Journal La Medihealtico

The Role of Maternal Stress Epigenetics in the Risk of Stunting among Children Aged 0–24 Months: A Community-Based Longitudinal Study

Juli Purnama Hamudi, Via Zakiah, Harni Harni — Tue, 30 Jun 2026 00:00:00 +0000

Stunting is a major child health problem influenced by multiple factors, including maternal conditions during pregnancy. This study aimed to analyze the relationship between maternal stress, epigenetic mechanisms, and the risk of stunting in children aged 0–24 months. A community-based prospective longitudinal cohort design was employed, involving 30 pregnant women who were followed until their children reached 24 months of age. Maternal stress was assessed using the Perceived Stress Scale (PSS), while epigenetic analysis was conducted via DNA methylation of the IGF2 gene from umbilical cord blood samples. Stunting status was determined based on length-for-age (LAZ) according to WHO standards. The results indicated a tendency toward an increased risk of stunting among mothers with high stress levels (OR=9.00; p>0.05), along with increased IGF2 methylation. Although not statistically significant, the pattern of association was clinically consistent. It is concluded that maternal stress may increase the risk of stunting through epigenetic mechanisms. Integrating stress management into antenatal care is recommended as a strategy for stunting prevention.

The Effectiveness of Combined Deep-Breathing Relaxation and Endorphin Massage in Reducing Pain and Anxiety During the Active Phase of the First Stage of Labor

Via Zakiah, Juli Purnama Hamudi, Harni Harni — Tue, 30 Jun 2026 00:00:00 +0000

Pain and anxiety during the active phase of the first stage of labor may increase physiological stress responses and potentially interfere with labor progress. Complementary therapies, including deep breathing relaxation and endorphin massage, have been widely used as non-pharmacological approaches to improve maternal comfort. To analyze the effectiveness of a complementary therapy combining deep breathing relaxation and endorphin massage in managing pain and anxiety during the active phase of the first stage of labor. A quasi-experimental study with a pretest-posttest control group design was conducted from January to March 2026 in the coastal area of Kendari City, Southeast Sulawesi, Indonesia. A total of 30 participants were recruited using purposive sampling and divided into an intervention group (n=15) and a control group (n=15). Pain intensity was assessed using the Numeric Rating Scale (NRS), while anxiety levels were measured using the Hamilton Anxiety Rating Scale (HARS). The intervention group demonstrated a significant reduction in pain intensity from 7.80 to 4.20 (p=0.000) and in anxiety levels from 26.5 to 18.3 (p=0.000). The mean reduction in pain (3.60 ± 0.75) and anxiety (8.20 ± 1.90) was significantly greater than that observed in the control group (p = 0.000). The combination of deep breathing relaxation and endorphin massage is an effective complementary therapy for reducing pain intensity and anxiety during the active phase of the first stage of labor and may be integrated into routine maternity care.

Prevalence and Socioeconomic Determinants of Food Insecurity Among Undergraduate Students in Indonesia: A Multi-Institutional Cross-Sectional Study

Netta Meridianti Putri, Resti Kurnia Triastanti, Riska Qurrota A’yun — Thu, 06 Aug 2026 00:00:00 +0000

Food insecurity among university students has become an important public-health issue, but evidence from Indonesia is lacking. This study estimated the prevalence and identified socioeconomic determinants of food insecurity among undergraduate students in Indonesia. We conducted a cross-sectional survey in November 2024 of 635 undergraduate students recruited from several higher-education institutions in Indonesia, mostly Universitas Tidar. Food insecurity was measured using the validated ten-item United States Department of Agriculture Adult Food Security Survey Module; raw scores ranged from 0–10 and were categorised into food secure, low, or very low food security, then dichotomised into food insecure (score ≥3) versus food secure. Sociodemographic and economic characteristics were collected through a self-administered questionnaire, and body-mass index was classified using Asia-Pacific cut-offs. Associations were examined using chi-square tests and multivariable logistic regression. The internal consistency of the food security module was good (Cronbach's α = 0.80). Overall, 43.3% of students were food insecure (95% CI 39.5–47.2), comprising 28.7% with low and 14.6% with very low food security. In the adjusted model, students living independently in boarding houses had markedly higher odds of food insecurity than those living with parents (adjusted odds ratio 4.91; 95% CI 3.27–7.38), and a clear dose–response gradient was observed for monthly allowance, with the lowest-allowance group at greatest risk (adjusted odds ratio 4.99; 95% CI 2.82–8.83). Sex, parental education, and smoking status were not significant after adjustment.

