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Introduction: Carpal Tunnel Syndrome (CTS) is the most common neuropathy caused by compression and tension of the median nerve in the carpal tunnel of the wrist. The most common symptoms of CTS include pain and paresthesia (tingling) with or without numbness in the me dian nerve area of ​​the wrist. Method: The method used was a case study on a 72-year-old male patient diagnosed with bilateral CTS who experienced pain (NRS 7/10), tingling, numbness, and limitations in hand movement and functional activity. Physiotherapy interventions provided included Ultrasound therapy (US), Transcutaneous Electrical Nerve Stimulation (TENS), nerve mobilization, and structured exercise therapy in the form of stretching and median nerve gliding. Evaluation was carried out using the Numeric Rating Scale (NRS) for pain and the Boston Carpal Tunnel Questionnaire (BCTQ) for functional activity. Result: The results showed a significant reduction in pain, with motion pain decreasing from a scale of 7 to 3 and pressure pain from 5 to 1 after three therapy sessions. Furthermore, there was an increase in functional activity, as indicated by a decrease in BCTQ scores, namely the Symptom Severity Scale (SSS) from 4 to 2 and the Functional Status Scale (FSS) from 4 to 2. This indicates a gradual improvement from the moderate-severe category to approaching mild. Conclusion: A multimodal physiotherapy approach is effective in reducing pain, reducing paresthesias, and improving hand function in CTS patients. Combining various therapeutic modalities has been shown to be more optimal than single therapies because it can address various pathological aspects simultaneously. Therefore, comprehensive, evidence-based physiotherapy interventions are highly recommended in the conservative management of CTS.

This study aims to analyze the difference in anxiety levels before and after the administration of Qur’anic murottal therapy among third-trimester pregnant women. The third trimester is often associated with increased physical discomfort and psychological stress, which may lead to higher anxiety levels. This research employed a pre-experimental design using a one-group pretest-posttest approach involving 25 respondents selected through purposive sampling. Anxiety levels were measured using the Perinatal Anxiety Screening Scale (PASS), and the data were analyzed using the Wilcoxon Signed Ranks Test. The findings showed that before the intervention, 48% of respondents experienced moderate anxiety and 52% experienced severe anxiety. After the intervention, 40% experienced mild anxiety, 48% moderate, and only 12% severe anxiety. The statistical test result indicated a Z value of -4.376 with a p-value of 0.000 (p < 0.05), which means there was a significant difference in anxiety levels before and after the intervention. These results suggest that murottal therapy is effective in reducing anxiety among third-trimester pregnant women and can be considered as a safe non-pharmacological intervention.

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.

Atrophic rhinitis or ozena is a chronic infection of the nasal cavity characterized by progressive atrophy of the nasal mucosa and turbinate bones accompanied by the formation of foul-smelling nasal crusts. This condition is more commonly found in females, particularly during puberty, and is frequently associated with populations of low socioeconomic status and poor environmental sanitation. The exact etiology of atrophic rhinitis remains unclear; however, several factors are believed to contribute, including chronic infection by *Klebsiella ozaenae*, vitamin A and iron deficiency, chronic sinusitis, hormonal imbalance, collagen diseases, trauma, and genetic predisposition. Common clinical manifestations include nasal obstruction, thick greenish nasal discharge, crust formation, epistaxis, anosmia, and *foetor ex nasi*, which is often more noticeable to people around the patient. Anterior rhinoscopy typically reveals widened nasal cavities, turbinate atrophy, thin and dry nasal mucosa, as well as purulent secretions and greenish crusts. Diagnosis is established through history taking, ENT physical examination, and supporting investigations such as microbiological culture, histopathological examination, radiological imaging, and paranasal sinus CT-scan. Management may be conservative with antibiotics, nasal irrigation, nasal drops, vitamin A supplementation, and iron preparations, or surgical in severe cases or those unresponsive to conservative therapy.

Children with Autism Spectrum Disorder (ASD) face unique challenges in building attachment relationships, due to ASD children experiencing impairments in communication, social interaction, and emotional regulation. This study aims to identify effective intervention strategies to improve the quality of attachment between parents and children with ASD through a Systematic Literature Review (SLR) approach. The review findings indicate that several interventions have proven effective in enhancing attachment between parents or primary caregivers and children with ASD, including the following interventions: DIR/Floortime, Focused Playtime Intervention (FPI), Parent-Child Interaction Therapy (PCIT), Circle of Security (COS), Positive Behavior Support (PBS), play training, massage therapy, and psychoeducation. The results of these interventions show that changes occur before and after the intervention, including strengthening two-way communication, increasing parental sensitivity, and improving the child's emotional responses. These findings have practical implications for parents, educators, and therapists in designing attachment-based approaches to support the social and emotional development of children with ASD. Responsive and supportive designing attachment-based approaches to support the social and emotional development of children with ASD. Responsive and supportive relationship-based interventions can build secure attachments between children with ASD and their parents and serve as an important reference in attachment-based parenting and therapy practices.

