Medica Hospitalia : Journal of Clinical Medicine

Full Text Volume 13 Number 2 July 2026

2026-07-31T18:27:24+08:00

Full Text Volume 13 Number 2 July 2026

Treatment with Platelet-Rich Plasma: an Evidence Based Case Report of Leprosy Ulcers

2026-04-17T12:34:56+08:00

Introduction: Leprosy foot ulcers occur in patients with leprosy-related neurological disorders and are classified as grade 2 disabilities. These chronic, non-healing ulcers represent a significant clinical challenge. Platelet rich plasma (PRP) application has emerged as a breakthrough treatment.

Case report: Two females (aged 48 and 58) with multibacillary leprosy presented with chronic midfoot ulcers persisting for 16 and 24 weeks. At baseline, ulcer areas were measured and biopsies were performed to assess TGF-β1, PDGF, and collagen density. Follow-up measurements for biomarkers occurred on day 13, and ulcer area was reassessed on day 41.

Discussion: Both patients received standard therapy plus PRP, resulting in reduced ulcer area, increased TGF-β1, and higher collagen density. PDGF levels increased in one patient but decreased in the other. PRP promotes epithelial and endothelial cell proliferation during neovascularization and stimulates extracellular matrix synthesis. Furthermore, it modulates the inflammatory response, facilitating tissue regeneration by balancing the immune system.

Conclusion: Combining standard therapy with PRP shows strong potential for healing chronic leprosy ulcers. Results demonstrated reduced ulcer area, increased TGF-β1, and improved collagen density, though PDGF levels remained inconsistent

Organic Catatonia Secondary to Central Nervous Infection : An Evidence Based Case Report

2026-05-06T10:21:55+08:00

Background: Organic catatonia has been associated with various infectious etiologies, particularly central nervous system infections. While benzodiazepines and electroconvulsive therapy (ECT) are the most extensively studied treatments, accurate identification and targeted management of the underlying cause remain essential for effective treatment

Aims : evaluating evidence-based therapeutic strategies for the management of organic catatonia in patients with infections.

Method : Electronic Data Based was conducted using PubMed, ScienceDirect, Google Scholar, Cochrane, and Proquest. Eligible studies published between 2015 and 2025 included randomized controlled trials, systematic reviews, and case reports or case series focusing on the treatment of organic catatonia associated with central nervous system infections. Literature reviews, abstracts, non-English publications, and studies not aligned with the predefined PICO were excluded. Selected articles were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal tools.

Results : 458 articles was identified, two studies (case series and case report) met the inclusion criteria. Abhijita et al. emphasized evidence-based management of organic catatonia secondary to meningitis (treated with ceftriaxone, doxycycline, lorazepam, and olanzapine, in addition to electroconvulsive therapy), while Doval et al. highlighted key diagnostic and therapeutic considerations in organic catatonia following encephalitis (treated with haloperidol, promethazine, lorazepam, amantadine, and escitalopram). Overall, these case reports offer valuable clinical insights.

Conclusion : Alongside infection-directed therapy, early recognition and timely pharmacological management of organic catatonia are essential for achieving optimal clinical outcomes.

Benefits of Topical Avocado Oil in Improving Skin Moisture: A Study in Atopic Dermatitis Patients

2026-05-08T11:17:44+08:00

BACKGROUND : Atopic dermatitis is a chronic skin condition characterized by recurrent flare-ups that impair skin barrier function and significantly affect patients’ quality of life. One of the key strategies in managing atopic dermatitis is to strengthen and maintain the skin's barrier function while reducing inflammation commonly achieved through the use of moisturizers such as petrolatum. However, petrolatum has several drawbacks, including a thick consistency that makes it difficult to apply, a greasy and shiny appearance, and the potential to cause follicular occlusion. As an alternative, avocado oil offers promising benefits due to its non-comedogenic properties and non-greasy finish.

AIM : To determine the difference in effectiveness between avocado oil and petrolatum in improving skin moisture. METHOD : This study is a single-blind randomized clinical trial using a two-parallel group pre- and post-test design. Samples were selected using consecutive sampling. The treatment was applied to the right and left forearms of patients with non flare-ups atopic dermatitis.

