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Hypertension is one of the most common chronic diseases among the elderly and is often accompanied by insomnia. This condition can increase anxiety and reduce quality of life. Progressive Muscle Relaxation (PMR) is an effective non-pharmacological therapy to lower blood pressure and improve sleep quality. This paper describes nursing care for elderly patients with hypertension and insomnia through PMR application at RSUD Embung Fatimah Batam City in 2025. A case study approach was used through the nursing process, including assessment, nursing diagnosis, intervention, implementation, and evaluation. The main nursing diagnosis was sleep pattern disturbance related to physical discomfort and anxiety. Interventions included education and PMR exercises for six consecutive days. Results showed blood pressure decreased from 180/100 mmHg to 130/80 mmHg, sleep quality improved from difficulty sleeping to 6–7 hours per night, and anxiety levels reduced. Progressive muscle relaxation therapy proved effective as an independent nursing intervention to reduce blood pressure and improve sleep quality in elderly patients with hypertension and insomnia. Nurses should use this therapy as a routine non-pharmacological intervention in gerontological nursing practice.

Heart disease is the leading cause of death in Indonesia and globally, necessitating an early screening system that is both accurate and clinically trustworthy. Although XGBoost demonstrates high predictive performance, its black-box nature undermines clinical trust, while low recall risks missed diagnosis an unacceptable consequence in population screening, especially in middle-income countries with limited healthcare resources. This study aims to develop a sensitive, transparent, and implementation-ready heart disease screening framework through the integration of SHAP-based Explainable AI. The CDC's Indicators of Heart Disease dataset (319,795 samples) was processed according to WHO/CDC standards, followed by class imbalance handling, hyperparameter optimization using RandomizedSearchCV, evaluation based on metrics sensitive to minority classes (AUC, recall, F1-score, AUC-PR), and threshold tuning to maximize recall. The baseline model showed a very low recall of 12.18%. After optimization and threshold tuning at 0.10, the model achieved recall >96% (96.79%) with a G-mean of 0.7477, supported by SHAP interpretation stability and the ability to capture non-linear interactions between advanced age (AgeCategory_WHO) and poor general health (GenHealth). SHAP analysis confirmed the alignment of dominant features with medical evidence, and its visualizations provide transparent explanations for healthcare professionals indicating its potential implementation as an interpretable clinical decision support system.

Prolactinoma is the most common functional pituitary adenoma, particularly in adolescent females, and is typically characterized by amenorrhea and galactorrhea resulting from hyperprolactinemia. However, in certain cases, serum prolactin levels may appear normal due to the hook effect, an immunoassay measurement error caused by extremely high prolactin concentrations that interfere with antigen–antibody complex formation. We report the case of a 17-year-old female presenting with a five-month history of galactorrhea, accompanied by breast pain, headache, and primary amenorrhea. Brain MRI revealed a pituitary mass measuring 1.4 × 0.8 × 0.5 cm, suspicious for prolactinoma, while serum prolactin was within the normal range (17.33 ng/mL). The discrepancy between clinical manifestations, lesion size, and laboratory findings raised suspicion of the hook effect. The patient was treated with dopamine agonists, bromocriptine and cabergoline, and referred for multidisciplinary management involving endocrinology, neurosurgery, and obstetrics–gynecology. Despite the absence of prolactin dilution testing, MRI findings supported the diagnosis of prolactinoma, and the patient demonstrated a favorable clinical response to therapy. This case highlights the importance of recognizing laboratory variability, performing comprehensive hormonal evaluation, and considering prolactin dilution assays when clinical and laboratory findings are discordant, particularly in adolescent patients with suggestive symptoms.

Tuberculosis (TB) is a chronic, infectious disease caused by the bacterium Mycobacterium tuberculosis. Primary infection occurs upon first exposure to bacillary tuberculosis, which often occurs in childhood, hence the term "childhood TB." The diagnosis of TB is usually made through a history that includes complaints of persistent cough, weight loss, fever, and weakness, along with a chest X-ray that shows typical abnormalities of pulmonary TB. In this case, a 21-month-old girl presented with a worsening, persistent cough accompanied by weight loss. The patient's mother reported that her child frequently had fevers and appeared weak. After a physical examination and supporting tests, the patient was diagnosed with TB. The patient was given pharmacological therapy in the form of anti-tuberculosis drugs (OAT), and parents were educated about the importance of adherence to TB treatment as prescribed by the doctor. Furthermore, providing a balanced, nutritious diet is recommended to support successful treatment.

