Bioscientia Medicina - Journal of Biomedicine and Translational Research
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From Tradition to Translation: A Systematic Review on the Pharmacological Actions of Eugenol Extracted from Ocimum Plants in Oxidative Stress, Inflammation, and Diabetes Mellitus
Get PDFBackground: Ocimum species, commonly known as basil, have a rich history in traditional medicine for various ailments. Eugenol, a primary bioactive compound found in several Ocimum species, has garnered significant scientific attention for its potential therapeutic properties. This systematic review aimed to comprehensively evaluate the pharmacological actions of eugenol extracted from Ocimum plants in the context of oxidative stress, inflammation, and diabetes mellitus.
Methods: A systematic literature search was conducted across major scientific databases for studies published between 2013 and 2024 that investigated the effects of eugenol derived from Ocimum plants on oxidative stress, inflammation, and diabetes mellitus. The search strategy included keywords such as "eugenol," "Ocimum," "antioxidant," "anti-inflammatory," and "antidiabetic." Inclusion criteria for studies involving in vitro, in vivo, and clinical studies that specifically examined the pharmacological actions of eugenol extracted from Ocimum species in the aforementioned conditions. Data on study design, intervention, outcomes, and key findings were extracted and synthesized narratively.
Results: The review identified ten key studies that met the inclusion criteria. These studies collectively suggested that eugenol extracted from Ocimum plants exhibited significant antioxidant activity by scavenging free radicals and enhancing endogenous antioxidant enzymes. Furthermore, eugenol demonstrated anti-inflammatory effects by modulating pro-inflammatory cytokines and inhibiting key inflammatory pathways such as NF-κB and COX. In the context of diabetes mellitus, studies indicated that eugenol could improve glucose metabolism by enhancing insulin sensitivity, protecting pancreatic beta cells, and inhibiting carbohydrate metabolizing enzymes.
Conclusion: This systematic review provided a comprehensive overview of the pharmacological actions of eugenol extracted from Ocimum plants in mitigating oxidative stress, inflammation, and diabetes mellitus. The findings from the included studies supported the traditional uses of Ocimum species and highlighted the therapeutic potential of eugenol as a natural agent in managing these conditions. Further well-designed clinical trials are warranted to validate these preclinical findings and translate them into clinical applications
Ocular Involvement as the Primary Presentation of Suspected Systemic Lupus Erythematosus: A Case of Bilateral Papilledema and Macular Edema
Get PDFBackground: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease known for its varied clinical presentations, often affecting multiple organ systems. Ocular involvement is common in SLE, but posterior segment manifestations like papilledema are rare, occurring in only about 1% of SLE patients. This case report details a unique instance of bilateral papilledema and macular edema as the primary presentation of suspected SLE in a young female patient.
Case presentation: A 24-year-old female presented with a one-week history of sudden-onset blurry vision in both eyes. Ophthalmological examination revealed reduced visual acuity (6/45 in both eyes), bilateral optic disc swelling, and macular edema. Further investigations, including Optical Coherence Tomography (OCT) and Magnetic Resonance Imaging (MRI), confirmed macular edema and optic nerve sheath distention. A positive Antinuclear Antibody (ANA) test suggested an autoimmune etiology. Lumbar puncture results were normal, ruling out idiopathic intracranial hypertension. The patient was diagnosed with bilateral papilledema and macular edema, with suspected underlying SLE. Prompt treatment with high-dose corticosteroids and acetazolamide led to significant clinical improvement.
Conclusion: This case highlights the rarity of bilateral papilledema and macular edema as initial presenting features of suspected SLE. It emphasizes the importance of thorough ophthalmological examination and relevant investigations in patients with sudden vision loss. Early recognition of such rare presentations is crucial to prevent potentially sight-threatening complications. This case underscores the need for a multidisciplinary approach for accurate diagnosis and management of complex presentations of systemic autoimmune diseases
Novel Application of a Modified Small T-Plate as an Internal Joint Stabilizer for Chronic Elbow Instability: Technique and Two-Year Results
Get PDFBackground: Chronic elbow instability, particularly following neglected or recurrent dislocations, presents a significant treatment challenge. Restoring stability while preserving functional motion is difficult, especially when standard internal joint stabilizers (IJS) are unavailable. We explored the use of a readily available small T-plate, modified intraoperatively, as a temporary internal hinge stabilizer.
