Bioscientia Medicina - Journal of Biomedicine and Translational Research
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The Role of Channa striata in Attenuating Inflammatory Markers (PCT, TNF-α, CRP) Following Intestinal Anastomosis in Hyperglycemic Rats: A Systematic Review and Dose-Response Meta-Analysis
Full text linkBackground: Hyperglycemia impairs wound healing and exacerbates inflammation, increasing the risk of complications following intestinal anastomosis. Channa striata (snakehead fish) extract, traditionally used for wound healing, contains bioactive compounds with potential anti-inflammatory properties. This systematic review and meta-analysis aimed to evaluate the dose-dependent effects of C. striata extract on procalcitonin (PCT), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) levels in hyperglycemic rats undergoing end-to-end intestinal anastomosis.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library databases for studies published between 2013 and 2024. Inclusion criteria were: studies using hyperglycemic rat models, end-to-end intestinal anastomosis, C. striata extract administration (with varying doses), and measurement of PCT, TNF-α, and/or CRP. Data extraction included study characteristics, animal model details, C. striata extraction method and dosage, and inflammatory marker levels at various time points. Risk of bias was assessed using the SYRCLE's RoB tool. A random-effects meta-analysis was performed to estimate the standardized mean difference (SMD) in inflammatory marker levels between C. striata-treated and control groups. Dose-response relationships were explored using meta-regression.
Results: Seven studies met the inclusion criteria. C. striata extract was administered via various routes (oral, intraperitoneal) and at different doses (ranging from 100 mg/kg to 1000 mg/kg). Meta-analysis revealed a significant reduction in PCT levels (SMD = -1.25, 95% CI: -1.80, -0.70; p < 0.001), TNF-α levels (SMD = -1.55, 95% CI: -2.15, -0.95; p < 0.001), and CRP levels (SMD = -1.38, 95% CI: -1.98, -0.78; p < 0.001) in C. striata-treated groups compared to controls. Meta-regression indicated a significant dose-dependent relationship for TNF-α (p = 0.02) and CRP (p = 0.04), with higher doses showing greater reductions. Risk of bias assessment revealed some concerns in most studies, primarily related to blinding and random sequence generation.
Conclusion: This systematic review and meta-analysis provides evidence that C. striata extract significantly reduces inflammatory markers (PCT, TNF-α, CRP) following intestinal anastomosis in hyperglycemic rats. A dose-dependent effect was observed for TNF-α and CRP, suggesting that higher doses may be more effective. Further high-quality studies with standardized protocols are needed to confirm these findings and determine optimal dosing regimens for clinical translation
The Efficacy of Antimalarial Therapy in the Treatment of Pulmonary Malaria: A Meta-Analysis
Full text linkBackground: Pulmonary malaria, a severe form of malaria that affects the lungs, is associated with high mortality rates. Antimalarial therapy is the cornerstone of treatment, but the optimal regimen remains a subject of debate. This meta-analysis aimed to evaluate the efficacy of different antimalarial therapies in the treatment of pulmonary malaria.
Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) was conducted to identify randomized controlled trials (RCTs) comparing different antimalarial therapies for pulmonary malaria. The primary outcome was mortality. Secondary outcomes included parasite clearance time, respiratory distress resolution, and length of hospital stay. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Results: Seven RCTs met the inclusion criteria, enrolling a total of 1,245 patients with pulmonary malaria. The studies compared various antimalarial regimens, including artemisinin-based combination therapy (ACT), quinine, and artesunate. The meta-analysis showed that ACT was associated with a significantly lower risk of mortality compared to quinine (RR 0.67, 95% CI 0.52-0.86, p = 0.002). There was no significant difference in mortality between ACT and artesunate (RR 0.92, 95% CI 0.75-1.13, p = 0.43). ACT was also associated with a faster parasite clearance time and quicker resolution of respiratory distress compared to quinine.
Conclusion: ACT is an effective treatment for pulmonary malaria, associated with reduced mortality and improved clinical outcomes compared to quinine. There was no significant difference in efficacy between ACT and artesunate. These findings support the use of ACT as the preferred antimalarial regimen for patients with pulmonary malaria
Immunophenotyping vs. Bone Marrow Aspiration in Pediatric Acute Leukemia: A Comparative Analysis
Full text linkBackground: Acute leukemia is a significant global health concern, with increasing prevalence worldwide and in Indonesia. Accurate diagnosis and classification of acute leukemia subtypes, primarily acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML), are crucial for effective treatment. Immunophenotyping and bone marrow aspiration (BMA) are commonly used diagnostic methods, each with its strengths and limitations. This study aimed to analyze the concordance between immunophenotyping and BMA in diagnosing and classifying acute leukemia in children.
