Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Epidural Hematoma Volume and Glasgow Coma Scale Score: A Cross-Sectional Analysis of Head Injury Patient
Full text linkBackground: Epidural hematoma (EDH) is a common neurosurgical emergency with potentially life-threatening consequences. The Glasgow Coma Scale (GCS) is a widely used tool for assessing the severity of head injuries, but its correlation with EDH volume remains unclear. This study aimed to investigate the relationship between EDH volume and GCS score in head injury patients.
Methods: A retrospective cross-sectional analysis was conducted on 63 patients with head injuries and EDH admitted to a tertiary care hospital between 2021 and 2023. EDH volume was measured using computed tomography (CT) scans, and GCS scores were recorded upon admission. Statistical analysis was performed to assess the correlation between EDH volume and GCS score.
Results: The mean EDH volume was 30.5 ml (SD = 22.5), and the mean GCS score was 11.2 (SD = 3.8). A significant negative correlation was found between EDH volume and GCS score (r = -0.437, p < 0.001), indicating that larger EDH volumes were associated with lower GCS scores.
Conclusion: EDH volume is significantly correlated with GCS score in head injury patients. This finding underscores the importance of prompt diagnosis and surgical intervention for EDH, especially in patients with large hematomas and low GCS scores
Neutrophil-Lymphocyte Ratio as a Novel Biomarker for Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study
Full text linkBackground: Early detection of diabetic nephropathy (DN) is crucial to prevent progression to end-stage renal disease. The gold standard for diagnosing DN involves urine microalbumin testing and renal biopsy. However, the availability of these diagnostic tools is limited in many healthcare facilities across Indonesia. Consequently, there is a pressing need for an alternative examination that is readily accessible and can effectively monitor the progression of DN.
Methods: This cross-sectional study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, from February 2024 to May 2024. The study aimed to investigate the correlation between neutrophil-lymphocyte ratio (NLR) and urinary albumin levels in type 2 diabetes mellitus (DM) patients. NLR, calculated from complete blood counts, has emerged as a potential inflammatory marker for various conditions. A total of 65 participants diagnosed with type 2 DM were enrolled in the study. Data analysis involved Spearman's correlation test to assess the relationship between NLR and urinary albumin levels.
Results: The majority of the 65 subjects were female (58.5%). The study found that 44 subjects had normoalbuminuria, 18 had microalbuminuria, and 3 had macroalbuminuria. A significant positive correlation was observed between NLR and albuminuria levels in type 2 DM patients (r = 0.795; p < 0.01).
Conclusion: The study's findings suggest that NLR is a potential cost-effective biomarker for the early detection of DN in type 2 DM patients, especially in resource-limited settings. Further large-scale studies are recommended to validate these findings and establish specific NLR thresholds for predicting DN progression
Immunomodulatory Effects of Mesenchymal Stem Cell Secretome in Systemic Lupus Erythematosus: A Meta-Analysis
Full text linkBackground: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by immune system dysregulation and multi-organ damage. Mesenchymal stem cells (MSCs) have emerged as a promising therapeutic option due to their immunomodulatory properties, primarily mediated through their secretome (MSCS). This meta-analysis aimed to evaluate the efficacy and safety of MSCS in SLE patients.
Methods: A systematic search of PubMed, Embase, and Web of Science was conducted for studies published between 2013 and 2024 investigating the effects of MSCS in SLE. Randomized controlled trials (RCTs) comparing MSCS with placebo or standard care were included. The primary outcome was SLE disease activity, assessed using the SLE Disease Activity Index (SLEDAI). Secondary outcomes included immunological markers (e.g., anti-dsDNA antibodies, complement levels), quality of life, and adverse events. Data were pooled using a random-effects model.
Results: Nine RCTs (n=485 patients) met the inclusion criteria. MSCS therapy significantly reduced SLEDAI scores compared to controls (standardized mean difference [SMD] -0.78, 95% CI -1.25 to -0.31, p=0.001). Significant improvements were also observed in anti-dsDNA antibody levels (SMD -0.62, 95% CI -1.01 to -0.23, p=0.002) and complement C3 levels (SMD 0.55, 95% CI 0.21 to 0.89, p=0.002). MSCS was generally well-tolerated, with no serious adverse events reported.