RESULT : The variable of user complaints was statistically significant in the general characteristics, with a p-value of <0.05. The TEWL (Transepidermal Water Loss) score for topical avocado oil showed a significant difference compared to petrolatum, with a p-value of <0.001.

CONCLUSION : A greater reduction in TEWL (indicating improved skin moisture) was observed with the application of 100% topical avocado oil in patients with non flare-ups atopic dermatitis, compared to the use of 100% topical petrolatum.

Maternal Mortality and Near Misses in the Spectrum of Hypertensive Disorders in Pregnancy at Dr. Kariadi Hospital in 2024

2026-05-08T11:10:58+08:00

BACKGROUND: High maternal mortality from hypertension in pregnancy reflects poor early detection and management. Preeclampsia-eclampsia remains a major cause of severe outcomes.

AIMS: To analyze the relationship between spectrum of hypertensive disorders in pregnancy and maternal near misses and mortality at Dr. Kariadi Hospital in 2024.

METHOD: Cross-sectional study using medical records of pregnant women with hypertensive disorders. All cases were analyzed to assess the relationship between spectrum of hypertension and maternal near miss and maternal death using the chi-square test, in accordance with the ethical approval of KEPK Dr. Kariadi Hospital.

RESULT: Most pregnant women had preeclampsia/eclampsia (77.3%), followed by superimposed preeclampsia (14.2%). Maternal near miss occurred in 13.3% and mortality in 9.3% of cases, with 206 live births. Organ dysfunction was found in 22.7%, mainly cardiovascular (10.7%), followed by respiratory, coagulation (each 2.2%), and immunological (5.8%). Overall organ dysfunction, especially cardiovascular, respiratory, renal, and coagulation associate with maternal near miss (p<0.05). The highest risks were seen in cardiovascular (PR 19.54; CI95% 10.13-37.66), renal (PR 7.96; CI95% 5.63-11.26), respiratory (PR 6.76; CI95% 3.83-11.94), and coagulation dysfunction (PR 4.88; CI95% 2.20-10.86). Immunological dysfunction was strongly associated with maternal mortality and had the highest risk (PR 26.50; CI95% 13.42-52.29).

CONCLUSION: Preeclampsia/eclampsia is the dominant condition and correlates to maternal near miss and death. Organ dysfunction significantly worsens outcomes.

From Eyeball to Exact: A Meta-Analysis of an Innovation in Episiotomy with Angle-Guiding Devices

2026-05-12T14:52:07+08:00

BACKGROUND: Episiotomy is a surgical incision performed to enlarge the vaginal outlet during childbirth, but an inaccurate mediolateral angle may increase the risk of obstetric anal sphincter injury (OASIS).

SCOPE: This systematic review focused on randomized controlled trials evaluating dedicated angle-guiding devices for mediolateral episiotomy, including Episcissors-60, Episioguide, and the Episiometer.

AIMS: To compare guided episiotomy devices with conventional eyeball technique in achieving appropriate episiotomy angles and reducing OASIS.

METHOD: A systematic search of PubMed, ScienceDirect, and Wiley was conducted according to PRISMA 2020 principles. Eligible studies included women undergoing vaginal birth in whom a guided device was compared with conventional scissors or routine practice. The primary outcome was post-suture episiotomy angle. Secondary outcomes were OASIS incidence, incision characteristics, pain, practical limitations, and risk of bias.

RESULT: Four randomized controlled trials involving 543 participants were included. Guided devices produced higher post-suture episiotomy angles than conventional technique (standardized mean difference 0.88, 95% CI 0.69-1.06; Z = 9.33; P<0.00001), slthough heterogeneity was substantial (I²=97%). Based on the pooled contingency table, OASIS was more frequent in the eyeball group than in guided group (OR 4.85, 95% CI 1.38-17.07; P-=0.0069)

CONCLUSION: Angle-guiding devices may improve episiotomy angle accuracy and may reduce OASIS risk, but the evidence remains limited by few trials, sparse OASIS event, indirect comparisons between devices, and substantial heterogeneity.

Comparative Effectiveness of Etoricoxib and Diclofenac Sodium in Improving Quality of Life Among Osteoarthritis Patients

2025-07-24T10:18:34+08:00

BACKGROUND : The effectiveness of etoricoxib versus diclofenac in outpatiens with pain due to osteoarthritis is unclear. There is still debate regarding the relative effectiveness and safety between both in improving the quality of life of OA patients

AIMS :To assess the effectiveness of etoricoxib compared to diclofenac by assessing the quality of life outcomes of Osteoarthritis patients using instruments such as the EQ-5D-5L.

