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Hypertension is one of the most common chronic diseases encountered in primary healthcare and may lead to serious complications if left uncontrolled. This case report aims to describe the management of a 48-year-old female patient with grade II hypertension through a family medicine approach at Nisam Primary Health Center, North Aceh Regency. The patient presented with intermittent headaches for one week, which worsened after physical activity and were accompanied by numbness in both legs. She had a five-year history of hypertension with poor adherence to antihypertensive medication. Physical examination revealed a blood pressure of 165/70 mmHg, leading to a diagnosis of grade II hypertension. Comprehensive management was conducted using patient-centered and family-centered approaches, including education regarding hypertension, lifestyle modification, DASH diet implementation, physical activity, medication adherence, and family support through home visits and family folders. The interventions were expected to improve blood pressure control, prevent complications, and enhance the patient’s quality of life. A family medicine approach plays an important role in comprehensive hypertension management at the primary healthcare level.

This case report examines the effectiveness of a combined pulmonary rehabilitation and musculoskeletal physiotherapy program for a 26-year-old male post-pulmonary tuberculosis patient with lumbar tuberculous spondylitis. The patient, who had completed anti-tuberculosis treatment, presented with low back pain, shortness of breath, fatigue, and limited mobility. Spirometry indicated severe restrictive ventilatory impairment (FVC 1.28 L, 32% of predicted), and lower extremity muscle strength was reduced (MMT 2-3/5). The patient used a TLSO brace and walking aid. Over a three-week physiotherapy program, the patient participated in breathing exercises, spinal mobilization, muscle strengthening, functional exercises, and education on brace use. Evaluation occurred at the first, second, and third weeks. After treatment, pain intensity decreased from VAS 6 to VAS 3, FVC improved to 1.72 L, chest expansion increased, muscle strength improved to MMT 4/5, and performance on the Five-Times Sit-to-Stand Test showed progress. The Functional Independence Measure (FIM) score increased from 98 to 115, reflecting improved functional independence. These findings suggest that the combination of pulmonary and musculoskeletal physiotherapy effectively improved respiratory function, muscle strength, and the patient’s overall functional capacity.

Post section caesarea (SC) and method of operative female sterilization (MOW) are surgical procedures that may cause various problems, such as pain, limited mobility, decreased muscle strength, and risk of postoperative complications. Physiotherapy management through exercise therapy is an important intervention to accelerate the recovery process. Objective this study aimed to determine the effectiveness of exercise therapy in improving the functional condition of patients post SC and MOW in Annisa Ward 32 A at PKU Muhammadiyah Karanganyar Hospital. Method: used was a case report on a 33-year-old female patient following SC and MOW procedures. The physiotherapy interventions included deep breathing exercises, active range of motion exercises of the extremities, light abdominal muscle contractions, gradual early mobilization, as well as breast massage and oxytocin stimulation. The results showed a reduction in pain from a scale of 4–5 to 2–3 based on the Numeric Rating Scale (NRS), improvement in mobility such as independent position changes, and increased activity tolerance, including sitting and walking with minimal assistance. In addition, the patient showed increased confidence in performing daily functional activities. Conclusion: exercise therapy has a positive effect on improving mobility, reducing pain, and accelerating functional recovery in post SC and MOW patients. Therefore, exercise therapy is recommended as an essential component of postoperative physiotherapy management to improve patients' quality of life.

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.

Background: Class II restoration according to the classification of Greene Vardiman Black is one of the procedures in dental conservation that often presents a challenge for operators or dentists during treatment. Class II restorations have their own level of difficulty, particularly during the placement of restorative materials into the cavity. One of the possible failures in Class II restorative treatment is marginal leakage, which can lead to microleakage at the restoration margins. Purpose: To report the success of class II restoration with composite resin using tofflmire matrix. Case report: A 23-year-old female patient came with a complaint of cavities, the complaint was felt since 1 year ago in the lower left back tooth, there was no pain and had never been treated. In the case, preparation and restoration were carried out using composite resin with isolation using tofflmire matrix, applied using an Incremental technique. Discussion: Class II posterior tooth restorations have challenges such as leakage due to the techniques and materials used. Composite resin is chosen because of its good adaptation, esthetics, and wear resistance. Incremental techniques are preferred because they reduce polymerization stress and provide optimal curing results. Tofflemire matrix is ​​used for stability and soft tissue protection.Conclusion: The selection of composite resin with an Incremental technique and the use of a Tofflemire matrix provides more optimal, aesthetic, and minimal risk of failure results for class II posterior tooth restorations.

