Journal Title Jurnal Sehat Indonesia (JUSINDO) DOI Prefix 10.59141 by Crossref Frequency 2 Issues per year (January & July) ISSN Online 2775-3077 Editor in Chief Cucu Herawati Publisher Publikasi Indonesia Indexing Crossref | Garuda Citation Analysis Google Scholar| Dimensions Jurnal Sehat Indonesia (Jusindo) is a double blind peer-reviewed academic journal and open access to health science fields. The journal is published biannual by CV. Publikasi Indonesia. Jurnal Sehat Indonesia (Jusindo) provides a means for ongoing discussion of relevant issues that fall within the focus and scope of the journal that can be empirically examined. This journal publishes research articles covering approach, which includes: Public Health, Occupational Health and Safety (Occupational Health; Hyperkes), Health Policy (and Health Analyst), Nutrition Science, Epidemiology, Environmental Health Engineering, Health Promotion, Life Insurance and Health Sciences, Environmental Health, Sports Science, Nursing Science, Obstetrics, Hospital Administration, Entomology (Health, Phytopathology), Biomedical Sciences, Ergonomics, Occupational Physiology, Physiotherapy, Medical Analyst, Physiology (Sports), Reproductive (Biology and Health), Acupuncture, Medical Rehabilitation.Journal has become a member of Crossref (Prefix: 10.59141) with Online ISSN 2775-3077 and Print ISSN 2775-0892
Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aCreative Commons Attribution-ShareAlike 4.0 International (CC-BY-SA). that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
The relationship between improved quality of life in patients undergoing aesthetic surgery and cosmetic procedures
Aesthetic procedures are increasingly performed worldwide and are associated with improved appearance satisfaction and quality of life. The success of aesthetic procedures is no longer measured solely by objective clinical outcomes but is increasingly evaluated using patient-reported outcomes. This study aimed to evaluate changes in quality of life before and after facial aesthetic surgery and non-surgical cosmetic procedures. This online survey-based pre-post analytical observational study used a structured questionnaire administered to adults aged 18 years or older who had undergone surgical or non-surgical facial cosmetic procedures within the previous 3–12 months. Quality of life was assessed using three FACE-Q domains: Appearance (23 items), Health-Related Quality of Life (10 items), and Adverse Effects (6 items), with each domain scored on a scale ranging from 0 to 100. Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. A total of 180 patients were included in the analysis (mean age, 30.26 ± 8.24 years; 53.9% underwent non-surgical procedures, and 46.1% underwent surgical procedures). Appearance scores improved from 52.48 ± 7.97 to 83.89 ± 8.02, Health-Related Quality of Life scores improved from 51.22 ± 8.74 to 84.12 ± 7.62, and Adverse Effects scores improved from 47.73 ± 8.79 to 80.92 ± 8.74 (all p < 0.001). Improvements in the non-surgical group were +32.23, +33.75, and +32.81 points, respectively, whereas the surgical group demonstrated improvements of +30.46, +31.90, and +33.61 points, respectively (all p < 0.001). Post-treatment scores were comparable between the non-surgical and surgical groups for Appearance (84.81 vs. 82.81; p = 0.094), Health-Related Quality of Life (85.08 vs. 82.99; p = 0.066), and Adverse Effects (80.49 vs. 81.41; p = 0.485). Overall, both surgical and non-surgical facial cosmetic procedures resulted in substantial and comparable improvements in appearance satisfaction and quality of life, supporting patient-reported outcomes as a key indicator of successful aesthetic treatment.
Copyright (c) 2026 Puguh Riyanto, Lydia Eryana Triastuti , Leoni Agnes , Nurmaliannysa Dwinandia Harahap , Cagar Irwin Taufan Pamungkas https://creativecommons.org/licenses/by-sa/4.0
Topical Fluorometholone versus Dexamethasone for Postoperative Inflammation Control following Phacoemulsification : A Systematic Review
Control of postoperative inflammation is a critical component of clinical management following phacoemulsification surgery, and topical corticosteroids remain the standard of care for this purpose; however, the comparative efficacy and safety profiles of fluorometholone (FML) versus dexamethasone (DEX) remain incompletely characterized due to the limited number of direct head-to-head clinical trials available in the literature. This systematic review screened studies comparing topical FML 0.1% against DEX 0.1% for the management of postoperative inflammation following phacoemulsification in adult patients without pre-existing ocular inflammatory conditions, with outcomes assessed including anterior chamber cell and flare grading, intraocular pressure (IOP) changes, incidence of cystoid macular edema (CME), and visual acuity, with data systematically extracted from both randomized controlled trials and observational studies. Direct comparative data between the two agents were limited; two independent network meta-analyses consistently ranked DEX as superior to FML for CME prevention, with DEX demonstrating the highest SUCRA probability [3,4], while one RCT reported that FML was associated with early IOP elevation, with 4.98% of patients experiencing a rise of ≥10 mmHg, whereas DEX showed no comparable elevation [1]. A separate meta-analysis comparing standard versus soft steroids demonstrated significantly lower anterior chamber flare with standard steroids (including DEX) at day 7 (SMD 0.26, 95% CI 0.05–0.47), though this difference did not persist at day 28 [5], and pharmacokinetic analyses revealed that FML achieves peak aqueous humour concentrations approximately 130-fold lower than prednisolone and substantially lower than DEX [6], with one study finding no significant difference in aqueous flare between FML and no steroid treatment at all [7]. These findings indicate that DEX demonstrates superior anti-inflammatory efficacy, particularly in preventing CME, likely attributable to its greater intraocular penetration capacity, whereas FML appears to offer a more favourable IOP safety profile across most available studies, although one contradictory trial reported higher IOP spikes associated with FML use, carrying the clinical implication that DEX is more effective for managing intraocular inflammation while FML may be adequate for mild ocular surface inflammation or as a step-down maintenance agent following initial DEX therapy. In conclusion, dexamethasone 0.1% demonstrates greater efficacy than fluorometholone 0.1% in controlling postoperative intraocular inflammation and preventing CME after phacoemulsification, albeit with a potentially elevated IOP risk in susceptible patients, and based on current evidence, fluorometholone should not be employed as first-line monotherapy for intraocular inflammation control following cataract surgery.
