Bioscientia Medicina - Journal of Biomedicine and Translational Research
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The Unseen Danger: A Meta-Analysis of Bystander Injuries in Firework-Related Ocular Trauma
Full text linkBackground: Firework-related ocular trauma represents a significant, preventable cause of severe vision loss, with incidence rates peaking during global cultural and national festivals. While the risks to active firework users are well-established, the burden of injury sustained by passive spectators, or bystanders, remains poorly quantified. This study aimed to synthesize global data to define the magnitude of this unseen danger.
Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, EMBASE, and Web of Science were searched for studies published between January 2015 and December 2025 that reported separable data on firework-related ocular injuries in bystanders and operators. A random-effects model calculated the pooled proportion of bystander injuries. Secondary outcomes included pooled odds ratios (ORs) for open globe injury (OGI) and severe vision loss (SVL; Visual Acuity <3/60).
Results: Eleven studies, encompassing 2,440 patients, met the inclusion criteria. This meta-analysis, despite significant heterogeneity in the source data (I² = 89%), suggests that nearly half of all victims were bystanders, with a pooled proportion of 47.5% (95% CI: 41.8%–53.2%). Bystanders had significantly lower odds of sustaining an OGI compared to operators (pooled OR: 0.72, 95% CI: 0.58–0.90). However, the odds of suffering permanent SVL were not statistically different between the two groups (pooled OR: 0.91, 95% CI: 0.73–1.14), indicating a comparable risk of blinding injury.
Conclusion: These findings must be interpreted with caution due to high inter-study heterogeneity and unmeasured clinical confounders. Nonetheless, the analysis strongly suggests that the risk to bystanders is unacceptably high and that public health paradigms focused solely on operator safety are insufficient. This study underscores the urgent need for prospective, standardized data collection and a shift in prevention strategies toward protecting passive spectators
Impaired Stimulated Pancreatic β-Cell Responsiveness is a Dominant Feature of Bisphenol A-Associated Metabolic Dysfunction in Type 2 Diabetes: A Cross-Sectional Analysis of Adjusted Associations in an Indonesian Cohort
Full text linkBackground: Exposure to the endocrine-disrupting chemical bisphenol A (BPA) is a suspected contributor to the type 2 diabetes mellitus (T2DM) pandemic. This study aimed to move beyond simple correlation and investigate the adjusted association between urinary BPA and the dual pathophysiological defects of T2DM—insulin resistance and pancreatic β-cell failure—with a novel emphasis on contrasting basal versus stimulated β-cell function in an understudied Indonesian cohort.
Methods: In a cross-sectional study, 40 patients with T2DM were recruited from a tertiary hospital in Palembang, Indonesia. Urinary BPA was quantified by liquid chromatography–mass spectrometry (LCMS). Insulin resistance was assessed by the homeostasis model assessment of insulin resistance (HOMA-IR). β-cell function was evaluated using the C-peptide index (CPI) at fasting and 1-hour post-75g oral glucose tolerance test (OGTT). Multivariable linear regression models were constructed to determine the association between urinary BPA (log-transformed) and metabolic indices, adjusting for age, gender, and body mass index (BMI).
Results: After adjusting for confounders, higher log-urinary BPA remained a significant independent predictor of higher log-HOMA-IR (β = 0.58, 95% CI: 0.31-0.85, p < 0.001). BPA was also independently associated with poorer β-cell function, showing a significant inverse association with the fasting CPI (β = -0.45, 95% CI: -0.73 to -0.17, p = 0.003). Critically, this association was markedly stronger and more profound with the 1-hour stimulated CPI (β = -0.79, 95% CI: -0.99 to -0.59, p < 0.001). The variance in stimulated CPI explained by the model (R2) was substantially higher than for other indices.
Conclusion: Higher environmental BPA exposure is independently associated with both heightened insulin resistance and compromised β-cell function in T2DM. The distinctly stronger association with impaired stimulated β-cell secretion, even after adjusting for key confounders, identifies a critical mechanism by which BPA may accelerate functional β-cell exhaustion, the pivotal event in T2DM progression
From Handlebar to Enucleation: Management and Prosthetic Outcome of a Severe Traumatic Globe Luxation
Full text linkBackground: Traumatic globe luxation (TGL) is a rare, severe ocular emergency involving the complete displacement of the eyeball from the orbit. It presents a profound clinical challenge, demanding a rapid and accurate assessment of complex prognostic factors to guide the difficult decision between globe salvage and primary enucleation.