Conclusion: This meta-analysis demonstrates that MSCS therapy has significant immunomodulatory effects in SLE, leading to improved disease activity and immunological profiles. Larger, well-designed RCTs with longer follow-up periods are needed to confirm these findings and assess the long-term efficacy and safety of MSCS in SLE
A Case of Concurrent COPD Exacerbation, Osteoporosis, and Fracture: Unveiling the Interplay
Full text linkBackground: Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory condition with systemic effects, including an increased risk of osteoporosis and fractures. This case report presents a patient with acute COPD exacerbation, osteoporosis, and vertebral fractures, highlighting the complex interplay between these conditions.
Case presentation: A 68-year-old male patient presented with acute exacerbation of COPD. He had a history of smoking, hypertension, and a previous diagnosis of pulmonary tuberculosis. Clinical examination revealed signs of respiratory distress, and imaging confirmed emphysema, pneumonia, osteoporosis, and vertebral fractures. The patient received treatment for COPD exacerbation and osteoporosis, showing improvement in respiratory symptoms and pain.
Conclusion: This case underscores the importance of recognizing the association between COPD, osteoporosis, and fractures. Early diagnosis and appropriate management of these co-morbidities are crucial for improving patient outcomes and quality of life
The Impact of Intravascular Imaging (IVUS/OCT) Guidance on Preventing In-Stent Restenosis and Improving Long-Term Clinical Outcomes in Complex PCI: A Meta-Analysis
Full text linkBackground: Percutaneous coronary intervention (PCI) in patients with complex coronary artery disease is associated with a higher risk of adverse events, including in-stent restenosis (ISR). Intravascular imaging, using either intravascular ultrasound (IVUS) or optical coherence tomography (OCT), has been proposed to optimize stent implantation and improve outcomes, but its definitive role requires comprehensive evidence synthesis.
Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Major electronic databases (PubMed, EMBASE, Cochrane CENTRAL) were searched from January 2014 to May 2025 for RCTs comparing intravascular imaging-guided PCI with angiography-guided PCI in patients undergoing complex procedures. The primary efficacy endpoint was Major Adverse Cardiovascular Events (MACE), a composite of cardiac death, target-vessel myocardial infarction, and clinically-driven target lesion revascularization. The key secondary endpoint was angiographic ISR. A random-effects model was used to calculate pooled Risk Ratios (RRs) and 95% Confidence Intervals (CIs).
Results: Seven RCTs, enrolling a total of 9,150 patients, met the inclusion criteria. The median follow-up was 24 months. Intravascular imaging guidance was associated with a significant reduction in the risk of MACE (RR: 0.66; 95% CI: 0.55-0.79; p<0.0001) compared to angiography guidance, with moderate heterogeneity (I²=52%). The risk of angiographic ISR was also significantly lower in the imaging-guided group (RR: 0.49; 95% CI: 0.38-0.63; p<0.0001). Furthermore, imaging guidance led to a significant reduction in cardiac death (RR: 0.55; 95% CI: 0.38-0.80) and clinically-driven target lesion revascularization (RR: 0.54; 95% CI: 0.42-0.69).
Conclusion: This meta-analysis provides definitive evidence that the use of intravascular imaging (IVUS or OCT) to guide complex PCI significantly reduces the incidence of long-term major adverse cardiovascular events and in-stent restenosis. These findings support the routine adoption of intravascular imaging as the standard of care to optimize outcomes in this high-risk patient population
Opioid Rotation vs. Dose Titration in Refractory Cancer Pain: A Meta-Analysis of Efficacy and Adverse Events
Full text linkBackground: The management of refractory cancer pain represents a formidable clinical challenge at the intersection of oncology and palliative medicine. When patients with advanced malignancy fail to achieve adequate analgesia or develop intolerable adverse effects from their opioid regimen, clinicians are faced with a crucial decision: to escalate the dose of the current opioid (dose titration) or to switch to a different opioid agent (opioid rotation). The optimal strategy remains a subject of intense debate and variable practice. This meta-analysis was conducted to rigorously compare the efficacy and safety of these two common interventions.
Methods: A systematic and comprehensive search was performed in the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases for randomized controlled trials (RCTs) published between January 2015 and December 2024. We included studies that directly compared opioid rotation with dose titration in adult palliative care patients diagnosed with refractory cancer pain. The primary efficacy outcome was the change in pain intensity, analyzed using the Standardized Mean Difference (SMD) to accommodate pain scales such as the Numerical Rating Scale (NRS) and Visual Analogue Scale (VAS). Primary safety outcomes were the incidence of severe neurotoxicity and severe constipation. Data were pooled using a random-effects model, and results were expressed as SMD for the continuous pain outcome and Risk Ratio (RR) for dichotomous adverse events, with corresponding 95% confidence intervals (CI).
