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Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that may persist into adulthood and affect academic, social, and occupational functioning. In adult patients, ADHD is frequently associated with an increased risk of Substance Use Disorder (SUD), raising concerns regarding the potential for misuse and dependence related to stimulant medications used in ADHD therapy. This study aimed to evaluate the effectiveness of pharmacotherapy for adult ADHD and to review the risk of stimulant misuse and dependence based on current scientific evidence. The method employed in this study was a literature review using data obtained from national and international journals indexed in Scopus, PubMed, and Google Scholar published between 2017 and 2026. The findings indicated that stimulant medications, such as methylphenidate and amphetamine, were effective in reducing the core symptoms of ADHD by increasing dopamine and norepinephrine activity in the central nervous system. Most studies reported that the use of stimulant medications at therapeutic doses and under medical supervision was not significantly associated with an increased risk of substance misuse or dependence. The risk of misuse was more commonly observed in cases involving non-medical use and inadequate clinical monitoring. In addition to pharmacological therapy, non-pharmacological approaches such as cognitive behavioral therapy (CBT) also contributed to improving treatment outcomes and patients’ quality of life. Therefore, the use of stimulant medications in adult ADHD patients may be considered relatively safe and effective when administered rationally, individually, and under appropriate medical supervision.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that may persist into adulthood and affect academic, social, and occupational functioning. In adult patients, ADHD is frequently associated with an increased risk of Substance Use Disorder (SUD), raising concerns regarding the potential for misuse and dependence related to stimulant medications used in ADHD therapy. This study aimed to evaluate the effectiveness of pharmacotherapy for adult ADHD and to review the risk of stimulant misuse and dependence based on current scientific evidence. The method employed in this study was a literature review using data obtained from national and international journals indexed in Scopus, PubMed, and Google Scholar published between 2017 and 2026. The findings indicated that stimulant medications, such as methylphenidate and amphetamine, were effective in reducing the core symptoms of ADHD by increasing dopamine and norepinephrine activity in the central nervous system. Most studies reported that the use of stimulant medications at therapeutic doses and under medical supervision was not significantly associated with an increased risk of substance misuse or dependence. The risk of misuse was more commonly observed in cases involving non-medical use and inadequate clinical monitoring. In addition to pharmacological therapy, non-pharmacological approaches such as cognitive behavioral therapy (CBT) also contributed to improving treatment outcomes and patients’ quality of life. Therefore, the use of stimulant medications in adult ADHD patients may be considered relatively safe and effective when administered rationally, individually, and under appropriate medical supervision.

Allergic rhinitis (AR) is an inflammatory process of the nasal mucosa initiated by a hypersensitivity reaction and caused by exposure to allergens mediated by immunoglobulin E (IgE), with several characteristic symptoms including: nasal congestion, a runny nose or watery nasal discharge (rhinorrhea), nasal itching, sneezing, and  postnasal drip (PND). According to the World Health Organization’s Allergic Rhinitis and its Impact on Asthma (WHO-ARIA) guidelines, based on the duration of symptoms, allergic rhinitis is classified into two categories: intermittent allergic rhinitis (symptoms lasting less than 4 days per week or for less than 4 weeks) and persistent allergic rhinitis (symptoms lasting more than 4 days per week and for more than 4 weeks). The prevalence of allergic rhinitis based on a doctor’s diagnosis is approximately 15%; however, it is estimated to reach 30% when considering patients with nasal symptoms. Appropriate management of allergic rhinitis, in addition to alleviating symptoms, is also expected to improve the quality of life of patients whose lives have been disrupted by the condition, as the higher the severity and frequency of allergic rhinitis symptoms, the greater the impact on reduced quality of life.

According to the WHO and the Ministry of Health, hypertension is defined as blood pressure ≥ 140/90 mmHg, consistent with the ESC/ESH guidelines. Hypertension is one of the leading causes of premature death worldwide. Symptoms experienced by patients with hypertension include headaches, sweating, palpitations, snoring, daytime sleepiness, muscle weakness, cramps, and cardiac arrhythmia. Clinical manifestations of hypertensive urgency include elevated blood pressure, severe headache, anxiety, and shortness of breath. Mrs. M, a 68-year-old woman, came to the Samudera Community Health Center complaining of a headache that had worsened approximately 3 days ago. The headache is felt at the back of the head, feeling heavy, and sometimes radiates throughout the entire head. The patient also describes the headache as throbbing. The headache was exacerbated when the patient could not sleep, consumed salty foods, and did not take her medication regularly.  The headache subsides slightly when the patient takes medication and sleeps with their head elevated.  The patient reported that the symptoms were also accompanied by nausea, dizziness, palpitations, and an inability to sleep at night. The patient has been diagnosed with hypertension for approximately 5 years. On physical examination, the patient’s blood pressure was 190/100 mmHg. The patient was advised to adopt a healthy diet by reducing salt intake. The patient was also prescribed the following medications: Captopril 25 mg twice daily, Amlodipine 5 mg once daily, Paracetamol 500 mg three times daily, and Domperidone 10 mg twice daily, to be taken as needed.

