Bioscientia Medicina - Journal of Biomedicine and Translational Research
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The Efficacy of Phyllanthus niruri Linn in Modulating Inflammatory and Cancer Stem Cell Markers in Colorectal Cancer: A Stratified Systematic Review and Meta-Analysis
Get PDFBackground: The progression of colorectal cancer (CRC) is driven by a complex interplay between chronic inflammation and a resilient population of cancer stem cells (CSCs). Phyllanthus niruri Linn (PNL), a medicinal plant with established immunomodulatory effects, presents a promising adjuvant therapeutic strategy. This study aimed to move beyond qualitative summaries to quantitatively assess PNL's efficacy by synthesizing evidence on its modulation of key inflammatory and CSC biomarkers.
Methods: Following PRISMA guidelines, a systematic search of PubMed, ScienceDirect, Google Scholar, and Scopus (2015–2025) was conducted. Studies quantifying the effects of PNL on Interleukin-8 (IL-8), Cyclooxygenase-2 (COX-2), or CD133 in CRC models were included. Recognizing the profound biological differences between experimental systems, a stratified meta-analysis was performed. Data were pooled using a random-effects model, stratified by study type (in vitro vs. in vivo) and intervention (monotherapy vs. combination therapy). The Standardized Mean Difference (SMD) was the primary effect measure.
Results: Seven studies met the inclusion criteria. In a stratified analysis of in vivo models, PNL monotherapy significantly reduced COX-2 (SMD -2.11; 95% CI [-3.10, -1.12]) and IL-8 (SMD -1.95; 95% CI [-3.01, -0.89]). The effect on the CSC marker CD133 was most pronounced in vitro (SMD -2.98; 95% CI [-4.87, -1.09]), while still significant in in vivo models (SMD -2.15; 95% CI [-3.45, -0.85]). The analysis revealed that the biological context (in vitro vs. in vivo) is a significant determinant of the observed effect size.
Conclusion: This stratified meta-analysis provides robust, context-specific evidence of PNL's ability to suppress key inflammatory and CSC markers in CRC. The findings reveal that PNL's potent anti-CSC activity observed in vitro is translated into a significant, though attenuated, effect in vivo, highlighting the critical influence of the tumor microenvironment and pharmacokinetics. This work substantiates the dual-pronged therapeutic potential of PNL as a promising bioactive adjuvant in CRC therapy
Chylous Ascites in Pediatric Lymphangiomatosis: Definitive Localization and Surgical Guidance with 99mTc-Nanocolloid SPECT/CT
Get PDFBackground: Chylous ascites, the peritoneal accumulation of triglyceride-rich lymphatic fluid, is a rare and clinically formidable condition, especially in children. It signifies a severe disruption of the lymphatic system. Systemic lymphangiomatosis, a congenital lymphatic malformation, is an exceptionally rare underlying cause. The cornerstone of effective treatment for refractory cases is the precise localization of the lymphatic leakage, which remains a profound diagnostic challenge.
Case presentation: We present the case of a 13-year-old female with systemic lymphangiomatosis who developed persistent, high-volume chylous ascites, with outputs reaching 1200 cc/day, following the surgical excision of an abdominal mass. Despite aggressive conservative management, the debilitating leakage continued, precipitating severe metabolic and nutritional derangements. To identify the point of extravasation, the patient underwent lymphoscintigraphy with Technetium-99m (99mTc) nanocolloid and hybrid Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT). While planar imaging confirmed a leak in the right lower abdomen, SPECT/CT provided definitive, high-resolution anatomical localization, pinpointing the site to the pre-peritoneal tissue at the level of the right anterior superior iliac spine. This finding directly guided a successful, targeted surgical repair.
Conclusion: This case demonstrates the indispensable role of 99mTc-nanocolloid SPECT/CT in the management of complex, post-surgical chylous ascites. By transforming a two-dimensional area of suspicion into a three-dimensional, surgically-actionable target, this hybrid imaging modality provided the essential roadmap for a curative intervention where all other measures had failed. This report advocates for the integration of SPECT/CT as a standard of care in the diagnostic algorithm for refractory chylous leaks, representing a key technology that facilitates definitive treatment and fundamentally improves patient outcomes
Challenging the Paradigm: A Clinicopathological Case Series on the Discordance between Cutaneous Burn Severity and Airway Injury Following a Volcanic Pyroclastic Flow Exposure
Get PDFBackground: Inhalation injury accompanying severe burns is a major driver of morbidity and mortality. The pathophysiology of injury from volcanic eruptions—a unique combination of extreme heat, abrasive particulates, and corrosive gases—is distinct from typical combustion smoke and not well-characterized. Flexible bronchoscopy is the gold standard for diagnosing and grading airway injury, yet its application in this context, particularly in relation to external burn severity, is unclear.