Although JKN aims to provide equitable and quality health services, fraudulent practices, such as phantom billing and diagnosis manipulation, continue to grow, harming BPJS Kesehatan and participants. This study aims to examine the effectiveness of legal sanctions against JKN claim fraud in FKRTL and identify gaps in their implementation. Although regulations are in place, law enforcement remains weak, with administrative sanctions failing to provide sufficient deterrence. The gap in this research lies in the lack of application of criminal sanctions in fraud cases, especially in existing regulations. The novelty of this research is its comparative approach between current administrative sanctions and the potential application of criminal sanctions in the context of healthcare fraud. The research method uses a normative-descriptive approach, analyzing regulations and fraud audit results, and identifying gaps in the implementation of legal sanctions. The results of the study indicate that strengthening criminal sanctions and integrating technology in claim monitoring can increase the effectiveness of fraud prevention. These findings are expected to strengthen regulations and improve the integrity of the JKN system, as well as provide policy recommendations for more effective law enforcement.

The development of molecular biology has significantly transformed clinical laboratory diagnostics, particularly through DNA analysis. One of the most widely used techniques is the Polymerase Chain Reaction (PCR), a DNA amplification method capable of rapidly, sensitively, and accurately multiplying specific genetic fragments. PCR has become an essential diagnostic tool for detecting infectious, genetic, and malignant diseases, even at early stages when the amount of target DNA is minimal. This article aims to analyze the role of PCR in DNA analysis as a diagnostic tool in clinical laboratories, including its working principles, advantages, and relevance in modern clinical practice. This study employs a literature review approach by examining various scientific sources such as international journals and molecular biology textbooks. The findings indicate that PCR offers high sensitivity and specificity compared to conventional methods, thereby improving diagnostic accuracy and accelerating appropriate therapeutic decisions. Therefore, PCR represents a crucial innovation in clinical laboratory diagnostics that significantly contributes to improving healthcare quality.

Electrolytes are essential minerals that play a critical role in various physiological processes within the body, including the maintenance of fluid balance, proper neuromuscular function, and the transmission of nerve impulses. They are vital for the stability of the heart and other crucial organs. When electrolyte levels become imbalanced, as seen in conditions such as hyponatremia (low sodium), hypernatremia (high sodium), hypokalemia (low potassium), hyperkalemia (high potassium), and hypocalcemia (low calcium), serious health issues can arise. These imbalances can result from factors like malnutrition, excessive losses through the kidneys or gastrointestinal tract, hormonal disorders, and certain systemic diseases. Understanding the underlying pathophysiological mechanisms and clinical manifestations of these disturbances is essential for effective diagnosis and treatment. Healthcare providers must identify the root causes of electrolyte imbalances while assessing their severity to implement appropriate management strategies. This often involves gradually correcting electrolyte levels to mitigate the risk of life-threatening complications such as arrhythmias, cerebral edema, and neurological impairment. By fostering a comprehensive understanding of electrolyte imbalances, healthcare professionals can improve diagnostic accuracy and therapeutic effectiveness, ultimately leading to better patient outcomes. This knowledge is crucial in minimizing morbidity and mortality associated with these disruptive conditions, ensuring that individuals receive prompt and effective care to restore balance and maintain overall health.

Emergency conditions refer to situations that require immediate intervention because they have the potential to threaten life, impair organ function, or cause disability if not managed promptly and appropriately. Status epilepticus is a neurological emergency defined by seizures lasting five minutes or longer, or by repeated seizures without regaining consciousness between episodes. Status epilepticus can develop in individuals both with and without a previous diagnosis of epilepsy and may result from a wide range of causes, such as metabolic abnormalities, infections of the central nervous system, stroke, head injury, sudden discontinuation of antiepileptic medications, and alcohol intoxication or withdrawal. Clinically, this condition is classified into convulsive and non-convulsive status epilepticus. The diagnosis is primarily clinical and must be established rapidly, while electroencephalography plays an important role, particularly in cases of non-convulsive status epilepticus. Management emphasizes initial stabilization of the airway, breathing, and circulation, after which benzodiazepines are given as first-line treatment, including intramuscular midazolam, intravenous lorazepam, or intravenous diazepam. Status epilepticus represents the most severe form of seizure activity, characterized by continuous, unremitting seizures accompanied by strong muscle contractions, respiratory compromise, and widespread abnormal electrical activity in the brain. If not treated promptly, the risk of permanent brain tissue damage increases and the condition may ultimately lead to death.

