Bioscientia Medicina - Journal of Biomedicine and Translational Research
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β2-Microglobulin: A Powerful Biomarker for Chronic Kidney Disease Progression
Full text linkBackground: Chronic kidney disease (CKD) is a global health concern with increasing prevalence. Early detection and accurate prognosis are crucial for effective management. β2-microglobulin (β2M) has emerged as a promising biomarker in CKD, but its prognostic value requires further evaluation. This meta-analysis aimed to comprehensively assess the association between β2M and CKD progression.
Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between 2013 and 2024 investigating the relationship between β2M and CKD progression. Studies were included if they reported hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between β2M levels and renal endpoints (e.g., end-stage renal disease [ESRD], doubling of serum creatinine, or a decline in estimated glomerular filtration rate [eGFR]). A random-effects model was used to pool the HRs.
Results: Six eligible studies involving 5,420 participants were included. The pooled analysis demonstrated a significant association between elevated β2M levels and increased risk of CKD progression (HR = 2.15; 95% CI: 1.78-2.59; p < 0.001). Subgroup analyses revealed that this association remained consistent across different CKD stages and underlying etiologies.
Conclusion: Elevated β2M is a strong and independent predictor of CKD progression. Its incorporation into clinical practice may improve risk stratification and guide therapeutic interventions in CKD patients
The Role of Superoxide Dismutase in Kidney Aging: A Meta-Analysis of Oxidative Stress, Inflammation, and Renal Function
Full text linkBackground: Kidney aging is an inevitable physiological process characterized by a progressive decline in renal function, increased oxidative stress, and chronic low-grade inflammation. Superoxide dismutase (SOD), a key antioxidant enzyme, plays a crucial role in mitigating oxidative damage. This meta-analysis aimed to comprehensively evaluate the association between SOD levels/activity and markers of oxidative stress, inflammation, and renal function in the context of kidney aging.
Methods: A systematic search of PubMed, Scopus, and Web of Science databases was conducted for relevant studies published between 2013 and 2024. Studies investigating the relationship between SOD (SOD1, SOD2, SOD3) and kidney aging in humans were included. Data on SOD levels/activity, oxidative stress markers, inflammatory markers, and renal function parameters were extracted. Random-effects models were used to pool the standardized mean differences (SMD) and 95% confidence intervals (CI).
Results: Nine studies with a total of 1,245 participants were included in the meta-analysis. Pooled analysis revealed a significant negative association between SOD activity and markers of oxidative stress (SMD = -0.85, 95% CI: -1.20 to -0.50, p < 0.001). Similarly, SOD activity was inversely associated with inflammatory markers (SMD = -0.62, 95% CI: -0.95 to -0.29, p < 0.001). Furthermore, a significant positive association was observed between SOD activity and eGFR (SMD = 0.78, 95% CI: 0.41 to 1.15, p < 0.001).
Conclusion: This meta-analysis provides compelling evidence that SOD plays a critical role in mitigating oxidative stress and inflammation in kidney aging, contributing to the preservation of renal function. These findings highlight the potential of SOD as a therapeutic target for age-related kidney diseases.
 
Beyond the Obstruction: A Case of Lung Cancer with Coincidental COPD Diagnosis
Full text linkBackground: Lung cancer frequently coexists with chronic obstructive pulmonary disease (COPD), particularly among smokers. The presence of both conditions can complicate diagnosis and lead to poorer outcomes. This case report presents a patient with lung cancer and concurrent COPD, highlighting the diagnostic and management challenges.
Case presentation: A 60-year-old male presented with a history of smoking, progressive dyspnea, and a recent diagnosis of right lung cancer (T4N3M1c, stage IV B). He also exhibited symptoms suggestive of COPD, such as chronic cough and expectoration. Spirometry confirmed moderate restriction and severe obstruction, consistent with COPD GOLD 3. The patient was managed with both lung cancer treatment and COPD therapy.
