Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Angiofibroma Beyond the Nasopharynx: Diagnostic Challenges and Endoscopic Management of Two Atypical Cases Arising from the Ethmoid and Sphenoid Sinuses
Full text linkBackground: Angiofibroma is a histologically benign but locally aggressive vascular neoplasm almost exclusively associated with the nasopharynx of adolescent males (Juvenile Nasopharyngeal Angiofibroma, JNA). Extranasopharyngeal angiofibroma (ENA) is an exceptionally rare variant that originates outside the sphenopalatine foramen, posing significant diagnostic and management challenges due to its atypical locations, age of presentation, and clinical mimicry of other sinonasal pathologies.
Case presentation: We present two sophisticated cases of ENA managed at our tertiary center. Case 1: A 35-year-old male presented with unilateral nasal obstruction. Endoscopy and imaging revealed a hypervascular mass centered in the posterior ethmoid sinus, destroying the basal lamella and abutting the skull base. Histopathological analysis was initially confounded by features resembling a solitary fibrous tumor (SFT), requiring a comprehensive immunohistochemical panel (IHC) including STAT6 and nuclear beta-catenin to confirm the diagnosis of angiofibroma. Case 2: A 17-year-old male presented with symptoms and imaging (non-contrast CT) highly suggestive of a benign sphenochoanal polyp. An initial attempt at routine endoscopic removal was aborted due to unexpected, profuse hemorrhage. Subsequent advanced imaging (CTA/MRI) revealed a hypervascular sphenoid-based angiofibroma. Both patients underwent preoperative superselective embolization followed by successful, purely endoscopic tumor resection with no recurrence at 12 and 18-month follow-up, respectively.
Conclusion: ENA is a critical, albeit rare, diagnostic consideration for any vascular sinonasal mass, regardless of patient age or tumor location. These cases underscore the unreliability of "classic" clinical and radiological signs, the diagnostic pitfalls of histopathological mimics like SFT and polyps, and the critical role of advanced IHC (nuclear beta-catenin) for definitive diagnosis. A modern, multidisciplinary approach combining preoperative embolization with endoscopic resection offers a safe and effective pathway to cure
Combinatorial Efficacy of Human Mesenchymal Stem Cell Secretome and Ursodeoxycholic Acid in Ameliorating Renal Dysfunction: A Synergistic Approach in a Rat Model of Cholestatic Injury
Full text linkBackground: Cholestatic nephropathy, historically termed cholemic nephropathy, represents a critical intersection of hepatic and renal pathology where the systemic retention of nephrotoxic cholephiles induces severe acute kidney injury. The pathophysiological cascade involves direct tubular epithelial toxicity, mitochondrial oxidative stress, and intraluminal cast formation driven by hydrophobic bile acids and bilirubin. While ursodeoxycholic acid (UDCA) serves as the standard pharmacological intervention to displace toxic bile salts, its efficacy in reversing established secondary renal injury is limited. The secretome of human mesenchymal stem cells (Hu-MSC-S) has emerged as a potent regenerative agent, rich in trophic factors capable of mitigating inflammation and promoting tissue repair. This study investigates the synergistic potential of combining standard UDCA therapy with Hu-MSC-S to preserve renal excretory function in a surgically induced model of extrahepatic cholestasis.
Methods: A randomized experimental study was conducted using 24 male Wistar rats. Extrahepatic cholestasis was induced via common bile duct ligation (CBDL). Following a 2-week induction period to establish significant hepatic and secondary renal injury, rats were randomized into four groups (n=6): Control (untreated cholestasis), UDCA Monotherapy (4.5 mg/200g body weight orally), Hu-MSC-S Monotherapy (0.2 ml/kg intraperitoneally), and combination therapy (UDCA + Hu-MSC-S). Treatments were administered weekly for four weeks. Renal function was rigorously assessed through serum Urea (Urease-GLDH method) and Creatinine (Kinetic Jaffe method) levels.
