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Background: Labor is a physiological process that is commonly accompanied by pain, causing discomfort, anxiety, and fear that may interfere with maternal well-being and labor progress. Effleurage massage is a complementary, non-pharmacological intervention used to reduce labor pain. Purpose: This study aimed to evaluate the effectiveness of effleurage massage in reducing pain intensity during the first stage of labor. Method: A literature review was conducted using articles retrieved from Google Scholar. An initial search identified 45 articles, and after screening based on publication year (2021–2026), relevance, and inclusion criteria, 10 research articles were included for analysis. Data were extracted and synthesized descriptively. Results: The findings consistently showed that effleurage massage reduced labor pain by promoting relaxation, decreasing muscle tension, improving blood circulation, and stimulating endorphin release through the gate control mechanism. Most studies also reported improved maternal comfort during labor. Conclusion: In conclusion, effleurage massage is an effective, safe, affordable, and easy-to-apply complementary therapy that can be integrated into midwifery care to reduce labor pain and enhance maternal comfort.  

Typhoid fever is a febrile illness that commonly occurs in urban areas with poor sanitation. It is usually caused by the consumption of untreated water and contaminated food. Because the S. typhi bacterium can survive in water for days, contamination of surface water—such as wastewater, freshwater, and groundwater—serves as the primary cause of typhoid fever. The patient presented to the Emergency Department of Cut Meutia General Hospital with complaints of high fever for approximately 4 days prior to admission, which had worsened over the past 2 days. The fever fluctuated and was accompanied by chills. It worsened at night and was not influenced by weather or temperature. These symptoms were accompanied by vomiting every time the patient tried to eat, nausea, abdominal pain, headache, and weakness. The patient reported vomiting the contents of their meal every time they ate, leading to a loss of appetite. These symptoms began when the patient first developed a fever. The patient also experienced abdominal pain. Spontaneous bleeding was denied. On physical examination, the patient appeared weak but was alert and oriented. On neck examination, palpable enlargement of the thyroid glands was found on the right and left sides of the neck, measuring 2x2 cm, mobile, and soft. On abdominal examination, increased bowel sounds were noted. Vital signs were normal except for the patient’s febrile temperature. Laboratory tests revealed a Tubex blood test result of scale 4 and a positive dengue IgG serology result.

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.

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.

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).

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.

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.

Background: Comprehensive midwifery care is essential for early detection of complications and reducing maternal and infant mortality rates. In Sleman Regency, despite high access to health services, continuous monitoring remains crucial for ensuring maternal and fetal safety. Objective: To provide comprehensive midwifery care for Mrs. M at Klinik Pratama Shaqi, Sleman, from the third trimester of pregnancy through the postpartum and neonatal periods. Methods: This is a descriptive qualitative study using a case study approach based on Varney's seven-step midwifery management and SOAP documentation. Findings: During pregnancy (37 weeks 6 days), the mother experienced physiological complaints of back pain and shortness of breath, managed through posture education and pregnancy exercises. Labor proceeded normally and spontaneously on October 6, 2024, utilizing "gentle birth" practices such as endorphin massage to reduce pain. A second-degree perineal tear occurred and was treated according to procedure. The baby was born healthy, weighing 3100 grams, with successful Early Initiation of Breastfeeding (EIB). During the postpartum and neonatal periods, uterine involution was normal, breast milk production was adequate, and the infant's growth met standards with no danger signs. Implications: Continuous assistance improves the mother's physical and psychological readiness and ensures a healthy neonatal transition.

Empowering pregnant women in their third trimester through Respectful Maternity Care-based childbirth preparation counseling is a relevant promotive and preventive strategy for improving maternal health. This counseling not only provides knowledge about the signs of labor, stages of labor, pain management options, and birth planning, but also equips mothers with an understanding of their rights in midwifery care. Childbirth preparation education often focuses solely on clinical aspects and fails to fully address the psychosocial aspects and the rights of mothers as service recipients. This has the potential to lead to an unpleasant childbirth experience and even contribute to disrespect and abuse during labor. This counseling can equip mothers with an understanding of their rights in midwifery care. With an empathetic, participatory, and woman-centered approach, pregnant women are expected to be able to recognize their needs, convey their preferences, and communicate effectively with health workers. The purpose of this counseling is to improve pregnant women's knowledge before and after being empowered in their third trimester through Respectful Maternity Care-based childbirth preparation counseling.