The Relationship Between Therapeutic Communication by Anesthesia Practitioners and Pre-Anesthesia Anxiety Levels Among Patients

Achmad Safi’i, Anis Prabowo, Sulastri Sulastri — Sun, 30 Aug 2026 09:35:55 +0000

Anesthesia and surgical procedures often cause anxiety in pre-anesthesia patients. Anxiety may affect both the physiological and psychological condition of patients before surgery. One of the efforts to reduce patient anxiety is through therapeutic communication performed by nurse anesthetists. To determine the relationship between therapeutic communication of nurse anesthetists and pre-anesthesia anxiety levels in patients at RS TK IV 03.07.04 Guntur Garut. This study used a quantitative research design with a cross-sectional approach. A total of 52 respondents were selected using purposive sampling technique. Data were collected using a therapeutic communication questionnaire and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire. Data were analyzed using Spearman rho test. The results showed that most therapeutic communication by nurse anesthetists was categorized as good in 30 respondents (57.7%). Most patients experienced mild anxiety, with 23 respondents (44.2%). Spearman rho test results showed a p-value of 0.000 (<0.05) with a correlation coefficient of -0.847, indicating a significant relationship with a very strong negative correlation. There is a relationship between therapeutic communication of nurse anesthetists and pre-anesthesia anxiety levels in patients at RS TK IV 03.07.04 Guntur Garut. The better the therapeutic communication provided by nurse anesthetists, the lower the anxiety level of pre-anesthesia patients.

Case Report: Malnutrition in an Adult Patient with Chronic Obstructive Pulmonary Disease

Agatha Nadya Lianto, Imelda Wiradarma — Mon, 31 Aug 2026 00:04:57 +0000

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disorder characterized by persistent airflow obstruction and is frequently accompanied by multiple comorbidities. One of the most common complications among patients with COPD is malnutrition, with approximately 20% of patients experiencing weight loss that contributes to reductions in skeletal muscle mass, respiratory function, and overall quality of life. Case Presentation: A 49-year-old male presented with complaints of dyspnea, cough, epigastric pain, fever, and decreased appetite. The patient had a medical history of COPD and pulmonary tuberculosis, for which treatment had been successfully completed in September 2024. Nutritional screening revealed that the patient appeared markedly underweight, with a body weight of 42 kg, a height of 185 cm, a body mass index (BMI) of 12.27 kg/m², and a mid-upper arm circumference (MUAC) of 18 cm, indicating severe malnutrition. Nutritional intervention was subsequently initiated, consisting of an energy intake of 1,500 kcal/day (38 kcal/kg body weight/day), protein intake of 70 g/day (1.7 g/kg body weight/day), a soft rice-based diet with finely minced high-carbohydrate, high-protein (TKTP) side dishes, supplementation with three eggs daily, and zinc tablets administered at a dosage of one tablet twice daily. Discussion: The provision of high-energy and high-protein nutritional therapy was intended to meet the patient's nutritional requirements, improve nutritional status, and facilitate the restoration of lost muscle mass. The use of a soft diet was expected to reduce postprandial dyspnea, prevent early satiety, and enhance dietary adherence. This case highlights that early nutritional screening and timely nutritional intervention constitute essential components of the comprehensive management of patients with COPD complicated by malnutrition. Long-term monitoring of body weight, nutritional status, and dietary tolerance is necessary to support successful patient rehabilitation and improve clinical outcomes.

