Hang Tuah Medical Journal

Therapeutic Plasma Exchange in Patients with Guillain–Barré Syndrome

EVANS P. BIASA — 2026-06-01

Abstract

Guillain–Barré Syndrome (GBS) is an acute autoimmune neuropathy that may rapidly progress to severe weakness and respiratory failure. Therapeutic plasma exchange (TPE) is a recommended immunomodulatory therapy, particularly in patients with severe clinical manifestations. Case Report: We report a 64-year-old female presenting with rapidly progressive quadriparesis requiring intensive care and mechanical ventilation. Nerve conduction studies confirmed Guillain–Barré Syndrome, Acute Motor and Sensory Axonal Neuropathy (AMSAN) subtype. The patient underwent four cycles of therapeutic plasma exchange. Although standard protocols generally recommend five cycles, treatment was discontinued earlier due to significant clinical improvement. Discussion: Following TPE, the patient demonstrated gradual clinical improvement, including hemodynamic stabilization, reduced ventilatory support, and successful extubation. This rapid clinical response supports an individualized approach to determining the number of TPE cycles based on continuous clinical evaluation, particularly in critically ill patients in the intensive care unit. Therapeutic plasma exchange may serve as an important immunomodulatory therapy in patients with severe Guillain–Barré Syndrome. Individualizing the number of TPE cycles based on clinical response can be considered in clinical practice without strict adherence to standard protocols. This case highlights that serial clinical evaluations may serve as a basis for considering individualized TPE cycle numbers in severely ill GBS patients in the intensive care unit.

The The Influence of Health Counseling on Handling Scabies (Sarcoptes Scabiei) on the Level of Self-Medication Knowledge of Islamic Boarding School Students

NABILA RADIAHAYYA — 2026-06-01

Scabies is a skin disease caused by the Sarcoptes scabiei mite, and is often suffered by individuals who live in groups such as dormitories, Islamic boarding schools, densely populated housing. Knowledge plays an important role in handling the transmission of scabies by practicing personal hygiene or by self-medication. This study aims to determine the level of knowledge of sel-medication in handling scabies in student at Islamic Boarding School in Purwokerto. The study was conduxted using a uestionnaire that had been tasted for validity and reliability through a one group pre-post design approach, which was conducted in march 2024 using a systematic random sampling technique and a sample of 55 students was obtained. Based on the results of the Cronbach alpha reliability test were reliable. The results of the univariate analysis showed that the majority of respondents were aged 15-20 years and female. The results of the bivariate anaysis of the Wilcoxon test showed that the level of khowledge of students before and after the intervention increased significantly (p-value < 0.05), namely from the good category of 61.8% to 89.1% and the sufficient category from 38.2% to 10.9%. in conclusion, periodic education is needed to provide information to student so that students’ knowledge increases further.

Keywords : level of khowledge, scabies, pre-post, questionnaire, systematic random sampling

Visual Acuity Profile of Online Motorcycle Taxi Drivers in Keputih Surabaya Subdistrict

VEYSHA IZDIHAR — 2026-06-01

Visual acuity is an important factor influencing driving safety, particularly among online motorcycle taxi drivers who work with high visual exposure and varying road conditions. Visual acuity plays a critical role in driver’s ability to detect road hazards, interpret traffic signs, and respond to dynamic traffic situations. Because online motorcycle taxi drivers frequently operate for extended hours which they are exposed to sunlight, glare, dust, wind, and prolonged screen use when interacting with customers and navigation applications which can affect eye comfort and performance. These occupational stressors may contribute to reduced visual efficiency, emphasizing the importance of regular monitoring. This study aims to determine the visual acuity profile of online motorcycle taxi drivers in Keputih Surabaya subdistrict. A descriptive observational design with a cross-sectional approach was used, involving 70 respondents. Visual acuity was examined using a Snellen chart and pinhole test and classified according to the World Health Organization standards. The results showed that 34 respondents (48.57%) had refractive errors, 27 respondents (38.57%) had normal visual acuity, and 9 respondents (12.86%) had non-refractive visual impairments. The majority of respondents with refractive errors remained within the normal visual acuity category (85.29%).