The goal of continuous midwifery care is to use the SOAP documentation technique to provide comprehensive care to pregnant women up to birth control according to care standards. From May 2 - July 14, 2025, Mrs.C, G2P1A0, 32 years old received continuous midwifery care from pregnancy until get contraception methods, starting at 34 weeks of gestation. The mother complained of back pain during prenatal check-ups. The labor process went smoothly. With the assistance of a midwife, the baby was born on June 10, 2025. Birth weight: 3000 grams; length: 50 cm; head circumference: 34 cm; chest circumference: 33 cm; received Hb0 vaccine two hours after birth, eye ointment, and vitamin K shortly thereafter. The baby did not experience any problems or complaints during the first visit. Mrs. C received four visits during the postpartum period. The mother did not feel anything during the first visit up to the following visits. She continued to breastfeed exclusively, and her vital signs and fundal height returned to normal. The mother used a three-month injectable contraceptive so as not to interfere with the exclusive breastfeeding program. Mrs.C has received continuous midwifery care during pregnancy and contraceptive use, and her health is normal. It is expected that the midwife will be able to provide continuous midwifery care so that in the event of an emergency, it can be immediately identified and promptly handled.

Labor pain is a significant challenge faced by in-partum mothers, with a prevalence of 70% in Indonesia, and 40% of women reporting severe pain (Central Statistics Agency, 2022). Conventional pharmacological methods often do not provide optimal results and can cause side effects. As a non-pharmacological alternative, oxytocin massage has shown promise in reducing labor pain intensity by stimulating the endogenous production of oxytocin, a natural analgesic hormone. This study aimed to assess the effect of oxytocin massage on labor pain intensity in in-partum mothers at Manado Medical Center Hospital. A pre-experimental design with a one-group pre-test post-test approach was used. The sample consisted of 30 in-partum mothers who met the inclusion criteria. Pain intensity was measured using the Numeric Rating Scale (NRS) before and after a 30-minute oxytocin massage administered by trained health workers. Data were analyzed using a paired t-test. The results showed a significant reduction in pain intensity from an average of 7.23 (SD=1.08) before the massage to 4.63 (SD=1.11) afterward, with a decrease of 2.6 points. The proportion of mothers experiencing severe pain decreased from 50% to 20%, while mild pain increased from 16.7% to 46.7%. The paired t-test revealed a highly significant difference with t=10.274 (df=29), p=0.000 (p<0.05). In conclusion, oxytocin massage is an effective non-pharmacological intervention that can significantly reduce labor pain and improve the birth experience. It can be incorporated into standard maternity nursing protocols to enhance maternal care.

Anxiety during pregnancy, particularly near the time of delivery, is a common issue that may adversely affect both maternal and fetal health. Elevated anxiety levels are associated with increased pain perception, prolonged labor, and a higher likelihood of complications. Non-pharmacological approaches, such as aromatherapy, are increasingly utilized due to their safety, simplicity, and effectiveness. Lavender aromatherapy is especially recognized for its calming effects and its ability to enhance emotional well-being. Previous research has indicated that lavender scent exposure can reduce both physiological and psychological indicators of anxiety, including among pregnant women. However, evidence from Indonesian primary healthcare settings remains limited. This study aimed to evaluate the effectiveness of lavender aromatherapy in reducing anxiety levels among pregnant women approaching childbirth. An analytical observational design with a pretest-posttest approach was applied to 30 participants selected through purposive sampling. Anxiety levels were assessed using a validated questionnaire before and after inhalation of lavender aromatherapy administered under standardized conditions. Data were analyzed using the Wilcoxon signed-rank test.The findings revealed a significant reduction in anxiety levels after the intervention (p < 0.05), with all participants experiencing improvement and no adverse effects reported. In conclusion, lavender aromatherapy is an effective complementary intervention to reduce anxiety and support maternal readiness for labor.

