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Ventricular septal defect (VSD) is a congenital heart defect characterized by a gap in the interventricular septum, with a prevalence of 20–30% of all cases of congenital heart disease. Based on their location, VSD is divided into perimembrane, muscular, and subarterial. This case report discusses a patient who came to the emergency room of Cut Meutia Hospital with good consciousness (GCS E4M6V5) and complained of shortness of breath, cough, nausea, and chest pain spreading to the neck and hands. The anamnesis showed chronic symptoms in the form of coughing up phlegm for two weeks, accompanied by throbbing headaches, dizziness, flatulence, and sleep disturbances. Physical examination showed vital signs of TD 140/90 mmHg, HR 86 x/min, RR 23 x/min, SpO₂ 37%, and temperature 37°C.  Supporting examinations in the form of chest X-rays showed cardiomegaly of the pulmonary segment, while ECG showed rhythmic sinuses with LAD axis, T-inverted in AVL, V1, V2, RsR' in V2, positive Cornell criteria, anterolateral myocardial infarction, RBBB, and LVH. Echocardiography shows the presence of a bidirectional shunt with a dominant right-to-left shunt. This case confirms the importance of comprehensive diagnosis through clinical and supporting examinations to determine optimal management in patients with VSD, as well as prevent further complications.

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.

Turbinate hypertrophy is a condition characterized by abnormal enlargement of the nasal turbinate mucosa, which can lead to chronic nasal obstruction and decreased quality of life. This condition is associated with inflammatory processes in which eosinophils play a role as part of the immune response. This study aimed to determine the relationship between eosinophil levels and the degree of turbinate hypertrophy based on blood examination in hospitalized patients. This research used an observational analytic design with a cross-sectional approach involving 40 patients diagnosed with turbinate hypertrophy at Cut Meutia General Hospital, North Aceh. Data were obtained from medical records, including patient characteristics, eosinophil levels, and the degree of turbinate hypertrophy. The results showed that most patients were aged 17–25 years, predominantly female, and commonly had non-allergic underlying conditions. The majority of patients had normal eosinophil levels (80%), while most cases were classified as grade III turbinate hypertrophy (65%). Statistical analysis using Fisher’s Exact Test demonstrated no significant relationship between eosinophil levels and the degree of turbinate hypertrophy (p>0.05). These findings suggest that eosinophil levels may not be a reliable indicator in assessing the severity of turbinate hypertrophy, particularly in patients with non-allergic conditions. This study highlights the need to consider other contributing factors in the evaluation and management of turbinate hypertrophy to improve diagnostic accuracy and treatment outcomes.

Introduction: Dengue fever is a viral infection transmitted through the bite of infected female Aedes aegypti mosquito, caused by four dengue virus serotypes (DEN-1 to DEN-4), with clinical manifestations ranging from asymptomatic to severe disease and may be accompanied by warning sign. Concurrent infections, such as acute diarrhea, may worsen outcomes, particularly in children. Case Report: A nine-month-old female presented with a five-day history of intermittent fever and watery diarrhea. Additional symptoms included vomiting, lethargy, and decreased appetite. Physical examination showed a moderately ill appearance and sunken eyes. Laboratory findings revealed positive dengue IgM, negative dengue IgG, thrombocytopenia (22,000/µL), and hematocrit of 37%. The patient was diagnosed with dengue fever with warning sign and acute diarrhea. Management included intravenous crystalloid fluids, antipyretics, antibiotics, H2 receptor antagonists, and zinc supplementation. Conclusion: Dengue with warning sign and concurrent acute diarrhea in children increases the risk of morbidity and mortality. Early and appropriate management is essential to prevent disease progression and improve clinical outcomes.