Case presentation: A 33-year-old male presented 18 hours after a motorcycle handlebar strike to his left orbit. The examination revealed a left globe luxation with No Light Perception (NLP) vision, a total afferent pupillary defect, and complete ophthalmoplegia. Computed tomography confirmed a closed-globe injury with a superior orbital rim fracture and a large retrobulbar hematoma, but could not delineate soft tissue integrity. Surgical exploration revealed two critical, paradoxical findings: an anatomically intact optic nerve despite its functional death, and a catastrophic avulsion of five of the six extraocular muscles. The medial, lateral, and inferior recti, along with both oblique muscles, were detached, while the superior rectus muscle was uniquely spared.
Conclusion: Based on the catastrophic loss of vascular supply from the avulsed muscles, which rendered the globe biologically non-viable, a primary enucleation was performed. This case suggests that in TGL, the integrity of the extraocular musculature is a paramount prognostic indicator, potentially superseding the anatomical status of the optic nerve in determining globe viability. It highlights the necessity of intraoperative exploration to definitively assess the extent of injury and illustrates a scenario where primary enucleation is not a treatment failure, but a definitive, rehabilitation-focused therapeutic strategy
Catamenial Pneumothorax in a Patient with Adenomyosis: A Case Report on a Successful Multidisciplinary Approach with Pleurodesis and Hormonal Therapy
Full text linkBackground: Catamenial pneumothorax, a rare manifestation of thoracic endometriosis syndrome (TES), presents a significant diagnostic and therapeutic challenge. It is characterized by recurrent spontaneous pneumothorax occurring in temporal relation to menstruation in women of reproductive age. The underlying pathophysiology is complex, often involving the ectopic presence of endometrial tissue within the thoracic cavity. Coexisting pelvic pathologies, such as adenomyosis, may be associated, further complicating the clinical picture.
Case presentation: We present the case of a 38-year-old woman with a four-month history of recurrent, right-sided pneumothorax, with symptoms consistently commencing 24 to 48 hours prior to the onset of her menstrual cycle. Initial investigations, including high-resolution computed tomography of the thorax performed between menstrual cycles and microbiological analysis for tuberculosis, were unremarkable. The diagnosis of catamenial pneumothorax was established based on the distinct cyclical pattern of her symptoms. A subsequent gynecological evaluation, prompted by a history of secondary dysmenorrhea and menorrhagia, revealed uterine adenomyosis via transvaginal ultrasonography. The patient was managed through a collaborative, multidisciplinary approach involving pulmonology, thoracic surgery, and gynecology. Treatment consisted of chemical pleurodesis with doxycycline, administered via a chest tube, followed by continuous hormonal suppression therapy with oral progestin (2 mg/day).
Conclusion: This case highlights the critical importance of maintaining a high index of suspicion for catamenial pneumothorax in women of reproductive age presenting with recurrent pneumothorax. A successful outcome was achieved through a coordinated, multidisciplinary strategy combining definitive pleural symphysis via pleurodesis with systemic hormonal therapy to suppress the underlying endometriotic process. This dual approach effectively prevented pneumothorax recurrence over a 12-month follow-up period, underscoring its efficacy in managing this complex condition
The Emerging Role of Integrins in Diabetic Kidney Disease: A Systematic Review and Meta-Analysis of Their Diagnostic and Prognostic Utility for Early Risk Stratification
Full text linkBackground: Current biomarkers for diabetic kidney disease (DKD), notably albuminuria and eGFR, are markers of established renal damage, limiting opportunities for early intervention. Integrins, cell-matrix adhesion receptors integral to podocyte health, are emerging as potential upstream indicators of the initial injury that drives DKD. This systematic review and meta-analysis provide the first quantitative synthesis of the evidence on the diagnostic and prognostic utility of integrins in DKD.
Methods: Following PRISMA guidelines, we systematically searched PubMed, Scopus, Embase, and Web of Science for studies published up to July 2025. We included studies that evaluated integrins in urine, serum, or tissue for the diagnosis of early DKD (microalbuminuria) or for predicting disease progression. Data were pooled using bivariate random-effects models for diagnosis and generic inverse variance models for prognosis.
Results: Eight studies involving 2,874 patients met the inclusion criteria. For diagnosing early DKD, five studies (n=1,880) yielded a pooled sensitivity of 0.88 (95% CI: 0.82-0.92) and specificity of 0.85 (95% CI: 0.79-0.90). The area under the summary receiver operating characteristic curve was 0.91 (95% CI: 0.88-0.94), indicating excellent accuracy. A subgroup analysis of non-invasive samples (urine/serum) demonstrated similarly high performance. For prognosis, three prospective studies (n=1,224) showed that elevated baseline integrins were associated with a significantly increased risk of disease progression (pooled Hazard Ratio: 2.15, 95% CI: 1.65-2.79) over a median 5-year follow-up.