Plasma Cell Leukemia (PCL) is a rare lymphoproliferative disorder characterized by the proliferation of malignant plasma cells in the bone marrow and their presence in the peripheral blood. PCL is classified into primary plasma cell leukemia (pPCL), which occurs de novo without a prior history of multiple myeloma, and secondary plasma cell leukemia (sPCL), which arises in association with relapsed or refractory multiple myeloma. A 58-year-old woman presented with right hip pain that had been ongoing for four months. The pain progressively worsened, limiting her ability to move her leg and eventually causing significant difficulty in walking. She also experienced bilateral lower limb weakness and an unintentional weight loss of 10 kg over the same period. The patient denied any history of trauma. Physical examination revealed pallor without signs of bruising or spontaneous bleeding. Laboratory findings showed severe anemia (Hb 6.5 g/dL), leukocytosis (24,100/µL), thrombocytopenia, an elevated erythrocyte sedimentation rate, and 25% plasma cells on peripheral blood smear. Bone marrow aspiration demonstrated 40% infiltration by plasma cells. Based on the patient’s clinical presentation, physical examination, and laboratory findings, the diagnosis is consistent with primary Plasma Cell Leukemia.

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.

Sectio caesarean surgery is a surgical procedure that can effectively prevent ma- ternal and newborn deaths when used for reasons of medical indications. Post operative sectio caesarean can pose several risks of complications, one of which is pain and surgical wound infection. Non pharmacological approach aromatherapy as a complementary therapy to reduce postpartum pain. This case study aims to analyze the influence aromatherapy lavender on reducing pain levels in post sectio caesarean mothers by using the case study method pre and post test. The case study was carried out in 25 May 2025 – 07 June 2025. This type of case study is descriptive with the number of subjects used, namely three post partum mothers in the RSUD Batang private sector with pain assessment using a questionnaire Numeric Rating Scale (NRS). The results of the case study showed a change in pain intensity from a scale of 6-7 to a scale of 4-5. This shows an influence aromatherapy lavender on reducing pain levels in postpartum mothers caesarean section Giving innovation aromatherapy can be used as an independent nursing in- tervention so that it can be applied to patients regularly.

Fournier gangrene (FG) is a progressive and life-threatening necrotising fasciitis that affects the perineum, perianal region, and external genitalia. FG is a rare condition with a high mortality rate, which is significantly influenced by comorbidities such as uncontrolled diabetes mellitus, which acts as a major predisposing factor. Early diagnosis and aggressive management, particularly surgical debridement, are key to improving patient outcomes. This study is a case report aimed at describing the clinical findings, management, and final outcome in one patient diagnosed with Fournier gangrene. Data were collected from the patient's medical records after obtaining consent. A 52-year-old man with a history of uncontrolled DM presented with complaints of pain radiating from the scrotum to the lower abdomen and perineum, scrotal swelling, and fever, which developed over 5 days. A urological physical examination revealed scrotal oedema, crepitus, and necrotic skin accompanied by foul-smelling discharge. Laboratory results showed leukocytosis and hyperglycemia. The patient was diagnosed with Fournier gangrene and immediately underwent necrotomy debridement. Pharmacological management included aggressive fluid resuscitation, broad-spectrum antibiotics, and supportive therapy. The diagnosis of Fournier gangrene was established based on clinical findings of skin necrosis, crepitus, and severe pain in the genital/perineal area with uncontrolled DM as a predisposing factor. Rapid and integrated management, including aggressive surgical debridement, broad-spectrum antibiotics, and fluid resuscitation, is fundamental to successful treatment. The patient in this case report showed improvement and was discharged after 8 days of treatment.

Labor is a complex interaction between psychological and physiological drives in women. (90%) delivery is accompanied by pain. In the active phase there is an increase in the intensity and frequency of contractions, so that the peak pain response is in this phase. Pain and soreness during labor are basically caused by strong contractions during labor. Breathing relaxation techniques can control pain by minimizing sympathetic activity in the autonomic nervous system. This study aims to determine the effect of deep breathing relaxation techniques on reducing labor pain in the first active phase. The type of design in this study is pre-experimental with The number of samples was taken according to the Accidental Sampling technique, samples were taken when patients went to the Andra Agustiana PMB Clinic with a minimum of 30 respondents. The data collection technique used a questionnaire sheet and a Numeric Rating Scale (NRS) pain scale. Data analysis used the Wilcoxon test. The results showed that before being given the breathing relaxation technique, most respondents experienced severe pain or pain levels on a scale of 7-10, namely 25 respondents (71.4%) and after being given deep breathing relaxation technique treatment, most respondents experienced moderate pain (scale 4-6) as many as 28 respondents (80%). The results of data analysis obtained the Asymp.significancy value = 0.000 (ρ<0.05). The conclusion is that there is an effect of providing deep breathing relaxation techniques on reducing labor pain in the first active phase. It is hoped that deep breathing relaxation techniques can be applied in the management of labor care as an alternative to reduce labor pain for mothers giving birth in the first active phase

