Medica Hospitalia : Journal of Clinical Medicine

Full Text Volume 12 Number 3 November 2025

Kariadi General Hospital (Author) — Fri, 28 Nov 2025 00:00:00 +0800

Full Text Volume 12 Number 3 November 2025

S1 Dorsal Root Ganglion And Inferior Hypogastric Plexus Pulsed Radiofrequency Neuromodulation May Improve Type III Coccydynia Pain: a Case Report

Trianggoro Budisulistyo (Author) — Fri, 28 Nov 2025 00:00:00 +0800

Introduction

Coccygeal pain occurs in 1% to 2.7% of people without a clear coccygeal origin, unless provoked by prolonged sitting or anatomical changes found incidentally during surgery. Pain transmission blocked by pulsed radiofrequency (PRF) neuromodulation of the inferior hypogastric plexus (IHP) and dorsal root ganglion (DRG) can improve both nociceptive and neuropathic pain.

Methods

A 16-year-old female with a one-month history of coccydynia, coccygeal numbness radiating to the heels, and normal motor, micturition and voiding functions. The CSK 15 needle was inserted through both S1 neuroforamens to reach the DRG, then pulsed radiofrequency (PRF) 42°C for 2 minutes using the Cosman G4 device, followed by triamcinolone 20mg 1mL also administered contralaterally. Thus, PRF was also performed on both sides of the IHP anterior to the sacrum through the S2 neuroforamen approach.

Results

Improvement was observed after one month (NRS 0-1), whereas coccygeal numbness improved gradually. The combination analgesic (paracetamol 300mg, diazepam 2mg, diclofenac sodium 12.5mg) or pregabalin 50mg is administered as required, while vitamin B12 50 mcg/ 12h is continued.

Discussion

The pelvic sympathetic trunk (PSN) lies extraperitoneally anterior to the sacral and anteromedial to the anterior sacral neuroforamen with four or five interconnected ganglia. It rise to the lumbar sympathetic trunk (above) and the impar ganglion (below), which involved in transmitting sympathetic nociceptive from the perineum, distal rectum, distal vagina, distal urethra and anus. The parasympathetic afferent cells within the S2-S4 DRGs associated with pelvic splanchnic and somatic nerves.

Conclusion

Neuromodulation treatment for coccydynia has good results in DRG and IHP.

Dengue Virus Infection in Pregnancy: A Case Series

Fri, 28 Nov 2025 00:00:00 +0800

Background: Indonesia is an endemic country for dengue virus infections, particularly in several regions. Dengue virus infection is a disease caused by the dengue virus and transmitted through the bite of the Aedes aegypti mosquito. In pregnancy, dengue virus infection increases the risk of dengue shock syndrome, pre-eclampsia, fetal distress, preterm delivery, cesarean section and maternal death. Despite the abundance of reports on dengue infection in pregnancy, data from Indonesia remain limited, particularly regarding clinical presentation, management decisions, and outcomes in resource-limited settings. This case series aims to contribute practical insights into clinical management, decision-making during the critical phase, and maternal-fetal outcomes in dengue-infected pregnancies.

Cases: We report three cases of dengue virus infection during pregnancies. All three patients presented with acute fever and thrombocytopenia. Two of the three exhibited elevated in transaminase enzymes. One patient tested positive for NS1 antigen, while the other two tested positive for anti-dengue IgM and IgG. Blood component transfusions were administered to two patients during treatment. Two cases underwent termination of pregnancy via cesarean section due to indications of maternal and fetal distress. One neonate initially presented with an abnormal outcome but showed clinical improvement after intensive treatment. All three cases had normal maternal outcomes.

Discussion: Pregnancy involves various physiological changes related to the cardiovascular, respiratory, and hematological systems. In these three cases, acute fever and thrombocytopenia (first and second cases) were observed, and there was no increase in hematocrit exceeding 20% of the baseline data, thus leading to a diagnosis of dengue fever. The WHO states that there is no difference in the amount and rate of intravenous fluid administration for pregnant and non-pregnant women, but recommends using pre-pregnancy body weight for fluid calculations. During the critical phase, termination of pregnancy should be performed only if the mother's life is threatened or if the patient experiences spontaneous labor. Timely multidisciplinary decision-making is crucial to optimize maternal and fetal outcomes, as fetal complications such as distress or preterm delivery may occur. In the first case, termination of pregnancy by cesarean section during the critical phase was performed due to induction failure and fetal distress. The neonate initially suffered moderate asphyxia but experienced clinical improvement after intensive care.