Case presentation: A 33-year-old male presented with chronic left elbow instability and functional impairment persisting for 14 years after an initial injury. Previous treatments, including traditional bone setting and K-wire fixation, had failed, resulting in recurrent dislocations. Surgical exploration revealed significant fibrosis and compromised ligamentous structures. Open reduction was performed, followed by stabilization using a modified small T-plate contoured to act as an internal hinge, maintaining the ulnohumeral joint space. The implant was removed after 4 weeks. At the 24-month follow-up, the patient exhibited excellent functional outcomes, with a stable elbow, substantial improvement in range of motion (Flexion-extension: 4.2°-129.2°; Pronation-supination: 80°), and an excellent Broberg-Morrey score, enabling pain-free daily activities.
Conclusion: This case demonstrated that a modified small T-plate can serve as an effective, low-cost internal hinge joint stabilizer for managing complex chronic elbow instability, particularly in resource-limited settings. It facilitated early controlled motion, promoted stable fibrous tissue healing, and resulted in excellent long-term functional outcomes. This technique presents a viable alternative when standard IJS devices are not accessible
Beyond the Scar: A Case Report on the Clinical Presentation, Diagnostic Nuances, and Surgical Management of Type I Cesarean Scar Pregnancy
Get PDFBackground: Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy where the gestational sac implants within the fibrous tissue of a previous cesarean section scar. Its incidence is rising in parallel with increasing cesarean delivery rates, posing significant risks of maternal morbidity, including uterine rupture and severe hemorrhage. Type I CSP, or endogenic CSP, involves implantation on a healed scar with growth primarily towards the uterine cavity. Early and accurate diagnosis, relying heavily on ultrasonographic nuances, is crucial for appropriate management and fertility preservation.
Case presentation: We present the case of a 36-year-old woman, G7P3033, with a history of two prior cesarean sections, who presented at 6-7 weeks of gestation with vaginal discharge. Transabdominal ultrasonography revealed a gestational sac implanted on the anterior uterine wall within the cesarean scar area, with a thin myometrium between the sac and the bladder, consistent with a Type I (endogenic, COS-1, Grade II) Cesarean Scar Pregnancy. The patient also had Stage II hypertension. After thorough evaluation and counseling, the patient underwent a laparotomy with wedge resection of the CSP and scar revision, along with bilateral fimbriectomy as per her request for sterilization.
Conclusion: This case highlights the importance of high clinical suspicion for CSP in pregnant women with previous cesarean sections presenting with early pregnancy symptoms. Detailed ultrasonography is paramount for accurate diagnosis, classification, and guiding management. Surgical management, specifically laparotomy with wedge resection and scar repair, proved to be an effective treatment for this Type I CSP, allowing for removal of the ectopic pregnancy and reinforcement of the uterine wall, while addressing the patient's desire for permanent contraception. Timely intervention is key to preventing life-threatening complications and preserving future reproductive options if desired
Management Strategies and Outcomes for Bilateral Pulmonary Hydatid Cysts: A Systematic Review and Meta-Analysis
Get PDFBackground: Bilateral pulmonary hydatid disease presents a complex therapeutic challenge, necessitating careful consideration of surgical timing, approach, and adjuvant medical therapy to optimize patient outcomes while minimizing morbidity. This systematic review and meta-analysis aimed to evaluate the different management strategies and their associated outcomes in patients with bilateral pulmonary hydatid cysts.
Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science databases was conducted for studies published between January 2014 and December 2024, reporting on management strategies (one-stage bilateral surgery, two-stage bilateral surgery, medical therapy) and outcomes (postoperative complications, recurrence, mortality, length of hospital stay) in patients with bilateral pulmonary hydatid cysts. Studies were selected based on predefined inclusion and exclusion criteria. Data were extracted by two independent reviewers, and quality assessment was performed using a modified Newcastle-Ottawa Scale. Pooled proportions for outcomes were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic.
Results: Seven studies, encompassing a total of 305 patients with bilateral pulmonary hydatid cysts, met the inclusion criteria. The studies varied in design, including retrospective cohorts and prospective case series. Management predominantly involved surgical intervention, with 148 patients (48.5%) undergoing one-stage bilateral surgery and 127 patients (41.6%) undergoing two-stage procedures. Perioperative albendazole was administered to 245 patients (80.3%). The pooled overall postoperative complication rate was 28.7% (95% CI: 21.5%-36.8%; I2=78%). Major complications occurred in 12.1% (95% CI: 8.0%-17.9%; I2=65%). The pooled recurrence rate at a mean follow-up of 38.5 months was 8.5% (95% CI: 5.1%-13.8%; I2=55%). Overall mortality was 2.1% (95% CI: 0.9%-4.5%; I2=0%). Patients undergoing one-stage surgery exhibited a trend towards higher overall complication rates (33.1% vs. 25.2% for two-stage) but shorter total hospital stays. Adjuvant albendazole therapy was associated with a trend towards lower recurrence rates.
