Medica Hospitalia : Journal of Clinical Medicine

Full Text Volume 12 Number 2 July 2025

Kariadi General Hospital — 2025-07-31

Full Text Volume 12 Number 2 July 2025

Association of Pre-treatment Serum Fibrinogen-Albumin Ratio Index (FARI) and Concurrent Chemoradiotherapy (CCRT) Therapeutic Response in Patients with Locally Advanced Cervical Cancer (LACC)

Gezta Nasafir Hermawan — 2025-07-31

BACKGROUND: Cervical cancer is currently the second most prevalent women malignancy cases in Indonesia. High prevalence of cases diagnosed as locally advanced cervical cancer / LACC (FIGO Stage IIB-IVA), where concurrent chemoradiotherapy (CCRT) is the main treatment modality. Several therapeutic efficacy predictors in other malignancy cases including the pre-treatment serum fibrinogen-albumin ratio index (FARI) have been associated with therapeutic response to CCRT. However, there were no recent studies in cervical cancer cases.

AIMS: To determine the association of pre-treatment FARI and CCRT therapeutic response in patients with LACC.

METHOD: This is a prospective cohort study in patients with LACC from January – May 2024 whose clinical stage was determined. The pre-treatment FARI was calculated in patients who had met both inclusion and exclusion criteria, and undergone the CCRT regimen. Patients who completed the regimen were evaluated for therapeutic response. Data processing was carried out using SPSS 25 for Windows software.

RESULT: In this study, it was found that the complete response (CR) group with the best outcome had the smallest pre-treatment FARI (9.79 ± 1.71), on the other hand the progressive disease (PD) group had largest pre-treatment FARI (33.72 ± 12.78). In addition, all CCRT therapeutic response groups had significantly different FARI values (P value < 0.05) and the FARI cut point value of 12.44 had a sensitivity of 100% and a specificity of 78.1% for predicting complete response (CR) to CCRT.

CONCLUSION: Low pre-treatment FARI is significantly associated with the likelihood of patients having a complete response (CR), which is the best outcome to CCRT.

Effect of R-CHOP Chemotherapy on Creatinine Clearance in Diffuse Large B-Cell Lymphoma

Handhika Mustika — 2025-07-31

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (LNH). First-line therapy for DLBCL is a combination regimen of Rituximab, Cyclophosphamide, Hydroxydoxorubicin, Vincristine (Oncovin), and Prednisone (R-CHOP). The CHOP regimen causes acute kidney injury (AKI) directly or mediated by reactive oxygen species (ROS). AKI is associated with significant morbidity and mortality in cancer patients, including high mortality, increased hospitalization, and a lower cancer remission.

AIM: Analyzing the effect of R-CHOP chemotherapy on creatinine clearance values in DLBCL lymphoma patients

METHOD: Analytical observational study with a retrospective design involved 38 patients diagnosed with DLBCL who underwent R-CHOP chemotherapy at RSUP dr. Kariadi Semarang. The independent variable of the study was the frequency of chemotherapy. The dependent variables of the study were serum creatinine levels and creatinine clearance which were measured in 4 phases, namely before, post 3x-, post 4x- and post 5x- R-CHOP chemotherapy. Analysis used the Friedman, T-dependent, and Wilcoxon tests.

RESULT: The creatinine clearance value of DLBCL lymphoma patients before administering R-CHOP had a normal value with an average of 68.98 mL/min. The creatinine clearance value of DLBCL lymphoma patients after administering R-CHOP after 3x chemotherapy was found to be an average of 78.26 mL/min, after 4x chemotherapy the average was 75.50 mL/min and after 5x chemotherapy the average was 73.24 mL/min. There was a significant difference in creatinine clearance values for DLBCL lymphoma patients before and after administration of R-CHOP (p=0.018).

CONCLUSION: Administration of R-CHOP chemotherapy has a significant effect on the creatinine clearance value of DLBCL lymphoma patients.