Case presentation: We present a retrospective analysis of two climbers who were the sole survivors admitted to our tertiary center after exposure to the pyroclastic flow from the 2023 Mount Marapi eruption. A 19-year-old female with 40% Total Body Surface Area (TBSA) deep burns and a 20-year-old male with 30% TBSA deep burns both presented with signs concerning for inhalation injury. Despite the devastating extent of their cutaneous injuries, flexible bronchoscopy in both patients revealed only mild, Grade 1 endobronchial injury (mucosal erythema and edema) based on the Abbreviated Injury Score (AIS) classification. The first patient succumbed to septic shock from her burns, while the second patient showed significant respiratory improvement following therapeutic bronchial lavage and made a full recovery.
Conclusion: This case series presents hypothesis-generating evidence suggesting that in victims of open-air volcanic pyroclastic flows, the severity of cutaneous burns may be a poor predictor of the degree of underlying endobronchial damage. These findings underscore the potential necessity of a low threshold for early flexible bronchoscopy to accurately diagnose, stratify, and therapeutically intervene in this unique patient population, irrespective of TBSA
Gonococcal and Non-Gonococcal Urethritis in a Global Travel Hub: A Retrospective Analysis of Syndromic Management, Suboptimal Cefixime Monotherapy, and the Public Health Crisis of Patient Retention in Bali, Indonesia
Get PDFBackground: The inexorable rise of antimicrobial resistance (AMR) in Neisseria gonorrhoeae represents a formidable threat to global public health, jeopardizing the efficacy of last-line treatments for gonococcal urethritis (GO). Southeast Asia is a recognized epicenter for the emergence and dissemination of AMR, yet granular surveillance data from many high-risk localities remain critically sparse. This study aimed to provide a comprehensive characterization of the clinical epidemiology, frontline management practices, and patient outcomes of male urethritis at a tertiary referral center in Bali, Indonesia—a major international crossroads for tourism and migration.
Methods: A retrospective, cross-sectional analysis was conducted on the medical records of male patients diagnosed with urethritis at the Dermatology and Venereology Polyclinic of Ngoerah Hospital between January 1st, 2021, and December 31st, 2024. A rigorous screening process of 215 initial records was undertaken to identify eligible cases. Data on sociodemographics, behavioral risk factors, clinical presentation, syndromic diagnosis, prescribed pharmacotherapy, and follow-up adherence were systematically extracted and analyzed using descriptive and comparative statistics.
Results: From the initial cohort, 58 male patients met the final inclusion criteria. The cohort was predominantly diagnosed with GO (n=39, 67.2%) over non-gonococcal urethritis (NGO) (n=19, 32.8%). Patients were primarily of productive age (25–44 years, 58.6%) and reported high-risk behaviors, including multiple sexual partners (65.5%). A critical deviation from international treatment guidelines was identified: 97.4% (38/39) of GO patients received oral cefixime 400 mg monotherapy, a regimen no longer recommended for first-line use due to AMR concerns. Furthermore, a profound fracture in the care cascade was evident, with an overall loss-to-follow-up rate of 58.6% (34/58). This failure was most pronounced in the GO cohort, where 76.9% (30/39) of patients did not return for scheduled follow-up, a rate significantly higher than the 21.1% (4/19) observed in the NGO cohort (p<0.001).
Conclusion: The clinical management of gonorrhoea at this major Indonesian referral center is defined by two systemic failures: the routine prescription of a suboptimal antimicrobial monotherapy and a near-total collapse of patient follow-up. This combination, situated in a high-transience international hub, creates an unmonitored, high-risk environment for the selection, amplification, and global dissemination of antimicrobial-resistant N. gonorrhoeae. These findings signal an urgent imperative to align local therapeutic protocols with evidence-based global standards and to implement robust, innovative strategies to ensure patient retention and verify the cure
The Paradoxical Role of Interleukin-10 in Systemic Lupus Erythematosus: A Correlational Study of Serum Levels and Disease Activity
Get PDFBackground: Systemic lupus erythematosus (SLE) is a multifaceted autoimmune disease where the cytokine Interleukin-10 (IL-10) exhibits a paradoxical role, functioning as both a potent anti-inflammatory mediator and a robust B-cell stimulator. The clinical significance of serum IL-10 as a biomarker of disease activity is a subject of intense debate, with conflicting reports in the literature. This study was designed to investigate this relationship within a specific Southeast Asian cohort.