Conclusion: Surgical management, whether one-stage or two-stage, remains the cornerstone of treatment for bilateral pulmonary hydatid disease, achieving acceptable morbidity and mortality with good long-term control in most patients. Postoperative complications are relatively common, highlighting the complexity of these cases. While one-stage surgery may shorten overall hospital stay, it might be associated with a higher risk of immediate complications. Adjuvant albendazole appears beneficial in reducing recurrence. The choice of surgical strategy should be individualized based on patient status, cyst characteristics, and surgical expertise. Further prospective, comparative studies are needed to delineate optimal management pathways
Balancing Efficacy and Tolerability: A Prospective Cohort Study of Oral and Intravenous Methylprednisolone for Active Graves' Ophthalmopathy in an Indonesian Tertiary Care Center
Get PDFBackground: In managing active, moderate-to-severe Graves' Ophthalmopathy (GO), a notable gap often exists between treatment efficacy in controlled trials and effectiveness in real-world practice. High-dose corticosteroids are standard, but the choice between intravenous (IV) and oral routes involves a complex trade-off between efficacy, tolerability, and practicality, particularly in diverse populations.
Methods: This single-center, pragmatic, prospective cohort study was conducted at a tertiary hospital in Indonesia from March 2023 to March 2024. Thirty-six GO patients were treated with either IV pulse or daily oral methylprednisolone based on a shared clinical decision-making process. The primary outcome was the change in proptosis. To address the non-randomized design and control for selection bias, a propensity score-adjusted Analysis of Covariance (ANCOVA) was used to compare treatment effectiveness.
Results: Baseline analysis revealed that patients selected for IV therapy had significantly more severe proptosis. Both unadjusted and adjusted analyses showed that each regimen resulted in a significant reduction in proptosis from baseline (p < 0.01). In the primary, propensity score-adjusted analysis, no statistically significant difference was detected in the degree of proptosis reduction between the IV and oral groups. However, the tolerability profiles were profoundly different; patients in the oral group experienced a significantly higher incidence of adverse events, including dyspepsia (66.7%) and Cushingoid features (55.6%), compared to a single case of transient hypokalemia in the IV group.
Conclusion: In this real-world setting, after statistically controlling for baseline severity, both IV and oral methylprednisolone demonstrated comparable effectiveness in reducing proptosis. However, the intravenous route was associated with a vastly superior safety profile. These findings underscore the critical importance of tolerability in clinical decision-making and support the continued recommendation of IV pulse therapy as the first-line treatment
Vitamin D in the Breast Cancer Continuum: A Systematic Review and Meta-Analysis of Primary Prevention, Patient Prognosis, and Adjunctive Treatment Response
Get PDFBackground: The role of vitamin D across the breast cancer spectrum remains complex and contested. Compelling preclinical antineoplastic mechanisms contrast with inconsistent clinical findings. Large randomized controlled trials (RCTs) show null effects for primary prevention, while observational studies often link higher vitamin D status at diagnosis with better prognosis. Key conflicts include this prevention-prognosis disconnect, debates over linear versus J-shaped prognostic dose-responses, and a "receptor-status paradox" where estrogen receptor-positive (ER-positive) disease shows prognostic links, but hormone receptor-negative (HR-negative)/triple-negative (TNBC) subtypes derive greater benefit (improved pathological complete response, pCR) from vitamin D intervention during neoadjuvant chemotherapy (NACT). This study systematically synthesizes evidence across these distinct clinical contexts.
Methods: Following PRISMA guidelines, we systematically reviewed PubMed, EMBASE, and CENTRAL (January 1st, 2014–September 2nd, 2025) for high-impact RCTs and large prospective cohort studies evaluating vitamin D supplementation or serum 25-hydroxyvitamin D (25(OH)D) levels regarding breast cancer incidence, prognosis (survival/recurrence), or pCR after NACT. Quality was assessed (Cochrane RoB 2; Newcastle-Ottawa Scale). Data were extracted dually. Findings were synthesized stratigraphically (prevention, prognosis, treatment). A random-effects meta-analysis pooled pCR data from NACT RCTs.