The Effect of Progressive Muscle Relaxation (PMR) on Sleep Quality of Pregnant Women in the Third Trimester at TPMB Yulia, Malang

ANISSATUL VAUZAH — 2026-06-01

Due to the substantial hormonal and physiological changes that occur throughout pregnancy, it is a crucial time. These changes may occasionally result in sleep disruptions during the third trimester, such as trouble falling asleep and numerous awakenings during the night. The health of both the mother and the fetus can be negatively impacted by inadequate sleep in the later stages of pregnancy, which raises the risk of postpartum depression, prolonged labor, preeclampsia, and cesarean delivery. This study examined how third-trimester pregnant women at TPMB Yulia Tri Jayanti Turen, Malang Regency, slept better after using Progressive Muscle Relaxation (PMR). Twenty respondents were chosen by deliberate sampling for this pre-experimental study, which employed a one-group pretest-posttest design. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality both before and after the PMR intervention, which lasted for 10 to 15 minutes every day for two to four weeks.The data was examined using the Wilcoxon Signed Rank Test.According to the findings, all respondents (100%) had poor sleep quality prior to the intervention, while 45% had good sleep quality following it. After PMR, sleep quality significantly improved, according to statistical analysis (p = 0.003). By methodically tensing and releasing muscle groups, PMR lowers sympathetic nervous system activity, increases parasympathetic dominance, stabilizes heart rate and blood pressure, and encourages relaxation—all of which improve sleep. These results imply that PMR is a successful non-pharmacological treatment to enhance third-trimester pregnant women's quality of sleep.

The Relationship Between Hypertension and the Incidence of Acute Coronary Syndrome: A Case–Control Study

MADE BAGUS MANIK SATRIA MAHOTTAMA — 2026-06-01

Abstract

Background: Acute Coronary Syndrome (ACS) is a major cardiovascular emergency associated with substantial morbidity and mortality. Hypertension is considered an important risk factor, yet local evidence remains essential. Objective: evaluate the relationship between hypertension and ACS occurrence in two referral hospitals in Bali, Indonesia. Methods: A hospital-based case–control study using medical record data was conducted at Karangasem and Tabanan District Hospitals. A total of 176 subjects were included: 88 ACS cases and 88 non-ACS controls. Purposive sampling with age- and sex-matching was applied. Bivariate analysis employed Chi-square test, reporting OR with 95% CI. Results: Most participants were aged >45 years (96.6%) and male (65.9%). Among cases, the most frequent ACS subtype was unstable angina (43.2%), followed by NSTEMI (34.1%) and STEMI (22.7%). The most common presenting symptoms were dyspnea (84.1%) and typical chest pain (79.5%). Hypertension was present in 39.8% of cases and 18.2% of controls. Hypertension was significantly related to ACS (p=0.002 OR of 2.97; 95% CI: 1.491–5.923).Conclusion: Hypertension is significantly related to ACS occurrence and increases the odds of ACS by nearly threefold.

The Effect of Rhizophora apiculata Stem Bark Extract on Dexamethasone-Induced Blood Glucose Levels in Rattus norvegicus

ARLISA NABILA LARASATI — 2026-06-01

Background: Dexamethasone is a glucocorticoid, if used long term it can cause increased oxidative stress and hyperglycemia. In diabetes patients, large amounts of antioxidants are needed as an antidote to free radicals in the body. Ethanol extract of Rhizophora apiculata stem bark has antioxidant and antidiabetic activity.

Objective: This study aims to evaluate the effect of ethanol extract of Rhizophora apiculata bark on the blood glucose levels of white rats induced by dexamethasone.