Methods: A retrospective cross-sectional study was conducted on 46 children diagnosed with acute leukemia at Dr. M. Djamil General Hospital Padang from January 2022 to July 2023. Data were collected from medical records, including patient demographics, immunophenotyping results, and BMA findings. Concordance between the two diagnostic methods was analyzed using Fisher's exact test.
Results: The study population consisted of 30 (65.2%) males and 16 (34.8%) females, with a median age of 4 years. Immunophenotyping identified 24 (52.2%) cases as ALL and 22 (47.8%) as AML. BMA classified 26 (56.5%) cases as ALL and 20 (43.5%) as AML. There was a high concordance between the two methods, with only 2 (4.3%) cases showing discordant results. These two cases were classified as AML by immunophenotyping but as ALL by BMA.
Conclusion: Immunophenotyping and BMA demonstrate a high level of concordance in diagnosing and classifying acute leukemia in children. The few discordant cases highlight the importance of considering both methods, especially in challenging cases, to ensure accurate diagnosis and appropriate treatment
Sternotomy and Pericardiectomy in a Patient with Constrictive Pericarditis and Multiple Comorbidities: A Case Report
Full text linkBackground: Constrictive pericarditis is a serious condition that can lead to heart failure. It is characterized by a thickened and scarred pericardium, which restricts the heart's ability to fill and pump blood effectively. The condition is often caused by infections, such as tuberculosis, but can also be caused by other factors, such as radiation therapy, heart surgery, or autoimmune diseases. A pericardiectomy, a surgical procedure to remove the thickened pericardium, is the definitive treatment for constrictive pericarditis.
Case presentation: This case report describes a 57-year-old male patient with constrictive pericarditis and multiple comorbidities, including recent tuberculosis, pleural effusion, ascites, and cholelithiasis. The patient presented with symptoms of shortness of breath, swollen legs, and a swollen stomach. After a thorough evaluation, including imaging studies, the diagnosis of constrictive pericarditis was confirmed. The patient underwent a sternotomy and pericardiectomy procedure, which was successful in relieving his symptoms and improving his cardiac function.
Conclusion: This case report highlights the successful management of constrictive pericarditis in a patient with multiple comorbidities. The case also emphasizes the importance of early diagnosis and timely intervention in patients with constrictive pericarditis
Navigating Spheno-Orbital Meningioma in Indonesia: Clinical Characteristics and Diagnostic Considerations from a Decade of Experience
Full text linkBackground: Spheno-orbital meningiomas (SOM) represent a distinct subgroup of meningiomas originating from the sphenoid wing, characterized by orbital extension, significant bony invasion, and hyperostosis. These tumors present diagnostic and therapeutic challenges due to their complex anatomical location near critical neurovascular structures and a notable tendency for recurrence. Understanding the specific clinical profile of SOM patients is essential for timely diagnosis and effective management strategies. This study aimed to delineate these characteristics within an Indonesian population.
Methods: A retrospective, descriptive, cross-sectional study was performed using medical record data from patients diagnosed with SOM between January 2012 and December 2022 at the Department of Neurosurgery, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Data collected included patient demographics, case history (new vs. recurrent), presenting symptoms, neurological status (Glasgow Coma Scale), and radiological findings (lesion singularity/multiplicity). Total sampling was employed, and data were analyzed descriptively.
Results: The study included 252 subjects. A striking female predominance was observed (95.6%), with a mean patient age of 44.3 years (range 14-79). The vast majority were new cases (94.4%). Protrusion (proptosis) was the most frequent presenting symptom (79.0%), followed by headache (11.1%), blindness (5.2%), and blurred vision (4.0%). Most patients (97.2%) were fully conscious (GCS 15) upon admission. Radiological assessment revealed single lesions in 71.4% of cases.
Conclusion: In this large Indonesian cohort, SOM predominantly affected middle-aged females and typically presented with proptosis. Awareness of this distinct clinical signature is crucial for improving diagnostic accuracy and facilitating prompt, comprehensive management. The findings underscore the need for high clinical suspicion, particularly in female patients presenting with orbital symptoms
Advances in Urinary Tract Infection Screening Among Pregnant Women: A 5-Year Systematic Review
Full text linkBackground: Urinary tract infections (UTIs), including asymptomatic bacteriuria (ASB), represent a significant clinical challenge during pregnancy, posing risks to both mother and fetus. Physiological changes increase susceptibility. Urine culture remains the diagnostic gold standard. This review assessed recent evidence on UTI clinical manifestations and diagnostic approaches in pregnant women.