Breast cancer is one of the diseases with the highest incidence rates among women and can cause death if not detected early. Breast self-examination (SADARI) is a simple method for detecting breast abnormalities early on. However, the knowledge and practice of breast self-examination (SADARI) among adolescent girls are still low. The purpose of this research is to determine the effect of health education on breast self-examination (BSE) on the knowledge and practice of early breast cancer detection at Pondok Pesantren Darul Amanah Sukorejo Kendal. Quantitative research method with a quasi-experimental design and a one group pretest-posttest design. A sample of 50 respondents with total sampling. Ethics test no: 03/EC-LPPM/UWHS/I-2026. Data analysis used the Wilcoxon test. The results showed that there is an influence of health education on knowledge with a p-value of 0.001 and on the practice of early breast cancer detection with a p-value of 0.001. It can be concluded that health education can enhance the awareness, understanding, and ability of adolescents to perform breast self-examination (SADARI) independently as an early detection effort for breast cancer, making it important to continue this practice sustainably.

Tinea incognito is a dermatophyte fungal infection when the clinical picture becomes unclear due to inappropriate treatment, which is usually caused by the use of topical steroids in cases of skin infections. A 46-year-old woman came with complaints of itchy reddish patches all over her body, experienced for 2 years. The itching worsened when consuming anchovies. The patient said she often took medication bought from a pharmacy without a doctor's prescription, the patient took methylprednisolone tablets and ointment. The itching complaint improved, but after stopping taking the medication, the itching complaint increased, and the patches widened. The patches first appeared on the right leg, initially resembling prickly heat spots then widened and spread to other parts of the body. Currently, the patches appear red in the shape of a ring with a clearer center. The patches were found on the face, neck, chest, abdomen, back, buttocks, left hand, and left foot. The patient noticed within a few months after taking the medication that her body was swollen, her weight increased, and her face looked rounder. A 20% KOH examination found hyphae and spores. Thus, the patient was diagnosed with Tinea Incognito caused by long-term topical steroid use. The patient was prescribed antifungal therapy with Ketoconazole 200 mg tablets once daily and Ketoconazole cream twice daily.

The rapid growth of beverage franchises in Indonesia, particularly MIXUE with over 4,000 outlets, necessitates an in-depth examination of the financial management strategies underlying its success. This study aims to analyze the effects of working capital management, supply chain support, and operational cost efficiency on financial performance, as well as to evaluate the investment feasibility of the MIXUE franchise in Indonesia. A mixed-methods sequential explanatory approach was employed, utilizing multiple regression analysis and capital budgeting methods including Net Present Value (NPV), Internal Rate of Return (IRR), Payback Period (PP), and Return on Investment (ROI). Data were collected from 50 franchise outlets across Jakarta, Bandung, Surabaya, and Semarang during 2022-2024, supplemented by in-depth interviews with 15 franchisees and 3 regional managers. Results reveal that all three independent variables significantly and positively affect financial performance: working capital management (β = 0.412; p = 0.002), supply chain support (β = 0.358; p = 0.008), and operational cost efficiency (β = 0.486; p < 0.001) with R² = 0.684. Investment feasibility analysis indicates an average positive NPV of IDR 290.1 million, IRR 36.5%, PP 22.2 months, and ROI 56.5%. This study contributes novel insights by integrating financial and supply chain analysis within the context of beverage franchising in emerging Asian markets, providing a comprehensive evaluation framework for prospective investors and franchise system developers.

Background: Autoimmune Hemolytic Anemia (AIHA) is a rare immunological condition that causes the destruction of red blood cells through autoantibodies. Case Presentation: This report discusses the case of a 38-year-old woman who presented with complaints of weakness and acute dizziness at RedaBolo, with a history of recurrent anemia over the past six months. Physical examination revealed clear signs of hemolysis, including icteric sclera and splenomegaly. Laboratory findings confirmed severe anemia (Hb 5.0 g/dL) with varied peripheral blood cell morphology (spherocytes, schistocytes, and teardrop cells). The diagnosis was supported by a positive Coombs test and hyperbilirubinemia.  Management: The therapeutic strategy focused on hemodynamic stabilization through transfusion of 4 units of packed red blood cells (PRC), immunosuppression with methylprednisolone 125 mg/day, and gastric protection. Conclusion: These interventions yielded satisfactory results, with the patient achieving significant clinical improvement and a hemoglobin level of 9.5 g/dL by the fourth day of treatment.

