Articles

Holistic Management of an Elderly Patient with Relapsed Pulmonary Tuberculosis and Herpes Zoster Accompanied by Inadequate Housing Conditions in Indonesia Primary Health Centre

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Pulmonary tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a major global health issue, particularly in developing countries. Weakened immunity in TB patients increases their risk of herpes zoster, whose incidence rises with age. Over 60% of cases occur in individuals older than 50 years, while only 10% affect those under 20. This case report highlights the application of evidence-based medicine in family practice, focusing on identifying risk factors, clinical issues, and patient management through a patient-centered, family-oriented approach. Data were collected through anamnesis, physical examinations, and home visits to evaluate family, psychosocial, and environmental factors. Additional information was obtained from the patient’s medical records. A holistic assessment was conducted from diagnosis to outcome, incorporating qualitative and quantitative analyses. The patient, Mr. A., a 72-year-old, presented with relapsed pulmonary TB and herpes zoster. He sought routine anti-tuberculosis drug retrieval and reported lesions on his left back with sensations of heat and itching. Interventions led to improvements in TB symptoms, healing of herpes lesions, and enhanced patient behaviour. Quantitative evaluations showed increased knowledge, medication adherence, and better dietary habits. The diagnosis and management followed national guidelines and relevant literature. Positive outcomes were observed in the patient’s symptoms, knowledge, and behaviours, as well as improvements within his family, as assessed during follow-ups. This case underscores the importance of holistic and evidence-based approaches in addressing complex comorbidities in primary care.

Holistic Management of Diabetic Ulcer in Construction Worker with Low-Risk Neuropathy Symptoms Score and Proximal Phalanx Diggiti III-IV Pedis Dextra Amputation History

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Diabetic ulcers are the most common complication of uncontrolled Diabetes Mellitus (DM), characterized by high blood glucose levels that lead to complications such as neuropathy (motor, sensory, autonomic) and vascular abnormalities, making infections more likely. According to research in Indonesia, the incidence of diabetic ulcers ranges from 15-25% of the total number of diabetes mellitus patients, with an annual prevalence of 2% to 5-7.5% in patients with neuropathy. Application of evidence-based medicine-based family doctor services to patients by identifying risk factors, clinical problems, and patient management based on a patient-centered and family problem-solving framework. This case report taken by primary data through auto-anamnesis, physical examination and home visits. Secondary data was obtained from the patient’s medical record. The assessment is based on a holistic diagnosis from entire of the study qualitatively and quantitatively. Patient Mr. E, 61 years old has internal factor risks such as elderly age, curative treatment patterns, inappropriate eating habits, lack of knowledge about the disease which, and external risk factors in the form of curative family treatment patterns and lack of family support related to patient’s disease. Patient’s management is holistic and comprehensive, patient-centered, family approach, and community-based in the literature based on EBM. Patient was intervened with media posters about DM, diet, proper diabetic ulcer care and educating families to support patients. Results of the intervention evaluation are increase in patient and family’s knowledge, controlled blood sugar, and eating behavior according to Adequacy of Nutrition Level.