METHOD : Study design using a cross-sectional study design by looking at the results of the quality of life of patients using NSAIDs in the form of diclofenac sodium and etoricoxib.

RESULT : The results showed that moderate positive correlation between etoricoxib or diclofenac sodium therapy in OA patients decreasing utility value ( 0.294; 95% CI = 0.098 - 0.467; p = 0.003). A strong positive correlation was shown between etoricoxib or sodium therapy in OA patients and VAS ( 0.558; 95% CI = 0.402 - 0.682; p = <0.000). These results indicate that each therapeutic use of etoricoxib or diclofenac sodium can improve the utility value or VAS, or conversely.

CONCLUSION : The quality of life value of etoricoxib is better than diclofenac sodium, which is 0.924 and there is a positive correlation between the use of etoricoxib and diclofenac sodium in improving quality of life and VAS values in osteoarthritis patients.

Association Of C-Reactive Protein And Modified Rodnan Skin Score With Carotid Intima-Media Thickness in Systemic Sclerosis

2026-06-09T14:51:28+08:00

BACKGROUND: Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by vasculopathy and progressive fibrosis with an increased risk of cardiovascular disease. The common carotid artery intima-media thickness is an indicator of subclinical atherosclerosis and may reflect inflammatory activity in SSc. Quantitative C-reactive protein (CRP) and the modified Rodnan Skin Score (mRSS) are associated with SSc disease activity, although their relationship with common carotid intima-media thickness remains unclear.

AIMS: To evaluate the relationship between quantitative CRP levels and mRSS values with common carotid intima-media thickness in adult patients with SSc.

METHOD: A cross-sectional study was conducted on 26 SSc patients at Dr. Kariadi General Hospital, Semarang. Common carotid intima-media thickness was measured using ultrasonography on both sides. Subjects were categorized based on the presence of intima-media thickening according to the ≥75th percentile for age and sex. Quantitative CRP levels were analyzed using the Mann-Whitney test, while differences in mRSS were analyzed using an independent T-test.

RESULT: Increased common CIMT was observed in 9 patients (34.6%). There was no significant difference in quantitative CRP levels between subjects without and with intima-media thickening (0.40 [0.07–1.10] vs. 0.40 [0.20–0.83] mg/L; P = 0.787). mRSS values also did not differ significantly between the two groups (18.29 ± 9.38 vs. 18.78 ± 12.48; P = 0.912).

CONCLUSION: There was no significant relationship between quantitative CRP levels or mRSS values and common carotid intima-media thickness in patients with SSc. These findings may be influenced by immunosuppressive therapy and study design.

Prolonged P-wave Dispersion Increases Risk of Perioperative Atrial Fibrillation After CABG Surgery

2026-05-12T15:02:39+08:00

BACKGROUND : Postoperative Atrial Fibrillation (POAF) is a secondary Atrial Fibrillation caused by cardiac surgical intervention, especially Coronary Artery Bypass Graft (CABG) Surgery. P-wave dispersion (Pdis) represents the difference between the maximum and minimum P-wave durations obtained from a standard 12-lead ECG. P-wave dispersion is considered a non-invasive ECG marker of atrial remodeling and may predict the occurrence of atrial fibrillation.

AIMS : This study analyzes the association between P-wave dispersion and Perioperative Atrial Fibrillation after Coronary Artery Bypass Graft Surgery.

METHOD : This was an observational, analytic study with a retrospective design. The total number of subjects was 48 patients, divided into the POAF group (n=24) and no POAF group (n=24). Demographic data and preoperative ECG records were obtained from the patient's medical records. The significance of P-wave dispersion was analyzed using independent t-test and logistic regression. The Receiver Operating Characteristic (ROC) test was used to define cut-off values, sensitivity, and specificity of P-wave dispersion.

RESULT : The total number of subjects in this study was 48 patients, consisting of 43 men and five women. The mean age of the patients was 57.85 ± 5.83 years. The mean P-wave dispersion was higher in patients who experienced POAF (64.97 ± 13.21 vs. 50.55 ± 7.14; p<0.001). P-wave Dispersion was significantly associated with the incidence of POAF (p<0.001; cut-off 55.65 ms; OR 9.00; 95% CI 2.437-33.244).