Morbus Hansen Type MB ENL Reaction

Mon, 31 Aug 2026 07:57:51 +0000

Leprosy (Morbus Hansen) is a chronic infectious disease caused by Mycobacterium leprae that primarily affects the skin and peripheral nerves with highly diverse clinical manifestations depending on the host's immune response. This disease remains a public health problem in several endemic countries, including Indonesia, because it can cause permanent physical disabilities and social impacts such as stigma and discrimination. This paper aims to provide a comprehensive overview of the etiology, classification, clinical manifestations, diagnostic methods, and management of leprosy based on various scientific literature and current health guidelines. The Ridley–Jopling and WHO classifications are used to determine the severity of the disease and determine the appropriate therapeutic regimen. Diagnosis is established through clinical evaluation, bacteriological examination, histopathological examination, and other supporting tests. The recommended primary therapy is Multidrug Therapy (MDT), which has proven effective in killing germs, preventing drug resistance, and reducing the risk of relapse. In addition to medical aspects, leprosy management also emphasizes the importance of early detection, public education, and stigma reduction so that patients can receive prompt and appropriate treatment.

Effectiveness of Diabetic Foot Ulcer Management Using the Modern Wound Care Approach: A Literature Review

Nurwahyuni Nurwahyuni, Fadil Mula Putra, Adlia Purnawaty Harifuddin — Mon, 31 Aug 2026 08:23:17 +0000

Diabetic ulcers are a complication of diabetes mellitus that can lead to vascular disorders, neuropathy, infection, and an increased risk of amputation. Wound care is an essential component of the management of diabetic ulcers. Modern wound care methods such as advanced dressings, moist wound healing, Negative Pressure Wound Therapy (NPWT), and ultrasound-assisted wound debridement are considered more effective than conventional methods because they create an optimal wound environment, accelerate healing, reduce the risk of infection, and improve clinical outcomes in patients with diabetic ulcers. This study employed a literature review method using a systematic literature search approach through the Google Scholar, PubMed, and ScienceDirect databases. The literature search was conducted in May 2026 using keywords related to modern wound care, diabetic foot ulcers, moist wound healing, and wound healing. The analyzed articles consisted of studies investigating the effectiveness of modern wound care approaches for diabetic ulcers. Data were analyzed descriptively and narratively based on the findings of each study. The review findings indicated that modern wound care approaches including modern dressings, moist wound healing, Negative Pressure Wound Therapy (NPWT), and ultrasound-assisted wound debridement are effective in accelerating the healing of diabetic ulcers. These methods help maintain wound moisture, promote granulation tissue formation, reduce infection, and lower the risk of amputation. A multidisciplinary approach also contributes to improved clinical outcomes in patients. Modern wound care approaches are more effective than conventional wound care in accelerating the healing of diabetic ulcers. The effectiveness of treatment depends on the type of intervention, the patient’s condition, and the wound care approach used.

Literature Review: Prevalence and Management of Impetigo in Children

Firly Aurelia Aisya, Nurelly Nurelly, Fitriya Idrus — Mon, 31 Aug 2026 09:01:28 +0000

Impetigo is a highly contagious superficial bacterial skin infection that commonly affects children. Its high incidence worldwide, limited epidemiological data in Indonesia, evolving treatment options, and increasing antibiotic resistance highlight the importance of studying its prevalence and management. This study aimed to determine the risk factors, prevalence, and management of impetigo in children based on recent scientific literature. A literature review was conducted by searching PubMed, Google Scholar, ScienceDirect, ResearchGate, and ProQuest. Articles published between 2021 and 2026 were selected according to inclusion and exclusion criteria and analyzed descriptively. Fifteen eligible articles were included. Impetigo most frequently occurred among children aged 2–5 years through school age. Prevalence varied across regions and was higher in areas characterized by population density, poor sanitation, and a high incidence of scabies. Commonly reported risk factors included age, poor hygiene, overcrowding, and comorbid skin diseases. Management was adjusted according to disease severity. Topical antibiotics, including mupirocin, fusidic acid, retapamulin, and ozenoxacin, were used for mild and localized cases, whereas systemic antibiotics, such as cephalexin, dicloxacillin, amoxicillin-clavulanate, or clindamycin, were used for extensive or severe cases and suspected Methicillin-resistant Staphylococcus aureus (MRSA) infections. Increasing resistance to several topical antibiotics remains a concern when selecting therapy. Impetigo remains common among children, with regional variations in prevalence. Management based on lesion extent, clinical condition, and antibiotic resistance patterns is essential to improve treatment success and prevent complications and transmission. This study may serve as a reference for healthcare professionals in preventing and managing childhood impetigo.