Conclusion: This case underscores the importance of considering COPD in patients with lung cancer, especially those with a history of smoking. Early diagnosis of both conditions is crucial for optimizing treatment strategies and improving patient outcomes
A Retrospective Three-Year Analysis of Adult Scabies at a Tertiary Referral Center in Bali, Indonesia
Full text linkBackground: Scabies, a parasitic infestation by Sarcoptes scabiei var. hominis, is a global health challenge with significant morbidity, particularly in tropical climates. While often studied in community settings, the profile of adult patients presenting to tertiary care facilities remains under-documented. This study aimed to delineate the clinical-demographic characteristics of adult scabies patients at a major referral hospital in Bali, Indonesia, to better understand this specific patient study.
Methods: A retrospective, descriptive study was conducted utilizing electronic medical records from the Dermatology and Venereology outpatient clinic at Prof. Dr. I.G.N.G. Ngoerah General Hospital from January 2021 to December 2023. Following a total sampling method based on strict inclusion and exclusion criteria, data from 38 adult patients with a clinical diagnosis of scabies were extracted. The analysis focused on descriptive statistics to summarize patient demographics, contact history, and prescribed therapeutic regimens.
Results: The study of 38 patients had a mean age of 34.1 ± 2.5 years. A male predominance was noted (n=22, 57.9%). The highest frequency of cases was in the 40-49 year age bracket (n=9, 23.7%). Most patients had completed senior high school (n=17, 44.7%) and were employed in the private sector (n=20, 52.6%). A family history of scabies was prevalent (n=18, 47.4%). While indirect transmission via shared clothing was rare (reported by only 7.9%), direct contact through bed sharing with at least one other person was common (n=24, 63.2%). The standard therapeutic protocol was combination therapy, with topical 5% Permethrin and oral antihistamines being the most frequent regimen (n=24, 63.2%).
Conclusion: Adult scabies patients at this tertiary center are typically middle-aged, educated, working males. Transmission is overwhelmingly linked to intimate household contact, highlighting the inefficiency of fomite-based spread compared to direct skin-to-skin contact. The standard use of combination therapy reflects a proactive clinical approach to managing both the parasitic infestation and the complex immunologic cascade of pruritus. These findings provide a crucial clinical baseline for this specific patient population
Deciphering Activity in Early Facial Vitiligo: A Case Report Integrating Clinical, Wood's Lamp, and Dermoscopic Findings
Full text linkBackground: The management of non-segmental vitiligo hinges on accurately assessing disease activity to guide appropriate therapy. A clinical challenge arises in patients presenting with a low vitiligo area scoring index (VASI), suggesting limited disease, which may be discordant with underlying inflammatory activity, potentially leading to therapeutic inertia.
Case presentation: A 34-year-old woman with Fitzpatrick skin type III presented with a two-month history of rapidly progressing facial vitiligo, preceded by an erythematous phase. Despite a low VASI score of 1, the patient-reported vitiligo disease activity (VIDA) score was +4. Dermoscopy was instrumental, revealing definitive in-vivo evidence of inflammation and instability, including a pinkish background, telangiectasias, and a reversed pigment network. Based on this discordance between disease extent and activity, a multi-modal therapeutic regimen was initiated. A six-month follow-up demonstrated disease stabilization and significant perifollicular repigmentation, with resolution of the inflammatory dermoscopic signs.
Conclusion: This case report illustrates the critical importance of an integrated diagnostic approach that moves beyond area-based assessment. It highlights how dermoscopy, when used to resolve the clinical paradox of low-extent but high-activity disease, can serve as an objective biomarker to justify timely and robust immunomodulatory intervention. This approach is crucial for altering the disease trajectory and optimizing patient outcomes
Weber Syndrome Revisited: A Classic Midbrain Stroke Presentation Secondary to Severe Dyslipidemia
Full text linkBackground: Weber syndrome is a classic brainstem stroke syndrome resulting from an ischemic lesion in the ventral midbrain. While historically defined by its striking clinical features—ipsilateral oculomotor nerve palsy and contralateral hemiparesis—its modern relevance lies in its direct causation by common, modifiable vascular risk factors. This report uses a quintessential case of Weber syndrome as a didactic tool to illustrate the profound microvascular consequences of a specific, severe metabolic phenotype.
