Surabaya Medical Journal

Avascular Necrosis of the Femur Head after the Installation of Internal Fixation of the Posteriol Wall of the Acetabulum: A Case Report

Achmad Haykal Baswedan — 2026-08-06

Background: One of the most common acetabular fracture was the posterior wall of the acetabulum, with the complication of avascular necrosis (AVN) of the femoral head. Several factors influence the development of AVN, including the severity of the trauma, delays in treatment, and the type of surgical intervention chosen.

Objective: To describe a patient with a posterior wall acetabular fracture with further developed to AVN for six months, and followed by an open reduction and internal fixation (ORIF).

Case: A 63-year-old male patient visited the RSD Dr. Soebandi Clinic in Jember for a follow-up after undergoing ORIF on his right acetabulum due to acetabular rim fracture. He reported experiencing pain and stiffness in his right groin for the past two weeks; however, he noted that the pain had subsided, and he had regained mobility. The patient smokes 1-2 packs of cigarettes daily, has no history of long-term steroid use, and does not consume alcohol. As a result of his condition, he underwent total hip arthroplasty and reconstruction. One year after the surgery, the patient was able to walk, and there was an improvement in his Harris hip score.

Conclusion: The fracture of the posterior wall of the acetabulum is a serious injury that can lead to several complications, including avascular necrosis (AVN). Total hip replacement (THR) is the preferred surgical treatment for patients with AVN when the femoral head and acetabulum are no longer viable. Patients with AVN who have undergone THR have shown positive outcomes in this and previous studies.

Combating Respiratory Failure due to Myasthenia Crisis in Area with Limited Resources; A Case Report

Emanuel Christoforus Lienanto — 2026-09-11

Background: Myasthenia crisis is a complication of myasthenia gravis that is characterized by respiratory muscle weakness resulting in respiratory failure. This condition often requires intubation and mechanical ventilation. Myasthenia crisis is a complication of myasthenia gravis that is characterized by respiratory muscle weakness resulting in respiratory failure. An impending crisis may be presented by dyspnea and bulbar symptoms. The occurrence of these symptoms indicates immediate attention.

Objectives: This paper reports an unusual case of myasthenia crisis in remote areas with limited management resources.

Case: A patient with a history of myasthenia gravis was admitted with a chief complaint of dyspnoea two days prior to admission. Then, the patient’s condition worsened until he was in a critical period due to loss of consciousness and respiratory failure. Intubation and mechanical ventilation were performed. The patient’s condition gradually improved, and in the fourth week after admission, mechanical ventilation was discontinued, extubated and able to breathe spontaneously. Plasmapheresis was given afterward.

Conclusion: Myasthenia crisis is a common complication of myasthenia gravis that requires immediate attention. Risk factors that trigger a crisis should be identified early so that the patient can be given immediate treatment if necessary. Either plasmapheresis or IVIG should be given as early as possible, depending on availability at the hospital.

Diagnostic Challenges in Identifying Ludwig’s Angina with Complicated Comorbidities in a Diabetic and Tuberculosis Patient in Emergency Settings: A Case Report

Ajeng Erawati — 2026-08-13

Background: Ludwig’s angina (LA) is a rapidly spreading infection of the submandibular, sublingual, and submental spaces that involves the floor of the mouth and may lead to airway compromise and sepsis. Predisposing factors such as dental infections, diabetes mellitus (DM), and immunocompromised conditions (e.g., tuberculosis) increase the risk and complicate management. Objective: To present a rare and severe manifestation of Ludwig's angina in a patient with uncontrolled DM and active TB, highlighting the synergistic effects of these comorbidities and underscoring the importance of early diagnosis, multidisciplinary care, and evidence-based intervention. Case: A 43-year-old male with a history of uncontrolled DM and tuberculosis presented with a 4–5 month progressive swelling and pain in the right submandibular area, worsening in the last week. Physical examination showed an indurated, warm, erythematous mass, limited neck movement, and poor dental hygiene. Discussion: Laboratory results revealed leucocytosis, elevated liver enzymes, hyperglycaemia, and chest X-ray suggesting pulmonary TB. SOFA score was calculated to assess the severity of systemic involvement. The patient received oxygen, IV antibiotics, insulin, and was referred for surgical debridement. Due to hemodynamic instability and complex comorbidities, the patient required referral to a tertiary care centre for definitive airway and surgical management. Conclusion: Ludwig’s angina in patients with DM and TB requires rapid multidisciplinary management. Delay increases morbidity and risk of airway obstruction or sepsis.

