Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Clinical Characteristics and Management of Steroid-Induced Glaucoma
Full text linkBackground: Steroid-induced glaucoma (SIG) is a secondary glaucoma characterized by elevated intraocular pressure (IOP) due to steroid use. This study aimed to analyze the clinical characteristics and management of SIG patients at Dr. M. Djamil General Hospital Padang, Indonesia, from January 2019 to August 2023.
Methods: A retrospective descriptive study was conducted using medical records of patients diagnosed with SIG. Data collected included age, gender, steroid type, route of administration, duration of use, IOP at diagnosis, underlying diseases, glaucoma stage, and treatment.
Results: Seventeen patients were diagnosed with SIG. The majority were female (70.58%) and aged 4-39 years (58.83%). The most common underlying diseases were systemic lupus erythematosus (SLE) and allergic conjunctivitis (47%). Oral steroid administration was most frequent (76.4%), with a usage duration of 2-12 months in most cases (70.6%). IOP at diagnosis ranged from 22 to 31 mmHg in most patients (82.3% right eye, 64.7% left eye). Most patients presented with mild glaucoma (70.5%). Topical anti-glaucoma medications were the primary treatment (76.4%), with trabeculectomy performed in some cases (23.6%).
Conclusion: SIG is a preventable condition. Early detection and appropriate management are crucial to prevent vision loss. The clinical characteristics identified in this study contribute to a better understanding of SIG in our population. Further research on the interplay of risk factors, genetics, and histopathology is needed to enhance our comprehension of SIG
Unfractionated Heparin versus Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Acutely Ill Medical Patients: A Meta-analysis
Full text linkBackground: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in acutely ill medical patients. Both unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are effective for VTE prophylaxis, but their relative efficacy and safety remain unclear.
Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing UFH and LMWH for VTE prophylaxis in acutely ill medical patients. We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 2013 to 2024. The primary outcome was the incidence of VTE. Secondary outcomes included major bleeding and mortality.
Results: Seven RCTs with a total of 5,412 patients were included. LMWH was associated with a significantly lower risk of VTE compared to UFH (relative risk [RR] 0.68; 95% confidence interval [CI] 0.52-0.88; p = 0.004). There was no significant difference in major bleeding (RR 0.91; 95% CI 0.65-1.27; p = 0.58) or mortality (RR 0.93; 95% CI 0.78-1.11; p = 0.43) between the two groups.
Conclusion: LMWH is more effective than UFH for VTE prophylaxis in acutely ill medical patients without increasing the risk of major bleeding or mortality. LMWH should be considered the preferred agent for VTE prophylaxis in this population
The Clinical Significance of DAT Positivity: A Comparative Analysis of IgG, C3d, and IgG/C3d-Positive Patients
Full text linkBackground: The direct antiglobulin test (DAT) is a crucial diagnostic tool in immunohematology, used to detect the presence of antibodies and/or complement components on the surface of red blood cells. DAT positivity is frequently associated with autoimmune hemolytic anemia (AIHA) and other immune-mediated hemolytic conditions. This study aimed to investigate the clinical significance of DAT positivity by comparing the characteristics of patients with IgG, C3d, and IgG/C3d-positive results.
Methods: A retrospective study was conducted on 55 patients with DAT-positive results, identified from the Blood Transfusion Unit of Dr. M. Djamil General Hospital Padang between June 2023 and August 2023. DAT-positive samples were further analyzed using monospecific anti-human globulin (AHG) reagents to determine the presence of IgG, C3d, or both on the red blood cells. Patient demographics, clinical diagnoses, blood groups, transfusion history, and hematological parameters were collected and analyzed.
Results: Out of the 55 DAT-positive patients, 51 (92.7%) were positive for IgG alone, 3 (5.5%) were positive for both IgG and C3d, and only 1 (1.8%) was positive for C3d alone. The majority of patients were adults (>18 years old) and female. A history of blood transfusion (>3 times) was common, particularly in the IgG-positive group. Hematological parameters indicative of hemolysis (hemoglobin ≤9 g/dL, reticulocyte count >2%, and total bilirubin >2 mg/dL) were observed in a significant proportion of patients, especially those with IgG and/or C3d positivity.
Conclusion: IgG positivity was the most common finding in DAT-positive patients, highlighting the prevalence of warm AIHA. The presence of C3d, alone or with IgG, suggests the involvement of complement activation and may indicate a different underlying pathology. This study emphasizes the importance of using monospecific AHG reagents to characterize DAT-positive results, as this information can aid in the diagnosis, management, and prediction of clinical outcomes
Serum Nerve Growth Factor as a Biomarker for Chemotherapy-Induced Peripheral Neuropathy: A Cross-Sectional Study
Full text linkBackground: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment. Nerve growth factor (NGF) plays a crucial role in neuronal health and has been implicated in CIPN development. This study investigated the relationship between serum NGF levels and CIPN in cancer patients undergoing chemotherapy.