Methods: This research use 32 rats grouped into 4 groups. G (-), standard feed, G (+) induced by dexamethasone, GP 1 bark extraxt and induced by dexamethasone at the same time as giving mangrove bark extract, and DT 2, dexamethasone and mangrove bark extract, then on the 22nd day a blood sample was taken to measure blood glucose levels.

Results: the average blood glucose level G- = 146.5; G+= 213.375; GP = 185.875; GT = 244.375. In the One Way Anova parametric test, significant results were obtained, 0.015 (p<0.05). Then in the Post Hoc LSD test; G- and G+ had a significance of 0.028 (p<0.05), while the G+ and GP and GT groups did not show significant differences.

Conclusion: Subcutaneous dexamethasone induction treatment was proven to increase blood glucose levels in male Rattus norvegicus. Administration of ethanol extract of Rhizophora apiculata stem bark as prophylaxis or therapy was unable to reduce blood glucose levels of male Rattus norvegicus induced by dexamethasone.

Combined Warm Foot Soaks and Massage Rollers to Reduce Blood Pressure in Elderly Hypertensive Patients

RETNO KIKI SAFITRI — 2026-06-01

Hypertension is a common health problem in adults and can lead to serious complications if not properly managed. At UPTD PSLU Tresna Werdha Natar, cases have increased over the past three years. Current management relies mainly on pharmacological therapy, while non-pharmacological interventions such as warm foot soaking and foot massage rollers have not been implemented. This study aimed to determine the effect of combining warm foot soaking and foot massage rollers on blood pressure in hypertensive patients at UPTD PSLU Tresna Werdha Natar, South Lampung, in 2025. This study used a quantitative pre-experimental design with a one-group pretest-posttest approach. A total of 17 respondents were selected using purposive sampling. The intervention consisted of warm foot soaking combined with a foot massage roller, administered three times per week for two weeks. Data were analyzed using the paired sample t-test. Most respondents were female (64.7%) and aged 60–70 years (58.8%). Before the intervention, the majority had stage 2 hypertension (76.5%). After the intervention, blood pressure decreased among respondents. The paired sample t-test showed a p-value of 0.000 (p < 0.05), indicating a significant effect of the combined intervention on reducing blood pressure. These findings suggest that this combination can be applied as a non-pharmacological intervention to help control blood pressure in elderly patients with hypertension.

Genetic Basis of Chromosomal Abnormalities in Recurrent Miscarriage Cases

AHRIYA DWI AFRIANA — 2026-06-01

Abstract

Recurrent miscarriage (RPL) is defined as the loss of two or more pregnancies before the 24th week of pregnancy. Various factors contribute to RPL, including genetic abnormalities such as chromosomal abnormality. This study aims to ascertain the genetic basis of RPL. This study was an observational descriptive study. Data were collected retrospectively from medical records of patients with RPL at the Medical Genetics Laboratory, Faculty of Medicine, Wijaya Kusuma University Surabaya, from 2014 to 2023. The study population consisted of patients with a history of two to three recurrent miscarriages, with the exception of patients with TORCH infection. The results showed that of the 41 patients who met the inclusion and exclusion criteria, comprise of 17 (89.4%) men and 20 (90.9%) women had normal karyotypes, while 2 (10.4%) men and 2 (9.09%) women showed abnormal karyotypes. The chromosomal abnormalities identified were reciprocal translocation between chromosome (6;13) and heteromorphism on chromosome 9. The results showed the importance of knowing the genetic basis of RPL as a basis for providing genetic counseling.