‘It’s like living in hell’ – Caregivers’ Experiences for Patients with Schizophrenia in a District of Probolinggo

Tomas Martin — 2026-09-09

Background: Schizophrenia frequently results in significant distress and impairment across multiple domains, including personal, familial, social, educational, and occupational functioning. Caregiving for individuals with schizophrenia can result in substantial stress and burden for caregivers.

Objective: This study aims to explore the experiences of caregivers in providing care for patients with schizophrenia in a district of Probolinggo.

Material and Method: This study employed a qualitative research design, used interviews as the data collection method, and analyzed the data using inductive thematic analysis.

Results: The objective experiences comprised three main themes: (a) caregiving activities, (b) challenges encountered in caregiving, and (c) changes in caregivers’ lives following the caregiving role. The subjective experiences consisted of four main themes: (a) caregivers’ emotional experiences during patient care, (b) caregivers’ perceptions of the illness, (c) positive meanings derived from the caregiving experience, and (d) caregivers’ expectations for the patient.

Conclusion: Based on the findings of this study, caregivers experience a wide range of situations while caring for individuals with schizophrenia.

The Characteristics of Patients with Lymphadenopathy Undergoing Fine-Needle Aspiration Biopsy at a Tertiary Hospital in Surabaya, Indonesia

Zuhdiyah Nihayati — 2026-09-10

Background: Lymphadenopathy is a frequently observed clinical presentation in outpatient settings. Lymphadenopathy may arise from various etiologies, such as reactive lymphoid hyperplasia, infectious diseases, or malignant neoplasms. The first choice to diagnose superficial lymphadenopathy is usually fine needle aspiration biopsy (FNAB). The role of fine-needle aspiration biopsy (FNAB) in diagnosing superficial lymphadenopathy is to identify the specific type and potential origin of metastatic malignancy within the lymph node.

Objective: This study aims to describe the characteristics of patients with lymphadenopathy who underwent fine-needle aspiration biopsy at Dr. Soetomo General Hospital.

Material and Method: This is a descriptive retrospective study using secondary data from patients with lymphadenopathy who underwent fine-needle aspiration biopsy at the Laboratory of Anatomical Pathology of Dr. Soetomo General Hospital (January 2019-December 2019).

Result: This study included 945 patients consisting of 410 males (43,4%) and 535 females (56,6%). Out of 945 cases, 499 (52.8%) were diagnosed as non-malignant lesions, 428 (45.3%) as malignant lesions, 11 (1.2%) as atypical cells, and 7 (0.7%) as inadequate.

Conclusion: The most common patients with lymphadenopathy at Dr. Soetomo General Academic Hospital Surabaya were female patients aged 41-60, with mostly non-malignant lesions.

Female Reproductive Factors as Risk of Open-Angle Glaucoma: A Systematic Review

Alyssa Gunawan — 2026-09-11

Background: Glaucomatous optic neuropathy arises through multifactorial vascular and mechanical pathways, and estrogen is thought to play a neuro-modulatory role protecting retinal neurons. Given that women constitute a majority of glaucoma patients worldwide, the influence of female reproductive factors on open-angle glaucoma (OAG) risk warrants systematic evaluation.

Objective: This systematic review aims to examine the correlation between female reproductive factors such as age at menarche, parity, menopause, and postmenopausal hormone (PMH) use and the risk of developing OAG.

Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive literature search was performed in PubMed and ScienceDirect databases for studies published between 2010 and 2025. Eligible studies included original articles in English that examined reproductive factors and OAG in adult women.

Result: The initial search identified 3080 articles from PubMed and 208 from ScienceDirect. After screening, only five studies met the inclusion criteria. Overall evidence indicates an association between earlier onset for natural menopause and increased OAG risk, while estrogen-only PMH use may offer a protective effect, particularly among African-American women.

Conclusion: Evidence suggests that female reproductive history may influence the risk of OAG. Early menopause appears to increase OAG susceptibility, whereas estrogen-only hormone therapy might reduce it. Given the limited number and heterogeneity of available studies, further large-scale, well-controlled research is needed to clarify these associations.