Conclusion: Based on the current, albeit limited, evidence, integrins show significant promise as highly sensitive and specific biomarkers for the early detection and potent predictors for the progression of DKD. While these preliminary findings require validation in larger cohort studies, the measurement of non-invasive integrins may represent a valuable future tool for improving early DKD risk stratification
Beta-Blocker Therapy in Older (≥75 Years) and Frail Patients with Heart Failure: A Systematic Review and Meta-Analysis
Full text linkBackground: Beta-blockers are a cornerstone of therapy for heart failure with reduced ejection fraction (HFrEF), but their efficacy and safety in the burgeoning population of very elderly and frail patients, particularly those with preserved ejection fraction (HFpEF), remain uncertain. This population is characterized by unique pathophysiological features, including altered pharmacokinetics, heightened inflammation, and autonomic dysregulation, which may modulate the treatment effect.
Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. We searched MEDLINE, Embase, and CENTRAL for randomized controlled trials (RCTs) and observational studies published between 2015-2025 that evaluated beta-blockers versus placebo or standard care in patients aged ≥75 years or defined as frail with heart failure. The primary efficacy outcome was all-cause mortality. The primary safety outcome was treatment discontinuation due to adverse events.
Results: Eight studies (three RCTs, five observational) involving 8,512 patients were included. In the overall population, beta-blocker therapy was associated with a reduction in all-cause mortality (Hazard Ratio: 0.88; 95% CI: 0.79−0.98), but with significant heterogeneity (I2=68%). Subgroup analysis revealed this benefit was confined to patients with HFrEF (HR: 0.72; 95% CI: 0.63−0.83), with no benefit observed in HFpEF (HR: 1.09; 95% CI: 0.95−1.25). In frail patients with HFpEF, a trend towards harm was noted (HR: 1.21; 95% CI: 0.98−1.49). Beta-blockers significantly increased treatment discontinuation (Odds Ratio: 2.15; 95% CI: 1.55−2.98), driven primarily by bradycardia.
Conclusion: Beta-blocker therapy reduces mortality in elderly patients with HFrEF, consistent with findings in younger populations. However, in elderly and frail patients with HFpEF, beta-blockers offer no mortality benefit and may be associated with harm, likely due to a pathophysiological mismatch between the drug's mechanism and the disease state
Autologous Parietal Peritoneum as a Biliary Interposition Conduit for Complex Post-Cholecystectomy Bile Duct Injuries: A Feasibility Study and Report of Two Cases
Full text linkBackground: Complex iatrogenic bile duct injuries (BDIs) are formidable surgical challenges, with Roux-en-Y hepaticojejunostomy (RYHJ) being the standard reconstruction. However, RYHJ permanently alters gastrointestinal physiology and is associated with significant long-term morbidity. This has prompted a search for physiology-preserving alternatives. We describe a novel technique using a tubularized autologous parietal peritoneal graft for biliary reconstruction.
Case presentation: This report details the successful management of two patients with high-grade, post-cholecystectomy BDIs (Strasberg-Bismuth Type E1 and E3). Both patients presented with obstructive jaundice and controlled biliary fistulae. Definitive single-stage reconstruction was performed. A segment of parietal peritoneum was harvested, tubularized over a T-tube to create an interposition conduit, and anastomosed to bridge the biliary defect. The repair was reinforced with a pedicled omental flap. Both patients demonstrated complete resolution of jaundice and normalization of liver function tests, with radiological evidence of graft patency and no stricture at 12-month follow-up.
Conclusion: This preliminary experience in two patients suggests that the use of a tubularized autologous parietal peritoneal graft is a surgically feasible technique for the reconstruction of complex BDIs. This approach offers a potential physiology-preserving alternative to traditional bilioenteric anastomosis. Its safety, efficacy, and long-term durability remain unknown and require rigorous evaluation in larger prospective studies
Lower Body Negative Pressure for Spaceflight Associated Neuro-ocular Syndrome: A Systematic Review and Meta-Analysis
Full text linkBackground: Spaceflight associated neuro-ocular syndrome (SANS) is a critical health risk for astronauts on long-duration missions, characterized by potentially vision-altering ocular changes. Lower body negative pressure (LBNP) is a primary countermeasure designed to reverse the foundational cephalad fluid shifts. This study provides the first rigorous, quantitative synthesis of LBNP's efficacy on key SANS-related ocular parameters.