Integrating Neck Massage and Progressive Muscle Relaxation: A Comprehensive Approach for Reducing Migraine Disability and Enhancing Quality of Life

Rina Budi Kristiani — 2025-07-31

BACKGROUND: Migraine is a highly disruptive and common neurological disorder characterized by intense headache and transient somatosensory and motor disturbances that affects approximately 1 billion people worldwide with many common causative factors and often results in disability and reduced quality of life. This study aims to determine the effect of combined neck massage and progressive muscle relaxation therapy on disability and quality of life of migraine sufferers.

METHOD: This quasi-experimental study used a pre-test-post-test control group design over eight weeks (May to July 2024), selecting 50 participants aged 18–60 years with migraines for over three months based on ICHD-3 criteria. The study utilized the Migraine Disability Assessment Questionnaire and the Migraine-Specific Quality of Life Questionnaire as instruments.

RESULT: The combination therapy of neck massage and progressive muscle relaxation both has a significant effect on reducing the severity, frequency, and duration of migraine attacks, as well as improving migraine-related disability (p =0.000) and quality of life (p-value = 0.001).

CONCLUSION: Combination therapy of neck massage and progressive muscle relaxation is effective in reducing migraine disability and improving the quality of life of migraine sufferers.

Analysis of Category I Cesarean Section Response Time on Maternal-Neonatal Outcomes at Adam Malik Hospital Medan

Mohammad Naufal — 2025-07-31

BACKGROUND: Maternal and neonatal mortality remain significant global health concerns. Category I cesarean sections are performed in life-threatening obstetric emergencies, with a recommended decision-to-incision interval (DII) of ≤30 minutes.

AIMS: To evaluate the proportion of category I emergency cesarean sections performed < 30-minute response time at Adam Malik Hospital, Medan, and to identify factors contributing to delays.

METHODS: This retrospective cohort study included 44 consecutively selected cases of category I emergency cesarean sections performed at Adam Malik Hospital, Medan, between January 1 and December 31, 2023. Eligible cases involved immediate threats to maternal or fetal life and had complete documentation of surgical timings. Time data including decision-to-incision interval and its components were extracted from electronic medical records and cross-validated with operating room and delivery ward logs. The primary outcome was decision-to-incision interval (DII), dichotomized at 30 minutes. Variables associated with DII (p <0.25) were included in multivariate analysis using Firth’s penalized logistic regression to account for small sample size and data separation.

RESULTS: Only 43.2% of cases achieved a DII of ≤30 minutes. Multivariable analysis identified patient transfer time (AOR = 16.91, 95% CI: 2.19–358.36) and anesthesia duration (AOR = 27.21, 95% CI: 2.29–889.18) as significant predictors of delay. No significant associations were found between DII and adverse maternal or neonatal outcomes.

CONCLUSION: Delays in patient transfer and anesthesia were the main contributors to prolonged DII in emergency cesarean sections. While these delays did not significantly impact short-term clinical outcomes, targeted improvements in emergency obstetric workflows may help hospitals meet national response time standards and enhance quality of care.

The Association between Atopy, and Family History of Asthma Patient and Severity Asthma based on Spirometry

Susanthy Djajalaksana — 2025-07-31

BACKGROUND: Asthma is a chronic inflammatory respiratory condition characterized by fluctuating symptoms, which often leads to diagnostic challenges. Accurate assessment and interpretation of clinical and functional parameters are essential to improve disease management and patient outcomes.

AIMS: This study aims to analyze the demographic and clinical profiles of asthma patients, particularly investigating the relationships among the degree of airway obstruction, spirometric indices, smoking exposure, environmental risk factors, atopic history, and family history, to better understand the multifactorial nature of asthma.

METHOD: A retrospective descriptive-analytic study was conducted using medical records of 107 asthma patients treated at the Outpatient Installation of the Lung Polyclinic, Wlingi General Hospital, Blitar Regency, from 2021 to 2022. Descriptive statistics were used to summarize demographic and clinical data, and Spearman correlation tests assessed associations between variables.