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.

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.

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.

Background: Carpal Tunnel Syndrome (CTS) is a condition caused by compression of the median nerve at the wrist, resulting in pain, paresthesia, and decreased hand function. This condition is commonly experienced by individuals who perform repetitive wrist activities. Objective: To determine the effectiveness of a combination of neural mobilization exercises and electrotherapy modalities in improving hand function, increasing muscle strength, and reducing pain in a patient with Carpal Tunnel Syndrome. Methods: This study used a case report design involving a 57-year-old female patient (Mrs. Q) who presented with pain and sensory disturbances in the right hand. The intervention was administered for four weeks and consisted of ultrasound therapy, Transcutaneous Electrical Nerve Stimulation (TENS), grip strengthening exercises, and nerve gliding exercises. Outcome measures included pain intensity assessed using the Numeric Rating Scale (NRS), muscle strength evaluated using Manual Muscle Testing (MMT), and functional ability measured using the Wrist Hand Disability Index (WHDI). Results: The evaluation showed a reduction in pain intensity, with resting pain at 0/10, tenderness at 4/10, and movement pain at 4/10. Muscle strength improved from grade 3 to grade 4 based on MMT. Functional ability also improved, as indicated by a 20% reduction in the WHDI score. The combination of these interventions proved effective as a conservative management approach for Carpal Tunnel Syndrome. Conclusion: The administration of ultrasound, TENS, grip strengthening exercises, and nerve gliding exercises over four therapy sessions in Mrs. Q resulted in decreased pain, increased muscle strength, and improved hand functional ability.

Edentulism is a condition of total tooth loss that has a significant impact on the efficiency of mastics, phonetics, and facial aesthetics. This case report presents the rehabilitation of a 72-year-old female patient with a condition of total mandible edentulus using two standard-diameter implants that support the overdenture with a locator retention system. Treatment procedures include clinical evaluation, radiographic analysis, implant placement, prosthesis placement, as well as follow-up evaluation to assess function and comfort. The results of the treatment showed an increase in patient retention, stability, and comfort in daily activities. In addition, patients reported improved confidence and quality of life after the use of implant-based overdentures. These findings confirm that overdenture with mandibular implant support is a predictive, effective, and reliable rehabilitation method in treating total edentulism. The success of this case provides clinical evidence that implant-based approaches are able to overcome the limitations of conventional prostheses, as well as being a solution that supports the functional and psychosocial aspects of elderly patients. Thus, implant-based overdenture can be recommended as the primary therapeutic option in the rehabilitation of mandibular edentulism.

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.

Pneumonia caused by extensively drug-resistant (XDR) Pseudomonas aeruginosa is still  clinicaly chalenging, particularly among geriatric patients with neurological comorbidities such as stroke. This report presents a case of XDR P. aeruginosa pneumonia complicated by sepsis in a 73-year-old patient, characterized by persistent leukocytosis until the tenth day of hospitalization despite empirical meropenem therapy. This evidence-based case report aims to analyze clinical outcomes, specifically 28-day and 30-day mortality rates, and to identify mortality predictors in the adult population through a systematic literature search of the PubMed and Google Scholar databases for the 2019–2026 period. Synthesized evidence from six core studies indicates that XDR P. aeruginosa infections carry a profoundly high 28-day mortality rate, ranging from 41% to 51% in cohorts receiving antibiotic monotherapy. Key mortality predictors identified include the presence of sepsis or septic shock, a delay in initiating adequate therapy exceeding 52 hours, advanced age, and the requirement for Intensive Care Unit (ICU) admission. The phenomenon of persistent or worsening leukocytosis during treatment, as observed in this case, serves as a critical clinical indicator associated with antimicrobial response failure and a dismal prognosis. Ultimately, XDR P. aeruginosa pneumonia is associated with poor clinical outcomes, where therapeutic success is strictly contingent upon the timely administration of antibiotic regimens with proven activity against these highly resistant isolates.

