Medica Hospitalia : Journal of Clinical Medicine

Full Text Volume 13 Number 1 March 2026

Kariadi General Hospital (Author) — Wed, 01 Apr 2026 00:00:00 +0800

Full Text Volume 13 Number 1 March 2026

C-Arm Assisted Surgical Foreign Body Removal in the Tongue: Evidence-Based Case Report

Wed, 01 Apr 2026 00:00:00 +0800

BACKGROUND: The term corpus alienum (foreign body) refers to an external object that should not be present within the human body. In managing such cases, X-rays are among the most important imaging modalities. To support surgical and orthopedic procedures, a mobile imaging device known as the C-Arm is often used. It provides real-time imaging during procedures involving bones or internal organs.

CASE REPORT: A 51-year-old male presented with a staple lodged in his tongue. He previously underwent blind surgery by an oral surgeon at RSUD Salatiga, but the foreign body could not be located. The patient was referred to RSUP Dr. Kariadi Semarang and scheduled for C-Arm assisted removal under general anesthesia.

DISCUSSION: Foreign bodies can cause discomfort and various symptoms. The C-Arm is a radiological device that provides real-time visualization using fluoroscopy and a monitor screen. With its assistance, the foreign body was accurately located and successfully removed from the tongue.

CONCLUSION: This case highlights the importance of imaging guidance in foreign body removal. The use of a C-Arm enabled precise localization and successful surgery after a previous failed attempt.

A Free-Floating Technique Simplifies Lower Face Thread Lift for Premature Lower Face Aging: An Evidence-Based Case Report

Wed, 01 Apr 2026 00:00:00 +0800

INTRODUCTION: Skin aging is a complex biological process influenced by a combination of endogenous (intrinsic) and exogenous (extrinsic) factors. A Thread Lift is a cosmetic procedure that lifts and tightens sagging tissue while enhancing facial contours, using threads made from the same material utilized in surgical wound closure. This case report aims to present a new, simplified thread lift technique available to dermatologists today, covering preventive measures, cosmetic strategies, topical and systemic therapeutic agents, and invasive procedures.

CASE: A 40-years-old man, a contractor and heavy smoker who participates in outdoor sports, is frequently exposed to the sun. He has complained of sagging in the lower cheek area for the past year. A thread lift treatment was performed. On the patient's second visit, a thread lift was conducted after marking an anchoring pattern in the retaining ligament and injecting 2% lidocaine at the entry point of the lateral face area. This was followed by tumescent anesthesia using a 25G cannula along the thread lift marking. The entry point was opened using an 18G needle, and the bevel-down thread lift was inserted above the mandibular angle into the subcutaneous layer without injuring the facial muscles as per the marking. The thread lift protocol used a thread (thread 6D cog PDO threads with needles). After the thread lift is inserted into the marionette line, pull on the entry point slowly until the thread lift elevates the epidermis to the subcutaneous layer, achieving repositioning of the lower face.

CONCLUSION: The free-floating Thread lift technique is an aesthetic procedure with a quick healing process and minimal side effects that help prevent premature aging, making it simple and suitable for all dermatologists to perform.

The Effect of Vitamin D Supplementation on Sputum Conversion, Erythrocyte Sedimentation Rate and Neutrophil-Lymphocyte Ratio in Pulmonary Tuberculosis Patients – A Randomized Controlled Trial

Wed, 01 Apr 2026 00:00:00 +0800

BACKGROUND : The health issue of pulmonary tuberculosis (TB) remains a concern in Indonesia. Vitamin D supplementation is one way to manage tuberculosis, which is a crucial case control metric. It is anticipated that vitamin D's anti-inflammatory properties will lower erythrocyte sedimentation rate (ESR) and inflammatory indicators, hence speeding up sputum conversion.

AIMS : To analyze the effect of vitamin D supplementation on sputum conversion, ESR and neutrophil-lymphocyte ratio (NLR) among pulmonary tuberculosis patients

METHOD : Patients with pulmonary tuberculosis who were treated as outpatients at Ulin Banjarmasin Hospital and Pekauman Health Centre between May-July 2024 and who satisfied the study's inclusion requirements were included in the randomised controlled trial. Subjects were randomly divided into 2 groups (19 subjects in the treatment group and 19 subjects in the control group) using random selection with sealed envelopes. The treatment group received antituberculosis drugs (ATD) and vitamin D supplementation at a dose of 10,000 IU/day for eight weeks after the initiation of TB therapy, while the control group received ATD and a placebo. ESR and NLR examinations were performed prior to treatment, in weeks 4 and 8, whereas sputum evaluations were conducted at weeks 2, 4, 6, and 8. Statistical Product and Service Solutions (SPSS) was used for data analysis. P-value <0,05 was significant statistically.