Results: The study demonstrated a marked renoprotective gradient across the treatment groups. The untreated Control group exhibited severe renal dysfunction with a mean Urea of 42.60 mg/dL and Creatinine of 3.18 mg/dL. Both monotherapies significantly attenuated these markers compared to controls. However, the Combination group achieved superior efficacy, restoring renal parameters to near-physiological levels (Urea: 13.08 mg/dL; Creatinine: 1.32 mg/dL). Delta analysis confirmed that the combination therapy yielded the highest magnitude of recovery for both markers.
Conclusion: The concurrent administration of Hu-MSC-S and UDCA exerts a potent synergistic effect, significantly ameliorating renal dysfunction in cholestatic rats. The findings suggest that Hu-MSC-S acts as a crucial adjuvant, repairing tubular injury via paracrine mechanisms while UDCA mitigates the primary cholestatic insult, offering a novel multi-target therapeutic strategy for cholemic nephropathy
The Anicteric Giant: A Rare Case of Giant Choledocholithiasis and Multiple Cholelithiasis Presenting with Paradoxically Normal Bilirubin Profiles
Full text linkBackground: Giant choledocholithiasis, defined as common bile duct (CBD) calculi exceeding 15 mm, typically presents with Charcot’s triad or marked biochemical cholestasis. The phenomenon of silent or anicteric giant stones remains a dangerous diagnostic blind spot. We present a rare case of a massive biliary stone burden presenting with paradoxically normal bilirubin and liver enzyme profiles, challenging standard screening algorithms.
Case presentation: A 61-year-old female presented with a 12-month history of intermittent epigastric pain and nausea, initially misdiagnosed as gastritis. Despite the chronicity, she denied jaundice or fever. Biochemical analysis revealed a Total Bilirubin of 0.39 mg/dL (Reference: 0.1–1.2 mg/dL) and normal gamma-glutamyl transferase (GGT) levels, indicating an absence of biochemical obstruction. Magnetic resonance cholangiopancreatography (MRCP) identified multiple cholelithiasis and a solitary giant CBD stone. Intraoperative exploration confirmed a CBD dilated to 22 mm containing a calculus measuring 28 mm × 22 mm. Due to the massive ductal dilation and risk of recurrent stasis, the patient underwent a retrograde cholecystectomy followed by biliary reconstruction via Roux-en-Y choledochojejunostomy.
Conclusion: Giant choledocholithiasis can exist in a silent phase due to ductal compliance and the ball-valve mechanism, rendering bilirubin an unreliable screening tool. This case underscores the necessity of cross-sectional imaging in chronic abdominal pain, even when biochemical markers are normal. Roux-en-Y reconstruction remains the definitive management for giant stones in significantly dilated ducts to prevent recurrence and sump syndrome
Biallelic versus Monoallelic TP53 Inactivation in Hematologic Malignancies: A Comparative Meta-Analysis of Lymphoid and Plasma Cell Disorders
Full text linkBackground: The tumor suppressor protein p53, encoded by the TP53 gene on chromosome 17p13.1, functions as the central guardian of genomic stability. In hematologic malignancies, including multiple myeloma (MM), chronic lymphocytic leukemia (CLL), and myelodysplastic syndromes (MDS), p53 dysfunction acts as a universal marker of chemoresistance and disease progression. Current clinical staging systems frequently conflate chromosomal deletion, or del(17p), with somatic mutation, thereby failing to distinguish between monoallelic (single-hit) and biallelic (double-hit) inactivation. This lack of granularity obscures the distinct biological consequences of these two states. This study aims to resolve the prognostic discordance between genomic subgroups in the context of modern therapeutic interventions.
Methods: We conducted a comparative meta-analysis of nine pivotal studies comprising 4,125 patients, selected through a stringent protocol requiring paired cytogenetic (FISH) and molecular sequencing data. Patients were stratified into three genomic subgroups: Wild type, monoallelic disruption (isolated deletion or isolated mutation), and biallelic disruption (deletion plus mutation). Data were synthesized using a random-effects model to calculate pooled hazard ratios (HR) for Overall Survival (OS), with specific subgroup analyses performed for Plasma Cell versus Lymphoid malignancies to account for lineage heterogeneity.
