Archives of The Medicine and Case Reports

Beyond Clinical Care: The Role of Midwives in Providing Holistic Support through Continuity of Care - A Case Study

Nanda Pratama Putri — 2024-11-11

Continuity of care (COC) in midwifery is a model that emphasizes a continuous and trusting relationship between a midwife and a woman throughout her pregnancy, childbirth, postpartum period, and beyond. This approach fosters holistic support, encompassing not only clinical care but also emotional, psychological, and social well-being. This case study explores the role of midwives in providing such comprehensive care within the COC framework. This study presents the case of Mrs. A, a 22-year-old primiparous woman who received COC midwifery care at TPMB Delima Winda Maolinda in Banjarmasin City, Indonesia. The care spanned her pregnancy, childbirth, postpartum period, newborn care, and family planning counseling. Data were collected through direct observation and interviews during midwifery care encounters. The study highlights the various dimensions of care provided, including antenatal check-ups, childbirth assistance, postpartum monitoring, newborn care education, and family planning guidance. It also explores the challenges and benefits of implementing COC in this particular context. In conclusion, this study demonstrates the positive impact of COC midwifery care on maternal and neonatal outcomes. The continuous support and personalized guidance provided by the midwife contributed to Mrs. A's emotional well-being, facilitated informed decision-making, and promoted healthy behaviors. This study underscores the importance of COC in midwifery practice and its potential to enhance the overall quality of care for women and their newborns.

Effectiveness of Mind-Body Interventions Delivered by Nurses in Improving Psychological Well-being and Surgical Recovery: A Meta-Analysis

Rifki Sakinah Nompo — 2024-12-06

Surgical patients often experience psychological distress that can hinder their recovery. Mind-body interventions (MBIs) delivered by nurses, such as guided imagery and mindfulness exercises, may improve psychological well-being and surgical recovery. This meta-analysis examined the effectiveness of nurse-delivered MBIs on adult surgical patients. A systematic search of PubMed, CINAHL, PsycINFO, and Cochrane Library databases was conducted from January 2013 to November 2024. Randomized controlled trials (RCTs) examining the effects of nurse-delivered MBIs on adult surgical patients were included. Primary outcomes were anxiety, depression, and pain. Secondary outcomes included length of hospital stay, postoperative complications, and medication usage. Random-effects models were used to calculate pooled effect sizes (Hedges' g). Six RCTs met the inclusion criteria, comprising 785 participants. Meta-analysis revealed that nurse-delivered MBIs significantly reduced anxiety (g = -4.09, 95% CI [-6.25, -1.93], p = 0.0002) and depression (g = -3.40, 95% CI [-4.96, -1.85], p < 0.00001) compared to standard care. Significant reductions in postoperative pain (g = -1.77, 95% CI [-2.10, -1.44], p < 0.00001) were also observed. No significant differences were found for length of hospital stay or postoperative complications. In conclusion, nurse-delivered MBIs effectively improve psychological well-being and reduce postoperative pain in adult surgical patients, supporting their integration into routine surgical care.

Smoking-Related Tear Film Abnormalities and Dry Eye Disease: A Meta-Analysis

Indira Putri — 2024-12-09

Dry eye disease (DED) is a prevalent ocular condition characterized by tear film instability and ocular surface inflammation. Smoking has been identified as a potential risk factor for DED, but the impact of different smoking modalities (active, passive, and e-cigarette) on tear film and DED remains unclear. This meta-analysis aimed to evaluate the association between various forms of smoking and tear film abnormalities leading to DED. A systematic search of PubMed, Embase, and Cochrane Library databases was conducted for studies published between 2013 and 2024 investigating the effects of active smoking, passive smoking, and e-cigarette use on tear film parameters and DED diagnosis. Data extracted included tear film break-up time (TBUT), Schirmer's test results, tear osmolarity, and DED diagnostic criteria. Pooled effect estimates were calculated using random-effects models. Eight studies met the inclusion criteria, comprising 4 on active smoking, 2 on passive smoking, and 2 on e-cigarette use. Active smoking was significantly associated with reduced TBUT (standardized mean difference [SMD] = -2.87; 95% CI: -3.12 to -2.62; p<0.00001), lower Schirmer's test scores (SMD = -2.79; 95% CI: -3.23 to -2.35; p<0.00001), and increased tear osmolarity (SMD = 12.55; 95% CI: 8.17 to 16.93; p<0.00001). Passive smoking and e-cigarettes showed a similar trend but with less pronounced effects. In conclusion, this meta-analysis provides evidence that active smoking significantly impairs tear film stability and contributes to DED. Passive smoking may also have detrimental effects, while the impact of e-cigarettes requires further investigation. These findings underscore the importance of smoking cessation in DED management and public health strategies for eye health.