RESULTS: A high proportion of patients had a history of smoking, with 22.4% being active and 52.3% passive smokers. However, no significant correlation was found between smoking status and asthma control. Common environmental risk factors included exposure to dust and cold air, though these did not consistently correlate with asthma exacerbations. Significant correlations were identified between the severity of airway obstruction and spirometric parameters such as FEV1, FVC, FEV1/FVC ratio, PEF, FEF 25, FEF 50, and FEF 75, confirming the impact of airflow limitation on lung function. No significant associations were found between asthma stability and atopic or family history.

CONCLUSION: The findings underscore the complexity of asthma pathophysiology, where airflow obstruction is clearly linked to reduced spirometric function, but other factors such as smoking, environmental exposures, atopy, and family history do not show consistent predictive value for asthma control. These results highlight the need for a comprehensive and individualized approach in asthma diagnosis and management.

Effectiveness Of Mar'ke Bilar Drink Formulation On Pro- Anti-Free Radicals In The Blood Of Women Of Childbearing Age Operators In Gas Stations

Ginta Siahaan — 2025-07-31

BACKGROUND: Women of childbearing age who wortk at gas stations are vulnerable to pollution exposure due to fuel emissions. The workers are susceptible to heavy metal (Pb) poisoning in the fuel content. This can cause health problems such as reproductive disorders, impaired kidney function and can even cause anemia in women.

AIMS: To determine the effectiveness of Mar'ke Bilar formulation on Pb, MDA, and SOD in blood.

METHOD: The study was Quasi Experimental with a pre and post test group design that allows researchers to see the comparison of the control group with the experimental group. The sample in the study was Women of childbearing age who worked as operators at gas stations with a total of 60 people and were determined based on purposive sampling with inclusion criteria then divided into 4 treatment groups. Data analysis used the T-dependent test to see the differences in each group then continued with the One Way ANOVA and Post Hoc-Tukey tests.

RESULT: The results of the study showed that the three of Mar’ke Bilar formulations were effective in reducing Pb and MDA levels, as well as increasing SOD levels, which are endogenous antioxidant enzymes that are important in the body's defense against oxidative stress. While formula 1 proved to be the most effective in increasing SOD levels.

CONCLUSION: Mar'ke Bilar affects blood Pb, MDA, and SOD levels and formulation 1 is the most effective in increasing SOD levels. It is necessary to consume colored foods such as Marke'Bilar which are very good for avoiding diseases caused by free radicals by air and water pollution, especially those caused by heavy metals.

Spatial and Temporal Analysis of Gallbladder Stone Cases at dr. Soekardjo Hospital, West Java: An Evidence-Based Study

Mudatsir Mudatsir — 2025-07-31

BACKGROUND: Gallbladder stone cases in East Priangan area have significantly increased due to diet, lifestyle, and stress levels of the community. However, studies on the seasonal variation of gallbladder stone cases remains limited, particularly in Indonesia.

AIMS: This study aims to investigate the occurrence of gallbladder stone cases in East Priangan, West Java, Indonesia, based on the medical reports in 2022−2023. Furthermore, the dispersal of gallbladder stone cases is mapped as spatial and temporal distributions.

METHOD: This study employed an observational, cross-sectional design. Data was collected from the medical records at dr. Soekardjo General Hospital of Tasikmalaya between January 2022 and December 2023. Data used in this study were available data of 2,032 visit records, comprising 1,311 visits in 2022 and 991 visits in 2023, for both inpatient and outpatient care. Two types of statistical tests were used in this study: the Chi-Square test and Moran's I value.

RESULT: The Global Moran’s I test revealed clusters in the spatial distribution of gallbladder stone for both 2022 (I = 0.434) and 2023 (I = 0.521). Additionally, monthly variations (p = 0.001), age (p = 0.023), and gender (p = 0.001) were found to be statistically significant factors influencing the risk of gallbladder stones.

CONCLUSION: The spatial distribution of gallbladder stone was concentrated in the certain clusters. Moreover, there were significant correlations between monthly variations, age, and gender with gallbladder stones.