Copyright (c) 2026 Melisa Maharani, Euis Eva Masruroh https://creativecommons.org/licenses/by-sa/4.0
The Relationship Between Smartphone Addiction and Sleep Quality Among 2016 Freshmen in The Faculty of Medicine at Pelita Harapan University
The proliferation of smartphone use among university students has raised concerns about addiction and its potential consequences on sleep health, with medical students representing a particularly vulnerable population due to their demanding academic schedules, high stress levels, and extensive use of digital devices for learning purposes; despite growing evidence linking smartphone addiction to sleep disturbances globally, limited research has examined this relationship specifically among Indonesian medical students while controlling for important confounding factors such as anxiety. This study aims to determine the relationship between smartphone addiction and sleep quality among 2016 cohort medical students at Universitas Pelita Harapan, while also identifying the most dominant factors affecting sleep quality in this population. A cross-sectional analytic study was conducted involving 52 medical students selected through simple random sampling, with data collected using four standardized instruments: a demographic questionnaire, the Generalized Anxiety Disorder 7-Item (GAD-7), the Smartphone Addiction Scale-Short Version (SAS-SV), and the Pittsburgh Sleep Quality Index (PSQI); bivariate analysis employed Chi-Square or Fisher Exact tests, followed by multivariate logistic regression using SPSS version 22 to identify the most dominant predictors of poor sleep quality. The results revealed that 56% of respondents (n=29) had high smartphone addiction, while 62% (n=32) experienced poor sleep quality. Bivariate analysis demonstrated a significant association between smartphone addiction and poor sleep quality (p=0.003; OR=6.626; 95% CI 1.760–19.725), with anxiety showing an even stronger association (p=0.000; OR=15.443; 95% CI 3.106–76.644). Multivariate logistic regression confirmed that both smartphone addiction (p=0.017) and anxiety (p=0.001) were independent predictors of poor sleep quality, with anxiety being the more dominant factor, while lifestyle factors including smoking, alcohol consumption, caffeine intake, and medication use showed no significant associations with sleep quality (p>0.05). The high prevalence of poor sleep quality among medical students underscores the urgent need for institutional interventions, and medical education institutions should implement educational programs addressing smartphone usage management and anxiety reduction to promote better sleep health, with future research employing longitudinal designs and objective sleep measures needed to establish causal relationships and evaluate intervention effectiveness.
Copyright (c) 2026 Jeanette Rachel Audrey Leo, Michael Tanaka , Stevent Sumantri , Irma Lusiana Tantri https://creativecommons.org/licenses/by-sa/4.0
The Relationship Between Self-Efficacy and Zinc Intake and Academic Achievement Among Junior High School Students
Academic achievement among junior high school students is influenced by various internal factors, particularly psychological factors such as self-efficacy and physiological factors such as adequate zinc intake, both of which play important roles in learning motivation and cognitive function. This study aimed to analyze the association between self-efficacy and zinc intake and academic achievement among junior high school students. This quantitative observational analytic study employed a case-control design and was conducted among eighth-grade students at SMP in PK Surakarta from October to December 2025. A total of 94 students were selected using purposive sampling. Self-efficacy was measured using the General Self-Efficacy Scale (GSES), zinc intake was assessed using a Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ), and academic achievement was determined based on Mid-Semester Summative Assessment scores. Data were analyzed using univariate analysis, bivariate analysis with the Chi-square test, and multivariate analysis using binary logistic regression. Low self-efficacy was associated with poor academic achievement (p = 0.032; OR = 2.567; 95% CI: 1.075–6.131), while low zinc intake showed a stronger association with poor academic achievement (p < 0.001; OR = 9.103; 95% CI: 2.456–33.708). In multivariate analysis, both zinc intake and self-efficacy were significantly associated with academic achievement. Zinc intake and self-efficacy were associated with academic achievement among junior high school students.