Melasma is a chronic acquired hyperpigmentation disorder affecting sun-exposed facial areas and associated with ultraviolet exposure, hormonal influences, and genetic predisposition. This review aims to describe the mechanisms of action, effectiveness, and safety of topical depigmenting agents in melasma management. Hydroquinone remains the traditional gold standard through tyrosinase inhibition, while triple-combination therapy with retinoids and corticosteroids demonstrates superior reduction in Melasma Area Severity Index scores compared with monotherapy. Non-hydroquinone agents such as tranexamic acid, azelaic acid, niacinamide, cysteamine, and thiamidol show comparable efficacy with improved tolerability. Common adverse effects include erythema and irritation, with rare ochronosis linked to prolonged hydroquinone use. In conclusion, individualized multimodal strategies with strict photoprotection are essential for effective and sustained melasma control.

Sectio caesarea is a common surgical procedure to deliver a baby when normal delivery is not possible or risky. Postoperatively, patients often experience acute pain that can interfere with the recovery process. The benson relaxation technique is a nonpharmacological method that has been shown to be effective in reducing pain through a relaxation and patient confidence approach. This study uses a case study approach on Mrs. T, a post-sectio caesarea patient at Harapan Bunda Hospital, Batam City. Nursing care is carried out comprehensively for three days, including assessment, diagnosis, intervention, implementation, and evaluation. The main intervention was the administration of benzone relaxation techniques for 10–15 minutes every day. After three days of applying the Benson relaxation technique, Mrs. T's pain intensity decreased from a scale of 6 (moderate pain) to a scale of 2 (mild pain). Patients show increased comfort, ability to be active, and decreased expressions of pain such as grimacing. These results support previous findings that benzon relaxation is effective as a nonpharmacological therapy in reducing postoperative pain. This technique can be a safe and easy-to-apply alternative in nursing practice, especially for post-sectio caesarean patients.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an obligate intracellular bacterium that affects the skin, peripheral nerves, upper respiratory mucosa, and eyes. Type 2 diabetes mellitus (T2DM) is a comorbidity that can worsen the course of leprosy. The female patient, Mrs. D, aged 55 years came to the emergency room of Cut Meutia Hospital with the main complaint of red bumps accompanied by pain on the face, hands, chest, and back since 3 days ago and additional complaints such as fever, joint pain, and numbness and loss of feeling in the legs, weakness, frequent thirst, and frequent urination. Dermatologic status is obtained in the facial region in the form of erythema nodules with firm boundaries with numular size, multiple. Laboratory examination showed anemia and leukocytosis. The therapy given was MDT MB package, ferrous sulfate 1x325 mg and PRC transfusion 3 kolf. Complaints arose acutely after the patient resumed taking MDT (multidrug therapy) leprosy drugs which had previously been stopped for more than 3 months. Based on the time of onset of symptoms, history of leprosy treatment, and the manifestation of systemic inflammatory lesions with signs of neurotropism, it can be suspected that the patient is experiencing a type 2 leprosy reaction or Erythema Nodosum Leprosum (ENL).

Background: Diabetes mellitus (DM) is a significant global health problem and continues to increase worldwide. Chronic and uncontrolled hyperglycemia is a major risk factor for macrovascular complications such as Peripheral Arterial Disease (PAD). Buerger Allen Exercise (BAE) is a recommended physical activity therapy to prevent peripheral arterial disease. Objective: This study aims to determine the effect of Buerger Allen Exercise on the Ankle Brachial Index (ABI) in diabetes mellitus patients. Methods: This study is a Quasi-experimental study with a pre-posttest with control group design. The study population was all Diabetes Mellitus patients at the Kusuma Bangsa Community Health Center, Pekalongan City with a sample of 32 respondents selected using a purposive sampling technique and divided into a control group and an intervention group. Buerger Allen Exercise in the intervention group was carried out for 5 consecutive days with a duration of 15 minutes. Data were analyzed using the Mann-Whitney Test. Results: In the control group, there was no significant difference in the average ABI value of the control group on day 1 and day 5 with a p-value = 0.195. In the intervention group, there was a difference in ABI scores before and after being given Buerger Allen Exercise with a p-value of 0.000. Conclusion: There is an effect of Buerger Allen Exercise on the Ankle Brachial Index value in diabetes mellitus patients at the Kusuma Bangsa Community Health Center.  