The prevalence of diabetic ulcers in Indonesia reaches 12-15% of all sufferers. This condition has an impact on the patient's psychological condition in the form of anxiety due to wounds that are difficult to heal, changes in body image, and concerns about the possibility of amputation. One of the nonpharmacological interventions that can help overcome anxiety is the slow deep breathing technique. The purpose of writing this scientific paper is to carry out Nursing Care for Mrs. M with Diagnosis of Diabetic Ulcers using the application of slow deep breathing intervention in reducing anxiety at Az-Zahra Hospital. The writing method is a nursing care process that includes the stages of study, nursing diagnosis, planning, implementation, and evaluation. The subject of care was Mrs. M, a patient with diabetic ulcers in the inpatient room of Az-Zahra Hospital. Data collection was carried out through interviews, observations, documentation studies, and physical examinations, and using a medical-surgical nursing care assessment format. The ethical principles applied use the principles of Nursing Ethics. The results of nursing care showed that after three days of slow deep breathing intervention, patients reported feeling calmer, sleeping better, and anxiety levels decreased from moderate to mild based on observation results and anxiety scales used. This suggests that slow deep breathing interventions are effective in helping to reduce anxiety in patients with diabetic ulcers. It is hoped that patients and families can continue these breathing exercises independently as part of stress management efforts and quality of life improvement.  

This study discusses the position of persons with disabilities, especially those with mental and intellectual disabilities, in carrying out legal actions following the judicial review of Article 433 of the Civil Code through the Constitutional Court Decision Number 93/PUU-XX/2022. Prior to this amendment, Article 433 of the Civil Code used discriminatory terms and automatically placed persons with disabilities under guardianship, thereby eliminating their legal capacity as independent legal subjects. This Constitutional Court decision changed the phrase "must be guarded" to "can be guarded" and emphasized that the placement of guardianship can only be made based on a competent medical diagnosis. The research method used is normative juridical through a statutory approach and court decisions. The results of the study show that the change in norms restores the constitutional rights of persons with disabilities, including the right to autonomy, equality before the law, and protection from discrimination. In addition, this change directly affects the requirements for capacity in making agreements according to Article 1320 of the Civil Code, so that persons with mental disabilities who have the capacity are still considered capable of acting. Therefore, this decision is an important step in realizing a legal system that is more inclusive, just and respects the dignity of people with disabilities.

Background: Dental caries is a major problem in orodental health, especially in children. The primary cause of caries is the activity of cariogenic microorganisms. Unbalanced remineralization of dental tissue followed by destruction of organic matters may cause cumulative and progressive damage to the tooth structure. Extensive caries lesions that have reached the pulp are an indication for pulp therapy with appropriate crown restoration. Case Report: A 10-year-old boy came with a complaint of a painful cavity in his upper right front tooth. The patient was considered communicative and cooperative. The patient also had a habit of consuming sweets. An intraoral examination revealed extensive caries on the entire surface of 53. A periapical radiograph showed a radiolucent area reaching the pulp cavity on the occlusal surface of 53 with resorption of the apical one-third of the root. Based on the examination results, reversible pulpitis was established as the primary diagnosis. The treatment plan was pulpotomy with a dental crown restoration. Treatment was carried out over four visits. First visit included complete examination, periapical radiography, and pulpotomy. The second visit included core buildup, tooth preparation, and dental impressions. The third visit included try-in and crown insertion, followed by a final follow-up visit. Conclusion: Pulpotomy with dental crown restoration can be an effective clinical approach to restore the function and aesthetics of anterior deciduous teeth, especially in cases that consider aesthetics and cost limitations.

The growing number of alleged medical malpractice cases in Indonesia, particularly physicians’ misdiagnosis resulting in patient death, underscores the need for stronger legal certainty and accountability in healthcare services. Physicians are professionally obligated to conduct diagnosis and medical treatment in accordance with professional standards, service standards, and standard operating procedures; however, negligence may occur and lead to severe harm. This study aims to analyze the legal provisions governing physicians’ liability for misdiagnosis causing patient death and to examine the forms of legal responsibility that may be imposed. The research applies a normative juridical method using a case approach and literature review, relying on primary legal materials such as the Indonesian Civil Code, the Criminal Code, the Medical Practice Law, the Hospital Law, and Law Number 17 of 2023 on Health, supported by secondary and tertiary sources. The findings indicate that physicians may be held liable under civil, criminal, and administrative law if the essential elements of medical negligence are proven, namely duty of care, breach of duty, harm (including death), and a causal relationship between the misdiagnosis and the fatal outcome. Moreover, liability may extend to hospitals under the doctrines of vicarious liability, hospital liability, and strict liability. This study implies the importance of strengthening professional competence, reinforcing disciplinary mechanisms, and ensuring balanced legal protection for both patients and healthcare professionals within Indonesia’s health law framework.

