Journal of Medicine and Health

The Systemic Immune Inflammation Index as a Post-Stroke Disability Predictor in Acute Ischaemic Stroke Patients

Gilbert C Gunawan — 2026-08-30

The Systemic Immune Inflammation (SII) Index is a biomarker that may help predict stroke prognosis. However, studies on the SII Index are still limited, particularly in Indonesia. The purpose of this study was to measure the SII Index as a predictor factor of disability-prognosis for acute ischemic stroke patients. This study used a retrospective cohort design. Subjects’ data (112 subjects) were collected from STROKE REGISTRY RS Bethesda Yogyakarta. In this study, the independent variable was SII Index, whereas the dependent variables were mRS and BI. SII Index was analysed via ROC/AUC with mRS output to find the best cut-off value. Bivariate analyses were performed using the Spearman rho test to observe the correlation between risk factors and clinical outcomes. Risk factors with significant correlations would be re-analyzed with regression tests to observe the correlations affected by one another. Of 112 patients, the best cut-off for SII Index was 773.242 (sensitivity 92.9%; specificity 62.2%). Significant correlations were found between the SII Index and stroke severity with both mRS and BI (p < 0.01 for all). Significant results were shown on the regression tests between the SII Index and both mRS and BI (p < 0.01 for all). SII Index has been proven as a predictor factor of disability-prognosis for acute ischaemic stroke.

Early versus Delayed Pulmonary Rehabilitation and Short-Term ICU Outcomes in Mechanically Ventilated Patients

Atika L Qomarianty — 2026-08-30

Mechanical ventilation is a life-saving intervention in the intensive care unit (ICU), yet it is commonly associated with prolonged immobilization, muscle weakness, and delayed recovery. Pulmonary rehabilitation (PR) has been applied to reduce these complications, although the optimal timing of its initiation in mechanically ventilated patients remains unclear. This study aimed to compare short-term ICU outcomes, including duration of mechanical ventilation and ICU length of stay, between patients receiving early and delayed PR. A retrospective cohort study was conducted using medical records of adult ICU patients who received pulmonary rehabilitation during mechanical ventilation from January to December 2024. Patients were grouped into early PR (≤ 48 hours after ICU admission) and delayed PR (> 48 hours). Baseline characteristics assessed included age, sex, primary diagnosis, and SOFA score. In total, 110 patients were included, with 27 in the early PR group and 83 in the delayed PR group. Baseline characteristics were generally comparable between groups. The early PR group experienced significantly shorter duration of mechanical ventilation (p < 0.001) and reduced ICU length of stay (p < 0.001) compared to the delayed PR group. These findings indicate a potential association between early pulmonary rehabilitation and short-term ICU outcomes.

Antifungal Effectiveness of Ultrasonic-Assisted Extraction (UAE)-Extracted Green Tea Leaf (Camellia sinensis) against Malassezia furfur In Vitro

Mahera A Rachmania — 2026-08-30

Fungal infections in Indonesia affect 2.89% of the population and have the potential to develop resistance to azole-class antifungals, as seen in Pityriasis versicolor caused by Malassezia furfur. Green tea leaf (Camellia sinensis) extract offers a safer antifungal alternative containing tannins, flavonoids, alkaloids, and triterpenoids. This experimental study evaluated C. sinensis extract effectiveness against M. furfur in vitro using a post-test only control group design. Extracts were prepared via Ultrasonic Assisted Extraction (UAE) method at 10%, 15%, 20%, and 25%, with sterile aquadest and 2% ketokonazol as controls. Antifungal activity was assessed using the well diffusion method on Sabouraud Dextrose Agar (SDA) by measuring the inhibition zone after 24 and 48 hours of incubation. Inhibition was generally moderate at 24 hours but weakened at 48 hours, except at 20% and 25% concentrations. Bivariate analysis of 24-hour data using the Kruskal-Wallis’s test showed a significant difference in the inhibition of M. furfur among green tea leaf extract concentrations (p<0.05), with higher concentrations associated with greater inhibition. Based on post-Hoc analysis, it was found that the 20% concentration was the most effective concentration for inhibiting M.furfur.

Comparison of Combined Epidural-General Anesthesia and General Endotracheal Anesthesia on Neutrophil-Lymphocyte Ratio and Blood Sugar Levels in Colorectal Surgery

Wawan Susilo — 2026-08-30

Colorectal surgery induces systemic inflammatory and neuroendocrine stress responses that may affect postoperative outcomes. The neutrophil–lymphocyte ratio (NLR) and random blood glucose (RBG) levels are simple biomarkers for assessing perioperative inflammatory and metabolic stress. Combined epidural–general anesthesia (CEGA) is presumed to better attenuate these responses than general endotracheal anesthesia (GETA). This randomized controlled trial compared the effects of CEGA and GETA on perioperative changes in NLR and RBG in patients undergoing colorectal surgery. A total of 24 patients with American Society of Anesthesiologists (ASA) physical status I–II were randomly assigned to the CEGA (n = 12) or GETA (n = 12) group. NLR and RBG were measured preoperatively and at 6 and 24 hours postoperatively. Both groups demonstrated significant increases in NLR and RBG at 6 hours after surgery, followed by a decline at 24 hours. However, NLR at 24 hours postoperatively was significantly lower in the CEGA group than in the GETA group (p = 0.009). RBG levels were also significantly lower in the CEGA group at 6 hours (p = 0.012) and 24 hours postoperatively (p = 0.007). These findings indicate that CEGA is more effective than GETA in attenuating inflammatory and metabolic stress responses in colorectal surgery.