Anti-inflammatory Properties of Hibiscus Leaf Extracts: A Potential Therapeutic Agent for Post-immunization Fever in Infants

Riri Aprianti — 2024-12-10

Post-immunization fever is a common side effect in infants, often causing discomfort and concern for parents. Hibiscus leaf extracts have been traditionally used for their anti-inflammatory and antipyretic properties. This study investigated the efficacy of hibiscus leaf extracts as a potential therapeutic agent for post-immunization fever in infants. A randomized controlled trial was conducted with 120 infants aged 2-4 months who received their first dose of the diphtheria-tetanus-pertussis (DPT) vaccine. Participants were randomly assigned to either the hibiscus extract group (n=60) or the control group (n=60). The hibiscus extract group received a standardized dose of hibiscus leaf extract orally, while the control group received standard care. Fever was assessed at regular intervals for 48 hours post-immunization. Infants in the hibiscus extract group exhibited a significantly lower incidence of fever (p=0.02) and a reduced duration of fever (p=0.04) compared to the control group. Furthermore, the hibiscus extract group showed a lower average temperature throughout the observation period. No adverse effects were reported in the hibiscus extract group. In conclusion, hibiscus leaf extracts demonstrate promising anti-inflammatory properties and may serve as a safe and effective therapeutic agent for post-immunization fever in infants. Further research is warranted to explore the underlying mechanisms and long-term effects.

Optimizing Maternal Health Outcomes: Examining the Relationship Between Primary Healthcare Center Organizational Characteristics and Maternal and Child Health (MCH) Handbook Utilization in Counseling

Barirah Madeni — 2024-12-10

Maternal mortality remains a significant global health challenge, disproportionately affecting low- and middle-income countries. The Maternal and Child Health (MCH) Handbook is a valuable tool for providing essential health information and promoting timely care-seeking behaviors during pregnancy. This study investigates the influence of primary healthcare center (PHC) organizational characteristics on the utilization of MCH Handbooks as counseling materials for pregnant women in Aceh Tengah District, Indonesia. A cross-sectional survey was conducted among 208 midwives across 17 PHCs in Aceh Tengah District. Data were collected on organizational characteristics (organizational climate, supervision, and leadership) and the utilization of MCH Handbooks in antenatal counseling sessions. Descriptive statistics, Chi-square tests, and logistic regression were used to analyze the data. The study found that 68.3% of midwives reported inadequate utilization of MCH Handbooks in counseling sessions. Supervision (p=0.006) and leadership (p=0.000) were significantly associated with MCH Handbook utilization, while organizational climate (p=0.738) showed no significant association. In conclusion, PHC organizational characteristics, particularly supervision and leadership, play a crucial role in promoting the effective use of MCH Handbooks in antenatal counseling. Strengthening supervision and leadership support within PHCs can enhance MCH Handbook utilization and potentially contribute to improved maternal health outcomes.

Impact of COVID-19 on Acute Coronary Syndrome: An Examination of Mortality and Demographic Factors

Dian Primadia Putri — 2024-12-19

The COVID-19 pandemic has significantly impacted cardiovascular health, with acute coronary syndrome (ACS) emerging as a major concern. This study investigates the relationship between demographic characteristics, mortality rates, and the incidence of ACS in COVID-19 patients. A retrospective study was conducted on a cohort of 68 patients diagnosed with both COVID-19 and ACS, admitted to a hospital in Medan between August 2020 and August 2021. Demographic data, COVID-19 severity, electrocardiogram (ECG) findings, and comorbid conditions were analyzed for their association with mortality. The mean age of the study participants was 58.2 years, with a male predominance (82.9%). The majority of patients experienced severe COVID-19 (62.9%), and the most common ECG finding was ST-elevation (62.9%). Hypertension was the most prevalent comorbidity (52.9%). Mortality was significantly associated with male gender (p=0.01) but not with COVID-19 severity, ECG findings, or comorbidities. In conclusion, male gender was identified as an independent predictor of mortality in COVID-19 patients with ACS. Further research is needed to elucidate the complex interplay of demographic factors, COVID-19, and ACS outcomes.