Methods: A cross-sectional study was conducted on 60 cancer patients receiving chemotherapy at Dr. M. Djamil General Hospital Padang, Indonesia, from June to October 2024. Serum NGF levels were measured, and CIPN was assessed using the Toronto Clinical Scoring System (TCSS). The relationship between NGF and CIPN was analyzed using the Mann-Whitney test.
Results: The median serum NGF level was significantly lower in patients with CIPN (n=43) compared to those without CIPN (n=17) (103.26 pg/ml vs. 148.91 pg/ml, p=0.029). No significant association was found between chemotherapy regimens and CIPN or NGF levels.
Conclusion: Lower serum NGF levels are associated with CIPN in cancer patients undergoing chemotherapy. NGF may serve as a potential biomarker for CIPN, aiding in early detection and management. Further research is needed to explore the clinical utility of NGF as a predictive and monitoring tool for CIPN
Programmed Intermittent Epidural Bolus (PIEB) Versus Patient-Controlled Epidural Analgesia (PCEA) with Continuous Basal Infusion for Labor Analgesia: A Meta-Analysis
Full text linkBackground: Maintaining effective labor epidural analgesia while optimizing maternal satisfaction and minimizing drug consumption remains a key objective in obstetric anesthesia. Programmed intermittent epidural bolus (PIEB) techniques have emerged as an alternative to traditional continuous epidural infusion (CEI) combined with patient-controlled epidural analgesia (PCEA). This meta-analysis aimed to compare the efficacy, local anesthetic (LA) consumption, and maternal satisfaction between PIEB regimens (typically combined with PCEA for rescue) and PCEA regimens supplemented with a continuous basal infusion (PCEA+Basal).
Methods: A systematic literature search was conducted for PubMed, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) published between January 2013 and December 2024 comparing PIEB (+/- PCEA) with PCEA+Basal for labor analgesia. Primary outcomes were hourly LA consumption, maternal satisfaction (rated as high/excellent), and need for clinician rescue analgesia (breakthrough pain). Secondary outcomes included pain scores (Visual Analog Scale - VAS), mode of delivery, duration of labor stages, motor blockade incidence, and neonatal outcomes (Apgar scores). Data were extracted from suitable studies identified through the search. A random-effects model was used for meta-analysis using RevMan software. Mean Differences (MD) or Odds Ratios (OR) with 95% Confidence Intervals (CI) were calculated. Heterogeneity was assessed using the I² statistic.
Results: Five studies involving a total of 1158 parturients met the inclusion criteria. The pooled analysis indicated that PIEB regimens were associated with a trend towards lower hourly LA consumption compared to PCEA+Basal (MD: -1.2 mL/hour; 95% CI: -2.5 to 0.1; P=0.07; I²=78%), although heterogeneity was high. Maternal satisfaction rated as 'high' or 'excellent' was significantly more frequent in the PIEB group (OR: 1.85; 95% CI: 1.20 to 2.85; P=0.005; I²=35%). The need for clinician rescue analgesia was numerically lower with PIEB, but the difference did not reach statistical significance (OR: 0.70; 95% CI: 0.45 to 1.10; P=0.12; I²=45%). No significant differences were noted in VAS pain scores during established labor, mode of delivery, or Apgar scores. Incidence of motor block appeared potentially lower with PIEB regimens.
Conclusion: Based on this meta-analysis, PIEB regimens appear promising for labor analgesia, potentially offering comparable efficacy to PCEA+Basal while possibly reducing local anesthetic consumption and enhancing maternal satisfaction. However, significant heterogeneity was observed for some outcomes. High-quality, large-scale RCTs directly comparing optimized PIEB+PCEA protocols with PCEA+Basal infusion are crucial to definitively establish the relative benefits and risks of these techniques
Unraveling the Angiogenic Landscape in Endometrioid Endometrial Carcinoma: VEGF Expression, Histopathological Differentiation, and Lymphovascular Invasion as Key Players
Full text linkBackground: Endometrioid endometrial carcinoma (EEC) is a prevalent gynecological malignancy whose prognosis is influenced by factors including histopathological grade and lymphovascular invasion (LVI). Angiogenesis, crucial for tumor growth and metastasis, is significantly mediated by vascular endothelial growth factor (VEGF). This study aimed to investigate the expression of VEGF in EEC and its correlation with histopathological differentiation and LVI.