Methods: A systematic literature search of PubMed and Google Scholar was conducted for experimental studies published in the last 5 years (2019-2023) focusing on UTI diagnosis in pregnancy. Search terms included "urinary tract infection," "pregnant women," "diagnosis," and "experimental study". Studies were selected using PRISMA guidelines and PICOS criteria. Data extraction and risk of bias assessment were performed.
Results: Fifteen experimental studies involving 4,377 pregnant participants were included. Common clinical manifestations included urgency, lower abdominal/pelvic pain, dysuria, fever, and hematuria. Urine culture was the primary diagnostic tool used. Escherichia coli was the most prevalent Gram-negative isolate, followed by Klebsiella spp. and Pseudomonas spp. Streptococcus aureus, Enterococcus faecalis, and Staphylococcus aureus were common Gram-positive isolates. Urine pH varied, with Gram-positive infections associated with more alkaline urine.
Conclusion: Clinical presentations of UTI in pregnancy were consistent across recent studies. Gram-negative bacteria, particularly E. coli, predominated. Urine culture remains the cornerstone of diagnosis, with urine pH potentially offering adjunctive diagnostic information
Evaluating Progesterone Level Fluctuations as a Response Indicator to Chemotherapy in Triple Negative Breast Cancer
Full text linkBackground: Triple negative breast cancer (TNBC) represents an aggressive subtype with limited targeted therapies and often poorer prognosis. Chemotherapy remains a cornerstone of treatment, yet its systemic effects, including hormonal alterations, are not fully elucidated. The role of progesterone in TNBC progression and its modulation by chemotherapy is particularly complex and warrants investigation. This study aimed to evaluate changes in serum progesterone levels following chemotherapy in TNBC patients.
Methods: A prospective cohort study was conducted at Dr. Moewardi General Hospital, Surakarta, involving 30 patients diagnosed with TNBC undergoing chemotherapy. Serum progesterone levels were quantified using the ELISA method before the first chemotherapy cycle and after the sixth cycle. Statistical analysis, primarily the Wilcoxon test, was used to compare pre- and post-chemotherapy levels.
Results: The cohort had a mean age of 49.13 ± 8.98 years. Prior to chemotherapy, progesterone levels varied: 53.3% were below normal (<0.5 ng/mL), 23.3% were normal (0.5-5 ng/mL), and 23.3% were above normal (>5 ng/mL). Following six cycles of chemotherapy, a significant decrease in progesterone levels was observed (p=0.020). The proportion of patients with below-normal levels increased to 63.3%. Overall, 10 patients showed decreased levels, 18 remained stable, and 2 showed increased levels. No significant correlation was found between progesterone level changes and baseline patient characteristics like age, menarche, or menopausal status.
Conclusion: Systemic chemotherapy significantly impacts progesterone levels in TNBC patients, leading to an overall decrease. Monitoring progesterone fluctuations during treatment may hold potential value for assessing therapeutic response or prognosis, warranting further investigation
Thoracic Epidural Anesthesia Facilitating Upper Abdominal Surgery in the Presence of Malignant Pleural Effusion and Hepatic Metastases: A Case Report
Full text linkBackground: Upper abdominal surgery in patients with advanced metastatic cancer, particularly with significant pulmonary and hepatic involvement, presents substantial perioperative challenges. Malignant pleural effusion (MPE) and hepatic metastases compromise cardiorespiratory reserve, increasing the risks associated with general anesthesia and surgical stress. Thoracic epidural anesthesia (TEA) offers potential benefits by providing effective analgesia, reducing pulmonary complications, and attenuating the surgical stress response.
Case presentation: We report the case of a 65-year-old male patient with metastatic breast cancer involving the lungs, liver, and spine, complicated by recurrent malignant pleural effusion. He presented with dyspnea and abdominal pain, requiring a laparotomy for liver biopsy to guide further oncological management. Given his ASA III status, significant pulmonary compromise (pre-operative SpO2 93-94% on room air, effusion requiring drainage), and the nature of the surgery, TEA was chosen as the primary anesthetic technique. An epidural catheter was successfully placed at the T9-T10 interspace, achieving a T4 sensory block using ropivacaine 0.5%. The laparotomy and liver biopsy proceeded with stable intraoperative hemodynamics and adequate surgical conditions.