This research discusses the authority of judges in declaring a lawsuit inadmissible (Niet Ontvankelijke Verklaard/NO) in civil cases based on Decision Number 82/Pdt.G/2025/PN Kwg. The issues examined in this study relate to the application of formal requirements of a lawsuit and the authority of judges in rendering an NO decision due to errors in determining legal subjects (error in persona). This study aims to analyze the application of civil procedural law regarding the formal requirements of a lawsuit and to examine the authority of judges in declaring a lawsuit inadmissible. The research method used is normative juridical with statutory and case approaches. The legal materials used consist of primary, secondary, and tertiary legal materials obtained through library research and analyzed qualitatively. The results of the study indicate that the formal requirements of a lawsuit hold a very important position in civil procedural law. Errors in determining legal subjects, particularly involving a party who has passed away without involving the heirs, result in a formally defective lawsuit and cause it to be declared inadmissible (Niet Ontvankelijke Verklaard). In Decision Number 82/Pdt.G/2025/PN Kwg, the judges exercised their authority in accordance with civil procedural law to maintain legal certainty and orderly judicial proceedings. However, the application of such authority is considered to be overly formalistic because it did not provide an opportunity to amend the lawsuit, thereby giving less attention to substantive justice for the plaintiff.

Reading ability is a fundamental skill that strongly influences the academic success of junior high school students, particularly ninth graders in preparing for national examinations. Nevertheless, many students continue to face difficulties in reading, including speed, comprehension, and motivation. This study aims to examine the effectiveness of implementing learning guidance services to improve the reading skills of ninth-grade students, while identifying supporting and inhibiting factors in its implementation. The research employed a descriptive qualitative approach through literature review from relevant scientific sources published within the last ten years. The findings reveal that learning guidance services play a crucial role in enhancing reading skills, learning motivation, and student independence. Guidance and counseling teachers act as strategic facilitators, while support from the school environment and family strengthens the success of the program. The practical implications highlight that structured, continuous, and collaborative learning guidance programs can help students better understand reading materials and develop positive study habits. Practical recommendations are addressed to teachers, counselors, and schools to design more varied and student-centered guidance services.

Liquidity management is an important aspect in maintaining the operational stability of Islamic banking. Inadequate liquidity management can affect a bank’s ability to fulfill its short-term obligations and reduce public trust in banking institutions. This study aims to examine the basic concepts of liquidity management, liquidity management practices, and the various challenges faced by Islamic banks in maintaining financial stability. The study employed a qualitative method using a literature review approach through the examination of various sources, including books, scientific journals, and research articles relevant to the topic. The collected data were analyzed descriptively to obtain a systematic understanding of liquidity management in Islamic banking. The findings indicate that liquidity management in Islamic banks is carried out through asset and liability management, fund collection, financing distribution, and the implementation of GAP management. In addition, Islamic banking faces several challenges, including the limited availability of Islamic money market instruments, imbalance between assets and liabilities, risks of massive customer withdrawals, and changes in economic conditions and regulations. Therefore, adaptive liquidity management strategies based on prudential principles are required to maintain operational stability and ensure the sustainability of Islamic banking institutions.

This study examine the reflection of Native american economic conditions in the 1990s as potrayed in Sherman alexie’s short story This is What It Means to say Phoenix, Arizona. As literary works often reflect social realities, this study focuses on economic struggles are represented through the experiences of the main characters, Victor and Thomas. The research employs a qualitative method with a sociology of literature approach using a Marxist perspective. The data are analyzed through a narrative examination of key events and character experiences related to economic conditions. The findings reveal tha the short story reflects persistent economic issues such as poverty, unemployment, and limited access to finansial resources, whic are rooted in historical inequality and structural marginalization. These conditions, as experienced by the characters, represent broader socio-economic realities faced by native American communities living in reservations. Therefore, this study highlights tha literary works funcition not only as artistic expressions but also as representations of social and economic realities, particulalry those of marginalized groups.