Comparison of Line Dance And Senam Lansia to Improve Cardiorespiratory Endurance In Elderly

Stephanie Indrawati Sugiarto — 2025-07-31

Background: Physical activity in the elderly has a positive impact on promoting healthy aging. Senam lansia is used to be taught to healthy elderly in community however it is boring because of monotonous movement. Line dance is an alternative aerobic exercise that has been taught to elderly. However, there was not any research that compares the effectiveness of both exercises to cardiorespiratory endurance.

Aims: This study come to verify that the increase of cardiorespiratory endurance in elderly after line dance was better than senam lansia.

Methods: This study was a quasi-experimental pre-test and post-test- controlled group design on 2 groups which was line dance group (n = 20) and senam lansia group (n = 16). The exercise was given based on each group 3 times a week for 6 weeks and VO₂max measurement were taken with 6-minute walking test before and after intervention in both groups.

Results: The increase of the mean difference/delta VO₂max between groups did not differ statistically between groups (line dance: 2,19 ± 3,54 vs senam lansia: 1,79 ± 1,68; p = 0,683). There was a statistically significant difference in the mean pre- and post- intervention VO₂max values at line dance group (32,20 ± 3,99; p = 0,013) and senam lansia group (27,03 ± 3,77; p = 0,001).

Conclusions: The increase of cardiorespiratory endurance in line dance group and senam lansia group did not differ statistically.

The Risk of Bag-Carrying Related to Musculoskeletal Pain in Medical Students

R. Ayu Aisyah Hanifah — 2025-07-31

BACKGROUND: Musculoskeletal discomfort affects medical students' neck, shoulders, and back. Musculoskeletal pain may be linked to bag-carrying behaviors, which encompass the manner of carrying, duration of use, and weight of the bag.

AIMS: This study aims to determine the relationship between bag-carrying habits and musculoskeletal pain.

METHOD: This is an observational analytic study with a cross-sectional approach. From 2022-2023, the research subjects were 70 Sriwijaya University medical students who met the inclusion and exclusion criteria. The sampling method employed a simple random sampling technique. We analyzed the obtained data using the Chi-square test in SPSS software.

RESULT: The majority of the subject was 20 years old and female. Most patients with musculoskeletal pain experience mild complaints in the lower neck (47.14%), right shoulder (41.43%), and back (41.43%). All of the p-values are> 0,05, including how to carry a bag, bag weight, and the duration of using a bag with neck, shoulder, and back pain among medical students of Sriwijaya University.

CONCLUSION: There is no significant relationship between bag-carrying habits, which include how to carry a bag, bag weight, and the duration of using a bag, with neck, shoulder, and back pain among medical students of Sriwijaya University.

The Correlation of Vitamin D Levels and Ghrelin, Adiponectin, and Resistin Levels Among Post-Ischemic Stroke Patients

Santoso Jaeri — 2025-07-31

BACKGROUND: Dyslipidemia is one of the modifiable risk factors for stroke. The pathogenesis of dyslipidemia is through several mechanisms including adipose tissue-mediated adiponectin, resistin, and leptin secretion. Vitamin D is correlated with lipid profiles, but there is no evidence of the role of vitamin D in ghrelin, adiponectin, and resistin secretion, which may contribute to the mechanisms of the impairment of lipid profile among post-ischemic stroke.

AIMS: To determine the correlation between vitamin D and ghrelin, adiponectin, and resistin among post-ischemic stroke.

METHODS: An observational analytic study with a cross-sectional approach was conducted among forty post-ischemic stroke patients which was obtained consecutively. The serum vitamin D, ghrelin, adiponectin, and resistin levels were measured using the venous blood obtained from the median cubital vein. Data analysis was performed using the Spearman correlation test to determine the correlation between the serum vitamin D levels, ghrelin, adiponectin, and resistin levels.