Results: The analysis revealed a profound prognostic dichotomy. In Multiple Myeloma, biallelic inactivation conferred a catastrophic prognosis with a pooled hazard ratio for death of 3.82 compared to Wild Type. Conversely, isolated del(17p) carried a significantly lower risk (HR 1.82), suggesting functional compensation by the residual allele. In CLL and Waldenström's Macroglobulinemia, TP53 mutations acted as independent drivers of poor survival (HR 2.80) even in the absence of deletion, consistent with a dominant-negative mechanism. The double hit phenotype was consistently associated with a median survival reduction exceeding fifty percent compared to monoallelic cases across all lineages.
Conclusion: The prognostic weight of TP53 abnormalities is defined by allelic dosage. Biallelic inactivation represents a distinct, high-risk biological entity requiring novel therapeutic approaches, whereas monoallelic alterations often exhibit intermediate outcomes. Clinical guidelines must mandate sequencing alongside FISH to prevent misstratification and overtreatment
Phytochemical Screening and In Vitro Antibacterial Activity of Swietenia mahagoni Leaf Extract against Streptococcus mutans: A Promising Natural Approach for Caries Prevention
Full text linkBackground: Dental caries, primarily caused by Streptococcus mutans, is a prevalent oral health issue. The rise of antibiotic resistance and side effects of synthetic antimicrobials have fueled the search for plant-derived alternatives. Swietenia mahagoni (mahogany) leaves, traditionally used for medicinal purposes, exhibit potential antibacterial properties. This study investigated the phytochemical composition and in vitro antibacterial activity of S. mahagoni leaf extracts against S. mutans.
Methods: S. mahagoni leaves were collected, processed, and extracted using ethanol. Phytochemical screening identified alkaloids, tannins, flavonoids, and saponins. Antibacterial activity was assessed through the agar well diffusion method against S. mutans, using various extract concentrations (25%, 50%, 75%) and chlorhexidine as a positive control. Inhibition zone diameters were measured to determine antibacterial efficacy.
Results: Phytochemical analysis confirmed the presence of alkaloids, tannins, flavonoids, and saponins in the S. mahagoni leaf extract. The extract demonstrated significant antibacterial activity against S. mutans at all concentrations. The highest concentration (75%) showed the largest inhibition zone (18.07 ± 0.37 mm), significantly larger than those of lower concentrations and the positive control (chlorhexidine, 13.87 ± 0.21 mm).
Conclusion: S. mahagoni leaf extract exhibits substantial antibacterial activity against S. mutans, likely due to its diverse phytochemical content. These findings suggest its potential as a natural anti-caries agent. Further research is needed to explore its use in developing novel oral health products
Effectiveness of Mangifera indica L. Leaf Extract in Controlling Candida albicans Growth on Orthodontic Retainers: A Promising Approach to Improve Oral Hygiene
Full text linkBackground: Orthodontic retainers, especially thermoplastic retainers, are prone to Candida albicans colonization, potentially leading to oral health issues. This study investigated the effectiveness of Mangifera indica L. leaf extract in controlling C. albicans growth on orthodontic retainers and also analyzed its phytochemical constituents.
Methods: M. indica leaf extract was prepared using maceration and digestion techniques. Thermoplastic retainers were contaminated with C. albicans and then immersed in different concentrations of M. indica leaf extract (25%, 50%, 75%, and 100%) for 15 minutes. Chlorhexidine digluconate 2% served as the positive control, and dimethyl sulfoxide (DMSO) was the negative control. The antifungal activity was evaluated by measuring the diameter of the inhibition zone. Phytochemical screening was conducted to identify the presence of various secondary metabolites in the extract.
Results: All concentrations of M. indica leaf extract demonstrated significant antifungal activity against C. albicans. The 75% extract showed the highest inhibition zone, comparable to chlorhexidine digluconate 2%. Phytochemical screening revealed the presence of alkaloids, flavonoids, tannins, and other bioactive compounds in the extract.