Methods: An observational, cross-sectional study was conducted at a tertiary referral hospital in Palembang, Indonesia, enrolling 48 adult patients with a confirmed diagnosis of SLE. Disease activity was quantitatively scored using the Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI). Serum IL-10 concentrations were precisely measured using a quantitative sandwich enzyme-linked immunosorbent assay (ELISA). The primary statistical analysis involved the Spearman rank correlation test. A post-hoc power analysis was performed to contextualize the statistical findings.
Results: The study population was predominantly female (95.8%), with the largest subgroup (54.2%) presenting with mild disease activity. The mean serum IL-10 concentration was 9.91±1.36 pg/mL in the mild activity group, rose to a peak of 12.22±1.95 pg/mL in the moderate activity group, and was 10.65±2.34 pg/mL in the severe activity group. The Spearman correlation test identified a weak, positive association that did not achieve statistical significance (r=0.274, p=0.059). The post-hoc power analysis confirmed the study was underpowered to definitively detect a correlation of this magnitude.
Conclusion: In this cohort of Indonesian SLE patients, a statistically significant correlation between serum IL-10 levels and disease activity was not established. Given the study's methodological context, including its cross-sectional design and limited statistical power, the findings are inconclusive but hypothesis-generating. The results reinforce the profound complexity of IL-10 biology in SLE and underscore the challenges in validating it as a standalone biomarker, highlighting the need for larger, longitudinal investigations
A Methodical Approach to a 15-Year Diagnostic Enigma: Unmasking Acrodermatitis Continua of Hallopeau Through Dermoscopy, Histopathology, and Structured Therapeutic Sequencing
Get PDFBackground: Acrodermatitis continua of Hallopeau (ACH) is a rare, debilitating variant of pustular psoriasis. Its profound clinical mimicry of common infections, particularly onychomycosis, often leads to extensive diagnostic delays and ineffective treatments, causing significant patient morbidity. This report details a case with a 15-year history of misdiagnosis, illustrating a structured methodological approach to diagnosis and management.
Case presentation: A 40-year-old Indonesian woman presented with a 15-year history of painful pustular lesions and severe onychodystrophy affecting seven digits, refractory to numerous antimicrobial therapies. The diagnostic process was systematically re-evaluated; dermoscopy revealed features inconsistent with onychomycosis (dotted vessels, hemorrhagic spots), prompting a definitive skin and nail matrix biopsy. Histopathology confirmed pustular psoriasis with pathognomonic Kogoj's spongiform pustules and Munro's microabscesses. Treatment was initiated with cyclosporine (3.3 mg/kg/day), leading to rapid remission. However, the development of gingival hyperplasia and hypertension necessitated a transition to weekly methotrexate (15 mg). The patient achieved and maintained clinical remission on this regimen.
Conclusion: This case underscores the necessity of a high index of suspicion for ACH in chronic, treatment-resistant nail dystrophy. It demonstrates that a methodical application of dermoscopy and histopathology is indispensable for overcoming clinical mimicry. The main lesson is that structured diagnostic evaluation and sequenced therapy, responsive to adverse events, are crucial for achieving long-term remission and restoring quality of life
A Rare Presentation of Type 2 Lepra Reaction: Necrotizing Erythema Nodosum Leprosum with Extensive Ulceration
Get PDFBackground: Leprosy, primarily caused by Mycobacterium leprae, is a chronic infectious disease that mainly affects the skin and peripheral nerves. Type 2 leprosy reaction (ENL) is an immune complex-mediated complication characterized by inflammation of the skin, nerves, and other organs. A less common manifestation of ENL is necrotizing ENL, which presents with extensive skin necrosis and ulceration. This case report describes a rare presentation of necrotizing ENL with extensive ulceration in a young woman with borderline lepromatous leprosy.