RESULT: The age of our subjects is approximate 57 years old with the proportion of males being more than female subjects. There is a significant association between serum vitamin D levels and gender, total energy as well carbohydrate diet but no significant association between hormonal status and the characteristics of subjects was revealed. Furthermore, there is no significant correlation between serum vitamin D levels with the hormonal status of ghrelin, adiponectin, or resistin levels (p=0.994; 0.395; 0.858, respectively).

CONCLUSION: There is no significant correlation between serum vitamin D levels and serum ghrelin, adiponectin, or resistin levels among post-ischemic stroke patients

Correlation of Single Breath Count Test with Peak Expiratory Flow Rate in Adult Patients Post COVID-19 Infection

Marcherly Wardi — 2025-07-31

BACKGROUND: The utilization of spirometry has garnered significant attention recently due to its potential role in transmitting COVID-19. There is a critical need for a straightforward bedside assessment capable of accurately measuring respiratory function without relying on equipment and minimizing the risk of airborne transmission.

AIMS: To know the correlation between Single Breath Count Test (SBCT) values and Peak Expiratory Flow Rate (PEFR) values in adult patients recovering from COVID-19.

METHOD: This study presents a cross-sectional design with consecutive subject recruitment. The SBCT was administered using a metronome, while PEFR was measured using a Mini Wright Peak Flow Meter on a sample of 38 participants, comprising 18 men and 20 women.

RESULT: Statistical analysis using Pearson’s parametric correlation test revealed a significant relationship between SBCT and PEFR (p < 0.05), with a moderate positive correlation observed (r = 0.516).

CONCLUSION: This research demonstrates a significant, moderate positive correlation between SBCT and PEFR in adult post-COVID-19 patients, indicating that higher SBCT values correspond to higher PEFR measurements.

The Association between Monocyte-derived Macrophages TNF-a Expression and Anthropometrics Measures in Polycystic Ovary Syndrome

Naylah Muna — 2025-07-31

BACKGROUND: Polycystic ovary syndrome (PCOS) is a female infertility disease that is often associated with low-grade chronic inflammation. This inflammation was suspected to correlate with certain body conditions, especially physical lipid composition that can be obtained under anthropometrics measurements. Monocytes and macrophages of PCOS patients were more susceptible to inflammation and contributed to this condition. Tumor Necrosis Factor-alpha (TNF-a), as one of the major inflammatory cytokines, holds an important role in the chronic inflammation of PCOS.

AIMS: This study aimed to evaluate the association of inflammatory cellular levels TNF-a in macrophage cells of women diagnosed with PCOS with physical anthropometrics.

METHOD: Twenty PCOS women and ten healthy women as the control group were recruited in this study. Anthropometric data were measured. Peripheral blood was collected, mononuclear cells were isolated, and then cultured. Monocytes were selected and differentiated into macrophages. Macrophages were then exposed to oxidized Low-Density Lipoprotein (ox-LDL) and underwent flow cytometry to examine the level of TNF-a. Anthropometric data and TNF-a level were analyzed using Spearman-Rho Correlation test followed by a linear regression test.

RESULT: TNF-a expression was found to be statistically correlated with Body Mass Index (BMI), waist circumference (WC), waist-to-height ratio, visceral fat level, and muscle mass of arm (MMA) (p<0.05). However, only WC and MMA gave significant impact to macrophage TNF-a expression based on linear regression association test with equation -96.971 + 0.601*waist circumference + 2.665*MMA.

CONCLUSION: TNF-a was strongly associated with waist circumference and muscle mass percentage of arm in PCOS cases.

The Effect of Smoking Habits on Decreased Liver Function in Active Smokers Aged 20-50 Years old

Mike Permata Sari — 2025-07-31

BACKGROUND: A study was conducted to determine the effect of smoking habits on decreased liver function in active smokers aged 20-50 years. This study was motivated by Indonesia’s high smoking prevalence and its associated liver-related health issues. The liver is an organ that plays a role in the body's metabolism. Smoking triggers the formation of free radicals, causing a decrease in liver function and inflammation.