Copyright (c) 2026 Aghniya Intan Ridhoputrie, Mohammad Shoim Dasuki https://creativecommons.org/licenses/by-sa/4.0
The Relationship Between mSOFA and the Ratio of Treatment Costs to BPJS Coverage in Medical Cases in the ICU at Dr. Cipto Mangunkusumo National General Hospital: A Cost Analysis Study
In the prospective payment system based on INA-CBGs, understanding the relationship between patient clinical complexity and the proportion of intensive care unit (ICU) costs relative to the INA-CBGs tariff is essential for evaluating service efficiency and equity in health financing allocation. However, few empirical studies in Indonesia have examined how factors such as the mSOFA score, mechanical ventilation use, hemodialysis, and length of ICU stay relate to ICU cost proportions. This prospective cohort study was conducted at Dr. Cipto Mangunkusumo National General Hospital from 1 January to 31 March 2026, involving 46 adult patients admitted to the medical ICU with complete INA-CBGs claims. Data were extracted from electronic medical records and the hospital’s financial information system, including daily mSOFA scores, mechanical ventilation status, hemodialysis administration, ICU length of stay, actual ICU costs, and corresponding INA-CBGs tariffs. The analysis showed that no increase in ICU cost proportion was observed with higher mSOFA scores or longer ICU stays. In contrast, variability in cost proportion decreased among patients with mSOFA ≥6 and ICU stays longer than four days, suggesting that in critically ill patients with high disease severity, ICU costs become relatively more predictable compared with INA-CBGs tariffs. ICU cost proportion is not determined linearly by a single intervention but instead results from a complex interplay among disease severity, accuracy of diagnosis and procedure coding, and daily clinical dynamics during ICU admission.
Copyright (c) 2026 Meirina, Rudyanto Sedono, Vera Irawany, Sidharta Kusuma Manggala https://creativecommons.org/licenses/by-sa/4.0
Comparative Approaches to Antimicrobial Resistance Testing in Sepsis: E-Test and Molecular Diagnostics – A Scoping Review
Sepsis remains a major global health problem with high morbidity and mortality. Rapid antimicrobial susceptibility testing (AST) is essential, but conventional methods are time-consuming and may delay appropriate therapy. This study aimed to compare phenotypic methods, particularly the E-test, and molecular diagnostics for antimicrobial susceptibility testing in sepsis. A scoping review was conducted using PubMed, ScienceDirect, and other sources for studies published between 2016 and 2026. From 214 identified records, 10 studies met the inclusion criteria and were analyzed. Molecular diagnostics provided results within 1–8 hours, while rapid phenotypic methods required 3–7 hours, compared to 48–96 hours for conventional methods. Molecular approaches showed high resistance detection accuracy (up to 99%), whereas phenotypic methods demonstrated high agreement with reference standards (>95–99%). Rapid diagnostics improved antimicrobial therapy optimization, with treatment modification reported in up to 21% of patients. Phenotypic and molecular methods have complementary strengths. Molecular diagnostics offer speed, while phenotypic methods such as the E-test ensure accuracy. An integrated approach may improve antimicrobial stewardship and clinical outcomes in sepsis.
Copyright (c) 2026 Putu Ngurah Pradnya Wibawa, Ni Putu Lia Juliantini, Ni Luh Putu Serly Ekayanti https://creativecommons.org/licenses/by-sa/4.0
Efficacy Versus Safety, an Updated Systematic Review of Proton Pump Inhibitors and H2-Receptor Antagonists for Stress Ulcer Prophylaxis
Stress-related mucosal disease (SRMD) remains a significant concern in intensive care, with mucosal damage often occurring within the first 24 hours of admission. While modern critical care practices and early enteral nutrition have reduced the incidence of clinically significant bleeding to approximately 2–3%, the consequences of such events—ranging from hemodynamic instability to prolonged mechanical ventilation—remain severe. Stress ulcer prophylaxis (SUP) is standard practice; however, the choice between proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) remains a subject of clinical debate. As newer data have emerged since 2022, there is a pressing need to re-evaluate whether the potent acid suppression of PPIs offers a genuine survival advantage or whether it introduces unnecessary infectious risks. A systematic search was conducted across PubMed, ScienceDirect, the Cochrane Library, and Scopus, covering literature from inception through 15 August 2025. This review specifically targeted geriatric populations (≥65 years) in acute care settings. The selection process involved rigorous screening using Rayyan software, identifying nine high-quality studies—including the landmark PEPTIC trial and several large-scale observational cohorts. Quality was assessed using the Cochrane RoB 2 tool for randomized trials and the Newcastle–Ottawa Scale for observational studies, ensuring a robust synthesis of contemporary real-world evidence. Analysis of the included studies revealed a complex trade-off between efficacy and safety. Regarding mortality, the evidence was largely neutral; the PEPTIC trial reported a 90-day mortality risk ratio of 1.05, and most observational cohorts similarly showed no clear survival benefit. In terms of efficacy, PPIs demonstrated superior ability to reduce clinically important gastrointestinal bleeding (GIB) in large-scale trials (RR 0.73 in the PEPTIC study), although this finding was not consistently replicated in observational data, where heterogeneity was high. Crucially, the “cost” of profound acid suppression became evident in safety outcomes. PPI use was associated with a higher incidence of *Clostridioides difficile* infection (CDI) and a trend toward increased hospital-acquired pneumonia. In contrast, H2RAs demonstrated a more favorable safety profile, with lower infectious complications and, in some settings, reduced healthcare resource utilization. The findings suggest that a “one-size-fits-all” approach to stress ulcer prophylaxis is no longer appropriate. While PPIs are effective in preventing major bleeding in high-risk patients—such as those with severe coagulopathy—they do not improve overall survival and may predispose vulnerable patients to serious infections. H2RAs emerge as a balanced alternative, offering adequate protection with fewer adverse effects. Clinicians should adopt an individualized SUP strategy, prioritizing PPIs for patients at the highest risk of hemorrhage while favoring H2RAs or early discontinuation in patients for whom the risk of infection and sepsis outweighs the potential benefit of gastrointestinal bleeding prevention.