The rapid advancement of digital technology in higher education has transformed learning and assessment systems, particularly through the adoption of Learning Management Systems (LMS) and Computer-Based Tests (CBT). However, many university students still face challenges in adapting to digital examination environments due to limited technical experience and digital literacy. This Community Service Activity (PKM) aims to enhance students’ academic readiness and digital competence through the implementation of a Moodle-based LMS at Universitas Murni Teguh. The activity was conducted in the form of an interactive workshop, including system introduction, simulation of CBT, guided practice, and discussion sessions involving university students and lecturers. The results showed a significant improvement in students’ understanding of LMS features, confidence in using CBT systems, and ability to manage digital-based examinations effectively. Active participation and engagement during the sessions reflected high enthusiasm and adaptability toward digital learning transformation. This activity demonstrates that the implementation of LMS Moodle is effective in improving academic preparedness and digital literacy among students, and can serve as a sustainable model for strengthening technology-based learning in higher education institutions.

The rapid advancement of digital technology in higher education has transformed learning and assessment systems, particularly through the adoption of Learning Management Systems (LMS) and Computer-Based Tests (CBT). However, many university students still face challenges in adapting to digital examination environments due to limited technical experience and digital literacy. This Community Service Activity (PKM) aims to enhance students’ academic readiness and digital competence through the implementation of a Moodle-based LMS at Universitas Murni Teguh. The activity was conducted in the form of an interactive workshop, including system introduction, simulation of CBT, guided practice, and discussion sessions involving university students and lecturers. The results showed a significant improvement in students’ understanding of LMS features, confidence in using CBT systems, and ability to manage digital-based examinations effectively. Active participation and engagement during the sessions reflected high enthusiasm and adaptability toward digital learning transformation. This activity demonstrates that the implementation of LMS Moodle is effective in improving academic preparedness and digital literacy among students, and can serve as a sustainable model for strengthening technology-based learning in higher education institutions.

Entamoeba histolytica is an intestinal protozoan that can cause diarrhea through fecal–oral transmission due to the consumption of food or water contaminated with parasitic cysts. Based on data from the Badan Pusat Statistik in 2017–2019, Simpang Keramat District, particularly Paya Leupah Village, still had limited access to clean water and low ownership of permanent sanitary latrines, which may increase the risk of environmental contamination. This study aimed to analyze the characteristics of dug wells and the risk factors associated with Entamoeba histolytica contamination in community well water. An observational analytic study with a cross-sectional design was conducted on 50 dug wells selected using purposive sampling. Data were obtained through field observations and laboratory examinations of well water samples. The results showed that most wells had distances to septic tanks that did not meet health standards (58%) and inadequate well floor conditions (82%), while the majority of wells had depths that fulfilled the recommended standard (76%). All well water samples tested negative for Entamoeba histolytica cysts; therefore, the association between risk factors and contamination could not be determined.

Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication of diabetes mellitus characterized by hyperglycemia, metabolic acidosis, and ketosis due to absolute or relative insulin deficiency. DKA may present as the initial manifestation of previously undiagnosed diabetes, particularly in young adults. We report a case of a 27-year-old male who presented with decreased consciousness preceded by shortness of breath. The patient had a three-month history of polyuria, polydipsia, polyphagia, and significant weight loss. Physical examination revealed a Glasgow Coma Scale score of 9 and signs of dehydration. Laboratory findings showed severe hyperglycemia (426 mg/dL), elevated HbA1c (8.5%), leukocytosis, and severe metabolic acidosis (pH 6.8; HCO₃⁻ 5.8 mmol/L). The diagnosis of DKA was established based on clinical and laboratory criteria. Management included aggressive fluid resuscitation, continuous intravenous insulin infusion, electrolyte correction, and antibiotic therapy for suspected infection. The patient showed gradual clinical improvement. This case highlights the importance of early recognition, identification of precipitating factors, and prompt management to reduce morbidity and mortality associated with DKA.