Case presentation: A 60-year-old female with a history of medication non-adherence for hypertension and hypercholesterolemia presented with acute left hemiparesis, right ptosis, and diplopia. Examination confirmed a right oculomotor palsy and left hemiparesis. Her Body Mass Index was 28.5 kg/m². Laboratory workup revealed a severe mixed dyslipidemia (LDL-C 168 mg/dL, Triglycerides 218 mg/dL). Brain MRI confirmed an acute infarct in the right ventral mesencephalon. Vascular imaging was unremarkable, pointing towards intrinsic small vessel disease. A comprehensive, multidisciplinary management plan was initiated, focusing on aggressive medical therapy, intensive rehabilitation, and strategies to overcome barriers to medication adherence.
Conclusion: This case highlights the elegant yet unforgiving precision of neuroanatomy and the powerful diagnostic utility of modern neuroimaging. More profoundly, it demonstrates the direct pathophysiological link between severe atherogenic dyslipidemia and the occlusion of a single, critical perforating brainstem artery. The patient’s significant functional recovery underscores that a holistic approach—combining evidence-based pharmacotherapy with a robust, patient-centered rehabilitation program and a dedicated strategy to ensure long-term adherence—is paramount to optimizing outcomes after a debilitating stroke
Beyond the Usual Suspects: Phialophora verrucosa Chromoblastomycosis in a Swimming Pool Attendant and Gardener
Full text linkBackground: Chromoblastomycosis (CBM) is a chronic, debilitating subcutaneous mycosis caused by traumatic inoculation of dematiaceous fungi. As a Neglected Tropical Disease, it poses significant diagnostic and therapeutic challenges, particularly in the endemic tropical and subtropical regions where it is most prevalent. While Fonsecaea pedrosoi is the most common etiologic agent, infections by other species are crucial to document for accurate epidemiological surveillance.
Case presentation: A 26-year-old immunocompetent male presented with a four-year history of a slowly progressive, verrucous plaque on his right hand, initiated by minor trauma. His history was notable for regular gardening without protective gear. A comprehensive diagnostic workup was performed. Dermoscopy revealed features characteristic of CBM, including reddish-black dots and yellowish-orange areas. While direct microscopy of skin scrapings was negative, histopathology of a skin biopsy confirmed a suppurative granulomatous reaction with pathognomonic muriform cells. Fungal culture on Sabouraud's dextrose agar definitively identified the causative agent as Phialophora verrucosa. The patient showed marked clinical improvement after three months of treatment with oral itraconazole (200 mg/day).
Conclusion: This case highlights the successful diagnosis of a rare CBM pathogen in Indonesia through a systematic, multimodal approach. It reinforces the need for a high index of suspicion for this mycosis in patients from endemic areas with chronic verrucous lesions and a history of cutaneous trauma. The essential role of mycology culture for definitive species identification is underscored, a critical step for guiding therapy and informing public health strategies
A Diagnostic Rarity: Apocrine Hidrocystoma Presenting as a Medial Canthal Mass in Adolescence
Full text linkBackground: Apocrine hidrocystomas are benign adnexal tumors of the glands of Moll, typically diagnosed in adults. Their presentation in adolescence is an exceptional clinical finding that challenges standard diagnostic paradigms for periocular masses in this age group, necessitating a broad and meticulous differential diagnosis.
Case presentation: A 15-year-old female presented with a two-month history of a stable, asymptomatic, 7×5×1 mm cystic mass at the inferomedial canthus of the left eye. The patient's primary concern was cosmetic. A comprehensive ophthalmologic examination was unremarkable. Orbital computed tomography confirmed a simple, preseptal subcutaneous cyst. A complete excisional biopsy was performed, and histopathological analysis revealed a unilocular cyst lined by a double layer of epithelium with inner columnar cells demonstrating pathognomonic decapitation secretion, confirming an apocrine hidrocystoma.
Conclusion: This case highlights the necessity of including apocrine hidrocystoma in the differential diagnosis of periocular masses in adolescents. The primary lesson is that a patient's age should broaden, not narrow, the diagnostic possibilities. Definitive diagnosis relies on histopathology, not demographic probability, and complete surgical excision remains the gold standard for both diagnosis and curative therapy, yielding an excellent prognosis
Evaluating Platelet-Large Cell Ratio (P-LCR) as an Accessible Biomarker for Myocardial Injury in Acute Coronary Syndrome
Full text linkBackground: The accurate and timely diagnosis of acute coronary syndrome (ACS) in resource-limited healthcare settings is critically hampered by the high cost and limited availability of the gold-standard biomarker, Troponin I. This study aimed to conduct a preliminary evaluation of the association between two accessible platelet indices derived from the complete blood count—the platelet-large cell ratio (P-LCR) and the immature platelet fraction (IPF)—and the quantitative degree of myocardial injury in patients with ACS.