Breast cancer is one of the leading causes of death among women, largely due to delayed diagnosis. Early detection through Clinical Breast Examination (CBE/SADANIS) is an important strategy to identify breast cancer at an early stage. However, the level of knowledge and awareness of Women of Reproductive Age regarding SADANIS remains low. This Community Service activity aimed to improve knowledge and awareness of SADANIS among Women of Reproductive Age through health education at PMB Rama Agustina. The activity was conducted through preparation, implementation, and evaluation stages. Health education was delivered using interactive lectures and discussions, supported by educational media such as leaflets and posters. Evaluation was carried out using pre-test and post-test questionnaires to assess changes in participants’ knowledge. The results showed an improvement in participants’ knowledge and a positive change in attitudes toward the importance of early breast cancer detection. In addition, participants demonstrated increased interest and willingness to undergo SADANIS examinations, either at the midwifery practice or at nearby primary healthcare centers. In conclusion, this activity was effective as a promotive and preventive effort to support early detection of breast cancer among women of reproductive age.

The increasing number of malpractice cases in Indonesia, particularly those related to misdiagnosis by medical practitioners, highlights the urgency of law enforcement in the health sector. This study aims to analyze the legal provisions and forms of physician liability for misdiagnosis resulting in patient death. The research employs a normative juridical approach with a library research method, using primary legal materials such as Law Number 17 of 2023 on Health, the Criminal Code (KUHP), and the Civil Code (KUHPerdata), as well as secondary legal materials including literature and legal health journals. The findings indicate that misdiagnosis proven to constitute professional negligence (culpa) may give rise to legal liability in three areas—criminal, civil, and administrative. Criminally, Article 440 of Law Number 17 of 2023 stipulates sanctions for medical personnel whose negligence causes serious injury or death (Republic of Indonesia, 2023). Furthermore, hospitals also bear responsibility under the doctrines of vicarious liability and hospital liability for the actions of medical practitioners under their supervision (Balubun, Simanjuntak, & Ginting, 2018). This research implies the need for a balanced legal protection framework between patients’ rights and the professional rights of medical practitioners, as well as the strengthening of medical supervision systems within healthcare institutions.

Permanent tooth loss is a common oral health problem experienced by patients. This condition can be caused by pathological conditions such as tooth decay, leading to tooth extraction. Rehabilitation treatment for partial posterior tooth loss aims to restore masticatory function, maintain occlusal relationships and periodontal health, and improve aesthetics. A 34-year-old man came with a complaint that his lower right posterior tooth had been extracted and wanted a permanent dentures to replace his missing tooth. The intraoral and periapical radiograph examination revealed that 46 was missing, and 47 had enamel caries. The diagnosis for 46 was determined to be partial edentulous. The treatment plan was a PFM fixed-fixed bridge with a sanitary pontic for 46, a rigid connector, and a full crown retainer for 45 and 47. In this case, the choice of PFM bridge is based on several considerations, i.e., high chewing loads, relatively low cost, and high long-term success. The PFM bridge has been the primary choice for posterior tooth rehabilitation, due to its durability and cost-effectiveness.

Congenital Megacalyces is a rare anomaly of the renal pelvis-calyceal system characterized by non-obstructive calyx dilatation due to renal medulla hypoplasia. This condition is often misinterpreted as hydronephrosis, leading to unnecessary surgical interventions. Advances in genomic technology and precision imaging have opened up opportunities to understand the molecular basis and anatomical structure of this anomaly more deeply. A literature review was conducted through PubMed, ScienceDirect, and Google Scholar, covering publications that discuss the relationship between genomics, imaging, and clinical management of congenital kidney abnormalities. The integration of Next Generation Sequencing (NGS), 3D MRI reconstruction imaging, and AI-based radiomics analysis has proven to enhance diagnostic accuracy, differentiate between obstructive and non-obstructive abnormalities, and assist in determining appropriate conservative therapies. Case studies demonstrate the association between SETBP1 mutations and the development of bilateral megacalyces, as well as the effectiveness of long-term monitoring based on multimodal data. The integration of genetic, imaging, and clinical data is a strategic step toward precision medicine in the management of Congenital Megacalyces. This approach improves diagnostic accuracy, reduces unnecessary invasive interventions, and supports individualized therapy based on genetic and anatomical risk factors.