Results: Seven RCTs, encompassing a total of 962 patients, met the stringent inclusion criteria. The pooled analysis revealed that the strategy of opioid rotation resulted in a statistically significant and clinically substantial greater reduction in pain intensity compared to continued dose titration (SMD -0.65, 95% CI [-0.88, -0.42], p<0.00001; I²=81%). Furthermore, the risk of developing severe neurotoxicity, including delirium and myoclonus, was significantly lower in the rotation group (RR 0.62, 95% CI [0.45, 0.85], p=0.003; I²=18%). There was no statistically significant difference in the incidence of severe constipation between the two intervention groups (RR 0.90, 95% CI [0.71, 1.14], p=0.38; I²=24%).
Conclusion: In patients with refractory cancer pain, the strategy of opioid rotation provided superior analgesia and was associated with a markedly lower risk of severe neurotoxicity when compared to the continued dose titration of the same opioid. These findings provide strong, high-level evidence to support the use of opioid rotation as a primary and proactive strategy for managing uncontrolled pain or dose-limiting side effects in the palliative care population
Orthoplastic Limb Salvage of a Gustilo-Anderson Grade IIIB Open Trans-Articular Knee Fracture: A Case Report on Staged Reconstruction with a Rotational Fasciocutaneous Flap
Full text linkBackground: High-energy, open trans-articular knee fractures with extensive soft-tissue loss represent a formidable challenge, carrying a high risk of deep infection, nonunion, and amputation. Successful limb salvage necessitates a collaborative orthoplastic approach, combining aggressive surgical debridement and skeletal stabilization with timely, vascularized soft-tissue coverage.
Case presentation: A 16-year-old male was admitted after a severe traffic accident, sustaining a Gustilo-Anderson Grade IIIB open fracture of the right knee. The injury comprised a comminuted distal femur fracture, a comminuted tibial plateau fracture (Schatzker VI), a comminuted patellar fracture, and a proximal fibula fracture. A 12x15 cm soft-tissue defect with a depth of 6 cm exposed the joint capsule and all fracture sites. The patient underwent a staged management protocol. The initial surgery involved extensive debridement of non-viable tissue and stabilization with a spanning multi-planar external fixator, followed by a second-look debridement. Definitive coverage was achieved on day five with a large, medially-based rotational fasciocutaneous flap and a split-thickness skin graft over the donor site. At the 1-year follow-up, all fractures had united, and the soft-tissue envelope was stable and sensate. The patient achieved a functional knee range of motion of 0-100 degrees and could ambulate without aids. The Lysholm knee score was 85, and the Knee Society Score (KSS) was 88.
Conclusion: This case report demonstrates that a meticulously planned, staged orthoplastic strategy can achieve successful limb salvage even in devastating open knee injuries. A large, local rotational fasciocutaneous flap can serve as a reliable and less complex alternative to free tissue transfer for covering massive defects in this region, particularly in young patients with favorable tissue characteristics
Beyond the Species Barrier: A Systematic Review and Risk of Bias Assessment on the Efficacy, Safety, and Translational Potential of Xenogenic Platelet-Rich Plasma for Wound Healing
Full text linkBackground: Chronic wounds represent a significant clinical burden. Autologous platelet-rich plasma (PRP) is an effective but patient-limited therapy. Xenogenic PRP (xPRP), derived from animal sources, offers a potential off-the-shelf, scalable alternative. This review synthesizes the current preclinical and early clinical evidence on the efficacy and safety of xPRP for wound healing.
Methods: A systematic search was conducted in PubMed, Scopus, ScienceDirect, and Google Scholar up to July 2025, with no publication date restrictions, following PRISMA guidelines. Studies evaluating xPRP on wound healing outcomes in in vivo, in vitro, or ex vivo models were included. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the SYRCLE tool for animal studies and a modified QUIN tool for in vitro studies. Data were synthesized narratively due to heterogeneity.
Results: Eleven studies met the inclusion criteria, comprising ten animal and three in vitro investigations (two studies reported both components). Evidence from porcine, bovine, and deer xPRP sources consistently demonstrated significant improvements in wound closure rates, re-epithelialization, angiogenesis, and collagen deposition compared to saline controls. Porcine xPRP, for instance, accelerated wound closure by up to 45% over controls in diabetic rodent models. However, when compared to autologous PRP, xPRP generally showed slightly inferior, though still positive, outcomes. Immunogenic responses were minimal and localized, with no systemic adverse events reported. Risk of bias assessment revealed that while most studies had clear objectives, many were at high risk of bias due to a lack of randomization, allocation concealment, and blinded outcome assessment.