Conclusion: Dengue virus infection in pregnancy increases the risk of morbidity and mortality for both mother and fetus. Therefore, strict monitoring and evaluation are needed, as well as management involving a multidisciplinary team that considers aspects of maternal and fetal safety.

Association of Premedication before Blood Transfusion with Transfusion Reactions in Mohammad Hoesin Hospital Palembang

Kemas Ya'kub Rahadiyanto, Desi Oktariana, Kemas Muhammad Alif (Author) — Fri, 28 Nov 2025 00:00:00 +0800

BACKGROUND: Premedication before blood transfusion is frequently used in clinical settings, albeit its effectiveness has not been shown. Premedication is used to stop transfusion-related fever and allergy. Unwanted or unanticipated consequences connected to the administration of unstable blood products are known as transfusion reactions.

AIMS: The aim of this study is to find out the association of premedication before blood transfusion with transfusion reactions.

METHOD: This study is an observational analytic study with cross-sectional design, the data obtained from Mohammad Hoesin Hospital Palembang from January 1st, 2020 to December 31st, 2021.

RESULT: 43 patients out of 73 samples did not receive premedication before the transfusion procedure, 8 patients (18.6%) experienced transfusion reactions, and 35 patients (81.4%) did not. 35 patients who received premedication, 2 patients (5.7%) experienced transfusion reactions, and 33 patients (94.3%) did not. The incidence of transfusion reactions at Mohammad Hoesin Hospital Palembang in the 2020–2021 period was not significantly associated with pre-transfusion premedication (p = 0.171). It is also not associated with blood transfusion history (p = 0.426), blood components (p = 0.793), or gender (p = 1.000).

CONCLUSION: Based on this finding, there is no significant association between premedication before blood transfusion and the transfusion reactions during period of 2020-2021 at Mohammad Hoesin Hospital Palembang.

Comparison of Genotypic (t-NGS) and Phenotypic Results for Mycobacterium tuberculosis Identification and Drug Susceptibility Testing (DST) against Tuberculosis

Fri, 28 Nov 2025 00:00:00 +0800

BACKGROUND: Accurate identification and drug susceptibility testing are crucial for tuberculosis eradication and treatment, but conventional methods require over four weeks to complete. Targeted Next Generation Sequencing (t-NGS) is a promising alternative that provides results in just four days, potentially replacing traditional methods. However, the concordance between genotypic and phenotypic methods has not been widely reported.

AIMS: This study aims to see the concordance between phenotypic and genotypic methods for identifying Mycobacterium tuberculosis and determining drug susceptibility.

METHOD: Sputum samples were collected from Balai Besar Laboratorium Kesehatan Masyarakat (BBLKM) Makassar from June 2024 until July 2024. M. tuberculosis DNA was extracted using the Qiagen DNA mini kit, amplified with Deeplex® Myc-TB by Genoscreen, and prepared with Illumina DNA Prep. t-NGS was performed on the MiSeq Illumina platform, and sequencing results were analyzed with Deeplex® Myc-TB by Genoscreen. A comparison of genotypic and phenotypic results (Culture and Drug Sensitivity Test) was conducted using SPSS.

RESULT: Discrepancies were noted between phenotypic and genotypic results for two samples (Samples 16 and 18), where phenotypic results indicated non-tuberculous mycobacteria (NTM) and genotypic results identified M. tuberculosis. These discrepancies were not statistically significant (p>0,05). Additionally, a minor discrepancy was observed in isoniazid results for one sample (Sample 2), but the statistical result is not significance (p>0.05).

CONCLUSION: t-NGS is a promising alternative to conventional methods due to its shorter testing time and capability to identify novel mutations, with discrepancies compared to phenotypic results being statistically insignificant. However, its higher cost and the need for specialized expertise limit its accessibility to some laboratories.

Validity of Leukocyte Esterase Dipstick Test Compared to Gold Standard Urine Culture in Hospitalized Children Suspected of Urinary Tract Infections

Fri, 28 Nov 2025 00:00:00 +0800

BACKGROUND : Urinary tract infection (UTI) is an illness that affects specifically the bladder and other structures in the urinary tract. The leukocyte esterase dipstick examination is recognized for its high sensitivity but limited specificity. Additional diseases, like glomerulonephritis, can yield positive outcomes in this test. This research was conducted to determine the validity of leukocyte esterase examination in urine culture in children suspected of urinary tract infection.

