early post-traumatic inflammatory phase, a trial of corticosteroid therapy may represent an effective non-surgical first-line option..

Sleep Quality as a Predictor of Depression in Preclinical Medical Students

Auriza Nabila Atiqah — 2026-06-30

Sleep quality has emerged as a critical determinant of mental health among medical students worldwide. Poor sleep patterns are frequently associated with increased depressive symptoms, particularly in preclinical medical students who face intense academic pressure and limited recovery time. This study aims to examine the relationship between sleep quality and depression and to analyze its psychological implications among preclinical medical students. A literature review approach was employed using articles indexed in PubMed, Scopus, and ScienceDirect published between 2022 and 2026. A total of 13 eligible studies were analyzed based on predefined inclusion criteria focusing on validated instruments such as the Pittsburgh Sleep Quality Index (PSQI) and Patient Health Questionnaire-9 (PHQ-9). The results indicate a consistent and significant association between poor sleep quality and higher levels of depression, with odds ratios ranging from 1.50 to 3.99 across studies. Psychological factors such as anxiety and academic stress were identified as major mediators in this relationship, while behavioral factors such as screen time further exacerbated sleep disturbances. The discussion highlights that sleep quality is not merely a symptom but a significant predictive factor of depression in this population. In conclusion, poor sleep quality significantly increases the risk of depression among preclinical medical students, emphasizing the need for early screening, sleep hygiene interventions, and institutional mental health support programs.

Short-Course versus Standard-Course Antibiotic Therapy for Pneumonia in Adult: A Systematic Review

Ni Wayan Devi Yulian — 2026-06-18

Pneumonia remains a significant cause of morbidity and mortality among adults worldwide, with substantial impacts on healthcare utilization and costs. Despite advancements in vaccines, diagnostics, and antimicrobial therapy, optimizing antibiotic duration remains a clinical challenge. Traditional regimens typically span 7–14 days, but prolonged therapy contributes to antimicrobial resistance, adverse events, and higher healthcare expenses. This study aims to evaluate the effectiveness and safety of short-course (?7 days) versus standard-course (?7 days) antibiotic therapy in adult patients with pneumonia. A systematic review was conducted following PRISMA guidelines, including randomized controlled trials and observational studies published between 2016 and 2026. Data on clinical cure, mortality, recurrence, hospital length of stay, and adverse events were extracted and analyzed. Results from seven studies involving 5,467 patients indicate that short-course therapy is generally non-inferior to standard-course therapy in terms of clinical cure and mortality, particularly among patients achieving early clinical stability. Recurrence rates were comparable, while some studies demonstrated reduced hospital stay and fewer antibiotic-related adverse events in short-course groups. These findings support individualized treatment durations guided by clinical response rather than fixed periods. In conclusion, short-course antibiotic therapy is an effective and safe strategy for appropriately selected adult patients with pneumonia, offering potential benefits for patient outcomes, antimicrobial stewardship, and healthcare resource optimization.

Analysis of Actual Costs and INA-CBG Rates for Breast Cancer Care in Indonesian Hospitals: A Narrative Review

Hanum Nasiha — 2026-06-23

Breast cancer is a global health challenge and a significant economic burden in Indonesia, given its high prevalence among women. This study aims to evaluate the gap between actual medical costs and INA-CBGs rates in breast cancer management to formulate policy recommendations for the sustainability of oncology services. The research was conducted through a narrative review of literature published in 2022–2026 from the Scopus, ProQuest, and Dimensions databases. The review of three selected articles confirmed the existence of a substantial disparity in costs, characterized by a consistent negative difference between actual hospital costs and JKN claim rates. The findings show that the largest cost component comes from cytostatic drugs at 62–69%, while radiotherapy services are reimbursed at only about 59–87% of actual costs. This discrepancy is further exacerbated by medical inflation and the increasing complexity of managing advanced cases. In conclusion, structural cost discrepancies threaten the financial stability of hospitals, necessitating a periodic revision of rates based on activity-based costing and the implementation of a carve-out policy for high-value oncology drugs to ensure sustainable service accessibility.

Delayed Diagnosed of Relapse Malaria Vivax in Pregnancy: Good Outcome After Prompt Therapy

Stella Pangestika — 2026-06-25

Malaria remains a major global health problem, particularly in endemic regions such as Indonesia, where pregnant women are highly vulnerable to infection and complications. Relapse Plasmodium vivax infection is increasingly recognized as a clinical challenge due to its dormant liver stage and potential for recurrent disease during pregnancy. This study aims to describe the clinical presentation, diagnostic approach, and management outcome of relapse vivax malaria in a third-trimester pregnant patient. A case report design was used based on clinical history, physical examination, laboratory findings, peripheral blood smear, and rapid diagnostic testing. The patient presented with fever, thrombocytopenia, and icteric sclera, and was confirmed positive for Plasmodium vivax with significant parasitemia and received dihydroartemisinin–piperaquine therapy with marked clinical improvement and platelet recovery. Findings emphasize the difficulty of differentiating malaria relapse from other hematologic conditions in pregnancy and the importance of early diagnosis in endemic areas. Early recognition and prompt treatment are essential to improving maternal and fetal outcomes in relapse vivax malaria during pregnancy. Future studies should focus on prevention of relapse, optimization of diagnostic algorithms, and evaluation of safe antimalarial strategies in pregnant populations in endemic regions. This will support better clinical decision-making and maternal health outcomes in practice

The Use of Natural Ingredients as Topical Therapy for the Treatment of Second-Degree Burns: A Review Article

Ni Nyoman Ita Trisnadewi — 2026-06-14

Second-degree burns are skin tissue damage involving the epidermis and part of the dermis, requiring appropriate treatment to prevent infection and accelerate tissue regeneration. Conventional therapy remains the primary choice, but long-term use can cause certain side effects. This situation has encouraged the increasing use of natural ingredients as alternative therapies because they are considered safer, easier to obtain, and contain bioactive compounds that support the wound healing process. This review article aims to assess the potential of various natural ingredients as topical therapies for healing second-degree burns. The method used is a literature review of research articles published between 2021 and 2026 through Google Scholar, PubMed, ScienceDirect, and DOAJ. The results of this study indicate that various plants such as kepok banana, moringa, breadfruit, red dragon fruit, and other herbal plants are effective in the burn healing process through various dosage forms such as creams, gels, ointments, spray gels, and nanogels. The dominant phytochemical compounds found include flavonoids, saponins, tannins, alkaloids, and terpenoids, which act as anti-inflammatory, antibacterial, and antioxidant agents. Overall, natural ingredients have the potential to be developed as an alternative treatment for second-degree burns that is effective and easily accessible to the public.