A Normocytic normochromic anemia is one of the most common types of anemia found in geriatric patients with chronic diseases or acute bleeding. Upper gastrointestinal bleeding (UGIB) may cause continuous blood loss resulting in decreased hemoglobin levels. This case report discusses a 72-year-old woman who presented to the Emergency Department of Cut Meutia Regional General Hospital with complaints of black stools for four days prior to admission accompanied by epigastric pain, nausea, weakness, and pallor. The patient had a history of long-term use of analgesic and anti-gout medications due to chronic joint pain, which was suspected to be a risk factor for UGIB. Physical examination revealed pale conjunctiva and tachycardia, while laboratory findings showed hemoglobin of 7.1 g/dL, hematocrit of 23.3%, MCV of 82 fL, MCH of 29 pg, and uric acid level of 11.56 mg/dL, leading to the diagnosis of normocytic normochromic anemia caused by UGIB accompanied by gout arthritis. The patient received intravenous fluid therapy, proton pump inhibitors, antifibrinolytic agents, gastroprotective therapy, packed red cell transfusion, and other supportive treatments. During hospitalization, clinical improvement was observed, including cessation of gastrointestinal bleeding, reduced epigastric pain, and increased hemoglobin level to 8.6 g/dL. This case highlights the importance of early diagnosis and comprehensive management in geriatric patients with anemia caused by UGIB and comorbid gout arthritis.

Hypertension is a major public health concern with a high prevalence and a significant risk of complications if left uncontrolled. Effective management requires not only pharmacological treatment but also non-pharmacological approaches and active family involvement. One potential non-pharmacological therapy is the use of celery (Apium graveolens), which is believed to lower blood pressure. This study aimed to evaluate the effectiveness of family education combined with celery decoction administration in reducing blood pressure among patients with hypertension. A descriptive case study design was employed using a family nursing care approach over three home visits, each lasting 30–45 minutes. The intervention included health education on hypertension and a demonstration of how to prepare and administer celery decoction, which was consumed twice daily. Data were collected through interviews, observation, and blood pressure measurements. The results showed a reduction in blood pressure from 159/90 mmHg to 130/80 mmHg, along with a decrease in symptoms such as headaches and dizziness. In addition, there was an improvement in family knowledge, caregiving skills, and the ability to modify the home environment. In conclusion, family-based education combined with the administration of celery decoction appears to be effective in reducing blood pressure and enhancing the family’s role in managing hypertension.

Background: HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome) remain global health issues, including in Indonesia. One of the management strategies is antiretroviral therapy (ART), which requires a high level of adherence to be effective. Objective: This study aims to analyze the effect of reminders on adherence to ARV treatment among people living with HIV (PLHIV) at the Tembuku I Community Health Center. Methods: This study employed a quasi-experimental design using a one-group pretest-posttest approach. The sample consisted of 30 PLWHA selected using total sampling, and data were analyzed using the Wilcoxon test. Results: Univariate analysis revealed that the average age of respondents was 35 years; the majority were female, had a high school education, and worked as homemakers and farmers. Bivariate analysis revealed that prior to the intervention, the majority of PLWHA (70%) had low adherence levels, whereas after the intervention, adherence levels increased to 100%. Statistical test results showed a p-value < 0.05, indicating a significant effect of social media-based reminders on improving ARV adherence in the Tembuku I Community Health Center area. Conclusion: The use of social media-based reminders is effective in improving adherence to ARV treatment among people living with HIV. This intervention can be recommended as a simple and practical strategy to support the success of ARV therapy in primary health care settings.

Stroke often causes hemiparesis, which impairs hand motor skills and independence in daily activities. Mirror therapy is a rehabilitation intervention that stimulates motor function through visual feedback, while patient motivation plays a crucial role in exercise adherence. This study aims to analyze the effect of mirror therapy and patient motivation on hand motor skills in patients with hemiparesis.The study used a quasi-experimental design with a pretest–posttest approach in 30 hemiparesis patients undergoing rehabilitation at the Ciherang Community Health Center. Mirror therapy intervention was administered for 20–30 minutes, three times per week for four weeks. Hand motor skills were measured using Manual Muscle Testing on a scale of 0–5, while patient motivation was assessed using a questionnaire.The results showed a significant increase in hand motor skills after mirror therapy (p < 0.05) and higher patient motivation was associated with greater motor score improvement (p < 0.05). Mirror therapy and patient motivation have been shown to have a positive effect on hand motor skills in hemiparesis patients, so this combined intervention can be considered as part of a stroke rehabilitation program.