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening mucocutaneous reactions characterized by extensive epidermal necrolysis and mucosal involvement. The entities represent a clinical continuum distinguished by the extent of epidermal detachment (SJS <10% body surface area [BSA], SJS/TEN overlap 10–30%, TEN >30%). Most cases are drug-induced, making early culprit-drug withdrawal and structured supportive care the cornerstones of management. Immunopathogenesis is primarily mediated by drug-specific cytotoxic T cells and NK cells through granulysin, Fas–Fas ligand, and perforin/granzyme pathways, with emerging roles of necroptosis and candidate biomarkers such as RIP3 and galectin-7. Diagnosis relies on timely recognition of the characteristic painful erythematous/targetoid lesions, Nikolsky/Asboe–Hansen signs, multi-site mucositis, accurate BSA assessment, and early severity scoring (e.g., SCORTEN) to guide referral and monitoring. Systemic immunomodulators (corticosteroids, cyclosporine, IVIg, anti-TNF agents) have variable evidence; thus, individualized selection and early multidisciplinary care particularly ophthalmologic involvement are essential to reduce acute mortality and long-term sequelae.

Epistaxis, or more commonly known as nosebleeds, is one of the most frequently encountered medical emergencies in the field of ENT. Epistaxis is a condition in which blood flows from the nasal cavity. Although often considered a minor disorder, epistaxis can be a sign of a more serious medical condition, especially if it occurs repeatedly or in large amounts. Globally, the prevalence of epistaxis is estimated to be around 21.7%, with a wide range of variation between countries, namely between 3 and 60 cases per 100,000 population per year. This paper aims to review the aspects of diagnosis and management of epistaxis based on the latest literature. The method used in this study was a search and analysis of various scientific publications, guidelines, and relevant current journals. The discussion covers the identification of types and signs of epistaxis, emergency management, and tampon insertion strategies. Understanding the appropriate and rapid diagnosis and management is essential to prevent the condition from worsening.

Aritmia merupakan gangguan irama jantung yang umum terjadi pada lansia dan dapat menimbulkan risiko kesehatan serius jika tidak terdeteksi secara dini. Penelitian yang dilakukan bertujuan untuk mengidentifikasi aritmia pada lansia menggunakan algortima K- Nearest Neighbor (KNN) berdasarkan data elektrokardiogram (EKG). Data yang digunakan berjumlah 105 data EKG lansia yang diperoleh dalam format CSV. Proses awal melibatkan pembersihan dan normalisasi data menggunakan metode StandardScaler, serta pelabelan awal menggunakan algoritma K-Means Clustering untuk mengelompokkan data ke dalam dua kelas: Normal dan Sangat Berpotensi Aritmia. Data kemudian dibagi menjadi 70% data latih dan 30% data uji dengan metode stratified split untuk menjaga proporsi label. Model KNN dilatih dengan parameter k = 3, dan dievaluasi menggunakan confusion matrix serta classification report. Hasil pengujian menunjukkan akurasi model sebesar 97% dengan nilai precision dan recall yang tinggi pada kedua kelas. Hasil ini menunjukkan bahwa algoritma KNN efektif dalam mengklasifikasikan kondisi aritmia pada lansia dan memiliki potensi untuk diterapkan dalam sistem pendukung diagnosis berbasis data EKG.

Gastric disease is a common health problem that can disrupt daily activities if not properly treated. To aid the initial diagnosis process, this study developed a web-based expert system capable of diagnosing various types of gastric disease based on the symptoms experienced by the user. This system uses the Dempster-Shafer method to address uncertainty in decision-making by combining a number of pieces of evidence in the form of symptoms to determine the level of confidence in a disease. The system was developed using the PHP programming language and a MySQL database and designed for easy browser access. Testing demonstrated that the system was able to provide fairly accurate diagnostic results that closely approximated the results of consultations with medical professionals. This system is expected to become an initial solution for the public in quickly and independently recognizing symptoms of gastric disease.