Conclusion: TEA provided effective anesthesia and analgesia for upper abdominal surgery in this high-risk patient with extensive metastatic disease and compromised pulmonary function. This approach facilitated the procedure while maintaining hemodynamic stability and avoiding the potential respiratory complications associated with general anesthesia and tracheal intubation. TEA should be considered a viable anesthetic option in carefully selected high-risk patients undergoing abdominal oncological surgery
Laparoscopic Cholecystectomy is Associated with Superior Clinical Outcomes in Pediatric Cholelithiasis: A 6-Year Comprehensive Surgical Outcome Analysis from Semarang, Indonesia
Full text linkBackground: The incidence of pediatric cholelithiasis is increasing globally, driven primarily by the childhood obesity epidemic. In a nation of over 270 million people like Indonesia, with rising obesity rates, understanding the optimal surgical management is a national health priority. This study provides the first detailed, comparative surgical outcome analysis for pediatric cholecystectomy from a major Indonesian referral center.
Methods: A retrospective cohort study of all pediatric patients (≤18 years) undergoing cholecystectomy from January 2019 to December 2024 was conducted. Data on preoperative demographics, clinical presentation, intraoperative variables (operative time, blood loss, conversion rate), and postoperative outcomes (length of stay, 30-day complications graded by Clavien-Dindo) were extracted. Laparoscopic (LC) and open cholecystectomy (OC) groups were compared using Mann-Whitney U and Fisher’s exact tests.
Results: The cohort of 30 patients (70% female, mean age 12.0 years) had a 60% prevalence of overweight or obesity. Laparoscopy was the initial approach in 25 cases (83.3%), with one conversion to open surgery (4%). Compared to the OC group (n=6), the definitive LC group (n=24) demonstrated significantly superior outcomes: median operative time was shorter (72 vs. 115 minutes, p=0.004), median estimated blood loss was lower (15 vs. 80 mL, p<0.001), and median postoperative length of stay was significantly reduced (3 vs. 5 days, p=0.002). The postoperative complication rate was lower in the LC group (8.3% vs. 33.3%, p=0.14), with all complications being minor (Clavien-Dindo Grade I-II).
Conclusion: Laparoscopic cholecystectomy is a safe, effective, and efficient procedure that provides superior clinical outcomes compared to the open approach in the Indonesian pediatric population. These findings provide robust local evidence to establish LC as the unequivocal standard of care and justify investment in minimally invasive surgical training and infrastructure to meet the rising burden of this disease
Fatal Lung-Kidney Crosstalk in Bronchopulmonary Dysplasia: A Case of Refractory Weaning Unmasking Confirmed Williams Syndrome and Severe Obstructive Nephrolithiasis
Full text linkBackground: Bronchopulmonary dysplasia (BPD) is the most common, serious morbidity of prematurity, frequently complicated by a protracted and difficult weaning process from respiratory support. Refractory weaning failure, defined as a lack of response to conventional BPD therapies, should trigger a broad investigation for non-pulmonary, systemic confounders.
Case presentation: We present the case of a 1,480-gram, 35+4 weeks' gestation female infant with severe hyaline membrane disease who subsequently developed moderate-to-severe BPD. The infant exhibited refractory respiratory failure, failing multiple extubation attempts, and showing no clinical improvement despite standard BPD management, including a 15-day course of furosemide. On day 58, investigation for worsening cholestasis incidentally revealed a 1.3 cm obstructive right renal calculus with severe hydronephrosis and acute pyelonephritis. This finding, coupled with evolving "elfin" facies, prompted a systemic workup. Key confirmatory data included severe hypercalcemia (13.4 mg/dL) and an echocardiogram revealing supravalvular aortic stenosis (SVAS). These findings, along with a characteristic phenotype, established a clinical diagnosis of Williams Syndrome. The infant rapidly developed urosepsis and anuric acute kidney injury (AKI), culminating in irreversible respiratory failure.
Conclusion: This case provides a definitive clinico-pathological correlation for a rare and fatal triad. The severe nephrolithiasis is explained by a "two-hit" mechanism: baseline idiopathic hypercalcemia from Williams Syndrome, massively amplified by iatrogenic hypercalciuria from furosemide therapy. The patient's demise was a direct consequence of lung-kidney crosstalk, wherein the obstructive urosepsis and AKI induced a fatal inflammatory and hydrostatic pulmonary edema that overwhelmed the infant's BPD-compromised lungs