Results: Six high-quality studies (3 RCTs, 3 cohorts; N=31,026) were included. (1) Prevention: The VITAL RCT (N=25,871; mean baseline 25(OH)D 30.8 ng/mL) found no reduction in incident invasive breast cancer with 2000 IU/day vitamin D3 (HR 1.02, 95% CI 0.79–1.31). (2) Prognosis: Cohort studies (N=4,835) showed higher 25(OH)D linked to better OS (Adj HR T3 vs T1: 0.72). Complexity emerged: one study linked benefit specifically to ER-positive recurrence (Adj HR 0.87), while another reported a J-shaped curve for EFS, with worse outcomes at both low (≤52 nmol/L; Adj HR 1.63) and high (≥99 nmol/L; Adj HR 1.37) levels versus intermediate. (3) Treatment: Meta-analysis of two NACT RCTs (N=310) showed vitamin D supplementation significantly increased pCR rates (38.1% vs 22.6%; Pooled RR 1.69, 95% CI 1.21–2.36; P=0.002; I²=0%). Subgroup data strongly suggested greater benefit in HR-negative/TNBC and baseline-deficient patients.
Conclusion: Vitamin D supplementation appears ineffective for primary breast cancer prevention in replete populations. Its prognostic role is complex, suggesting an optimal 25(OH)D range (potentially ~30-40 ng/mL) and possible ER-specific hormonal modulation effects, though causality from observational data remains uncertain. Critically, vitamin D intervention during NACT significantly improves pCR, particularly in HR-negative/TNBC, likely via distinct chemosensitization/immunomodulatory mechanisms. This synthesis provides a framework for understanding these context-dependent roles, supporting vitamin D assessment and potentially adjunctive NACT supplementation, especially in deficient patients with aggressive subtypes, pending necessary validation in larger trials
Modulation of TGF-β/Smad and Nrf2 Signaling Pathways by Thymoquinone in the Attenuation of Renal Fibrosis: A Systematic Review and Meta-Analysis of Pre-clinical Models
Get PDFBackground: Renal fibrosis is the irreversible, final common pathway for all progressive forms of chronic kidney disease (CKD), leading to end-stage renal disease. Its pathogenesis is characterized by the over-activation of pro-fibrotic signaling, chiefly the Transforming Growth Factor-beta (TGF-β)/Smad pathway, and the failure of endogenous cytoprotective mechanisms like the nuclear factor erythroid 2-related factor 2 (Nrf2) antioxidant response. Thymoquinone (TQ), the primary bioactive constituent of Nigella sativa, is a pleiotropic compound with known anti-inflammatory and antioxidant properties. This study was designed to systematically quantify its mechanistic efficacy in modulating the core Nrf2 and TGF-β pathways in established pre-clinical models of renal fibrosis and injury.
Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. We performed a comprehensive search of major databases (including PubMed and Scopus) for pre-clinical in vivo studies published between 2014 and 2025 that investigated TQ monotherapy or TQ-dominant combination therapy in rodent models of renal injury. The eight studies that met the inclusion criteria utilized diverse models: Unilateral Ureteral Obstruction (UUO), cisplatin-induced nephrotoxicity, gentamicin-induced nephrotoxicity, 5-fluorouracil (5-FU)-induced acute kidney injury (AKI), lipopolysaccharide (LPS)-induced inflammation, carfilzomib (CFZ)-induced renal impairment, and ischemia-reperfusion (IRI). Primary outcomes were the expression of renal Nrf2 and TGF-β1. Secondary outcomes included markers of fibrosis (collagen deposition, histology scores), renal function (BUN, creatinine), oxidative stress (MDA, SOD, GSH, CAT), and inflammation (TNF-α, NF-κB, IL-6, IL-1β). Data were pooled using a random-effects model, and primary analyses were stratified by injury model subgroup.