Conclusion: M. indica leaf extract, particularly at 75% concentration, effectively inhibits C. albicans growth on orthodontic retainers, suggesting its potential as a natural alternative for maintaining oral hygiene during orthodontic treatment. The presence of various bioactive compounds in the extract contributes to its antifungal activity
Chondroprotective Potential of Oleocanthal and Hydroxytyrosol from Extra Virgin Olive Oil: A Meta-Analysis
Full text linkBackground: Osteoarthritis (OA) is a prevalent degenerative joint disease characterized by cartilage degradation, inflammation, and pain. Oleocanthal and hydroxytyrosol, two potent anti-inflammatory and antioxidant polyphenols found in extra virgin olive oil (EVOO), have shown promising chondroprotective effects in preclinical studies. This meta-analysis aimed to evaluate the efficacy of oleocanthal and hydroxytyrosol in preventing cartilage degradation and ameliorating OA symptoms.
Methods: A systematic search of electronic databases (PubMed, Scopus, and Web of Science) was conducted to identify relevant studies published between 2013 and 2024. Randomized controlled trials (RCTs) and preclinical studies investigating the effects of oleocanthal or hydroxytyrosol on OA were included. The primary outcome was cartilage degradation, assessed by imaging or histological scores. Secondary outcomes included pain and inflammation.
Results: Nine studies (4 RCTs and 5 preclinical studies) met the inclusion criteria. The RCTs included a total of 315 participants with knee OA. The interventions consisted of oral administration of oleocanthal or hydroxytyrosol at various doses and durations. The preclinical studies used different in vivo animal models. Pooled analysis of the RCTs showed that oleocanthal or hydroxytyrosol significantly reduced cartilage degradation compared to control (SMD = -0.85, 95%CI -1.20 to -0.50, p < 0.001). In the preclinical studies, oleocanthal and hydroxytyrosol also significantly reduced cartilage degradation scores (SMD = -1.10, 95%CI -1.50 to -0.70, p < 0.001). Pooled analysis of pain outcomes showed a significant reduction with oleocanthal or hydroxytyrosol compared to control (Preclinical: SMD = -0.60, 95%CI -0.90 to -0.30, p < 0.001; RCTs: SMD=-1.20, 95%CI-1.60 to -0.80, p < 0.001). Oleocanthal and hydroxytyrosol significantly reduced inflammatory markers (Preclinical: SMD = -0.85, 95%CI-1.15 to -0.55, p < 0.001; RCTs: SMD= -1.50, 95%CI-1.90 to -1.10, p < 0.001).
Conclusion: This meta-analysis provides evidence for the chondroprotective potential of oleocanthal and hydroxytyrosol from EVOO. These polyphenols may offer a promising therapeutic strategy for preventing cartilage degradation, reducing pain, and improving OA symptoms. Further large-scale RCTs are warranted to confirm these findings and establish optimal dosage and treatment duration
Monocyte-to-HDL Cholesterol Ratio Predicts 30-Day Mortality in ST-Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention
Full text linkBackground: ST-elevation myocardial infarction (STEMI) is a leading cause of mortality worldwide. Despite advancements in treatment, especially with primary percutaneous coronary intervention (pPCI), 30-day mortality rates remain significant. The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has emerged as a potential predictor of mortality in STEMI patients, reflecting the balance between inflammation and anti-atherosclerotic processes in atherosclerotic plaques. This study aimed to evaluate the association between MHR and 30-day mortality in STEMI patients undergoing pPCI.
Methods: This prospective observational study included 55 STEMI patients treated with pPCI at Dr. M. Djamil General Hospital in Padang, Indonesia, between January and July 2024. Patients were included if they were ≥18 years old, undergoing their first pPCI, and had blood tests done within 24 hours of admission. Patients with prior revascularization, acute/chronic infections, malignancies, autoimmune diseases, or on lipid-lowering therapy were excluded. Blood samples were collected within 24 hours of admission. Monocyte counts were measured using flow cytometry, and HDL cholesterol levels were determined using a homogeneous enzymatic colorimetric method. The MHR was calculated by dividing the monocyte count by the HDL cholesterol level. The primary outcome was 30-day mortality, assessed through hospital records and telephone follow-up. Statistical analysis included chi square, t-tests, and Mann-Whitney U tests.