METHOD: In this study, mix method design was used with active smokers as the smoker group and the control group was respondents not active or passive smokers. Groups are categorized again based on age, ie 20-30, 31-40, and 41-50. The study population is the academic community of the Hermina Health Institute Jatinegara Campus and the community living on Kapitan III Road Tapos District, Depok City. Liver function is evaluated through enzymes SGPT, SGOT, ALP, and CRP as parameters for inflammation. To evaluate the influence of smoking habits and lifestyle factors on liver function risk, an analysis of variance (ANOVA) followed by post-hoc testing and linear regression analysis were performed.

RESULT: Laboratory results showed that mean levels of ALT, AST, ALP, and CRP were higher in the smoker group compared to controls across all age categories, although most values remained within normal limits. ANOVA revealed statistically significant differences in all biomarkers (p<0.05), and post-hoc tests identified specific age-related group differences. Smokers’ habit data indicated that most smokers began smoking between the ages of 15–20 and had smoked for over five years. Lifestyle analysis showed a higher prevalence of insufficient physical activity, reduced sleep duration, and higher BMI among smokers. CLDQ scores for both groups generally reported minimal emotional disturbance and no signs of advanced liver disease.

CONCLUSION: Smoking is associated with elevated liver enzymes (ALT, AST, ALP) and CRP levels, indicating subclinical hepatic and inflammatory alterations. These biochemical changes correlate with lifestyle risk factors and diminished quality of life. Early screening and lifestyle modification are recommended to prevent long-term hepatic damage among smokers.

Optimization Axial T2WI Lumbar MRI in Spinal Stenosis: Effects of GRAPPA Acceleration Factor on Image Quality and Anatomy

Diah Nisaa Harumsari — 2025-07-31

BACKGROUND: Patients with lumbar spinal stenosis (LSS) who struggle to lie down for long periods may encounter issues during lumbar MRI exams. GRAPPA, a parallel imaging method to speed up MRI scans, can reduce the Signal to Noise Ratio (SNR), affecting image quality and anatomical information.

AIMS: This study aims to find the best GRAPPA acceleration factor by assessing its effect on image quality and anatomical information.

METHOD: This study involved scans on 10 Lumbar MRI patients with LSS cases. The scans were performed using a Siemens Magnetom Aera 1.5 Tesla MRI machine with T2WI TSE axial cut. Each patient underwent 4 treatments with acceleration factors of 1 (without GRAPPA acceleration factor), 2, 3, and 4. Image quality was analysed using ROI to obtain SNR and CNR values. The radiologist assessed the anatomical information on the images. The analysis included a one-way ANOVA and the Kruskal-Wallis test was performed for image quality and anatomical information.

RESULT: The research found that the GRAPPA acceleration factor significantly affects image quality and anatomical information in axial T2WI TSE Lumbar MRI scans for patients with LSS (p-value < 0.01). A factor of 3 reduces examination time by 65.35% without significant differences (p > 0.05) in image quality and anatomical information.

CONCLUSION: The acceleration factor in axial T2WI TSE lumbar MRI significantly affects image quality and anatomical information for lumbar spinal stenosis cases. An acceleration factor of 3 is optimal for maintaining quality and anatomical information.

Effects of 4G 2100 MHz Radiation on Lymphocyte Levels: An Experimental Study in Wistar Rats

Nafiisah Nafiisah — 2025-07-31

BACKGROUND: Electromagnetic radiation (EMR) from mobile phones has become a global concern due to its potential impact on the immune system. However, the effects of EMR on lymphocyte levels remain inconsistent across studies.

AIMS: This study aimed to evaluate the effects of 4G 2100 MHz EMR exposure on lymphocyte levels in Wistar rats.

METHOD: This research employed a true experimental design with a Post Test Only Controlled Group Design. Four groups of male Wistar rats were used: a control group (G1) and three exposure groups subjected to EMR for 15 (G2), 30 (G3), and 45 days (G4). The exposed groups were subjected to 2 hours per day of 4G 2100 MHz EMR using a Redmi A2 mobile phone in WhatsApp call mode. Lymphocyte levels were analyzed using ANOVA to determine differences among the groups.