Methods: Following PRISMA guidelines, a systematic search of PubMed, ScienceDirect, and the Cochrane Library (2015–2025) was conducted. Studies quantifying the effect of LBNP on intraocular pressure (IOP), optic nerve sheath diameter (ONSD), or choroidal thickness (CT) in microgravity or its ground-based analogs were included. A random-effects meta-analysis calculated the pooled mean difference (MD). Leave-one-out sensitivity analysis and assessment of publication bias were performed to ensure robustness.
Results: Seven studies (N=89 subjects) met the criteria. The meta-analysis demonstrated that LBNP application resulted in statistically significant reductions in IOP (MD = -2.15 mmHg; 95% CI [-3.01, -1.29]; p < 0.001), ONSD (MD = -0.31 mm; 95% CI [-0.45, -0.17]; p < 0.001), and subfoveal Choroidal Thickness (MD = -18.50 µm; 95% CI [-25.65, -11.35]; p < 0.001). Subgroup analysis revealed a more pronounced effect in ground-based studies. The results were robust in sensitivity analyses, and funnel plots suggested a low risk of publication bias.
Conclusion: This meta-analysis provides robust, quantitative evidence supporting LBNP's efficacy in acutely mitigating the cardinal structural signs of SANS. By directly counteracting the underlying pathophysiology, LBNP is affirmed as a cornerstone countermeasure technology essential for preserving astronaut ocular health during the upcoming era of deep space exploration
Challenges in Managing Corneal Ulcer with Hypopyon in an Uncontrolled Diabetes Mellitus Patient: A Case Report
Full text linkBackground: Corneal ulcer is an ophthalmological emergency that can cause blindness. The risk of increasing this complication occurs mainly in patients with systemic diseases such as diabetes mellitus.
Case presentation: a 50-year-old male patient was treated with OS corneal ulcer cum hypopyon with a history of diabetes mellitus. On the first visit, the visual acuity examination was found to be 6/7.5 in both eyes, and the results of the corneal erosion examination were in the left eye. However, on further evaluation, the left eye's visual acuity worsened to 6/45. Anterior segment examination of the left eye showed infiltration and hypopyon formation on the next visit evaluation. The patient's condition did not improve with conventional therapy, so surgical intervention was performed in the form of amniotic membrane transplantation, hypopyon aspiration, and intracameral antibiotic injection. Corneal and hypopyon scraping culture results did not show bacterial and fungal growth. Corneal condition improved after blood sugar was controlled with insulin.
Conclusion: Corneal ulcers with hypopyon in patients with diabetes and diabetic keratopathy require a comprehensive approach to address infection, inflammation, and impaired healing. Multidisciplinary collaboration, especially blood sugar control, is important to improve long-term prognosis
Profound Immunosuppression with Reversed CD4:CD8 Ratio in a Tuberculosis Patient with Acquired Immunodeficiency Syndrome: A Case Report
Full text linkBackground: The co-occurrence of tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS) presents a formidable clinical challenge due to the synergistic impact on the immune system. This case report describes a patient with TB/AIDS co-infection exhibiting profound immunosuppression characterized by a severely diminished CD4 count and an unusual reversal of the CD4:CD8 ratio.
Case presentation: A 39-year-old male presented with symptoms indicative of both TB and advanced HIV infection, including shortness of breath, weight loss, and oral thrush. Physical examination revealed bilateral lung crackles. Laboratory investigations confirmed pulmonary TB and revealed a critically low CD4 count (6 cells/µL), and a CD8 count of 71 cells/µL, resulting in a reversed CD4:CD8 ratio of 0.08. The patient's HIV viral load was markedly elevated at 598,403 copies/mL. This case underscores the complex interplay between TB and HIV, highlighting the profound impact of co-infection on immune system function. The patient's severely depleted CD4 count and the atypical CD4:CD8 ratio reflect the advanced stage of HIV infection and the superimposed TB. The findings emphasize the need for close monitoring and aggressive management of co-infected patients to mitigate the risk of opportunistic infections and disease progression.
Conclusion: This case report documents a rare and severe presentation of TB/AIDS co-infection with profound immunosuppression and a reversed CD4:CD8 ratio. It serves as a reminder of the significant morbidity and mortality associated with advanced HIV and TB co-infection, particularly in cases of delayed diagnosis or suboptimal treatment adherence