Case presentation: A 20-year-old female presented with multiple, progressively enlarging, painless ulcers on her right leg and painful reddish nodules on her left arm and left leg. She had a history of borderline lepromatous leprosy. Dermatological examination revealed madarosis, infiltration, nodules, hyperpigmentation macules, ulcers, and blackish crusts. Sensory testing showed hypoesthesia in the abdomen and back, and anesthesia in both lower arms and legs. Histopathological examination confirmed the diagnosis of necrotizing ENL.
Conclusion: Necrotizing ENL is a rare and severe complication of leprosy. This case highlights the importance of early diagnosis and appropriate management with multi-drug therapy and corticosteroids to prevent significant morbidity and disability
Propolis from Mount Lawu: Dose-Dependent Antioxidant and Anti-Inflammatory Effects in a Rat Model of Wound Healing
Get PDFBackground: Chronic wounds present a significant healthcare challenge, necessitating the exploration of effective adjuvant therapies. Propolis, a natural product derived from beehives, has demonstrated antioxidant and anti-inflammatory properties. This study investigated the dose-dependent effects of Mount Lawu propolis extract on oxidative stress and inflammation in a rat model of wound healing.
Methods: A completely randomized experimental design was employed using male rats (Rattus norvegicus). Granulation tissue wounds were induced, and the rats were treated with varying doses of ethanol extract of Mount Lawu propolis. Immunohistochemical analysis was performed to assess the expression of Malondialdehyde (MDA) and Interleukin-6 (IL-6) in the wound tissue.
Results: The results demonstrated a significant dose-dependent decrease in MDA and IL-6 expression in the propolis-treated groups compared to the control group. The high-dose propolis group exhibited the most substantial reduction in both MDA and IL-6 levels.
Conclusion: Mount Lawu propolis extract exhibits potent antioxidant and anti-inflammatory effects in a dose-dependent manner, suggesting its potential as an adjuvant therapy for chronic wound management
Clinical Spectrum of Orbital Cellulitis: Case Series From Subperiosteal Abscess to Life-Threatening Cavernous Sinus Thrombosis
Get PDFBackground: Orbital cellulitis encompasses a range of orbital infections with varying severity. This case series highlights the diverse clinical presentations, management strategies, and outcomes of orbital cellulitis, emphasizing the importance of prompt diagnosis and treatment.
Case presentation: We present two cases of orbital cellulitis with contrasting presentations. The first case involved a 16-year-old male with acute rhinosinusitis who developed severe orbital cellulitis complicated by cavernous sinus thrombosis (CST), requiring aggressive medical and surgical interventions. The second case involved a 2-month-old female with a subperiosteal abscess secondary to ethmoid and maxillary sinusitis, who responded well to medical management alone.
Conclusion: Orbital cellulitis presents a wide spectrum of clinical scenarios, ranging from localized infections to life-threatening intracranial involvement. Early recognition, appropriate imaging, and timely intervention are crucial for optimizing outcomes. While CST necessitates aggressive measures, subperiosteal abscesses can often be managed medically, particularly in young children
Clinical and Demographic Profile of Chronic Kidney Disease Patients Undergoing Kidney Transplantation at a Tertiary Hospital in Indonesia
Get PDFBackground: Chronic kidney disease (CKD) is a global health problem, and kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). This study aimed to describe the clinical and demographic profile of CKD patients undergoing kidney transplantation at Dr. M. Djamil General Hospital, Padang, Indonesia.
Methods: A descriptive retrospective study was conducted using medical records of CKD patients who underwent kidney transplantation between 2015 and 2023. Data on age, gender, duration of hemodialysis, donor-recipient relationship, blood pressure, blood type, crossmatch results, serum urea and creatinine levels, and etiology of CKD were collected and analyzed.
Results: The study included 18 patients, all aged 19 to 59 years. The majority of patients were male (55.6%) and had undergone hemodialysis for less than 3 years (55.6%). Prehypertension and hypertension were the most prevalent blood pressure categories (44.4% each). Blood types A and O were most common (27.8% each), with consistent crossmatch results across groups. High levels of serum urea and creatinine were predominant, and hypertension was the most frequent etiology of CKD (66.7%).
Conclusion: This study provides valuable insights into the characteristics of CKD patients undergoing kidney transplantation in Indonesia. The findings highlight the importance of early detection and management of CKD, particularly hypertension, to reduce the burden of ESRD and the need for transplantation