Copyright (c) 2026 Ignasius Adi Dharma, I Wayan Oka Semara Jaya , Nyoman Kertia https://creativecommons.org/licenses/by-sa/4.0
Innovative α-Cryptoxanthin (α-C) Anti-Aging Serum Based on Lecithin and Hyaluronic Acid in a Self-Emulsifying Delivery (SED) System
Skin aging is not only due to complex biological processes but also affected by exposure to ultraviolet (UV) radiation. Exposure to UV radiation triggers the formation of Reactive Oxygen Species (ROS), hyperpigmentation, decreased elasticity, and collagen production. α-cryptoxanthin (α-C), one of the carotenoids with significant antioxidant, anti-inflammatory, and photoprotective properties. However, its use in serum preparations is still very limited. α-C also has lipophilic properties and low solubility in water. Therefore, this study aims to develop an anti-aging serum α-cryptoxanthin based on lecithin-hyaluronic acid using a self-emulsifying delivery (SED) system as an approach to improve delivery stability and potential effectiveness of active ingredients. The method used is a non-experimental study by collecting data, recording, and processing literature materials. Eligible studies were identified through searches on PubMed, Scopus, Google Scholar, Web of Science, Wiley, and ScienceDirect from 2016–2026. The results showed that α-C provides indirect photoprotective by neutralizing ROS due to UV exposure, reducing hyperpigmentation and supporting skin structure through stimulation of collagen production. Hyaluronic acid also improves skin hydration and elasticity which all contribute to a younger skin appearance. This innovation also supports the Sustainable Development Goals (SDGs) point 3 (Good Health and Well-Being) through the development of skin care concepts and point 12 (Responsible Consumption and Production) by encouraging the use of natural active ingredients and sustainable cosmetic formulation innovations.
Copyright (c) 2026 Jess Henry Aryasatya https://creativecommons.org/licenses/by-sa/4.0
Anesthesia in a Pediatric Patient with Acyanotic Congenital Heart Disease: A Case Report
Anesthesia in pediatric patients with acyanotic congenital heart disease requires a specialized approach due to complex interactions between cardiac anatomy and physiology, as well as the risk of perioperative hemodynamic instability. A two-month-old, 5-kg infant presented with a congenital heart defect and a left eyelid anomaly present since birth. Physical examination revealed superior palpebral coloboma with symblepharon and exposure keratitis. The patient was scheduled for surgical repair, and preoperative assessment identified anemia and thrombocytosis. Anesthetic management included preoperative fasting, fluid calculation, and premedication with atropine sulfate 0.1 mg and intravenous fentanyl 15 mcg (2–3 mcg/kg body weight). Intubation was facilitated using atracurium, and anesthesia maintenance was achieved with sevoflurane and fentanyl. Intraoperative monitoring ensured adequate end-tidal CO₂ (EtCO₂) levels and oxygen saturation. The one-hour procedure addressed the eyelid defect, followed by postoperative analgesia. The patient was monitored for three days postoperatively and discharged on the fourth day. Previous studies have shown that children with congenital heart disease undergoing non-cardiac surgery face increased perioperative risks influenced by factors such as overall condition and disease severity. Accordingly, clinical outcomes are highly dependent on anesthesia management tailored to these physiological considerations. Pediatric patients with congenital heart disease can safely undergo general anesthesia for non-cardiac procedures when comprehensive preoperative preparation and meticulous intraoperative monitoring are implemented.