RESULT : The study subjects were 38 pulmonary TB patients, most of whom were women (65.0%) with an average age of 50.42 ± 18.61 years. Overall, during the 8 weeks of intervention, there was a significant effect of vitamin D supplementation on sputum conversion (OR = 1.61, 95%CI = 0.030-0.931, p = 0.037). There was no significant effect of vitamin D supplementation on NLR (regression coefficient = 0.549, 95%CI = -1.769-2.858, p = 0.641) and ESR (regression coefficient = -5.529, 95%CI = -20.658-9.599, p = 0.474).

CONCLUSION : Vitamin D supplementation significantly affects sputum conversion. In the 8th week, almost all subjects who initially had positive BTA became negative. But does not significantly affect ESR and NLR.

Correlation Hemoglobin and Hematocrit Levels with Total Iron Binding Capacity (TIBC) Levels in Chronic Kidney Disease Patients

Galuh Ajeng Lidyaningrum, Andika Aliviameita (Author) — Wed, 01 Apr 2026 00:00:00 +0800

BACKGROUND : Chronic Kidney Failure (CKD) is a condition where the kidneys are structurally and functionally damaged characterized by a decrease in Glomerular Filtration Rate (GFR) reaching ≤ 60 ml/min/1.73m2 for more than three months. About 80 - 90% of patients with CKD experience anemia.

AIMS : This research aims to determine the correlation of hemoglobin and hematocrit levels with Total Iron Binding Capacity (TIBC) levels in patients with chronic renal failure.

METHOD : The research design used quantitative analysis with cross sectional method. The study used secondary data of as many as 55 respondents of chronic kidney disease patients undergoing hemodialysis. This study was conducted at the East Java Province Haji Hospital in March 2025.

RESULT : The normality test results showed that hemoglobin and hematocrit levels were not normally distributed (p < 0.05) while TIBC levels were normally distributed (p > 0.05). Kendall's tau b non-parametric correlation test there is no correlation between hemoglobin levels with TIBC (r = 0.134; p = 0.154), and hematocrit with TIBC levels (r = 0.172; p = 0.066).

CONCLUSION : The results of this study showed no correlation between hemoglobin and hematocrit levels with total iron binding capacity (TIBC) levels in chronic kidney disease patients undergoing hemodialysis at Haji Provincial General Hospital of East Java .

The Effect Of Walking As A Physical Activity On Sleep Quality In The Third Trimester Of Pregnancy

Wed, 01 Apr 2026 00:00:00 +0800

BACKGROUND : Sleep disorders are common in pregnant women during the third trimester, with frequent urination being a prevalent issue due to weakened bladder muscles, leading to deteriorated sleep quality. Physical activity, such as walking, is recommended as an easy, effective, and economical way to improve sleep quality in pregnant women.

AIMS : To analyze the effect of walking on sleep quality in third-trimester pregnant women at Kebakkramat I Karanganyar Health Center, Central Java.

METHOD : This study used a Quasi-Experimental design with a Pretest-Posttest Control Group approach. The sample consisted of 80 third-trimester pregnant women, selected using Multistage Sampling. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to measure sleep quality. The intervention involved walking for 20 minutes over two weeks.

RESULT : The analysis used the Delta score mean test between the pre-tests and post-tests for each respondent to show a significant effect of walking on sleep quality. A negative delta value shows a decrease in the PSQI score, indicating improved sleep quality for the respondent, and vice versa. The intervention group had a lower delta score mean of -3.13 compared to the control group, indicating that walking effectively improves sleep quality.

CONCLUSION : Walking has significant potential to improve sleep quality in third-trimester pregnant women. Pregnant women are encouraged to walk regularly and increase their knowledge about pregnancy.

Risk Factors for Carbapenem-Resistant Organisms Pneumonia in the Pediatric and Neonatal Intensive Care Units: A Study at Dr.Kariadi Hospital

Wed, 01 Apr 2026 00:00:00 +0800

BACKGROUND: Inappropriate antibiotic use has led to bacterial resistance, including carbapenem-resistant organisms (CROs), which cause severe infections in neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) patients. CRO infections are associated with high morbidity and mortality rates, with limited treatment options. Risk factors such as prolonged hospitalization, broad-spectrum antibiotic use, invasive procedures, and prior infections contribute to these cases. This study is the first in Indonesia to specifically examine CRO pneumonia risk factors in NICU and PICU children.