Mindfulness intervention therapy is a psychotherapy that can be used to reduce depressive symptoms. This study aims to determine whether mindfulness therapy contributes to reducing the level of depression in patients cancer at the Cipto Mangunkusumo Hospital, Jakarta. The research design used was the experimental design of the one group pretest-posttest design. The total number of samples used for the population was 30 people who met the criteria for depression. Relevant data was collecterd through clinical interviews, observations and psychological test. The Beck Depression Inventory II (BD-II) questionnaire was used to collect data for this study. According to the Wilcoxon analysis, the results were statistically significant p = 0.000, indicating a large effect size in reducing depressive symptoms with mindfulness therapy. These results are supported by improved patients understanding of depression and mindfulness concepts, as well as enhanced abilities in adapting emotional coping strategies. The results of qualitative analysis showed that subjek felt more happy, be positive, not hopeless, effective communication skills and be able to resolve their problems. This research can make a significant contribution to efforts to prevent and treat depression in cancer patients, improving their quality of life through increasing mindfulness.

Uterine myoma is a benign smooth muscle tumor of the uterus commonly found in women of reproductive age and may cause symptoms related to mass effect and hematologic disturbances. We report the case of a 41-year-old woman presenting with progressive vaginal pain for 3 months, accompanied by low back pain and impaired daily activities, without vaginal bleeding, vaginal discharge, fever, or urinary or defecatory symptoms. Laboratory examination revealed severe microcytic hypochromic anemia with a hemoglobin level of 4.7 g/dL, while ultrasonography demonstrated a 9.93 × 10.32 cm mass described as symmetric, well circumscribed, and hyperechoic, leading to a working diagnosis of uterine myoma with anemia. The patient was managed with general condition monitoring, intravenous fluids, analgesics, transfusion of four units of packed red cells, and laparotomy as definitive intervention. Following transfusion and surgery, the hemoglobin level increased to 9.4 g/dL and subsequently to 11.0 g/dL, accompanied by improvement in postoperative symptoms and clinical condition. This case demonstrates that a large uterine myoma may present predominantly with pelvic pain and functional impairment in the absence of vaginal bleeding. A comprehensive approach involving systematic evaluation, preoperative correction of anemia, appropriate surgical intervention, and postoperative monitoring is essential to improve safety and clinical outcomes in patients with symptomatic pelvic masses.

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.

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.

Heart failure is a clinical syndrome characterized by shortness of breath and fatigue resulting from structural or functional abnormalities of the heart.  Acute Decompensated Heart Failure (ADHF), also known as decompensated heart failure, is a condition of worsening chronic heart failure that can occur acutely, subacutely, or insidiously, with symptoms progressively worsening over several days or weeks. A 1-year-old male patient presented to the Dermatology Clinic at Cut Meutia General Hospital with the chief complaint of A 60-year-old female patient was brought to the Cut Meutia Emergency Department with the complaint of shortness of breath that had worsened 1 day prior to admission; the shortness of breath worsened during light activity and when the patient was lying down. She also complained of swelling in both legs for one week prior to admission, which had progressively worsened. On examination, skin turgor was slow to return in the left and right lower extremities; palpation of the neck revealed jugular vein distension. Inspection showed a normal chest contour; auscultation of the lungs revealed rhonchi. Cardiac percussion revealed enlargement of the upper, left, and right borders of the heart, as well as the cardiac border at the level of the waist. Auscultation revealed a murmur at the fourth intercostal space on the left side. Examination of the lower extremities revealed pitting edema on both the left and right sides.  Supportive X-ray examination revealed severe cardiomegaly. An ECG revealed sinus rhythm, an irregular rate of 80 beats per minute, LAD axis, P wave not identifiable, PR interval 0.20 seconds, QRS complex 0.6 seconds, inverted T waves in I and AVL, LVH (+), RVH (-), PVCs, AF, and lateral ischemia. Echocardiography revealed severe aortic stenosis due to RHD and an LVEF of 21%. The patient has been prescribed furosemide, warfarin, bisoprolol, and spironolactone.