Background: Anxiety can affect physiological functions in patients prior to surgery, including increased heart rate and respiration, changes in blood pressure and temperature, relaxation of smooth muscles in the bladder, cold and clammy skin, and dry mouth, which may reduce the patient’s energy level. Psychologically, anxiety can lead to increased postoperative pain, delayed wound healing, increased physical disability, and decreased quality of life. One effective non-pharmacological intervention to reduce anxiety is Benson relaxation therapy. Objective: This study aimed to determine the effect of benson relaxation therapy on reducing anxiety levels in pre operative. Methods: This study used a case study design involving one preoperative patient with anxiety symptoms in the Teratai Ward of Prof. Dr. Margono Soekarjo Hospital, Purwokerto. Benson relaxation therapy was administered for 3 days, twice daily, with a duration of 15 minutes per session. Anxiety levels were measured using the Zung Self-Rating Anxiety Scale (ZSAS) before and after the intervention. Results: The patient showed a decrease in anxiety score from 55 (moderate anxiety) to 40 (mild anxiety) after receiving Benson relaxation therapy. Subjectively, the patient reported feeling calmer, more accepting, and motivated. Objectively, there was a reduction in heart rate and physical signs of anxiety. Conclusion: Benson relaxation therapy is effective in reducing anxiety levels in preoperative patients. This intervention can be used as a non-pharmacological alternative to support psychological recovery of pre-operative patients.

Bacterial infections are diseases that can be transmitted by bacteria from sufferers to others, either directly or indirectly. Cases of bacterial infections are more common among children. The use of antibiotics is needed to treat life-threatening conditions caused by bacteria by killing bacteria or making it difficult for bacteria to grow and reproduce. Antibiotics are a type of drug given to prevent bacterial infections, or are drugs given to high-risk patients. This research method is a descriptive study by collecting medical record data to find out the description of bacterial infections and the use of antibiotics in pediatric inpatients at RSU Cut Meutia Aceh Utara in 2022. This research technique used purposive sampling with a sample size of 183 samples. The results of this study showed that 183 children suffered from bacterial infections and received injection antibiotic therapy, the majority were boys, namely 106 children (57%), the age group with the most number of sufferers, namely aged 0‒5 years, totaling 76 children (41%), the percentage of bacterial infections most commonly found in pediatric inpatient wards at RSU Cut Meutia Aceh Utara in 2022, namely typhoid fever as much as 33%, the class of antibiotics most commonly used at RSU Cut Meutia is cephalosporins (93%).

Congestive heart failure (CHF) is a cardiovascular disease that frequently causes shortness of breath (dyspnea) and negatively impacts patients’ quality of life. The management of dyspnea involves not only pharmacological approaches but also nonpharmacological interventions, one of which is handheld fan therapy, which works by stimulating sensory receptors in the facial area. This study aims to describe the effect of handheld fan therapy on reducing shortness of breath in patients with CHF. This study employed a descriptive design using a case report method on a single 63-year-old female patient diagnosed with CHF. The intervention was conducted over four days, involving the use of a handheld fan for 10 minutes, held at a distance of 15–30 cm from the face and directed toward the nose and mouth. Measurements were taken before and after the intervention using respiratory rate and oxygen saturation as parameters. The results showed a gradual decrease in respiratory rate from 24 breaths/minute to 18 breaths/minute, as well as an increase in oxygen saturation from 91% to 96% during the intervention period. These findings indicate an improvement in breathing patterns and increased respiratory efficiency in the patient. Handheld fan therapy is effective as a nonpharmacological intervention for reducing shortness of breath and improving oxygenation in patients with CHF. This intervention is safe, easy to use, and can be implemented as a complementary therapy in nursing practice.