AIMS : To assess the accuracy of leukocyte esterase testing on urine culture in children suspected of having a .

METHOD : This study employed a diagnostic test method with a cross-sectional design. Research data were obtained from medical record of pediatric patients admitted to RSUP dr. Hasan Sadikin from 2022 to 2023 with suspected urinary tract infection.

RESULT : The values for the diagnostic test results are follows true positive 80%, false positive 51%, true negative 25%, and false negative 40% respectively. The calculations reveal that the leukocyte esterase dip stick has a sensitivity of 67%, specificity of 33%, positive predictive value (PPV) of 61%, negative predictive value (NPV) of 38%, a positive likelihood ratio of 1.56, and a negative likelihood ratio of 0.625.

CONCLUSION : This study indicates that the leukocyte esterase dipstick examination has a sensitivity rate of 67%, specificity rate of 33%, PPV of 61%, and NPV value of 38%. The leukocyte esterase dipstick has a high sensitivity level and a low specificity level.

Anxiety, Stress, and Depression in Recurrence of Gastritis Symptoms Among Inmates with a History of Drug Abuse in Bandung

Angga Wilandika, Wulan Nurazizah, Santy Sanusi (Author) — Fri, 28 Nov 2025 00:00:00 +0800

BACKGROUND: Drug abuse inmates in correctional institutions undergo rehabilitation programs and are supervised according to the determined sentence, thus losing their freedom. This condition causes psychosocial problems such as anxiety, stress, and depression, which may be associated with physical issues, including the recurrence of gastritis symptoms.

AIMS: To identify the correlation between anxiety, stress, and depression with recurrence of gastritis symptoms in drug abuse inmates at the correctional institution.

METHOD: The study used a cross-sectional design and involved 34 inmates with a history of gastritis due to drug abuse. Purposive sampling was used to select the participants. The levels of anxiety, stress, and depression were measured using the Indonesian version of the Depression Anxiety Stress Scales (DASS-21). The Gastritis Recurrence Questionnaire evaluated the recurrence of gastritis symptoms in the inmates. The data was analyzed using descriptive statistics such as frequency distribution, and inferential analysis was conducted using the Kendal-tau test to identify correlations between the variables.

RESULT: The study findings indicate a correlation between anxiety, stress, and depression and the recurrence of gastritis symptoms in inmates in correctional institutions (p-value < 0.05). Most inmates with a history of drug abuse experience psychosocial problems such as very high anxiety (29.4%) and severe stress (32.4%). At the same time, 73.5% do not experience depression.

CONCLUSION: Psychosocial issues like anxiety, stress, and depression have been found to contribute to the likelihood of recurrence of gastritis symptoms in inmates. The higher the levels of anxiety, stress, and depression, the greater the possibility of recurrence of gastritis symptoms. Correctional institution managers should be prepared to address these psychosocial issues to help inmates reduce the recurrence of gastritis symptoms.

Relationship Between Level of Simple Carbohydrate and Trans Fat Intake with Severity of Coronary Artery Stenosis Based on Gensini Score at Kariadi Hospital Semarang

Fri, 28 Nov 2025 00:00:00 +0800

BACKGROUND: Coronary artery disease accounts for 111 million (27%) out of 400 million cases of cardiovascular disease worldwide. Regular consumption of foods high in trans fats and simple carbohydrates is a major cause of increased blood lipid and glucose levels, which are key risk factors for coronary artery disease.

AIMS: This researches to examine the relationship between the amount of simple carbohydrate and trans fat intake and the severity of coronary artery stenosis based on the Gensini score.

METHODS: This research used a cross-sectional observational design involving 56 patients with chronic coronary syndrome who had undergone coronary angiography and were found to have stenosis in their coronary arteries. The parameters assessed included the amount of simple carbohydrate intake, trans fat intake, LDL levels, HDL levels, triglyceride levels, HbA1C levels, hs-CRP levels, oxLDL levels, and Gensini score.

RESULTS: There was a significant relationship between the amount of simple carbohydrate intake and the severity of coronary artery stenosis based on the Gensini score (p=0.004), and between the amount of trans fat intake and the severity of coronary artery stenosis based on the Gensini score (p=0.02). Additionally, there was a significant relationship between trans fat levels and LDL levels (p=0.017), and oxLDL levels (p=0.014), but not with HDL, triglyceride, or hs-CRP levels (p>0.05). Confounding variables such as age, gender, socioeconomic status, body mass index, hypertension, diabetes mellitus, dyslipidemia, statin use, antidiabetic drug use, physical activity, and statin use showed no significant relationship (p>0.05).