Nasopharyngeal Carcinoma in the Nias Tribe Indonesia: Prevalence, Risk Factors, and Characteristics

Hana Isal Salina Ginting — 2024-12-20

Nasopharyngeal carcinoma (NPC) is a malignancy with a distinctive racial and geographical distribution, exhibiting a high prevalence in Southeast Asia, including Indonesia. The Nias tribe, an indigenous group in Indonesia, has a particularly high incidence of NPC, which may be linked to unique environmental and genetic factors. This study aimed to investigate the prevalence, risk factors, and characteristics of NPC among the Nias people to inform targeted prevention and control strategies. A retrospective study was conducted on 150 NPC patients treated at a referral hospital in Medan, Indonesia, between 2018 and 2023. Data were collected from medical records, including demographics, clinical presentation, Epstein-Barr virus (EBV) infection status, dietary habits, and environmental exposures. Descriptive statistics and comparative analyses were performed to identify risk factors associated with NPC in the Nias population. The prevalence of NPC among the Nias tribe was 30% (45 out of 150 NPC patients). The majority of Nias patients were male (60%) and aged 40-60 years (70%). EBV infection was prevalent in 80% of the Nias patients. Significant risk factors included consumption of preserved foods (78%), exposure to firewood smoke (65%), and a family history of NPC (20%). Most patients presented with advanced-stage disease (III and IV), with common symptoms such as neck lumps, epistaxis, and nasal obstruction. In conclusion, NPC poses a substantial health burden on the Nias tribe. EBV infection, consumption of preserved foods, exposure to firewood smoke, and genetic predisposition are significant risk factors. Public health interventions should prioritize early detection through EBV screening, health education on risk factors, and promotion of alternative cooking fuels to reduce exposure to carcinogens.

The Rising Incidence of Atypical Post-Streptococcal Glomerulonephritis in Children: A Meta-Analysis and Implications for Diagnosis and Management

Ni Luh Ayudimartini — 2024-12-20

Post-streptococcal glomerulonephritis (PSGN) is a common cause of acute nephritis in children. While typically presenting with classical features, atypical presentations are increasingly recognized, posing diagnostic and management challenges. This meta-analysis aimed to evaluate the rising incidence of atypical PSGN in children and explore its implications for clinical practice. A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between 2013 and 2024 reporting on atypical PSGN in children. Data extracted included incidence rates, clinical presentations, laboratory findings, treatment strategies, and outcomes. A random-effects model was used to pool data and assess heterogeneity. Six studies (n=1248 children with PSGN) were included. The pooled prevalence of atypical PSGN was 28.7% (95% CI: 25.9-31.6%; I2= 68%). Clinical Presentations of Atypical PSGN included Nephrotic syndrome: 14.4% (95% CI: 12.2-16.8%), Isolated hematuria: 10.5% (95% CI: 8.8-12.4%), Rapidly progressive glomerulonephritis (RPGN): 4.2% (95% CI: 3.2-5.5%), Acute kidney injury (AKI): 8.7% (95% CI: 7.1-10.4%). Atypical PSGN was associated with a higher risk of complications (odds ratio [OR] 1.8, 95% CI: 1.3-2.5) and a longer duration of hospitalization (mean difference 2.7 days, 95% CI: 2-3.4). In conclusion, atypical PSGN is increasingly common in children, presenting with diverse clinical manifestations. Clinicians should maintain a high index of suspicion for atypical presentations to ensure prompt diagnosis and appropriate management. Further research is needed to identify risk factors for atypical PSGN and optimize treatment strategies.