OBJECTIVES: This study aimed to analyze the risk factors for pneumonia caused by carbapenem-resistant organisms (CROs) in children in the pediatric and neonatal intensive care unit.

METHODS: This case-control study was conducted in neonatal intensive care unit (NICU) and Pediatric Intensive Care Unit (PICU) of Dr. Kariadi Hospital, Semarang, using medical records of patients admitted between November 2022 and October 2024. This study analyzed the relationship between various risk factors, including hospitalization duration, antibiotic use, mechanical ventilation, catheterization, prior surgery, and bacterial infection history, with CRO pneumonia in NICU and PICU patients.

RESULTS: This case-control study in NICU and PICU on 87 pediatric pneumonia patients found that 55.2% had CRO pneumonia. Multivariate analysis revealed that carbapenem use for >7 days (p = 0.049), mechanical ventilation (p = 0.044), and urinary catheterization (p = 0.020) were independent risk factors for CRO pneumonia.

CONCLUSION: CRO infections in NICU and PICU patients are highly prevalent, with prolonged carbapenem use, mechanical ventilation, and urinary catheterization as independent risk factors for CRO pneumonia.

Correlation Between Bacterial Count and Duration of Tracheostomy Tubes Use

Wed, 01 Apr 2026 00:00:00 +0800

BACKGROUND: Tracheostomy tubes (TTs) are life-sustaining medical devices widely used for patients with upper airway obstruction or requiring prolonged mechanical ventilation. However, TTs serve as an indwelling substrate that promotes bacterial colonization and biofilm formation, particularly by resistant pathogens such as Pseudomonas aeruginosa and Staphylococcus aureus. Despite the well-recognized clinical risks, evidence correlating the duration of TT use with quantitative bacterial load in the Indonesian hospital setting remains limited, creating a gap in local clinical guidance for tube replacement scheduling.

AIM: To analyze the correlation between TT duration of use and bacterial colony count (CFU/mL), and to identify the predominant colonizing pathogens in order to inform evidence-based infection prevention and tube replacement timing.

METHOD: This cross-sectional observational study was conducted from July 2020 to January 2021 at Dr. Sardjito General Hospital, Yogyakarta, Indonesia. A total of 20 polyvinyl chloride (PVC) Portex™ tracheostomy tubes were collected via consecutive sampling from patients undergoing decannulation procedures. Bacterial cultures were performed at the Department of Microbiology, Universitas Gadjah Mada, with bacterial load expressed as colony-forming units per milliliter (CFU/mL). Spearman’s rank correlation was used for statistical analysis.

RESULTS: Mean bacterial counts (CFU × 10³/mL) were 48.5, 9,853.83, and 28,200.00 for TT use durations of <30 days, 30–90 days, and >90 days, respectively. Spearman’s rank correlation demonstrated a strong positive association between duration and bacterial count (r = 0.70, p = 0.01). Pseudomonas aeruginosa was the most prevalent organism, identified in 60% of tubes.

CONCLUSION: Duration of TT use exceeding 30 days is significantly correlated with higher bacterial colonization burden. Pseudomonas aeruginosa was the predominant pathogen. These findings support the recommendation for scheduled TT replacement within 30 days as an infection control measure in tracheostomized patients.

Association Between Vitamin A and Zinc Intake with Inflammatory markers in Pulmonary Tuberculosis

Surya Mitrasari, Fariz Nurwidya, Yohannessa Wulandari, Heidy Agustin (Author) — Wed, 01 Apr 2026 00:00:00 +0800

BACKGROUND: Indonesia has the second highest burden of tuberculosis (TB) worldwide, with an incidence of 354 per 100,000 population and approximately 969,000 cases reported in 2021. Micronutrients such as vitamin A and zinc play important roles in immune function and may influence inflammatory responses in TB. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are potential markers of systemic inflammation; however, evidence regarding their association with dietary micronutrient intake in pulmonary TB patients remains limited, particularly in Indonesia.

AIMS: To examine the association between vitamin A and zinc intake and inflammatory markers in pulmonary TB patients.