Conclusion: Xenogenic PRP demonstrates considerable promise as a bioactive therapeutic for wound healing, promoting key regenerative processes with a reassuring preliminary safety profile. However, the current evidence base is limited by methodological inconsistencies and a high risk of bias. Future research must prioritize standardized preparation protocols and methodologically rigorous, large-animal and human clinical trials to validate its translational potential
Nummular Dermatitis Masquerading as Recalcitrant Tinea Corporis: A Diagnostic Pitfall Resolved by Dermoscopy and Histopathology
Full text linkBackground: The morphological mimicry between nummular dermatitis (ND) and tinea corporis represents a significant source of diagnostic error in clinical practice. This convergence on a similar clinical phenotype—the annular plaque—often leads to inappropriate antifungal therapy and a protracted, debilitating course for the patient, as powerfully illustrated in this case.
Case presentation: We present the case of a 22-year-old female with a five-year history of chronic, recalcitrant, and intensely pruritic annular plaques on her lower legs, with a baseline pruritus score of 8/10 on a Visual Analog Scale (VAS). Previous treatments based on presumptive diagnoses, including potent topical corticosteroids and systemic antifungals, had failed. This report demonstrates a pivot from a morphology-based assessment to a multimodal diagnostic algorithm. The cornerstone of this shift was dermoscopy, which revealed patchy, irregularly distributed red dotted vessels—a classic signature of an eczematous process—and a notable absence of features suggestive of a dermatophyte infection. The diagnosis was confirmed by histopathology. A strong correlation between disease flares and psychosocial stressors was identified, and a holistic management plan targeting the cutaneous inflammation, the compromised skin barrier, and the neurogenic triggers led to a rapid and substantial improvement in her clinical status and quality of life, with the Dermatology Life Quality Index (DLQI) score decreasing from 9 to 3 and the pruritus VAS score dropping to 1/10.
Conclusion: This case argues for a revised diagnostic paradigm for chronic annular lesions, one that de-emphasizes ambiguous morphology and prioritizes the integration of a detailed psychodermatological history with in-vivo microscopic analysis via dermoscopy. This approach not only prevents therapeutic futility but also underscores that successful, long-term management of ND is contingent upon a patient-centered strategy that addresses the interconnectedness of the skin barrier, the immune system, and the psycho-neuro-cutaneous axis
The Hidden Hazard of Celebration: A Meta-Analysis of Ocular Morbidity from Colored Powder Festivals and Implications for Global Travel Medicine
Full text linkBackground: The globalization of colored powder festivals, such as Holi, has exposed millions, including international tourists, to significant ocular health risks from synthetic industrial dyes that have replaced traditional organic powders. This study was conducted to quantify the prevalence of acute ocular morbidities from these festivals, providing an evidence base to inform clinical practice and public health policy, particularly within travel medicine.
Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed, Google Scholar, ScienceDirect, and ProQuest for observational studies published up to July 2024. Studies reporting ocular complications from colored powder exposure were included. Data were extracted by two independent reviewers, and methodological quality was assessed using JBI checklists. A random-effects model was used to calculate pooled prevalence for key ocular injuries. Heterogeneity was investigated using sensitivity analyses, and publication bias was assessed with funnel plots.
Results: Six studies from India, encompassing 189 patients, met the inclusion criteria for quantitative analysis. The patient population was predominantly young males (mean age 20-30 years). The meta-analysis revealed a high pooled prevalence of key ocular morbidities. The prevalence for chemical conjunctivitis was 95% (95% CI: 87%-100%), though with substantial but anticipated heterogeneity (I²=82%). The prevalence for corneal epithelial defects was 37% (95% CI: 23%-53%; I²=45%), and for superficial punctate keratopathy was 75% (95% CI: 57%-90%; I²=0%). Most injuries were bilateral.
Conclusion: Participation in colored powder festivals, based on extensive evidence from Holi in India, presents a quantifiable and significant risk of acute ocular morbidity. The high prevalence of chemical-induced ocular surface disease necessitates urgent recognition of this "hidden hazard." Proactive, evidence-based preventive strategies, including tiered recommendations for protective eyewear and updated pre-travel health advisories, are imperative to safeguard the vision of millions of celebrants worldwide