RESULT: The average lymphocyte levels in groups G1, G2, G3, and G4 were 68.92 ± 4.78%, 63.37 ± 6.29%, 67.00 ± 11.51%, and 64.35 ± 13.58%, respectively. Statistical analysis revealed no significant differences among the groups (p = 0.703).

CONCLUSION: Exposure to 4G 2100 MHz EMR for 15–45 days did not significantly change lymphocyte levels in Wistar rats. These findings support the need for further studies to evaluate other immunological parameters and the long-term effects of EMR exposure.

Antibacterial and Antioxidant Effect from Nanoparticle of Andrographis paniculata Extract on Wistar Rat Infected with Listeria monocytogenes

Nawasyifa Atmaja — 2025-07-31

BACKGROUND: Listeria infection triggers the production of ROS (Reactive Oxygen Species) and radical-waste accumulation such as Malondialdehyde (MDA). Andrographis paniculata, triggers the production of Superoxide Dismutase (SOD) as antioxidant and suppresses the bacteria multiplication in host’s body. However, these active-phytochemical have poor destruction due to their large size and molecular weight. Nanoparticle technology may overcome this problem to increase bioavailability and benefit of herbal pharmacology.

AIMS: to evaluate the effectivity nanoparticle of A. paniculata extract to increase bacteria elimination, increase SOD level, and reduce MDA level in rat infected with L. monocytogenes

METHOD: Experimental research with post-test only controlled trial design was conducted using white rats (Rattus novergicus strain Wistar) into Normal (N), Negative Control (K-), A. paniculata extract (EAP-200), and Nanoparticle of A. paniculata extract Group (nEAP-100, nEAP-200, and nEAP-400). Colony was measured using total plate count method. SOD & MDA level were measured using colorimetric method

RESULT: L. monocytogenes bacterial count from group with extract A. paniculata was significantly lower than those in negative control (p<0,05). SOD level from group with extract A. paniculata was very significantly higher than those in negative control (p<0,01), while MDA level from group with extract A. paniculata was very significantly lower than those in negative control (p<0,01). Dose of 200 mg/kgBW in nanoparticle form was the most optimum dose.

CONCLUSION: Extract of A. paniculata at various doses and form, increase bacterial clearance, increase SOD level, and reduce MDA level in rat infected with L. monocytogenes.

The Role of Mammography in Early Detection of Breast Cancer: A Case Collection Report

Lilik Lestari — 2025-07-31

Background: Breast cancer is still the main cause of death in women, both globally and nationally. Therefore, mammography screening needs to be carried at to detect breast cancer early.

Cases Presentation: This paper presents the mammography findings of the 83 patients at dr. Ario Wirawan Pulmonary Hospital, Salatiga, Indonesia. Mammography examination used projection cuts, namely craniocaudal (CC) and mediolateral oblique (MLO). The classification used for this case series is BI-RADS.

Discussion: The results showed that of the 83 patients examined with mammography, 2 patients showed BI-RADS 4, indicating breast cancer, and 9 patients showed BI-RADS 2, indicating benign tumors. This case series report is consistent with previous studies explaining that mammography is important for making an accurate diagnosis of breast cancer between benign and malignant calcifications.

Conclusion: Mammography has a role in the early detection of breast cancer. Mammography examination using CC and MLO projections is a standard procedure that aims to obtain high-quality breast images and provide accurate information for early diagnosis of breast cancer.

Zero Fluoroscopy Transcatheter Device Closure in Subaortic Ventricular Septal Defect

Marco Wirawan Hadi — 2025-07-31

Background: For the last decade, transcatheter closure of ventricular septal defect (VSD) has been the treatment of choice, using fluoroscopy as a guide. However, the risk of radiation and/or contrast agent exposure has been an issue, especially in young patients. We would like to highlight the first case of zero fluoroscopy transcatheter VSD closure in Central Java.