Cardiovascular dysfunction is a disorder of the blood vessels, such as hypertension, heart failure, and stroke. In 2016, cardiovascular disease was the leading cause of death worldwide, based on data from the World Health Organization (WHO). Coronary Heart Disease (CHD) is the leading cause of death, along with stroke, as shown by the Sample Registration System survey in 2014.This case involves a 64-year-old male, Mr. N, who presented to the emergency department of RSUD dr. Fauziah Bireuen with complaints of chest pain that developed gradually and worsened over the past month. The pain was located across the entire chest and radiated to the back and neck. The pain was described as severe, like being crushed by a heavy load, worsened during strenuous activities such as cutting grass and chopping wood, and relieved when the patient bent forward. The pain could occur at any time, with a Visual Analog Scale (VAS) score of 10 (severe pain). The patient also reported easy fatigue during heavy physical activity over the past month. Laboratory examination revealed elevated leukocytes, mean corpuscular volume (MCV), segmented neutrophils, troponin I, cholesterol, and triglycerides. The patient was diagnosed with extensive anterior ST-elevation myocardial infarction (STEMI) post successful fibrinolytic therapy.

This research aims to analyze criminal acts that may be qualified as perpetrators of the crime of obstruction of justice from the perspective of the criminal law applicable in Indonesia, as well as to analyze the application of the law against perpetrators of obstruction of justice in Indonesia. The type of research used in this thesis is doctrinal research. The doctrinal approach has a normative character; therefore, its object of study consists of a set of legal norms (black letter law) at the level of application (professional constituency), or, at certain levels of analysis, this approach extends to the examination of legal theory. Based on the results of the research, the author finds that the provisions governing acts that may be qualified as the crime of obstruction of justice in Indonesia encompass all forms of interference, from the beginning to the end, with the entire ongoing legal and judicial process. A perpetrator of obstruction of justice is aware that a person has committed a crime or is undergoing a legal process and then deliberately commits acts that may hinder or obstruct law enforcement officials in conducting examinations of the criminal offender, with the purpose that the processes of investigation, prosecution, or examination before the court are impeded, cannot be carried out, or ultimately fail to be carried out. The forms of legal enforcement against perpetrators of acts obstructing the judicial process (obstruction of justice) in Indonesia include, among others, intentionally damaging, concealing, or destroying evidence before or after the commencement of the investigation process.

Immature permanent teeth with open apices and pulpal necrosis present a significant challenge in endodontic treatment. Apexification procedures have been developed to stimulate the formation of a hard tissue barrier at the apex, thereby allowing adequate obturation. Objective: This case report aims to describe the evaluation of apexification treatment based on radiographic findings. Case Report: An 8-year-old boy accompanied by his mother presented to PKU Muhammadiyah Surakarta Hospital with a history of a fall one week earlier. The affected tooth had previously received a temporary restoration from another dentist. According to the patient’s mother, medication had been placed in tooth to devitalize the pulp prior to temporary filling. Clinical examination revealed that tooth 11 exhibited a fracture involving approximately half of the crown and extending into the pulp chamber. Discussion: Initial radiographic examination in 2018 indicated that immature teeth have lower structural resistance compared with mature teeth; therefore, endodontic intervention such as apexification is required to establish apical barrier and adequate obturation. The material used for apexification in this case was a combining calcium hydroxide and iodoform. In contrast to the initial stage, radiographic evaluation in 2024 demonstrated that root development had progressed to stage V. According to Cvek’s classification of root development, stage V (Cvek stage V) represents a condition in which root development is fully completed. Conclusion: Based on long-term clinical and radiographic evaluation in this case, apexification treatment proved effective in stimulating the formation of an apical barrier and supporting root maturation in immature permanent teeth.

The principle of good faith constitutes a fundamental element within Indonesia’s trademark law system, particularly in processes ranging from trademark registration to the cancellation of registered marks. This study examines the role of the good faith principle as a primary legal foundation for trademark annulment, using the dispute over the Minyak Kutus Kutus trademark as a case study. The conflict emerged when the trademark was registered by an individual who was not the original creator, leading to legal disputes and judicial examination. This research adopts a normative juridical method by analyzing various legal sources, including statutory regulations, court decisions, and relevant legal doctrines. The findings indicate that the principle of good faith is not merely an ethical norm but also functions as an important legal instrument to protect the legitimate rights of original trademark owners from attempts of unlawful control through bad-faith registration. Furthermore, the court’s decision in the Kutus Kutus case demonstrates the crucial role of enforcing the good faith principle in maintaining legal certainty while ensuring protection for fair and honest business actors in Indonesia’s trademark system.