Anemia in adolescents is a serious health issue that impacts students' concentration and productivity. This community service activity aims to conduct early detection of anemia through a comprehensive manual screening method at three high schools: SMA Sains Alumnika Palembang, SMA Candradimuka, and SMA Mandiri. The implementation method involved three main stages: identification of clinical signs and symptoms (5L), visual observation of the palpebral conjunctiva, and hemoglobin (Hb) level measurement using Point of Care Testing (POCT) devices. Held from April 1st to 8th, 2026, the activity involved the active participation of students and school authorities as an effort toward independent nutritional surveillance. The screening results showed a correlation between subjective symptoms, pale conjunctiva conditions, and Hb measurement results in the field. Changes in students' behavior regarding nutritional intake and the emergence of new awareness among school authorities about the importance of routine check-ups served as indicators of successful social transformation. In conclusion, integrated manual screening is highly effective as a preventive health measure for adolescents within educational environments.

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.

Anemia in toddlers is a serious nutritional problem that impacts physical growth, cognitive development, and the child's immune system. This study aims to provide an overview of the level of knowledge, attitudes, and practices of parents in preventing anemia in toddlers. This quantitative study involved 50 respondents using a structured questionnaire instrument covering the domains of knowledge, attitudes, practices, and sources of health information. The results showed that respondents' knowledge was in the adequate category; although all respondents (100%) understood the negative impact of anemia on growth and intelligence, only 80% understood the technical definition and clinical symptoms accurately. In the attitude domain, respondents showed a very positive response (100%) to the importance of balanced nutrition and early prevention. Regarding the practical aspect, although regular visits to integrated health posts (Posyandu) reached 100%, the consistency of daily animal side dish intake remained at 80%. An interesting finding showed a shift in information sources, with social media (80%) dominating over direct exposure to information from health workers (40%). This study concluded that there is a gap between positive attitudes and consistent daily practices, and the need to optimize health education through digital media by medical personnel to reduce the incidence of anemia in toddlers.

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.

Health anxiety is a psychological condition characterized by excessive and persistent worry about having or developing a serious illness despite the absence of objective medical evidence. Among adolescents, health anxiety often manifests through recurrent somatic complaints that lead to repeated visits to primary health care services. This study aims to describe the dynamics of health anxiety in an adolescent and to examine the early response to a cognitive behavioral therapy (CBT) intervention delivered in a primary health care setting. This research employed a clinical case study design with a descriptive qualitative approach supported by quantitative assessment data. The participant was an adolescent presenting with recurrent physical complaints without identifiable medical pathology. Data were collected through clinical interviews, behavioral observation, and standardized psychological instruments, namely the Short Health Anxiety Inventory (HAI-18) and the Patient Health Questionnaire-15 (PHQ-15). Quantitative analysis focused on pre- and post-intervention score comparison, calculation of change scores, and the Reliable Change Index to evaluate individual-level change. The findings revealed a high level of health anxiety accompanied by low severity of somatic symptoms, indicating that psychological distress was primarily driven by maladaptive cognitive interpretations rather than physical pathology. Following the CBT intervention, a reduction in health anxiety scores was observed, reflecting an early improvement, although the change did not reach statistical significance based on the Reliable Change Index. These results suggest that CBT may produce meaningful early changes in health anxiety when implemented in primary health care settings, even with brief intervention formats. The study highlights the importance of early psychological assessment and intervention for adolescents with recurrent somatic complaints and supports the integration of mental health services within primary health care. However, findings should be interpreted cautiously due to the single-case design, and further research with larger samples and longitudinal follow-up is recommended

This meta-review evaluates the effectiveness of diverse mental health programs targeting Syrian refugees in Turkey over the period 2015-2023 through a systematic synthesis of 47 studies involving a total of 12,847 participants. Meta-regression results demonstrate a statistically significant reduction in Post-Traumatic Stress Disorder symptoms, with a large effect size (d = -0.86, 95% CI [-1.02, -0.70], p < .001), as well as a significant reduction in depressive symptoms (d = -0.72, 95% CI [-0.88, -0.56], p < .001) following intervention. Among the therapeutic approaches examined, Cognitive Behavioral Therapy exhibited the strongest therapeutic effect (β = 0.45, p < .001), followed by Eye Movement Desensitization and Reprocessing (β = 0.38, p < .001). Further moderator analysis revealed that group-based interventions were more effective than individual approaches (OR = 1.86, 95% CI [1.42, 2.30]). At the same time, program duration of 12-16 weeks showed a strong correlation with optimal clinical outcomes (r = 0.67, p < .001). These findings extend the results of Acarturk et al. (2022) regarding the effectiveness of CBT and reinforce the argument advanced by Shehadeh et al. (2016) concerning the superiority of group-based approaches, while also indicating a longer optimal intervention duration than previously reported. In contrast to the meta-analysis by Antuña-Camblor & Hernández (2025), which emphasized EMDR, this study identifies CBT as superior to EMDR among Syrian refugees in Turkey. The novelty of this study lies in its comprehensive analysis of program moderator factors and the identification of the most effective intervention duration parameters for the target population.