Differences in Clinical Manifestations of Measles in Children with Complete and Incomplete Immunization History: Literature Review

A. Vania Nurul Anisah, Husni Esa Darussalam, Nur Ahmad Tabri — Mon, 07 Sep 2026 14:45:44 +0000

Measles is a highly contagious acute infectious disease. The six clinical manifestations assessed in this review are fever, cough, coryza, conjunctivitis, shortness of breath, and diarrhea. This literature review aims to analyze differences in these six manifestations in children based on their history or level of measles immunization completion. A search was conducted through PubMed, Google Scholar, and ScienceDirect, prioritizing original studies from 2020–2026. Articles in Indonesian, English, or other languages that were available in full text and could be adequately extracted were included. A total of five pediatric studies were included in the narrative and comparative synthesis. The results showed that fever was the most common symptom across all groups, thus limiting the ability to clinically differentiate immunization status. Cough, coryza, and diarrhea tended to be lower in vaccinated children in some studies, while findings regarding conjunctivitis were inconsistent. Direct evidence regarding shortness of breath is limited because most studies reported indirect respiratory indicators. In conclusion, a history of measles immunization tends to be associated with milder manifestations in some outcomes, but does not exclude the possibility of measles. Diagnosis still requires clinical assessment, epidemiological history, and laboratory confirmation.

Integration of Islamic Values in the Medical Professional Education Curriculum

Rania Hairunnisa Ngutro, Shulhana Mokhtar, Zulfitriani Murfat — Mon, 07 Sep 2026 15:13:45 +0000

The dichotomy between general scientific knowledge and Islamic values remains an unresolved structural challenge in medical education in Indonesia. Curricula focused solely on clinical and technical competencies have proven insufficient to cultivate physicians who are not only medically proficient but also possess noble character, spiritual integrity, and Islamic ethical sensitivity in patient care. Moreover, the healthcare world today faces mounting global pressures inequitable access to services, erosion of professional integrity, and a steady decline of empathy in day-to-day medical practice making the strengthening of profession ethics grounded in Islamic values an increasingly urgent agenda. This study uses a review article method (literature review) by collecting, examining, analyzing, and synthesizing various relevant previous research findings. The data sources are scientific articles from national and international journals that are fully accessible, with the criteria of being published in the last 5–10 years, related to the integration of Islamic values and medical education, and available in either Indonesian or English. Three main domains were found for integrating Islamic values into medical professional education: (1) Islamic values in clinical practice such as trustworthiness, honesty, justice, patience, and reliance on God; (2) the foundation of Islamic medical ethics derived from the Qur'an, Sunnah, consensus (ijma'), and analogical reasoning (qiyas), with the Maqasid al-Shariah framework as the main guide; and (3) shaping the character and professionalism of Muslim doctors, which includes intellectual competence, moral integrity, and spiritual care for patients. Integrating Islamic values into the medical education curriculum isn't just about adding a moral aspect; it's an epistemological foundation that shapes a complete Muslim doctor — clinically competent, morally upright, and sensitive to the spiritual dimensions of patients. A holistic strategy is needed, including developing a comprehensive curriculum, ongoing faculty training, and evaluation mechanisms based on Islamic values.

Relationship Between Hypertension History and Nutritional Status with the Incidence of Preeclampsia in Pregnant Women: Literature Review

Mon, 07 Sep 2026 15:38:12 +0000

Preeclampsia is one of the leading causes of perinatal morbidity and mortality worldwide, particularly in developing countries. High intake of saturated fats, pro-inflammatory diets, and excess body weight increase the risk of hypertension during pregnancy. A history of hypertension and maternal nutritional status are recognized as important risk factors contributing to the occurrence of preeclampsia. This literature review aimed to determine the relationship between a history of hypertension and nutritional status with the incidence of preeclampsia in pregnant women, based on several sources obtained through the internet, including research findings from international and national journals, citations from the Faculty of Medicine UMI, ClinicalKey, textbooks, and conference proceedings published between 2015 and 2026. The review findings indicate that the majority of studies reported that a history of hypertension significantly increases the risk of preeclampsia. In addition, excessive nutritional status such as overweight and obesity is strongly associated with a higher incidence of preeclampsia through mechanisms involving chronic inflammation, insulin resistance, oxidative stress, and endothelial dysfunction. Conversely, undernutrition and deficiencies of certain micronutrients may worsen the risk through impaired placental perfusion. The combination of a history of hypertension and suboptimal nutritional status exerts a synergistic effect on increasing the risk of preeclampsia. It is concluded that a history of hypertension and nutritional status are important determinants of preeclampsia; therefore, preconception screening, blood pressure control, and nutritional interventions need to be strengthened as preventive strategies.