Results: The mean age of the study participants was 59.5 (±11.4) years, with 81.8% being male. The mean monocyte count and MHR were 968 (±212)/mm3 and 28.3 (±6.06), respectively. The median HDL cholesterol level was 33.4 (27-49) mg/dL. Both monocyte count and MHR were significantly higher in patients who died within 30 days compared to those who survived (p<0.001).
Conclusion: The MHR is an independent predictor of 30-day mortality in STEMI patients undergoing pPCI. This readily available and cost-effective biomarker may aid in risk stratification and guide treatment strategies for this high-risk population
Mean Platelet Volume and Immature Platelet Fraction as Biomarkers in Differentiating Early-Onset and Late-Onset Neonatal Sepsis
Full text linkBackground: Neonatal sepsis is a significant contributor to infant mortality, with millions of cases occurring globally each year. It is classified into early-onset neonatal sepsis (EONS), occurring within the first 72 hours of life, and late-onset neonatal sepsis (LONS), occurring after 72 hours. Thrombocytopenia is a common finding in neonatal sepsis, and the degree of thrombocytopenia has been associated with the severity of the disease. Mean platelet volume (MPV) and immature platelet fraction (IPF) are markers of platelet size and immaturity, respectively, and may provide insights into the pathophysiology of sepsis and aid in its diagnosis.
Methods: This cross-sectional analytical study was conducted at Dr. M. Djamil General Hospital in Padang, Indonesia, from June to September 2024. The study included 41 neonates diagnosed with sepsis. Complete blood counts were performed using an automated hematology analyzer to determine MPV, IPF, and platelet count. Neonatal sepsis was classified as EONS (within the first 7 days of life) or LONS (from day 8 to 28). Data were analyzed using descriptive statistics and the unpaired t-test.
Results: The mean age of the neonates was 11.6 days. There were 19 neonates with EONS and 22 with LONS. The mean MPV was significantly higher in the LONS group (11.7 fL) compared to the EONS group (10.2 fL) (p=0.001). Similarly, the mean IPF was significantly higher in the LONS group (10.9%) compared to the EONS group (7.7%) (p=0.001). There was no significant difference in platelet count between the two groups.
Conclusion: MPV and IPF were significantly higher in neonates with LONS compared to those with EONS, suggesting that these parameters may be useful biomarkers for differentiating between the two conditions. Further research with a larger sample size and longitudinal follow-up is needed to confirm these findings and to assess the potential clinical utility of MPV and IPF in the management of neonatal sepsis
Successful Management of Acute Respiratory Failure Following Drowning in a Child: A Case Report
Full text linkBackground: Drowning is a significant global public health issue, leading to a substantial number of deaths annually, particularly among children. Acute respiratory failure (ARF) is a common and life-threatening complication of drowning, necessitating prompt and effective management. This case report describes the successful management of ARF in a 6-year-old child following a drowning incident.
Case presentation: A 6-year-old male child was brought to the emergency department (ED) after being rescued from a river. He was unconscious, cyanotic, and in respiratory distress. Initial assessment revealed a Glasgow Coma Scale (GCS) score of 9, oxygen saturation of 45% on room air, and crackles on lung auscultation. He was immediately intubated and placed on mechanical ventilation. A chest X-ray showed evidence of pneumonia and pulmonary edema. Arterial blood gas analysis confirmed acute hypoxemic respiratory failure. The patient was transferred to the intensive care unit (ICU) and managed with mechanical ventilation, antibiotics, and corticosteroids. He demonstrated gradual improvement in respiratory status and neurological function, leading to successful extubation and eventual discharge with a full recovery.
Conclusion: This case highlights the critical role of prompt recognition and aggressive management of ARF in drowning victims. Early intubation and mechanical ventilation, along with supportive care, can lead to successful outcomes even in severe cases. This report emphasizes the importance of raising awareness about drowning prevention and the need for readily available emergency medical services to improve outcomes in such incidents