Diabetes mellitus type 2 is a chronic metabolic disorder that frequently affects elderly patients and is often accompanied by multiple comorbidities. The increasing prevalence of diabetes in the aging population contributes to higher morbidity and mortality, especially when complicated by geriatric syndromes, electrolyte imbalances, and infections such as pneumonia. This study aims to present a case of type 2 diabetes mellitus in an elderly patient with associated geriatric problems, electrolyte disturbances, and pneumonia. The method used is a descriptive case report based on clinical findings, laboratory examinations, and radiological assessment. A 76-year-old male presented with generalized weakness, weight loss, decreased appetite, respiratory symptoms, and functional decline. Physical examination and laboratory findings revealed uncontrolled diabetes, electrolyte imbalance, hypoalbuminemia, and signs of infection. Chest radiography confirmed pneumonia. Management included pharmacological therapy such as antibiotics, fluid and electrolyte correction, and supportive care, along with non-pharmacological interventions including dietary regulation and monitoring. The findings highlight the complexity of managing elderly patients with multiple comorbid conditions, emphasizing the need for a comprehensive and multidisciplinary approach. Early detection and appropriate management are essential to improve clinical outcomes and prevent further complications in geriatric patients with diabetes mellitus.

Supraventricular tachycardia (SVT) is one of the most common arrhythmias in the pediatric population, often resulting from re-entry mechanisms involving accessory pathways or dual atrioventricular nodal physiology. Although generally well tolerated in children with structurally normal hearts, its management can be challenging, particularly in recurrent or persistent cases. This study is a case report describing a pediatric patient with hemodynamically stable SVT treated at Dr. Wahidin Sudirohusodo Hospital. Data were collected retrospectively from medical records, including history taking, physical examination, and supporting investigations such as serial electrocardiography (ECG), laboratory tests, chest radiography, and transthoracic echocardiography. Management was conducted according to current clinical guidelines, including vagal maneuvers, pharmacological therapy with beta-blockers and antiarrhythmic agents (amiodarone), and monitoring of treatment response based on clinical evaluation and ECG, along with identification and treatment of underlying triggers. We report a case of a 10-year-old female presenting with suspected SVT and pericarditis, who experienced episodes of narrow QRS complex tachycardia that were successfully converted to sinus rhythm following amiodarone administration. Echocardiographic evaluation revealed mild to moderate tricuspid regurgitation with preserved ventricular function. Laboratory and radiological findings suggested an underlying inflammatory process, which was considered a triggering factor. This case highlights the importance of a comprehensive approach in the diagnosis and management of pediatric SVT, including addressing underlying conditions and ensuring continuous monitoring to prevent recurrence.

Chronic Coronary Syndrome (CCS) is a contemporary term that replaces stable coronary artery disease (CAD) and describes a spectrum of clinical conditions resulting from chronic abnormalities of the coronary arteries. This condition is characterized by a mismatch between myocardial oxygen supply and demand that is transient and reversible, commonly presenting as stable angina pectoris. CCS contributes significantly to global cardiovascular morbidity and mortality, including in Indonesia. The underlying pathophysiology primarily involves atherosclerosis and microvascular dysfunction leading to myocardial ischemia. Diagnosis is established through comprehensive history taking, physical examination, and both invasive and non-invasive investigations such as electrocardiography, stress testing, and cardiac imaging. Risk stratification using pre-test probability plays a crucial role in guiding further diagnostic evaluation. The management of CCS aims to relieve symptoms and prevent adverse cardiovascular events through pharmacological and non-pharmacological approaches, as well as revascularization when indicated. Pharmacological therapy includes antianginal agents, antiplatelet drugs, and lipid-lowering agents, while lifestyle modifications such as smoking cessation, healthy diet, and regular physical activity are essential in preventing disease progression. With accurate diagnosis and comprehensive management, the morbidity and mortality associated with CCS can be reduced.

Anxiety is a common psychological issue among pregnant women in the third trimester, often triggered by fear of childbirth, concerns about fetal health, and hormonal changes. If not properly addressed, it may negatively affect both maternal and fetal outcomes. Non-pharmacological approaches, such as music therapy, are increasingly used to promote relaxation and emotional well-being. This study aimed to determine the effect of music therapy using spiritual songs on the anxiety levels of third-trimester pregnant women at GMIM Siloam Sonder Minahasa Hospital. A pre-experimental design with a one-group pretest–posttest approach was applied. The sample consisted of 30 pregnant women selected through total sampling. Anxiety levels were measured before and after the intervention using a validated instrument, and the data were analyzed using the Wilcoxon signed-rank test. The findings revealed a significant reduction in anxiety levels following the intervention. The statistical test showed a p-value of 0.000 (p < 0.05), indicating a significant effect of spiritual music therapy on reducing anxiety. These results suggest that spiritual songs can provide emotional comfort, enhance relaxation, and foster a sense of peace among pregnant women. In conclusion, music therapy using spiritual songs is an effective, safe, and complementary non-pharmacological intervention to reduce anxiety in third-trimester pregnant women and can be considered as part of maternal healthcare support.