The Role of HbA1c Levels in DM Patients with Coronary Heart Disease Incidents

Mon, 07 Sep 2026 23:58:36 +0000

Diabetes mellitus is a major risk factor for coronary heart disease (CHD), particularly when long-term glycemic control is inadequate. Glycated hemoglobin (HbA1c) reflects average blood glucose levels over the previous two to three months and may serve as an indicator of cardiovascular risk. This study aimed to examine the role of HbA1c levels in the incidence, severity, and clinical outcomes of CHD among patients with diabetes mellitus. A narrative literature review was conducted using articles published between 2021 and 2026 and retrieved from Google Scholar, PubMed, ScienceDirect, and ResearchGate. Studies were selected according to predetermined inclusion and exclusion criteria and critically evaluated using the Joanna Briggs Institute appraisal instruments. A total of 29 relevant studies were reviewed and synthesized narratively. Most studies demonstrated that elevated HbA1c levels were associated with an increased risk of CHD, greater coronary artery stenosis, more severe atherosclerotic lesions, and poorer cardiovascular outcomes, including major adverse cardiovascular events, restenosis following percutaneous coronary intervention, hospital readmission, and mortality. However, several cross-sectional studies reported no statistically significant association, possibly because of differences in sample characteristics, study design, duration of diabetes, assessment methods, and accompanying cardiovascular risk factors. Overall, poor glycemic control contributes to the development and progression of CHD through chronic hyperglycemia, oxidative stress, endothelial dysfunction, inflammation, and accelerated atherosclerosis. Regular HbA1c monitoring and individualized glycemic control are therefore important components of cardiovascular risk prevention and diabetes management.

Systematic Review: The Effect of Preemptive Ketamine Administration on Post-Surgical Neutrophil to Lymphocyte Ratio And Interleukin-6 (Il-6) Levels

Muhammad Fakhri R, Muhammad Wirawan Harahap, Herawaty Baderu — Tue, 08 Sep 2026 00:24:35 +0000

Surgical stress induces systemic inflammation characterized by increased neutrophil-to-lymphocyte ratio and interleukin-6 levels, which may contribute to postoperative pain, immune dysfunction, and complications. This systematic review aimed to evaluate the effects of preemptive ketamine administration on postoperative neutrophil-to-lymphocyte ratio and interleukin-6 levels. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Relevant studies were identified through PubMed, ScienceDirect, the Cochrane Central Register of Controlled Trials, Google Scholar, and ClinicalKey. Study selection was based on predefined population, intervention, comparison, outcome, and study-design criteria. Data were extracted using standardized tables, methodological quality was assessed using appropriate risk-of-bias instruments, and the findings were synthesized narratively according to ketamine dose, surgical procedure, biomarker measurement time, and clinical outcomes. Of 807 records identified, 17 studies were included in the final synthesis. Preemptive intravenous ketamine or S-ketamine generally reduced the early postoperative increase in the neutrophil-to-lymphocyte ratio and suppressed interleukin-6 secretion, particularly at subanesthetic doses of 0.3–0.75 milligrams per kilogram. These immunomodulatory effects were accompanied by lower postoperative pain scores, reduced opioid requirements, fewer episodes of postoperative nausea and vomiting, and a lower risk of chronic postsurgical pain. However, variations in dosage, surgical procedures, anesthetic techniques, and biomarker measurement times limited direct comparisons between studies. Preemptive ketamine appears to provide beneficial analgesic and immunomodulatory effects by attenuating postoperative systemic inflammation, although further standardized randomized trials are required to determine the optimal dosing regimen.