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia resulting from impaired insulin secretion, insulin action, or both. Globally, DM continues to pose a growing health challenge, particularly type 2 DM, which is closely associated with insulin resistance. In this condition, body cells fail to respond effectively to insulin, so even though the pancreas initially produces sufficient or excessive amounts of insulin, its effectiveness gradually declines. Over time, pancreatic beta-cell function deteriorates, further exacerbating chronic hyperglycemia. This persistent condition may lead to long-term complications, including nephropathy, retinopathy, neuropathy, and cardiovascular diseases, through mechanisms such as oxidative stress, inflammation, and the formation of advanced glycation end products (AGEs). The prevalence of type 2 DM is expected to continue rising, including in Indonesia, highlighting the need for comprehensive management strategies. An important aspect of DM management is the assessment of health-related quality of life. Quality of life reflects an individual’s perception of their health status within social and cultural contexts. This can be evaluated using generic instruments such as the WHOQOL-BREF questionnaire. In this case report, the quality of life of a patient with type 2 DM was assessed using the WHOQOL-BREF to provide a comprehensive understanding of the disease’s impact on the patient’s daily life.

Mammae aberrans in the axilla is a developmental abnormality caused by the persistence of breast tissue along the milk line and can cause fluctuating axillary masses due to hormonal stimulation, with a reported prevalence of approximately 0.4–6%. Methods: This article is presented as a descriptive case report based on data from the Department of Surgery at Cut Meutia Regional General Hospital, North Aceh, including medical history, physical examination, routine blood tests, fine needle aspiration biopsy (FNAB), excision, histopathological examination, and follow-up. Results: A 16-year-old female patient complained of a lump in her right axilla for approximately two years, which had enlarged in the last month and caused severe pain before menstruation. Examination revealed a mass measuring approximately 3×3×2 cm, without lymph node enlargement, and normal routine blood tests. Two FNAB punctures showed fat droplets/matrix without epithelial proliferation or malignant cells (benign smear) with the impression of aberrant mammary glands. The patient underwent mass excision; histopathology showed mature fatty tissue and fibrocollagen accompanied by ductular proliferation without signs of malignancy, and at the 1-week follow-up, the pain had disappeared and the lump was no longer visible. Discussion: The cyclic pain pattern associated with menstruation is an important clue for distinguishing aberrant mammary glands from differential diagnoses of axillary masses in adolescents, while excision provides diagnostic certainty and symptom improvement. Conclusion: Mammae aberrans should be considered in adolescents with axillary masses affected by the menstrual cycle, and excision is recommended in symptomatic cases for histopathological confirmation and resolution of complaints.

Generalized pustular psoriasis (GPP) is a severe inflammatory form of psoriasis characterized by widespread sterile pustular eruptions. Pro-inflammatory mediators released during chronic inflammation may contribute to comorbidities, including type 2 diabetes mellitus (T2DM). A 65-year-old woman presented with pustular eruptions over almost the entire body for seven days, accompanied by burning sensation and pruritus. Some pustules coalesced forming “lakes of pus,” while others appeared as erythematous plaques with coarse white scales. The patient had a history of T2DM. Based on clinical findings, the patient was diagnosed with GPP. She was hospitalized for seven days and followed up weekly until week 10. Inflammatory mediators such as Th-1, TNF-α, IL-6, IL-7, IL-8, IL-17, and IL-23 in psoriasis may inhibit insulin receptor signaling and glucose uptake, leading to insulin resistance and increased blood glucose levels. The duration of treatment until remission in psoriasis patients with T2DM tends to be longer than in non-diabetic patients. In patients with comorbidities, low-dose methotrexate (5–7.5 mg/week) was administered. The coexistence of GPP and T2DM may lead to more severe exacerbations, prolonged treatment duration, and reduced quality of life, posing challenges in management.