METHODS: A cross-sectional study was conducted among 133 pulmonary TB patients recruited consecutively from March to April 2024 at Persahabatan Hospital. Vitamin A and zinc intake were assessed using a semi-quantitative food frequency questionnaire (SQ-FFQ), while NLR and PLR values were obtained from medical records. Data normality was tested using the Kolmogorov–Smirnov test, and correlations were analyzed using Spearman’s test. The median vitamin A intake was 105.47 RE/day and zinc intake was 7.38 mg/day, with median NLR and PLR of 2.91 and 202.08, respectively.

RESULTS: No significant correlations were found between vitamin A or zinc intake and NLR or PLR (p > 0.05).

CONCLUSION: In conclusion, vitamin A and zinc intake were not associated with inflammatory markers in pulmonary TB patients, although host-related factors may contribute to the inflammatory response.

Comparison of Effectiveness Cost Therapy and Increasing Level of Haemoglobin, Ferritin in Pregnant Women with Anemia Whom Are Given Iron Tablet Everyday and Every Two Days

Agung Pramartha Irawan, M. Besari Adi Pramono, Asih Wijayanti (Author) — Wed, 01 Apr 2026 00:00:00 +0800

BACKGROUND: Anemia is common in pregnancy, with a prevalence of 48.9% in Indonesia (Riskesdas 2018). It increases the risk of impaired fetal growth, stunting, and intellectual disorders. Iron supplementation, as recommended by Permenkes No. 88/2014, is a key preventive strategy. Evidence such as Moretti et al. (2015), suggests that alternate-day supplementation improves absorption due to reduced hepcidin activity.

AIM: To evaluate the effectiveness of administering iron tablets every two days in terms of treatment cost, increases in hemoglobin (Hb) and ferritin levels, and incidence of gastrointestinal adverse effects.

METHODS: This was a true experimental study using a randomized pre–post test control group design. The control group received iron tablets daily for two months, while the intervention group received iron tablets every two days. The study was conducted at the Obstetrics and Gynecology Polyclinic of Kariadi Central General Hospital and Halmahera Primary Health Care over eight months (December 2023 – July 2024). Each group included 23 subjects. Body weight, hemoglobin, and ferritin were measured at baseline and after two months. Adverse effects and neonatal outcomes were also documented.

RESULTS: Baseline characteristics were normally distributed. The intervention group showed a significant increase in hemoglobin and ferritin levels, higher neonatal birth weight, and lower treatment cost and adverse effects compared to the control group (p < 0.05). Post-treatment differences between groups were 0.5 g/dL for hemoglobin and 17.2 ng/mL for ferritin.

CONCLUSION: Administering iron tablets every two days is effective in improving hemoglobin and ferritin levels in pregnant women with anemia and is also cost-effective with fewer adverse effects.

Correlation between referral type (emergency vs scheduled) and maternal perinatal outcome in suspected placenta accreta spectrum : a retrospective cohort study in Dr.Kariadi hospital Semarang 2020-2023

Wed, 01 Apr 2026 00:00:00 +0800

BACKGROUND : Maternal Mortality Rate (MMR) in Indonesia at 2023 was 189 over 100.000 live births. The most popular reason for maternal death was obstetrics hemorrhage. Obstetric hemorrhage can be caused by abnormal placentation. Abdominal delivery by cesarean section has increased recently in Indonesia. Cesarean section will increase the risk for placenta accreta spectrum, which raises maternal morbidity and mortality.
AIM : To analyze the correlation of emergency and scheduled referral with maternal and perinatal outcomes of suspected placenta accreta spectrum patients in Dr.Kariadi Hospital Semarang 2020 – 2023.
METHODS : A cohort retrospective study performed in May 2024, involved 153 women with suspected placenta accreta spectrum were referred to Dr.Kariadi Hospital Semarang in 2020 – 2023, divided by emergency referral and scheduled referral groups. We use Placenta Accreta Index (PAI) Score and all patients who fulfilled the criteria of the placenta accreta spectrum based on FIGO to predict suspicious placenta accreta spectrum. Descriptive analysis included the base characteristics of the patients. Correlation analysis with maternal and perinatal outcomes using Chi Square analyze of SPSS 25.00 version.
RESULTS : A total of 69 patients with emergency referrals and 84 patients with scheduled referrals. Mean age was 32.97, median 32(24-44), median of gestation was 3(1-6) and 3(1-9), median of gestational age was 35(22-41) and 36(32-39). The emergency referral had a higher risk for cesarean hysterectomy with OR (95%CI) 2.92 (1.51–5.67), for maternal hemorrhage with OR (95%CI) 2.34 (1.22–4.49), for blood transfusion with OR (95%CI) 6.02 (2.46–14.76), for intensive care admission with OR (95%CI) 4.39 (1.5–12.79), for prematurity with OR (95%CI) 2.56(1.32–4.92), for asphyxia with OR (95%CI) 3.41(1.56–7.47). There were significant differences between emergency and scheduled referrals for vaginal delivery (p=0.03), and perinatal mortality (p=0.04). Estimated blood loss was 1453.7± 1253.6 ml in emergency referral and 878.3 ± 823.7 ml in scheduled referral.
CONCLUSION : Emergency referrals had worse maternal and perinatal outcomes than scheduled referrals for suspicious placenta accreta spectrum patients.