Copyright (c) 2026 I Made Pasek Budiadnyana, I Ketut Wibawa Nada https://creativecommons.org/licenses/by-sa/4.0
Management of Short-Segment Hirschsprung-Associated Enterocolitis in an Infant in East Kalimantan, Indonesia: A Case Report
Hirschsprung’s disease (HD) is a congenital disorder characterized by the absence of ganglion cells in the Meissner’s and Auerbach’s plexuses. The incidence of HD has been reported to be higher in Asian infants; nevertheless, HD cases in Indonesia remain underexamined. Delayed diagnosis places neonatal patients with HD at a 13-fold increased risk of developing Hirschsprung-associated enterocolitis (HAEC) preoperatively, which may be a life-threatening condition. A 51-day-old female infant was brought to the emergency room with abdominal distension and vomiting, and had bowel movements only 1–2 times per week, with an estimated volume of approximately 5 cc per episode. Radiographic examination showed a narrowed sigmoid colon and constriction of the rectosigmoid region, accompanied by proximal colonic dilatation. A HAEC score was calculated, yielding a result of 14, consistent with Hirschsprung-associated enterocolitis. Management in this case followed the American Pediatric Surgical Association Board of Governors Guidelines. A transanal Swenson procedure with frozen section biopsy was performed, and intraoperative findings confirmed short-segment Hirschsprung-associated enterocolitis. The diagnosis and patient management were carried out appropriately in accordance with established guidelines and clinical standards.
Copyright (c) 2026 Megaria Sihombing, Santi Rini, Nisa Alyananda Ritonga, Sonia Edna Rumondang, Nurmasithah Nurmasithah https://creativecommons.org/licenses/by-sa/4.0
The Relationship Between Depression Levels and Antisocial Behavior Among Students in the Faculty of Medicine at Nusa Cendana University
The prevalence of psychological distress among medical students is higher than that of the general population, with depression being one of the most commonly reported conditions. Psychosocial disorders, such as stress and depression, may develop into more severe depressive disorders and antisocial behavior if left untreated. This study aimed to identify the relationship between depression levels and antisocial behavior among students at the Faculty of Medicine, Nusa Cendana University. A cross-sectional design was employed in this study. The sample consisted of 122 students from the Faculty of Medicine, Nusa Cendana University, from the 2017, 2018, and 2019 cohorts. Depression levels were measured using the validated Beck Depression Inventory-II (BDI-II) questionnaire, while antisocial behavior was assessed using the Subtypes of Antisocial Behavior (STAB) questionnaire. Data were analyzed using Somers’ d correlation test. The results showed that 86 respondents (70.49%) had minimal or no depression, 19 respondents (15.57%) had mild depression, 11 respondents (9.02%) had moderate depression, and 6 respondents (4.92%) had severe depression. Regarding antisocial behavior, 109 respondents (89.34%) demonstrated low levels of antisocial behavior, 13 respondents (10.66%) demonstrated moderate levels, and no respondents exhibited high levels of antisocial behavior. The analysis revealed a p-value of 0.001 (α < 0.05), indicating a statistically significant relationship between depression levels and antisocial behavior among students. Therefore, this study concluded that depression levels were significantly associated with antisocial behavior among students at the Faculty of Medicine, Nusa Cendana University (p = 0.001).
Copyright (c) 2026 Saka Pamukti Supriyadi, Conrad Liab H. Folamauk, Rr. Listyawati Nurina https://creativecommons.org/licenses/by-sa/4.0
Senescence-Associated Secretory Phenotype as a Key Driver of Intestinal Aging: A Narrative Review
Population aging is accompanied by progressive deterioration of intestinal structure and function, leading to impaired epithelial regeneration, increased intestinal permeability, chronic inflammation, and gut microbiota dysbiosis. Emerging evidence has identified the senescence-associated secretory phenotype (SASP) as a major mediator linking cellular senescence to intestinal aging; however, current evidence remains fragmented. This narrative review aimed to synthesize recent findings regarding the role of SASP in intestinal aging, with particular emphasis on its molecular mechanisms, biological consequences, and potential therapeutic strategies. A literature search was conducted in PubMed using the keywords ("senescence-associated secretory phenotype" OR SASP) AND (gut OR intestin* OR gastrointestin*) AND aging. The initial search identified 113 publications. After title and abstract screening, 60 articles were retained, and the exclusion of review articles and other non-original publications resulted in 28 original studies. Following full-text assessment, 26 articles were included for qualitative synthesis. The available evidence indicates that SASP contributes to intestinal aging by promoting chronic inflammation, impairing intestinal stem cell function, disrupting epithelial barrier integrity, remodeling the extracellular matrix, and altering gut microbiota composition. These interconnected mechanisms create a self-amplifying cycle that accelerates intestinal dysfunction and the loss of tissue homeostasis. Furthermore, emerging senotherapeutic approaches, including senolytics, senomorphics, and microbiota-targeted interventions, show promise in mitigating SASP-mediated intestinal aging. Overall, SASP represents both a key mechanistic driver and a promising therapeutic target for preserving intestinal homeostasis and promoting healthy aging.