Schizophrenia is a complex psychiatric disorder that disrupts cognition, emotion, perception, and behavior, significantly affecting daily functioning and social interaction. Paranoid schizophrenia, a well-recognized subtype, is characterized by persistent paranoid delusions, frequently accompanied by hallucinations—most commonly auditory—and other perceptual disturbances, often leading to unpredictable or aggressive behaviors. A 34-year-old male patient, Mr. A, was brought to Cut Meutia General Hospital on February 9, 2024, by his father and the village chief due to episodes of aggression. The patient reported that his behavior occurred because a creature was controlling his body and disturbing him. His family indicated that he had experienced similar episodes in the past and had previously been hospitalized for the same condition. Based on established clinical guidelines, he was diagnosed with paranoid schizophrenia. Pharmacological management was initiated, including risperidone, clozapine, lodemer injection, diazepam injection, divalproex, and trihexyphenidyl, targeting psychotic symptoms, agitation, and behavioral disturbances, with the aim of stabilizing his mental state, preventing further aggressive episodes, and supporting overall functional recovery.

This study, titled “Happiness According to Hamka and Its Relevance to Efforts to Overcome Mental Distress,” is motivated by the increasing mental strain experienced by modern society, which is reflected in rising levels of stress, anxiety, loss of life meaning, and various forms of depression. These symptoms indicate a deeper spiritual and emotional imbalance that cannot be resolved solely through clinical approaches, but requires insights from philosophical and religious thought. The purpose of this research is to reexamine Hamka’s concept of happiness and identify its relevance in supporting efforts to reduce mental distress in contemporary life. Using a qualitative-descriptive method with a library research approach, this study reviews Hamka’s key writings such as Tasawuf Modern, Falsafah Hidup, and Lembaga Budi alongside literature on psychology and mental health. Through a hermeneutic-philosophical analysis, the study finds that Hamka defines happiness as inner tranquility rooted in faith, sincerity, and spiritual connection with God, rather than material satisfaction or outward pleasures. He emphasizes that true happiness is achieved when intellect, emotion, and faith interact harmoniously, allowing individuals to manage desires, accept destiny, and uphold moral awareness. This perspective is highly relevant for addressing mental distress today, as Hamka highlights the importance of spiritual strengthening and purification of the soul as forms of internal healing capable of fostering resilience and emotional stability.

Appendicitis is one of the most common causes of acute abdominal pain in children and is considered a surgical emergency requiring immediate diagnosis and management to prevent serious complications. Diagnosing appendicitis in children is often challenging because the symptoms are non-specific, and the child's ability to articulate complaints is limited. This case report discusses a 6-year-and-9-month-old boy who presented with a chief complaint of lower right abdominal pain accompanied by nausea, vomiting, and fever. Based on the results of the anamnesis, physical examination, and supporting investigations in the form of laboratory tests and abdominal ultrasound (USG), a diagnosis of acute appendicitis was established. The patient then underwent an appendectomy with good recovery and no complications. This case emphasizes the importance of comprehensive clinical evaluation and the use of non-invasive supporting examinations such as ultrasound in establishing the diagnosis of appendicitis in children. It highlights the critical role of timely diagnosis and intervention, which can lead to favorable outcomes and prevent the risk of perforation or other serious complications. Early recognition and appropriate surgical decision-making are key to improving patient prognosis.

Hirschsprung’s disease is a congenital disorder caused by abnormal nerve cell development in the large intestine, leading to chronic intestinal obstruction in infants. This condition often manifests through symptoms such as constipation, abdominal distension, vomiting, and failure to thrive. The weak immune system of infants makes them highly susceptible to bacterial infections and further complications. At Bidadari General Hospital, there were 110 patients suspected of having Hirschsprung’s disease. One of the major challenges in managing these cases is the limited number of medical specialists, particularly pediatricians and pediatric surgeons, resulting in long waiting times for accurate diagnosis, especially during peak service hours. To address this issue, this study applies the Dempster-Shafer method in an expert system to assist in diagnosing Hirschsprung’s disease based on clinical symptoms. The method effectively handles uncertainty and combines multiple pieces of medical evidence to produce more accurate diagnostic probabilities. The analysis results show that from the selected symptoms, the highest diagnosis probability corresponds to short-segment Hirschsprung’s disease with a confidence level of 71.54%. These findings suggest that the Dempster-Shafer method can serve as an effective alternative tool to support early and accurate diagnosis of Hirschsprung’s disease in infants.