The Effect of an Elastic Band Resistance Training Program on Increasing Upper and Lower Limb Muscle Strength in Elderly with Sarcopenia

Rizal Mustofa, Rifky Ismail, Hari Peni Julianti, Budi Setiyana (Author) — Wed, 01 Apr 2026 00:00:00 +0800

BACKGROUND : Prevention and treatment of sarcopenia are important to achieve physical health in aging, including maintaining the physical ability to live independently and carry out daily activities.

AIMS : To determine the effect of a muscle-strengthening exercise program using elastic bands for 8 weeks in order to increasing muscle strength in elderly people with sarcopenia. Arm muscles (biceps and triceps) and leg muscles (quadriceps and gastrocnemius) were measured.

METHOD : An intervention study with a one-group pre- and post-test design. Subjects were taken from the elderly home by as many as five women and five men. Subjects were given strengthening exercises using elastic bands in as many as 2 sets; each set was done in as many as 10 movements, and each movement was given a rest interval of 30 seconds. The elastic band strengthening exercise program was carried out three times per week, with a period of eight weeks, so that the total training was 24 sessions. Changes in muscle strength were measured using a MicroFET2 hand-held dynamometer. Furthermore, the results of muscle measurements were tested using the paired-samples T test to determine the difference in muscle strength between before and after doing the exercise program.

RESULT : Female and male subjects had an insignificant average age of 68.80 ± 5.12 years for women and 68.60 ± 5.64 years for men. The average BMI value in women and men had an ideal value of 24.38 ± 2.89 kg/m2 and 24.82 ± 5.65 kg/m2. The right limbs in the biceps, triceps, quadriceps, and gastrocnemius muscles each experienced an increase in muscle strength during the intervention, namely 2.67 kg, 2.14 kg, 1.99 kg, and 1.87 kg. Then for the left limbs, the biceps, triceps, quadriceps, and gastrocnemius muscles also experienced an increase, namely 2.96 kg, 1.42 kg, 2.28 kg, and 2.51 kg. The intervention carried out in this study can significantly increase upper limb and lower limb muscle strength (p<.05).

CONCLUSION : Resistance training using elastic bands routinely for 8 weeks can increase the strength of the biceps, triceps, quadriceps, and gastrocnemius muscles. This exercise can also reduce the risk of sarcopenia and improve the quality of life for the elderly. This exercise program can be a recommendation for intervention because it is economical and easy to do independently at home.

The Correlation Between Social Support And Incidence Of Depression In Coronary Heart Disease Patients

Wed, 01 Apr 2026 00:00:00 +0800

BACKGROUND: Coronary heart disease can cause psychological impacts in the form of depression which, if not managed optimally, can worsen the patient's condition. One of the psychosocial factors that cause depression is low social support. Social support can strengthen individual coping with the acceptance of disease conditions in patients.

AIMS: This study aims to determine the relationship between social support and depression in coronary heart disease patients at the Heart Installation of Dr. Kariadi Hospital Semarang.

METHODS: This research is a descriptive quantitative correlation with a cross sectional approach. The research sample amounted to 39 respondents calculated by the Isaac and Michael formula with the sampling technique using accidental sampling. The research instruments used were Multidimensional Scale of Perceived Social Support (MSPSS) to assess social support and Beck Depression Inventory-II (BDI-II) to assess depression.

RESULTS: The results of the Pearson Product Moment test showed a highly significant correlation between social support and depression (p = 0.000) with a value of r = -0.756 indicating a strong level of correlation with a negative correlation direction.

CONCLUSION: The correlation between the two variables is strong and inversely proportional where the higher the social support received, the more depressive symptoms experienced will decrease. Family education is needed to maintain and increase social support to prevent and reduce depression in coronary heart disease patients.