Copyright (c) 2026 Yustina Nuke Ardiyan, Johana Puspasari Dwi Pratiwi https://creativecommons.org/licenses/by-sa/4.0
Strategy for Managing Solid Medical Waste at Health Care Facilities (Fasyankes) Within the Working Area of the Balai Jaya Community Health Center, Rokan Hilir Regency
This research aims to analyze the existing conditions of solid medical waste management, identify internal and external factors influencing medical waste management, and formulate a solid medical waste management strategy in health care facilities (fasyankes) within the working area of the Balai Jaya Community Health Center (Puskesmas), Rokan Hilir Regency. The research employed a descriptive approach using SWOT analysis. Data were obtained through observations, in-depth interviews, and documentation studies conducted at various types of health care facilities within the working area of the Balai Jaya Community Health Center. The analysis was performed using the IFAS and EFAS matrices to determine the strategic position of solid medical waste management. The results indicate that solid medical waste management in the Balai Jaya Community Health Center’s working area is not yet optimal. The improper mixing of medical and nonmedical waste is still observed, waste containers do not fully comply with established standards, Temporary Storage Facilities (Tempat Penyimpanan Sementara [TPS]) for hazardous and toxic waste (Bahan Berbahaya dan Beracun [B3]) do not meet requirements in some health care facilities, dedicated waste management personnel are unavailable, and regular training on medical waste management has not been implemented. Furthermore, most health care facilities do not routinely weigh and record waste generation, resulting in inadequate documentation of waste management practices. Internal factor analysis indicates that the primary strengths include health care workers’ knowledge of medical and hazardous waste management, the use of personal protective equipment, and their awareness of occupational health and safety.
Copyright (c) 2026 Rikcart Padot Sianturi, Eni Sumiarsih, Dedi Afandi https://creativecommons.org/licenses/by-sa/4.0
Male Breast Cancer Initially Misdiagnosed as Gynecomastia: A Case Report of Delayed Diagnosis in a 62-Year-Old Man
Male breast cancer is a rare malignancy, accounting for approximately 1% of all breast cancer cases; however, its rarity frequently contributes to delayed diagnosis. Gynecomastia, a benign proliferation of male breast glandular tissue, may mimic early-stage male breast cancer and represents a significant diagnostic challenge. This case report describes a 62-year-old man with a right subareolar breast mass that was initially diagnosed as gynecomastia based solely on clinical assessment. Conservative management was pursued until progressive enlargement and nipple retraction prompted surgical referral. Core needle biopsy confirmed invasive ductal carcinoma, not otherwise specified (NOS), Grade II, with pathological staging of pT2N1M0 (Stage IIB). The patient underwent modified radical mastectomy followed by adjuvant chemotherapy and hormonal therapy. This case highlights that male breast cancer predominantly presents as invasive ductal carcinoma (85–95%), with hormone receptor positivity observed in more than 90% of cases. Clinical red flags can help distinguish male breast cancer from gynecomastia when systematically assessed, while core needle biopsy remains the diagnostic standard. This case underscores the critical importance of tissue biopsy in male patients presenting with a unilateral, firm, or eccentric breast mass, regardless of initial clinical suspicion. Early histopathological evaluation is essential to minimize diagnostic errors and optimize patient outcomes.
Copyright (c) 2026 Alendra Chakramurty, Tresnawaty Tresnawaty https://creativecommons.org/licenses/by-sa/4.0
Hemodynamic Stability During Severe Scoliosis Surgery Using A Dexmedetomidine-Based Anesthesia Regimen: A Case Report
Severe adult idiopathic scoliosis with a Cobb angle >80° is a complex condition that presents significant anesthetic challenges due to restrictive ventilatory impairment, potential hemodynamic instability, and the risk of massive blood loss during spinal surgery. A 20-year-old woman with an American Society of Anesthesiologists (ASA) Physical Status Classification II was diagnosed with Lenke type 3 idiopathic scoliosis (Cobb angle: 83°) and scheduled for spinal stabilization surgery. Preoperative evaluation revealed a Mallampati class II airway, preserved cardiac function (ejection fraction [EF] 62%), and restrictive pulmonary impairment with low cardiopulmonary risk. General anesthesia was administered using a combination of dexmedetomidine (0.3 mcg/kg/hour), fentanyl (3 mcg/kg), propofol (2 mg/kg), rocuronium (1 mg/kg), and desflurane (6–7 vol%). Intraoperative hemodynamic parameters remained stable. Postoperatively, the patient was successfully extubated in the operating room and transferred to the inpatient ward after 24 hours of intensive care unit (ICU) monitoring, with adequate pain control and no neurological complications. The dexmedetomidine-based anesthesia regimen provided hemodynamic stability, reduced the requirement for additional anesthetic agents, and supported early extubation without respiratory depression. A comprehensive anesthetic approach and blood conservation strategy contributed to optimal clinical outcomes. Comprehensive anesthesia management in severe scoliosis may improve physiological stability, reduce complications, and facilitate recovery.