Methods: This observational analytical study employed a cross-sectional design using 36 archival paraffin block samples of EEC diagnosed between January 2022 and December 2024 at the Anatomical Pathology Laboratory of Dr. M. Djamil General Hospital Padang. Cases were selected via simple random sampling from a population of 59. Histopathological grade (Grade 1, 2, or 3 based on FIGO architectural and nuclear criteria) and LVI (negative, focal, or substantial) were re-evaluated from Hematoxylin-Eosin (H&E) stained slides. VEGF expression was assessed by immunohistochemistry, scored semiquantitatively based on the percentage of positive tumor cells and staining intensity, and categorized as low or high. Data were analyzed using Chi-square tests, with p<0.05 considered statistically significant.
Results: The mean age of patients was 54.36 years, with the highest prevalence in the 51-60 age group (41.7%). Grade 3 tumors were most common (38.9%), followed by Grade 2 (33.3%) and Grade 1 (27.8%). LVI was present in 47.2% of cases, predominantly focal (38.9%). High VEGF expression was observed in 58.3% of EEC cases. A statistically significant association was found between high VEGF expression and higher histopathological grade (p=0.000), with 66.7% of Grade 3 tumors showing high VEGF expression. No significant association was found between VEGF expression and LVI (p=0.080).
Conclusion: High VEGF expression significantly correlated with higher histopathological grades in EEC, suggesting its role in tumor aggressiveness and dedifferentiation. However, a significant association with LVI was not established in this cohort. VEGF expression warrants further investigation as a potential prognostic biomarker and therapeutic target in EEC
The Landscape of Condyloma Acuminata and Concomitant STIs in Denpasar: A Retrospective Analysis with Implications for Public Health Strategies
Full text linkBackground: Condylomata acuminata (CA) is a prevalent sexually transmitted infection (STI). Research into the risk factors and characteristics associated with CA is crucial for developing effective prevention strategies. This study aimed to determine the prevalence and characteristics of CA patients at Prof. Dr. I.G.N.G. Ngoerah General Hospital in Denpasar, Bali, Indonesia.
Methods: A retrospective cross-sectional study was conducted using medical records of CA patients attending the STI and Dermatology Clinic at Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, from January 2021 to December 2023. Data collected included patient visit status, age, gender, occupation, education, concomitant STIs, sexual orientation, marital status, and use of protective measures. Data were processed descriptively.
Results: Of 284 CA patients, 69.7% were male and 30.3% were female. The mean age was 28.99 ± 11.38 years. Married individuals constituted 41.5% of cases. Private employees were the predominant occupation (34.2%). Fifty percent of patients had no concomitant STIs, while HIV was present in 37.7% of the total sample (75.4% of those with any concomitant STI). A significant proportion (49%) reported not using protective measures during sexual intercourse.
Conclusion: The prevalence of CA at Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, was 40 per 1000 visits during the study period. CA was predominantly observed in adult males who were married, heterosexual, had completed high school, worked as private employees, and did not use protective measures during sexual intercourse. These findings underscore the need for targeted public health interventions
Beyond Co-Expression: Unraveling the Complex Relationship Between PD-L1 and Tumor-Infiltrating Lymphocytes in Basal Cell Carcinoma Subtypes
Full text linkBackground: Basal cell carcinoma (BCC) is the most prevalent non-melanoma skin cancer, characterized by high recurrence rates. Immunotherapy, particularly targeting the Programmed Death-1 (PD-1)/Programmed Death-Ligand 1 (PD-L1) axis, offers a promising therapeutic avenue. The interplay between PD-L1 expression on tumor and immune cells and the nature of Tumor-Infiltrating Lymphocytes (TILs) is crucial for immune response, yet their relationship in BCC, especially across diverse histological subtypes, remains incompletely understood. This study aimed to investigate the correlation between PD-L1 expression and TILs density in various BCC subtypes, seeking to elucidate the complexities of their interaction within the tumor microenvironment.
Methods: This analytical observational study utilized a cross-sectional design, analyzing 20 archived paraffin-embedded BCC tissue samples from Dr. Saiful Anwar Regional General Hospital Malang. PD-L1 expression was assessed by immunohistochemistry using the 22c3 clone and evaluated via the Combined Positive Score (CPS). TILs were semi-quantitatively assessed as percentage infiltration and categorized into low, moderate, and high grades. Histological subtypes of BCC were documented. Spearman correlation was used to analyze the relationship between PD-L1 expression and TILs.