Analysis of Maternal Knowledge, Posyandu Practices and Community Support on the Incidence of Stunting in Children

Putu GBAA Putra — 2026-08-30

Stunting among children persists as a substantial public health threat that has enduring impacts on physical growth, cognitive development, and human capital. Although its prevalence has declined in several regions, stunting remains a strategic issue that requires a comprehensive approach. This study aimed to analyze the association of maternal nutritional knowledge, frequency of Posyandu visits, and community support with stunting among children using the Social Ecological Model (SEM) framework. This study was designed as an analytical observational case-control study in the service areas of the Tabanan III and Kediri I Community Health Centers (Puskesmas). A total of 100 respondents (50 cases and 50 controls) were selected using consecutive sampling with frequency matching. Data were collected using a structured questionnaire and secondary data on children’s nutritional status and were analyzed using bivariate analysis. The results showed no significant association between maternal nutritional knowledge (p = 0.617; OR = 0.320; 95% CI: 0.032–3.184), visits to the Posyandu (p = 0.118; OR = 2.316; 95% CI: 0.793–6.764), or community support (p = 1.000; OR = 1.000; 95% CI: 0.425–2.352) and the incidence of stunting. Maternal nutritional knowledge, Posyandu visits, and community support were not identified as significant predictors of stunting in the study population.

Risk Factors Associated with Amputation in Patients with Diabetic Foot Ulcer in Sultan Fatah Regional General Hospital

Moses A Krisnanda — 2026-08-30

Diabetes mellitus (DM) is a chronic metabolic disease with increasing global prevalence and high mortality rates. Diabetic foot ulcer (DFU) is a debilitating yet preventable DM complication and a leading cause of non-traumatic lower-extremity amputation, affecting quality of life. This study aimed to analyse risk factors associated with amputation in patients with DFU in Sultan Fatah Regional General Hospital. This cross-sectional analytic study used medical records of DFU patients hospitalized between January–December 2023. Variables included gender, age, body mass index (BMI), DM and DFU duration, hypertension, haemoglobin level, leucocyte count, lipid profile, glycated haemoglobin (HbA1c), estimated-glomerular filtration rate (eGFR), and amputation status. A total of 114 patients were analysed using univariate analysis, bivariate analysis (Fisher’s exact test), and multivariate analysis (logistic regression). The amputation rate in this study was 8.8%. Highly significant association was shown between amputation and both DM and DFU duration (p<0.01), while low haemoglobin, high HbA1c, and low eGFR showed significant association (p<0.05). DM duration was found as an independent risk factor in this study (OR=17.58; 95% CI: 1.88–164.62; p<0.05). Identifying these risk factors may help guide targeted prevention efforts aimed at lowering amputation rates and preserving quality of life in this patient group.

Foot Exercises as an Innovative Therapy for Diabetes Mellitus Ulcers: A Case Report

Upik Rahmi — 2026-08-30

Diabetic foot ulcers (DFUs) remain a major complication of type 2 diabetes mellitus (DM), often leading to prolonged healing and increased morbidity. Foot exercises have been proposed as an adjunct therapy to enhance circulation and promote tissue recovery. This case report describes a 59-year-old female patient with type 2 DM presenting with a foot ulcer treated with diabetic foot gymnastics twice weekly for three weeks, in combination with standard wound care. Wound assessment using the Bates-Jensen Wound Assessment Tool (BWAT) demonstrated significant improvements, including reduction in wound size and depth, decreased exudate, and enhanced granulation and epithelial tissue formation. The patient’s BWAT score decreased following the intervention, indicating improved tissue perfusion and peri-wound skin condition, thereby accelerating healing. The exercise regimen also supported better muscle strength, joint mobility, and overall foot function, contributing to improved quality of life. This case illustrates the potential role of foot exercises as a simple, low-cost, and effective complementary therapy for managing DFUs, warranting further investigation through controlled studies.