CONCLUSION: There is a significant relationship between the amount of simple carbohydrate and trans fat intake and the severity of coronary artery stenosis based on the Gensini score.

Hypokalemia Correlates with Troponin levels in Moderate-Severe COVID-19 Patients, Independent to Coagulation Status

Fri, 28 Nov 2025 00:00:00 +0800

Background: Myocardial injury is a common complication of COVID-19, often marked by elevated cardiac troponin and linked to poorer outcomes. Besides recognized causes such as viral injury, inflammation, and coagulopathy, electrolyte disturbances like hypokalemia may also increase cardiac vulnerability. SARS-CoV-2 can promote potassium loss through activation of the renin angiotensin aldosterone system, but the relationship between low potassium and troponin elevation remains unclear.

Aim: To evaluate whether serum potassium levels are associated with troponin elevation in patients hospitalized with moderate to severe COVID-19, and whether this association is influenced by disease severity or D-dimer levels.

Methods: Cross-sectional study of 50 adults with moderate or severe COVID-19. Serum potassium, troponin, and D-dimer were measured once during admission. Associations were tested using independent t-tests, Mann-Whitney tests, and Fisher’s exact tests, with p < 0.05 considered significant.

Results: Among 50 patients (39 moderate, 11 severe COVID-19), 35 (70%) had normal potassium, 12 (24%) hypokalemia, and 3 (6%) severe hypokalemia; 9 (18%) had elevated troponin. Potassium was lower in patients with elevated troponin than in those with normal levels (3.53 ± 0.53 vs. 3.99 ± 0.58 mmol/L, p = 0.038), and potassium status was significantly associated with troponin elevation (p = 0.0401). No significant differences were detected when patients were grouped by disease severity, with potassium (p = 0.44) and troponin (p = 0.66) levels similar in moderate and severe cases. D-dimer levels were not significantly different by severity (p = 0.175) and showed no association with potassium (p = 0.24) or troponin (p = 0.91).

Conclusion: In hospitalized patients with moderate to severe COVID-19, lower potassium levels were associated with elevated troponin, regardless of disease severity and without a detectable link to D-dimer status. These findings suggest hypokalemia may contribute to myocardial injury in COVID-19 and support regular monitoring and timely correction of electrolyte disturbances.

Improvement of Muscle Endurance in Men with Low Activity Levels after Above Anaerobic Threshold Exercise Intensity

Fri, 28 Nov 2025 00:00:00 +0800

Background: Low level of physical activity can reduce physical fitness. Aerobic training can improve physical fitness. A precise aerobic training based on anaerobic threshold (AT) is recommended by American College of Sports Medicine (ACSM) whenever possible.

Methods: This was a randomized-single blinded control trial including 24 male subjects with low level of physical activity in Kariadi hospital during December 2023 until February 2024. It was randomized with a sealed envelope. Subjects were allocated in 2 groups (above AT and below AT). Physical performance was measured using SPPB score and muscle endurance that was presented using total repetition of 1RM of knee flexor muscle.

Results: There was no significant difference between two groups for total SPPB score (p=0.053). There was a significant difference of muscle endurance between two groups (p=0.010) with the above AT group resulting in higher improvements of muscle endurance (12.00 ± 5.71 vs. 6.67 ± 3.26).

Conclusion: Aerobic exercise with intensity based on AT did not show significant differences in total SPPB score. However, aerobic exercise above AT showed a better improvement of muscle endurance in healthy adult men with low levels of physical activity.

Differences In The Severity Of Diabetic Neuropathy Based On Electromyography In Type 2 Diabetes Mellitus Patients With And Without Comorbidities

Fri, 28 Nov 2025 00:00:00 +0800

Introduction: Diabetic neuropathy is one of the most common complications of type 2 Diabetes Mellitus. Hyperglycemia causes axonal abnormalities and impaired schwan cell metabolism. Hypertension and hyperlipidemia associated with atherosclerosis, lipid metabolism and arterial compliance. This study aims to determine the difference in the severity of diabetic neuropathy based on electromyography between type 2 DM patients with and without comorbidities.