Results: Of the 20 BCC cases, 55% exhibited PD-L1 positivity (CPS ≥ 1). TILs infiltration was predominantly moderate (70%), with 25% high and 5% low. The cohort included nodular (40%), infiltrating (35%), and basosquamous (25%) as the main subtypes, with specific variants also analyzed. Basosquamous BCC consistently showed positive PD-L1 expression (100% of its cases positive), while nodular and infiltrating subtypes displayed varied PD-L1 expression. TILs distribution also varied across subtypes, with nodular BCC exhibiting the full range from low to high TILs. Overall, no significant correlation was observed between PD-L1 expression and TILs density (Spearman's r = -0.077, p = 0.747).
Conclusion: This study confirms PD-L1 expression and TILs presence in BCC but reveals no direct linear correlation between them across the cohort, even when considering broad subtypes. Basosquamous BCC consistently expressed PD-L1. The lack of overall correlation suggests a complex, potentially subtype-specific interplay within the BCC tumor microenvironment, warranting further investigation into functional TILs subsets and other immune modulators
The Nexus of Neuroinflammation and Psychopathology in Neuropsychiatric Systemic Lupus Erythematosus (NPSLE): A Meta-Analysis of Anti-NMDAR, Anti-Ribosomal P Antibodies, and Psychosomatic Manifestations (Depression, Anxiety, Cognitive Dysfunction)
Full text linkBackground: Neuropsychiatric systemic lupus erythematosus (NPSLE) significantly impacts patients through diverse neurological and psychiatric symptoms, including prevalent psychosomatic manifestations like depression, anxiety, and cognitive dysfunction. Specific autoantibodies, such as anti-N-methyl-D-aspartate receptor (anti-NMDAR) and anti-ribosomal P protein (anti-RP) antibodies, are implicated in its complex neuroinflammatory pathogenesis. This meta-analysis aimed to quantitatively assess the association between these autoantibodies and these key psychosomatic outcomes in NPSLE.
Methods: A systematic literature search of PubMed, EMBASE, Scopus, and PsycINFO (2014-2024) identified observational studies reporting on anti-NMDAR or anti-RP antibodies and depression, anxiety, or cognitive dysfunction in adult NPSLE patients. Data from six eligible studies (850 patients) were extracted and quality was assessed. Pooled odds ratios (ORs) or standardized mean differences (SMDs) were calculated using a random-effects model, with heterogeneity and publication bias evaluated.
Results: Anti-NMDAR antibody positivity was significantly associated with increased odds of cognitive dysfunction (OR = 2.85, 95% CI = 1.90-4.28). Anti-RP antibody positivity was significantly linked to increased odds of depression (OR = 3.20, 95% CI = 2.15-4.76) and anxiety (OR = 2.50, 95% CI = 1.65-3.78). Moderate heterogeneity was noted for some analyses.
Conclusion: This meta-analysis highlights distinct associations: anti-NMDAR antibodies with cognitive dysfunction, and anti-RP antibodies with depression and anxiety in NPSLE. These findings underscore the potential role of these autoantibodies in specific psychosomatic symptom clusters, guiding further research and clinical consideration in NPSLE management
The Pointed Challenge: Endoscopic Management of an Ingested Sharp Foreign Body and a Synthesis of Modern Techniques
Full text linkBackground: The ingestion of sharp-pointed foreign bodies constitutes a high-acuity medical emergency, distinguished from other ingested objects by its significant potential for severe complications, including visceral perforation and hemorrhage. While flexible endoscopy has emerged as the cornerstone of management, its successful application hinges on a systematic, protocol-driven approach. This manuscript presents a case of an ingested straight pin and uses it as the framework for a critical synthesis of modern diagnostic and therapeutic strategies.
Case presentation: A 40-year-old female presented to the emergency department, hemodynamically stable and completely asymptomatic, two hours after accidentally swallowing a straight pin. A benign abdominal examination belied the potential danger. Plain radiography confirmed a single, sharp metallic object in the gastric antrum. An urgent esophagogastroduodenoscopy under general anesthesia was performed. The pin was securely grasped with rat-tooth forceps and extracted without incident. The patient's recovery was uneventful, and she was discharged on the first postoperative day.
Conclusion: This case provides a high-fidelity validation of current international guidelines, demonstrating that a protocol-driven approach—encompassing rapid triage, definitive imaging, and urgent therapeutic endoscopy—is both safe and maximally effective for upper gastrointestinal sharp foreign bodies. The successful outcome underscores the critical importance of this management algorithm in preventing progression to life-threatening complications. This case-driven synthesis reinforces that adherence to a rigorous, evidence-based protocol is the most effective strategy to navigate this pointed clinical challenge and consistently achieve optimal patient outcomes