Labor is the process of expelling the products of conception, namely the fetus and placenta, after reaching full term and being viable in the womb. There are two types of delivery: normal delivery and caesarean section (SC). Caesarean section (SC) is a surgical procedure performed through an incision in the uterine wall to deliver the fetus. Caesarean delivery is indicate in cases of cephalopelvic disproportion, breech or transverse fetal position, fetal weight exceeding 4,000 grams, or maternal health conditions that may endanger the mother and fetus. One of the common complications following caesarean delivery is pain. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. An intervention that can be applied to reduce post SC pain is Guided Imagery Therapy. Guided imagery therapy is a non-pharmacological intervention aimed at reducing and controlling pain by creating pleasant and relacing thoughts, focusing on breathing, and visualizing positive scenarios. This study employed a descriptive case study design using the nursing process from assessment to evaluation. The study was conducted on two patients with moderate pain (pain scale 4-6) after SC at TK II Putri Hijau Hosiptal Medan. The results showed that after the application of guided imagery therapy for three days with a duration of 40 minutes per session, pain levels decreased to mild (pain scale 1-3). In ptient I, pain decreased from a score of 5 to 3, an in patient 2, from a score of 6 to 3. In conclusion, guided imagery therapy was successfully applied in reducing post -SC pain levels and can serve as a reference for further research on pain reduction following caesarean section.

A 64-year-old male patient presented to the emergency department (ED) of RS Cut Meutia with complaints of left-sided chest pain radiating to both arms, which had been occurring for two days prior to his hospital admission. The chest pain was described as sharp, sudden, and progressively worsening, and it persisted without relief from positional changes. The pain intensity was rated as 9/10 and was accompanied by cold sweats and nausea. The patient had a history of type 2 diabetes mellitus for 15 years and had been on antidiabetic medications, although he could not recall the names of the medications. The patient was a smoker but had quit smoking upon being diagnosed with diabetes. Vital signs and general status were within normal limits upon examination. Local examination of the heart revealed a murmur on auscultation. Laboratory results showed anemia, leukocytosis, hyperglycemia, and hypercholesterolemia. Electrocardiography (EKG) indicated signs of inferior STEMI (ST-Elevation Myocardial Infarction). The patient was treated with furosemide 1 amp/12 hours, atorvastatin 1x20 mg, arixtra 1x0.25 mg, aspilet 1x8 mg, clopidogrel 1x75 mg, nitrokaf retard 2x2.5 mg, and bisoprolol 1x2 mg, along with non-pharmacological management, including three-way catheter insertion and oxygen therapy at 2-4 liters per minute. Acute Coronary Syndrome (ACS) carries a poor prognosis if not managed promptly and correctly. Understanding the appropriate management of ACS is crucial in preventing further myocardial occlusion and improving patient outcomes. Therefore, rapid and accurate intervention is vital in improving the prognosis for patients with ACS.

Tuberculosis is one of world health problem, especially in developing countries. Treatment regimen with multiple first-line anti-tuberculosis drugs (ATD) such as Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, And Streptomycin remains the most effective for treatment of tuberculosis. Adverse drug reactions (ADRs) to antituberculosis drugs may range from mild gastrointestinal disturbances to serious hepatotoxicity, peripheral neuropathy, and cutaneous adverse effects. We report a 65 year old male patient with a  complaint of yellowish discoloration of sclera, nausea and vomitting after three days of initiation of ATD theraphy. The patient has been diagnosed with Tuberculosis relaps and has been taking ATD since June 2024. Patient noted epigastric pain. Laboratory examination found an increase in bilirubin level and imbalance electrolyte. The treatment is in the form of discontinuation of ATD, supportive therapy and followed by hepatoprotective supplements. ATD should be discontinued in patients with hepatotoxicity and fixed drug eruption until liver function and clinical symptoms improve. Initiation of ATD administration is carried out by administering one by one regimen. The patient is currently experiencing antituberculosis drug-induced hepatotoxicity, which is managed by providing supportive care and  different AT regimen was prescribed.