Endovascular Stent Graft with Staged Hybrid Vascular Surgery of a Giant Extracranial Internal Carotid Artery Aneurysm: A Rare Case Report

Hadiyan A Muhammad — 2026-08-30

Extracranial internal carotid artery aneurysm (EICAA) is a rare vascular entity defined as focal dilation exceeding 1.5 times the normal arterial diameter. Although uncommon, EICAA carries a high risk of thromboembolism, rupture, and neurological complications. This case report aims to describe the clinical characteristics, diagnostic approach, and endovascular management strategy of a giant extracranial internal carotid artery aneurysm, contributing to the limited literature on this rare condition. A patient presenting with a progressively enlarging left cervical mass over four months, accompanied by pain and intermittent bleeding. Physical examination revealed a well-defined, pulsatile, solitary mass measuring approximately 10 × 8 × 7 cm, with elastic consistency and fixation to surrounding tissues. Contrast-enhanced imaging, including computed tomography angiography and carotid angiography with three-dimensional reconstruction, confirmed the diagnosis of a large extracranial internal carotid artery aneurysm. Advanced imaging plays a crucial role in establishing the diagnosis and guiding treatment planning. Management options include open surgical repair and endovascular intervention using stent grafts, with the choice of approach based on aneurysm morphology, anatomical location, patient comorbidities, and operator expertise. In conclusion, early recognition of EICAA is essential to prevent life-threatening complications. Comprehensive imaging and individualized treatment strategies are key to achieving optimal outcomes.

Optic Neuritis Mimicking as Idiopathic Intracranial Hypertension in a Child: A Case Report

Muhammad R Abdullah — 2026-08-30

Sudden visual loss in a child can be caused by optic neuritis or idiopathic intracranial hypertension (IIH), the latter being strongly associated with obesity. This report aims to describe a pediatric case with overlapping clinical features of optic neuritis and IIH, highlighting a diagnostic and therapeutic challenge. An 11-year-old girl presented with sudden bilateral visual loss. Right eye vision was light perception, while left eye vision was hand movement. A neuroophthalmic examination confirmed optic disc edema and increased retinal nerve fiber layer thickness on an optical coherence tomography scan. Her body mass index was in the obese range. Treatment initially involved a high-dose intravenous steroid injection for optic neuritis. MRI scans were normal, but after three days of treatment, there was only minimal improvement. Acetazolamide was then added for two weeks due to suspicion of IIH. After oral steroid continuation for three months, there was significant visual improvement. Follow-up showed good visual acuity. This case underscores the importance of recognizing optic neuritis as the primary cause of acute visual loss in children, even in the presence of confounding features such as obesity.

Functional Recovery in a Geriatric Woman with Late-Subacute Stroke and Vascular Dementia: A Case Report

Ferdinand D Kurniawan — 2026-08-30

This case report presented task-oriented rehabilitation of a 66-year-old woman with vascular dementia due to late-subacute stroke. The patient exhibited cognitive and mobilization decline that led to significant functional impairments in her daily activities, including her hobby of gardening, looking after her grandchildren, and partial dependence on self-care. This report highlighted the effectiveness of task-oriented rehabilitation for a geriatric patient with late-subacute stroke, in which isolated rehabilitation was thought to be less effective. A multidisciplinary approach combining executive-function and divided-attention training, tailored to the patient's individual needs and goals for resuming avocational activities (gardening and caring for her grandchildren, including playing catch and having them sit on her lap), was implemented. The intervention comprised task-oriented occupational therapy and cognitive rehabilitation targeting executive function and divided attention. The patient showed notable improvements, with avocational activities performed daily and independently within 3 months of task-oriented rehabilitation. The MOCA-Blind score improved from 12 to 15 out of 22, BMI increased from 12 to 15.22 kg/m², and the Zarit Burden Interview score decreased from 22 to 11. Combined-personalized, task-oriented rehabilitation was effective in late-subacute stroke rehabilitation, especially in the geriatric population in which the consequences of aging limit functional recovery.

Cognitive Behavioural Therapy as an Adjunct to Pharmacotherapy in Bipolar Disorder: A Systematic Review of Treatment Outcomes and Relapse Prevention

Adeline C Phelps — 2026-08-30

Bipolar disorder is a chronic psychiatric condition characterized by recurrent mood episodes and significant functional impairment. Although pharmacotherapy remains the primary treatment, relapse rates remain high, highlighting the need for effective adjunctive interventions. This study aimed to synthesize evidence on the effectiveness of Cognitive Behavioural Therapy (CBT) as an adjunct to pharmacotherapy in improving treatment outcomes and preventing relapse in bipolar disorder. A literature review was conducted using PubMed, Scopus, and ScienceDirect, identifying 30 eligible studies published between 2013 and 2023. Most included studies employed randomized controlled trials and quasi-experimental designs. Of the 30 studies, 22 reported statistically significant improvements (p < 0.05) in patients receiving CBT in addition to pharmacotherapy. Synthesized findings indicate that CBT contributes to reductions in depressive symptoms, improved cognitive and psychosocial functioning, and enhanced emotional regulation. Several studies also demonstrated neurobiological changes, particularly in prefrontal and limbic connectivity. Studies with structured CBT protocols (8–20 sessions) and adequate duration showed more consistent benefits. However, variability in outcomes was observed due to differences in study design, sample size, and intervention protocols. Overall, CBT appears to be an effective adjunctive therapy in bipolar disorder, particularly when delivered in a structured and sustained manner.