Copyright (c) 2026 William Wilson Wantania, Diana Christine Lalenoh https://creativecommons.org/licenses/by-sa/4.0
Acute Fatty Liver of Pregnancy (AFLP): A Case Report
Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening obstetric emergency that typically occurs during the third trimester and may lead to acute liver failure in pregnant women. Maternal and fetal mortality rates are substantially increased without prompt diagnosis and treatment; therefore, early recognition and immediate intervention are essential. This case report describes a 34-week pregnant woman who was admitted to the hospital with complaints of nausea, vomiting, heartburn, weakness, and jaundice. Laboratory examinations revealed signs of acute liver failure, including hypoglycemia, elevated liver enzymes, hyperbilirubinemia, severe coagulopathy with disseminated intravascular coagulation (DIC), and thrombocytopenia. The diagnosis of AFLP was established based on the Swansea criteria, with the patient fulfilling ≥6 criteria. The patient was managed in the intensive care unit (ICU), where stabilization was achieved through oxygen therapy, glucose infusion, electrolyte correction, transfusion of blood components, including fresh frozen plasma (FFP) and platelets, to manage DIC, vitamin K administration, and broad-spectrum empirical antibiotic therapy. Once stabilized, an emergency cesarean section was performed at 34 weeks of gestation to prevent further disease progression. The infant was delivered with a birth weight of 2,450 g and Apgar scores of 3 and 5, requiring admission to the neonatal intensive care unit (NICU). Following delivery, the mother’s condition gradually improved, with liver function and coagulation parameters showing improvement within 3–4 days and approaching normal levels within 1 week. Both the mother and infant recovered and were discharged home in good condition.
Copyright (c) 2026 Yustisa Sofirina Harahap, Sidharta Kusuma Manggala https://creativecommons.org/licenses/by-sa/4.0
Complete Dissolution of a Small Gallstone After Three Months of Ursodeoxycholic Acid Therapy: A Case Report
Cholelithiasis is a common biliary tract disorder frequently encountered in clinical practice. Laparoscopic cholecystectomy remains the standard treatment for symptomatic gallstones; however, nonsurgical therapy with ursodeoxycholic acid (UDCA) may be considered for selected patients with small, uncomplicated gallstones. We report the case of a 68-year-old woman who presented with right upper quadrant abdominal pain. Abdominal ultrasonography revealed a solitary gallstone measuring 0.58 cm without evidence of cholecystitis. The patient was treated with ursodeoxycholic acid at a dose of 500 mg daily. Follow-up ultrasonography performed after three months of therapy demonstrated complete resolution of the gallstone. This case highlights that UDCA may serve as an effective nonsurgical treatment option for selected patients with cholelithiasis, particularly those with small solitary gallstones without inflammatory findings. Clinicians should consider UDCA as a therapeutic alternative for patients who are unsuitable for surgery or decline operative intervention, with routine ultrasonographic follow-up recommended to assess treatment response.
Copyright (c) 2026 I Wayan Oka Semara Jaya, Ignasius Adi Dharma, I Made Suma Wirawan https://creativecommons.org/licenses/by-sa/4.0
Antifungal Therapy for Complicated Intra-Abdominal Infection: A Case Report
Complicated intra-abdominal infection (cIAI) is a serious condition characterized by the extension of infection beyond the gastrointestinal tract into the peritoneal cavity and is associated with high morbidity and mortality. Management of cIAI requires a comprehensive approach, including prompt diagnosis, adequate source control, and appropriate antimicrobial therapy. This case report describes the role of antifungal therapy in the management of cIAI in a critically ill patient with multiple risk factors for invasive fungal infection. A 52-year-old woman with a history of cervical cancer treated with radiotherapy and chronic hemodialysis presented with abdominal pain, nausea, vomiting, and inability to tolerate oral intake. Diagnostic evaluation revealed obstructive ileus and necrotic ileal tissue requiring exploratory laparotomy and intestinal resection. Postoperatively, the patient was admitted to the intensive care unit and received broad-spectrum antibiotics combined with fluconazole as empirical antifungal therapy. Clinical and laboratory improvements were observed during intensive care management, leading to stabilization and subsequent transfer to a high-dependency unit. This case highlights the importance of considering antifungal therapy in healthcare-associated intra-abdominal infections, particularly among immunocompromised and critically ill patients at risk of Candida infection. Early recognition, adequate source control, and individualized antimicrobial selection remain essential for optimizing patient outcomes.