The Effect of Providing Additional Food with Green Beans and Catfish on the Body Weight of Underweight Toddlers

DANIA SAFA'ATIN AINI — 2026-06-01

Underweight in children aged 1–5 years can hinder growth and development. Children with a weight-for-age Z-score (WAZ) < -2 SD are classified as underweight by WHO and require nutritional intervention. Supplementary feeding (PMT) based on local food with high protein and energy content can improve nutritional status. This quasi-experimental study employed a pretest–posttest control group design involving 32 children at Posyandu Balai Desa Sumberagung, divided into 16 intervention and 16 control participants. The intervention group received PMT made from mung bean and catfish for 30 days, while the control group received routine Posyandu services. Researchers did not directly observe children consuming PMT but relied on parental reports. Body weight was measured before and after the intervention and analyzed using Paired Sample T-Test and Independent Sample T-Test (α=0.05). Results showed the mean WAZ of the intervention group increased from -2.47 to -1.85 (p=0.000), whereas the control group increased from -2.46 to -2.33 (p=0.006). The difference between groups was significant (p=0.003). PMT made from mung beans and catfish significantly improved children’s weight. Study limitations include small sample size, short intervention duration, and reliance on parental reporting. Future studies are recommended to include larger samples, longer interventions, direct observation of consumption, and consider dietary patterns, health status, and variations of local food preparations.

Comparison of Thrombocyte Nadir between Dengue Fever and Dengue Hemorrhagic Fever Patients

WISNU TRANAYA PUTRA — 2026-06-01

Background: Dengue infection remains a major public health problem and is frequently accompanied by thrombocytopenia. The lowest platelet level during illness (thrombocyte nadir) may reflect clinical severity and assist in early risk stratification. Objective: To compare the mean thrombocyte nadir between patients with dengue fever (DF) and dengue hemorrhagic fever (DHF). Methods: A cross-sectional study was conducted using medical record data of 150 hospitalized dengue patients at Sanjiwani Hospital (2022–2024). Dengue was confirmed by IgM anti-dengue testing or NS1 antigen detection. DHF was defined as a ≥20% increase in hematocrit at admission. Patients with a history of idiopathic thrombocytopenic purpura were excluded. Demographic and clinical data were summarized descriptively, and differences in thrombocyte nadir between DF and DHF were analyzed statistically. Results: Of 150 patients, 119 (79.3%) had DF and 31 (20.7%) had DHF. The thrombocyte nadir differed significantly between groups, with DHF demonstrating a lower nadir than DF (p = 0.001). Conclusion: Thrombocyte nadir is significantly lower in DHF compared with DF, supporting the usefulness of serial platelet monitoring to aid severity assessment and clinical surveillance in hospitalized dengue patients.

The Effect of Slow Deep Breathing on Maternal Anxiety During Implant Installation

HELEN MARSHANDA — 2026-06-01

The Family Planning (FP) program is a government initiative to control population growth through the use of long-term contraceptive methods, including implant contraception. However, fear and anxiety regarding pain during implant insertion often become barriers for acceptors. This study aimed to determine the effect of slow deep breathing relaxation techniques on anxiety levels of women during implant insertion at TPMB Afita Delianah, Turen, Malang Regency. A quantitative quasi-experimental study with a Nonequivalent Control Group design was conducted with 32 respondents divided equally into an intervention group and a control group. The intervention group received slow deep breathing exercises for 15 minutes before implant insertion, while the control group did not receive any intervention. Anxiety levels were measured using the Hamilton Anxiety Rating Scale (HARS) before and after the intervention. Data analysis included Shapiro-Wilk normality test, paired t-test, Levene’s homogeneity test, and Independent Sample T-Test. Results showed that before the intervention, the mean anxiety score of the intervention group was 28.75 and the control group was 27.88. After the intervention, the intervention group’s anxiety score significantly decreased to 20.00, while the control group only decreased to 27.13. Independent Sample T-Test results indicated that the reduction in anxiety was significantly greater in the intervention group compared to the control group (p < 0.05). These findings indicate that slow deep breathing relaxation is effective in reducing anxiety during implant insertion. This technique can serve as a practical, safe, and applicable non-pharmacological strategy in midwifery practice to enhance women’s psychological comfort during reproductive health procedures.