Case Illustration: A 27-year-old female was referred to outpatient department due to worsening shortness of breath in the last 3 months before admission. She had a history of recurrent respiratory tract infections, feeding difficulty, and failure to thrive. Her vital signs were stable, 99% oxygen saturation, and grade 3/6 pansystolic murmur in the lower left sternal border. Transoesophageal echocardiography showed 3 mm subaortic VSD, left to right shunt. Transcatheter VSD closure was successfully done using Konar-MF™ VSD Occluder No. 8/6 mm retrograde approach without fluoroscopy.

Conclusion: The first zero fluoroscopy transcatheter device closure in Central Java has been successfully done in a 27-year-old female with subaortic VSD. Zero fluoroscopy transcatheter VSD closure is a feasible, safe, and effective procedure.

Bupivacaine-Fentanyl Induced Anaphylactic Reaction in Cesarean Delivery Undergoing Spinal Anesthesia: A Case Report

Ulfa Filliana — 2025-07-31

BACKGROUND: Incidences of anaphylaxis during pregnancy are unreported but high risks to both infant and mother due to pharmacokinetic profile changes of local anesthesia agents in pregnancy.

CASE: A 36-year-old woman (G4P2A1) delivered an infant at 40 weeks of her gestation using a cesarean surgical procedure with spinal anesthesia technique. The spinal anesthetic was administrated bupivacaine 15 mg and adjuvant analgesic (fentanyl 25 mcg). The delivery proceeded seamlessly. The patient was experiencing itching, swelling, and erythema in almost every part of her body, including her face, neck, arm, thigh, and leg in 43 minutes after drugs administration. This anaphylaxis reaction resolved after 22 minutes using 2 ampoules of intravenous dexamethasone 5 mg/ml and 1 ampoule of intravenous methylprednisolone 125 mg/ml. No data on second phase allergy was reported from the patient and infant who are born healthy and have a good response, indicated by an Apgar score 8-9.

CONCLUSION: The alterations pharmacokinetic profile of local anaesthesia in pregnancy can cause adverse effects such as anaphylaxis reactions. Anaphylaxis reactions require suitable therapeutic intervention (adrenaline and glucocorticoids) to ensure the safety of both the mother and infant during the delivery operation.

Generalized Gingival Enlargement in Young Adult with Chronic Periodontitis: A Case Report

Aurelia Krisnadita — 2025-07-31

BACKGROUND: Dental plaque is a natural biofilm that, if inadequately controlled, can lead to gingivitis and chronic inflammatory gingival enlargement. Persistent gingival overgrowth may impair both function and aesthetics, often requiring surgical intervention such as gingivectomy, when non-surgical treatments prove ineffective.

CASE REPORT: A 22-year-old male presented with swollen and bleeding gums. Patient reported no history of systemic diseases or the use of any specific medications. Intraoral examination revealed gingival hyperemia, enlargement, and carious lesions on multiple teeth. Despite initial treatment with scaling root planing (SRP) and oral hygiene instruction, gingival enlargement persisted. Panoramic radiography revealed additional findings, including alveolar crest resorption and impacted third molars. A four-stage gingivectomy was performed under local anesthesia, followed by postoperative care, including antibiotics (Clindamycin), analgesics, mouthwash, and strict oral hygiene maintenance. Restorative treatments and splinting of mobile teeth were also carried out.

DISCUSSION: The patient's gingival enlargement was primarily plaque-induced, further exacerbated by local factors such as dental caries. Scaling and root planing (SRP) alone proved insufficient due to the presence of fibrotic tissue, necessitating surgical intervention via gingivectomy. Postoperative healing was successful, with notable improvements in gingival contour, consistency, and oral hygiene indices. Patient education and adherence to postoperative care were crucial in achieving favorable outcomes.

CONCLUSION: Effective management of chronic inflammatory gingival enlargement requires accurate diagnosis, appropriate initial therapy, and surgical intervention when indicated. In this case, staged gingivectomy, combined with comprehensive oral care, successfully restored gingival health and aesthetics, emphasizing the importance of individualized treatment planning and patient cooperation.