Copyright (c) 2026 Mega Halida, Vera Irawany , Adhrie Sugiarto https://creativecommons.org/licenses/by-sa/4.0
Clinical Outcomes and Complications of Simultaneous Bilateral Total Knee Arthroplasty Compared with Staged Total Knee Arthroplasty in Patients with Severe Knee Osteoarthritis
Osteoarthritis (OA), the most common degenerative joint disease and a leading cause of disability, primarily affects the knee joint. In severe knee OA, total knee arthroplasty (TKA) is an effective treatment option; bilateral cases may be managed through simultaneous bilateral total knee arthroplasty (simBTKA) or staged total knee arthroplasty (staTKA), depending on patient characteristics and risk profiles. simBTKA may reduce overall treatment duration and healthcare costs but is associated with a higher risk of short-term mortality, venous thromboembolism, increased transfusion requirements, and more complex rehabilitation. Evidence remains limited regarding which patients derive the greatest benefit, medium- to long-term outcomes (patient-reported outcome measures [PROMs], including the Oxford Knee Score [OKS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and range of motion [ROM]), and total treatment costs. This study aimed to compare the clinical outcomes and complications of simBTKA and staTKA in patients with severe knee OA using a retrospective cohort design based on medical records of patients with severe bilateral OA who underwent either simBTKA or staTKA at RSCM, Fatmawati Central General Hospital, and St. Carolus Hospital between January 2021 and September 2024, according to predefined eligibility criteria. The assessed outcomes included OKS, WOMAC, ROM, length of stay (LOS), and complication incidence, which were analyzed using SPSS version 25 for Windows. Before adjustment, WOMAC scores were higher in the simBTKA group than in the staTKA group (median 28 vs. 14; p = 0.012), with no significant differences observed in OKS or ROM. Following ANCOVA adjustment, WOMAC scores were lower in the simBTKA group than in the staTKA group (adjusted mean 22.31 vs. 28.72; p = 0.04), and ROM was superior in the simBTKA group (adjusted mean 119.42 vs. 112.80; p = 0.03). Blood loss was greater in the staTKA group than in the simBTKA group (median 650 vs. 200 cc; p < 0.001). Overall, after adjustment, WOMAC scores and ROM outcomes were better in the simBTKA group than in the staTKA group, whereas blood loss was greater in the staTKA group.
Copyright (c) 2026 Othdeh Samuel Halomoan Siahaan, Ludwig Andribert Powantia Pontoh , Ismail Hadisoebroto Dilogo , Endro Tomo Sumargono https://creativecommons.org/licenses/by-sa/4.0
Clinical Profile and Bacteriological Patterns of Urinary Tract Infections in Hospitalized Pediatric Patients at Ngoerah Hospital
Urinary tract infection (UTI) is a common bacterial infection in children, particularly among infants, and may lead to complications such as renal scarring and hypertension. Clinical manifestations vary according to age, with infants often presenting with nonspecific symptoms, while Escherichia coli is the most frequently identified pathogen, followed by other Gram-negative organisms. However, local data regarding bacterial patterns and clinical manifestations of pediatric UTIs at Ngoerah Hospital remain limited. This descriptive study aimed to characterize bacterial patterns and clinical features among children with UTIs who were hospitalized at Ngoerah Hospital from 2020 to 2025 using medical record data to strengthen local epidemiological evidence. A minimum of 100 patients was selected through consecutive sampling based on sample size calculations for descriptive categorical studies. Data were extracted from medical records, analyzed using SPSS version 20, and presented as frequency and percentage distributions. Among the 100 children with UTIs hospitalized at Ngoerah Hospital between 2020 and 2025, the highest proportion of cases occurred in the >5-year age group (51%), with a relatively balanced sex distribution. The most common clinical manifestation was fever (73%), followed by dysuria (18%). The bacterial etiology was predominantly composed of Gram-negative organisms, with Escherichia coli (38%) and Klebsiella pneumoniae (21%) identified as the most common pathogens, followed by Pseudomonas aeruginosa (12%), Proteus mirabilis (7%), and Enterococcus faecalis (4%). Overall, pediatric UTIs at Ngoerah Hospital between 2020 and 2025 were most frequently observed among children aged >5 years and commonly presented with fever, with Escherichia coli identified as the predominant causative organism.
Copyright (c) 2026 Ni Putu Ayu Elistya Ning Purwani, Gusti Ayu Putu Nilawati , I Made Karma Setiyawan https://creativecommons.org/licenses/by-sa/4.0
The Role of Emotional Intelligence and Self-Efficacy in Predicting Academic Achievement of Medical Students
Academic achievement among medical students is often measured using the Grade Point Average (GPA), which reflects a student's overall academic performance throughout the course of study. Medical students face substantial academic demands that frequently result in moderate to severe levels of stress. Emotional intelligence, encompassing self-motivation, emotional regulation, empathy, and teamwork, has been shown to influence academic performance, while students with high self-efficacy tend to achieve better academic outcomes. This study aimed to examine the relationships between emotional intelligence, self-efficacy, and GPA, both individually and simultaneously. An analytical observational study with a cross-sectional design was conducted. The participants consisted of 108 medical students from Universitas Muhammadiyah Semarang, selected through purposive sampling. Emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire–Short Form (TEIQue-SF), and self-efficacy was assessed using the Academic Self-Efficacy Scale (TASES). Bivariate analysis was performed using the Mann–Whitney U test, while multivariate analysis was conducted using multinomial logistic regression. The majority of respondents demonstrated high emotional intelligence but low self-efficacy, and most had a high GPA. There was no significant association between emotional intelligence and GPA or between self-efficacy and GPA, and neither variable showed a significant independent effect in the multivariate analysis. However, emotional intelligence and self-efficacy jointly had a significant effect on GPA. In conclusion, emotional intelligence and self-efficacy were not individually associated with GPA; however, together they significantly influenced GPA, although other factors likely also contributed to the academic performance of these medical students.
Copyright (c) 2026 Aisya Alya Iqlima Rizfahdilla, Rihadini Pudjo, Gharini Sumbaga Narhadina https://creativecommons.org/licenses/by-sa/4.0