CONCLUSION : P-wave Dispersion is significantly associated with Postoperative Atrial Fibrillation. P-wave dispersion value greater than 55.65 ms increases the risk of POAF after CABG by 9-fold.

Relationship between Serum Interleukin-6 Level and Severity of Acne Vulgaris in Women

2026-06-09T15:09:36+08:00

BACKGROUND: Acne vulgaris is more common in women than men and is observed more frequently in older adolescents than younger adolescents (pre-teens). This is due to higher sebum production, which supports the growth of Propionibacterium acnes. Propionibacterium acnes contributes to initiating and maintaining inflammatory processes induced by immunological reactions. It activates the Toll-like receptor (TLR) 2 and 4 immune systems by releasing interleukin-6 (IL-6) as a core mediator of inflammation.
AIMS: This study aims to determine the relationship between serum IL-6 levels and the severity of acne vulgaris in women
METHOD: This research employs an analytical observational study design with a cross-sectional approach, involving 15 female subjects diagnosed with acne vulgaris, divided into three groups. The study will occur in Semarang city from July 2024 to September 2024.
RESULT: This study involved 15 female students from Diponegoro University, categorized based on the severity of acne vulgaris (mild, moderate, severe). Blood samples were taken to measure serum IL-6 levels using the ELISA method. The average IL-6 levels found were: mild 1.00 ± 0.55 pg/ml, moderate 1.47 ± 0.27 pg/ml, and severe 1.99 ± 0.42 pg/ml. Analysis revealed a significant relationship between serum IL-6 levels and the severity of acne vulgaris (p = 0.011), supporting the hypothesis of a correlation between the two.
CONCLUSION: There is a significant relationship between serum IL-6 levels and the severity of AV in women. There is a meaningful difference in serum IL-6 levels between the mild and severe AV groups.

RELATIONSHIP BETWEEN LOCATION AND NUMBER OF LESIONS BASED ON HEAD CT SCAN WITH BEHAVIORAL PSYCHOLOGICAL SYMPTOMS OF DEMENTIA

2026-07-20T10:17:53+08:00

Background: Behavioral Psychological Symptoms of Dementia (BPSD) characterized by disturbances in perception, thought content, mood, or behavior, frequently occur alongside Vascular Cognitive Impairment (VCI), significantly affecting the functional and cognitive status of post-stroke patients. Previous studies have identified certain stroke characteristics — such as multiple lesions, infarct volume and lesion location (e.g. left hemisphere) — as risk factors for post-stroke dementia. Epidemiological data on BPSD and research on the relationship between the location and number of stroke lesions and BPSD remain limited.

Aim: To determine the relationship between the location and number of stroke lesions based on head CT scan with BPSD

Methods: Cross-sectional study involving post-ischemic stroke patients at the Outpatient Installation of Kariadi Hospital Semarang. An evaluation was conducted on the location and number of stroke lesions in relation to the occurrence of Behavioral Psychological Symptoms of Dementia, based on Abe’s Behavioral Psychological Symptoms of Dementia Score. The confounding variables of the study were age, occupation, education level, nutritional status, and caregiver. Analysis was conducted using the Independent T test, Mann Whitney U and Kruskal-wallis. Significant results p<0.05

Results: The mean ABE BPSD score was 7.17 with a median of 4. The most common symptoms were depression/low mood, irritability, and sleep disturbance (33.3% each), followed by excitement and agitation (28.6%). Of the total subjects, 31% had stroke in the non-dominant hemisphere, 26.2% in the dominant hemisphere, and 42.9% in both hemisphere. A total of 64.3% had frontal lesions, while 35.7% had non-frontal lesions. Based on the number of lesions, 54.8% had single lesions and 45.2% had multiple lesions. The location of the lesions in the frontal region (p<0.001), the number of multiple lesions (p<0.001) and younger age (p=0.042) were significantly associated with a more severe ABE BPSD score.

Conclusion: Location of frontal lesions, number of multiple lesions based on head CT scan and younger age have significant association with BPSD in post-ischemic stroke patients with VCI.