Methods: This study used a cross sectional design. A total of 78 diabetic neuropathy subjects from Outpatient Installation of Dr. Kariadi Hospital Semarang were divided into 3 groups, 26 subjects without comorbidities, 25 subjects with comorbid hypertension and 27 subjects with comorbid hypertension and hyperlipidemia. Inclusion criteria were aged 40-80 years, distal symmetrical polyneuropathy classification, without comorbid and with comorbid hypertension and hyperlipidemia. Exclusion criteria were patients with chemotherapy, HNP, CKD stage 5, incomplete medical records. Data were analyzed using Kruskal-Wallis comparative test.

Results: There is a difference in the severity of diabetic neuropathy based on EMG between type 2 DM patients without comorbidities and with comorbidities (p<0.01). No difference in the severity between patients with type 2 DM without comorbidities and with comorbid hypertension (p 0.058). There is a difference in the severity between patients with type 2 DM without comorbidities and with comorbid hypertension and hyperlipidemia (p<0.01).

Conclusion: There is a difference in the severity of diabetic neuropathy based on EMG between patients with type 2 DM without comorbidities, with comorbid hypertension and with comorbid hypertension and hyperlipidemia. The more comorbidities, the greater the severity of diabetic neuropathy.

Correlation between Maximal Inspiratory Pressure and the Sit-to-Stand Test in Post-COVID-19 Patients

Fri, 28 Nov 2025 00:00:00 +0800

BACKGROUND: Coronavirus Disease 2019 (COVID-19) can lead to long-lasting complications such as ongoing respiratory issues and functional impairments. Damage to the alveoli and respiratory muscles, particularly the diaphragm, may result in lower maximal inspiratory pressure (MIP) and decreased physical performance. Although prior studies have examined the connection between MIP and functional tests in various respiratory conditions, research focusing on post-COVID-19 populations, particularly in Indonesia, is scarce.

AIMS: To investigate the correlation between Maximal Inspiratory Pressure (MIP) and 30-second Sit-to-Stand (30s STS) test performance in adult post-COVID-19 patients.

METHOD: A cross-sectional study was conducted at two tertiary hospitals in Jakarta, Indonesia, involving 40 adults post-COVID-19 patients aged 18–59 years. Participants underwent clinical screening, spirometry, MIP measurement using the MicroRPM device, and the 30s STS test. Pearson correlation analysis was used for normally distributed variables with significance set at p < 0.05.

RESULT: The average MIP was 79.03 ± 26.68 cmH₂O, while the mean score for the 30s STS test was 12.78 ± 2.47 repetitions. Spirometric measurements revealed an average FEV₁ of 2.23 ± 0.57 L, FVC of 2.84 ± 0.69 L, and an FEV₁/FVC ratio of 81.19%. A moderate positive correlation between MIP and 30s STS performance was identified (r = 0.515, p = 0.001).

CONCLUSION: There is a significant moderate correlation between MIP and 30s STS performance among post-COVID-19 patients, suggesting that simple functional tests can be effective tools for assessing respiratory muscle strength and informing rehabilitation strategies in clinical environments.

In Vitro Testing of the Antibacterial Activity of Ethanol Extract of Lontar Leaves (Borassus flabellifer) Against Staphylococcus aureus

Fri, 28 Nov 2025 00:00:00 +0800

BACKGROUND: Staphylococcus aureus is a bacterium that frequently causes infections and often develops resistance to antibiotics. Efforts to identify alternative treatments using herbal remedies are increasing. In Indonesia, a country rich in biodiversity, lontar leaves (Borassus flabellifer) have been traditionally used and show potential antibacterial activity.

AIMS: To evaluate the antibacterial activity of ethanol extract of lontar leaves against Staphylococcus aureus in vitro.

METHOD: This experimental study employed a post-test-only control group design. Antibacterial activity was tested using the well diffusion method. Extracts were obtained through maceration with 96% ethanol and tested at 75%, 50%, and 25% concentrations. Ciprofloxacin was used as the positive control, and 10% DMSO as the negative control.

RESULTS: The inhibition zone diameters were 21.86 mm (75%), 19.64 mm (50%), and 18.37 mm (25%). The positive control (ciprofloxacin) measured 24.43 mm, while the negative control (DMSO) showed 0 mm.

CONCLUSION: The 96% ethanol extract of lontar leaves demonstrated antibacterial activity against Staphylococcus aureus, with higher concentrations yielding stronger inhibition.