Malnutrition and stunting among children under five remain major public health challenges in developing countries, including Indonesia. These conditions are associated with increased morbidity, mortality, impaired cognitive development, and reduced productivity in adulthood. Stunting reflects chronic nutritional deficiencies, while severe malnutrition indicates acute or prolonged inadequate nutrient intake, often exacerbated by infections, poor caregiving practices, and unfavorable socioeconomic conditions. This case report aims to describe the clinical condition, contributing factors, management, and outcomes of a 14-month-old female toddler diagnosed with severe malnutrition and stunting without complications in Blang Dalam Geuteung Village, Nisam Subdistrict, North Aceh Regency. The assessment was conducted using a family medicine approach, incorporating detailed history taking, physical examination, anthropometric measurements, and nutritional status evaluation based on World Health Organization Z-score indicators. Interventions included nutritional rehabilitation through appropriate dietary intake, family education on balanced nutrition and proper feeding practices, routine growth monitoring, and optimization of primary healthcare services. The results showed gradual improvement in the child’s nutritional status, evidenced by weight gain, better appetite, and improved feeding patterns following the intervention. This case highlights the importance of early detection, comprehensive family-centered management, and continuous monitoring in addressing malnutrition and stunting at the primary care level. Strengthening community-based interventions, improving caregiver knowledge, and enhancing collaboration between healthcare providers and families are essential to reduce the burden of malnutrition and support optimal child growth and development.

Hypertension and hypercholesterolemia are closely related non-communicable diseases and major risk factors for cardiovascular disease, particularly in older adults. These conditions are influenced by medical, behavioral, family, and environmental factors, requiring a holistic family medicine approach through home visits. This study aimed to describe the clinical condition, family function, and environmental factors of a 60-year-old female patient with hypertension and hypercholesterolemia using the APGAR and SCREEM approaches. This study employed a qualitative descriptive design in the form of a case report involving Mrs. S (60 years old) in Lebbek Village, Pamekasan Regency. Data were collected through anamnesis, physical examination, total cholesterol measurement using a GCU meter, environmental observation, and assessment of family function and environmental factors. The results showed blood pressure values of 161/96 mmHg and 160/96 mmHg on repeated measurement, with a total cholesterol level of 154 mg/dL. The patient had a high-salt and high-fat diet with low physical activity. APGAR assessment indicated poor family function with a total score of 4, particularly in the partnership and resolve domains, while the growth domain was categorized as accepting. SCREEM analysis identified education as the main barrier. In conclusion, management of this condition requires family-based interventions focusing on improving family cooperation and health education tailored to the patient’s literacy level.

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.

Nephrotic syndrome (NS) is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, and hypercholesterolemia, most commonly occurring in children. This disease can be caused by various conditions, such as minimal change disease, FSGS, or lupus nephritis. This case report discusses a 16-year-old boy who experienced nephrotic syndrome with symptoms of swelling throughout his body, accompanied by decreased appetite and a productive cough. The patient presented with complaints of swelling throughout his body that began 7 days after hospitalization and was accompanied by coughing and shortness of breath. A physical examination revealed massive edema, abdominal hypertympany, and shifting dullness. Laboratory tests revealed proteinuria, hypoalbuminemia, and decreased serum albumin. Other supporting tests confirmed nephrotic syndrome. The patient received medication therapy including diuretics, corticosteroids in the form of methylprednisolone, and albumin. Nephrotic syndrome in children can develop gradually and requires management that includes steroids, diuretics, and close monitoring of kidney function and electrolytes. Early detection and appropriate treatment can help improve the patient's prognosis.

Children constitute a vulnerable group requiring protection from sexual crimes, including pedophilia. This research aims to examine criminal law provisions protecting child victims of pedophilia crimes in Indonesia and identify obstacles in their implementation. Using a normative juridical method with statutory and conceptual approaches, the findings demonstrate that legal protection is comprehensively regulated through the Criminal Code (KUHP), the Child Protection Law (Law Number 35 of 2014), Law Number 17 of 2016, and the Electronic Information and Transactions Law (ITE). These regulations provide a strong legal basis both in terms of principal criminal sanctions and additional sanctions such as chemical castration, electronic monitoring device installation, and perpetrator identity disclosure. The regulations also emphasize victims' rights to medical and psychological rehabilitation as well as identity protection. However, implementation faces several obstacles, including low case reporting rates due to stigma and taboo culture, evidentiary difficulties arising from victim trauma, weak inter-agency coordination, limited resources, and the emergence of digital pedophilia modi. Efforts to address these obstacles include strengthening law enforcement capacity, providing child-friendly justice systems, comprehensive rehabilitation services, public legal education, and synergy between government and non-government institutions in child protection.