Methods: An exploratory, cross-sectional study was conducted on 51 consecutive patients diagnosed with ACS at a tertiary referral hospital in Medan, Indonesia. The relationship between admission P-LCR, IPF, and Troponin I was assessed using a multi-faceted statistical approach, including Spearman's rank correlation, an exploratory multivariable linear regression model, and a Receiver Operating Characteristic (ROC) curve analysis. A post-hoc power analysis was performed to contextualize the findings.
Results: The study was found to be statistically underpowered (power ≈ 60%) to reliably detect weak correlations. A statistically significant but weak positive correlation was observed between P-LCR and Troponin I levels (Spearman's ρ = 0.31, p = 0.026). This association remained significant after adjusting for age, gender, and ACS subtype, but the overall model demonstrated minimal explanatory power (Adjusted R² = 0.18). The ROC analysis for P-LCR in discriminating between normal and elevated Troponin I was poor (Area Under the Curve = 0.65; 95% CI: 0.50 - 0.79). No significant correlation was found between IPF and Troponin I (p = 0.093).
Conclusion: P-LCR exhibits a weak, independent statistical association with the degree of myocardial injury in ACS patients. However, its poor discriminatory performance, coupled with the profound methodological limitations of this preliminary study, demonstrates that P-LCR is not a clinically useful biomarker for the identification or stratification of myocardial injury. These findings underscore the significant translational gap between a plausible biological hypothesis and a clinically viable diagnostic tool, highlighting the immense complexities that must be addressed in future, more robustly designed research
Clinicopathological Spectrum and Management of Lacrimal Gland Tumors: A Five-Year Retrospective Analysis from an Indonesian Tertiary Center
Full text linkBackground: Lacrimal gland tumors are a rare and heterogeneous group of neoplasms, representing a significant diagnostic and therapeutic challenge. Regional data, particularly from Southeast Asia, is sparse. This study aims to define the clinicopathological spectrum, radiological features, and management strategies for lacrimal gland tumors at a major tertiary referral center in Indonesia.
Methods: A retrospective, cross-sectional analysis was conducted on all patients with histopathologically confirmed lacrimal gland tumors treated between January 2019 and June 2024. Data extracted from medical records included demographics, detailed clinical presentations (visual acuity, proptosis, pain scores), radiological findings from computed tomography (CT) and magnetic resonance imaging (MRI), definitive histopathological diagnoses with immunohistochemical profiles, and treatment modalities with short-term outcomes. Descriptive statistics and comparative analyses were performed.
Results: A total of 35 patients (19 male, 16 female; mean age 48.2 ± 16.5 years) were included. Non-epithelial lesions (88.6%) were more common than epithelial tumors (11.4%). The most prevalent diagnosis was idiopathic orbital inflammation (IOI) (n=12, 34.3%), followed by lymphoproliferative disorders (n=11, 31.4%). Adenoid cystic carcinoma (ACC) was the most frequent malignant epithelial tumor (n=3, 8.6%). Superior eyelid edema was the hallmark of non-epithelial lesions (83.9%), whereas proptosis (mean 6.2mm) and severe pain (mean VAS 7.3/10) were characteristic of ACC. Radiological findings were highly correlative, with IOI showing diffuse gland enhancement and ACC demonstrating bone erosion and perineural invasion. Management was tailored to histology, with corticosteroids for IOI, radiotherapy for lymphomas, and radical surgery for ACC.
Conclusion: In this Indonesian cohort, lacrimal gland tumors are predominantly non-epithelial, with inflammatory and lymphoproliferative conditions being most common. A high index of suspicion for malignancy, particularly ACC, is warranted in patients presenting with pain and proptosis. Integrating clinical, radiological, and pathological data is paramount for accurate diagnosis and effective management