Results: Thymoquinone treatment resulted in a profound and significant upregulation of the protective Nrf2 pathway (SMD: 2.38; 95% CI [1.05, 3.71]; p < 0.001; 3 studies) and its downstream target Heme Oxygenase-1 (HO-1). Concurrently, TQ treatment markedly suppressed the primary pro-fibrotic driver, TGF-β1 (SMD: -2.09; 95% CI [-2.99, -1.19]; p < 0.001; 2 studies). This pivotal dual modulation translated into significant functional and structural improvements. TQ robustly attenuated renal fibrosis scores (SMD: -1.89; 95% CI [-2.55, -1.23]; p < 0.001; 2 studies). Stratified subgroup analysis showed TQ significantly improved renal function in both chemotoxic AKI models (BUN SMD: -2.31; 95% CI [-3.22, -1.40]) and chronic obstructive/fibrosis models (BUN SMD: -1.17; 95% CI [-1.75, -0.59]). This functional protection was underpinned by potent, broad-spectrum reversal of oxidative stress and inflammation across all subgroups.
Conclusion: Thymoquinone consistently ameliorates renal injury and fibrosis across a wide spectrum of pre-clinical models. Its mechanism of action is multifaceted, critically involving the dual modulation of opposing pro-fibrotic and protective pathways: it suppresses the TGF-β1 cascade while simultaneously activating and restoring the Nrf2 antioxidant response. This body of evidence strongly supports Thymoquinone as a high-potential candidate for translational research and development as a novel, network-targeting therapy for human renal fibrosis
Masquerading as an Orbital Malignancy: A Rare Presentation of Pott’s Puffy Tumor with Intraorbital Extension in a Diabetic Adult
Get PDFBackground: Pott’s puffy tumor (PPT) is a rare, life-threatening clinical entity characterized by frontal bone osteomyelitis and subperiosteal abscess, typically resulting from untreated frontal sinusitis. While predominantly a pediatric diagnosis, adult presentation is exceptionally rare and often associated with immunocompromised states. The clinical mimicry of PPT, particularly when presenting with bone destruction and orbital extension, frequently leads to misdiagnosis as a malignant neoplasm. This study aims to report a rare and instructive case of Pott’s puffy tumor in a 52-year-old diabetic female.
Case presentation: We report a case of a 52-year-old female with uncontrolled Type 2 Diabetes Mellitus presenting with progressive left ocular proptosis, globe displacement, and blurred vision persisting for two months. Imaging revealed a heterogeneous mass in the frontoethmoidal sinus with extensive osteolytic destruction of the orbital roof and frontal bone, initially raising strong suspicion of a sinonasal malignancy or metastasis. The patient underwent a bicoronal craniectomy and debridement. Intraoperative findings revealed a purulent subperiosteal collection and necrotic bone, confirming the diagnosis of PPT with intraorbital extension. The defect was repaired via craniofacial reconstruction using bone cement. Post-operative culture analysis confirmed a polymicrobial infection.
Conclusion: This case underscores the necessity of maintaining a high index of suspicion for PPT in diabetic adults presenting with proptosis and osteolytic radiographic findings. Although rare, PPT can masquerade as a malignancy. Early recognition and a multidisciplinary approach combining aggressive surgical debridement with targeted antibiotic therapy are imperative to prevent catastrophic intracranial and orbital complications
Longitudinal Observational Analysis of Traumatic Brain Injury Epidemiology and Pre-Hospital Intervals During the COVID-19 Pandemic in a West Java Tertiary Center
Get PDFBackground: The COVID-19 pandemic necessitated large-scale social restrictions (PSBB) in Indonesia, drastically altering population mobility and, consequently, the landscape of neurotrauma. While the reduction in road traffic Incidents (RTIs) during lockdowns is well-documented, the collateral impact on the golden hour—the critical pre-hospital interval for traumatic brain injury (TBI) resuscitation—remains under-researched in lower-middle income countries (LMICs). This study analyzes the longitudinal shifts in TBI epidemiology, injury mechanisms, and hospital admission intervals across pre-pandemic, pandemic, and relaxation phases.
Methods: This retrospective observational study analyzed 1,519 TBI patients admitted to the Emergency Department of Dr. Hasan Sadikin General Hospital (RSHS), a tertiary referral center in West Java, from January 2019 to December 2021. The cohort was stratified into three phases: Pre-Pandemic (2019), Pandemic/PSBB (2020), and Relaxation (2021). Variables included demographics, injury mechanisms, Glasgow Coma Scale (GCS), loss of consciousness (LOC), and Hospital Admission Interval (MRS).
Results: Total TBI admissions exhibited a sharp V-shaped trend, decreasing by 75% in 2020 compared to 2019, driven by a collapse in RTI volume (490 to 107 cases). Admissions rebounded in 2021 (n=705). Males (78.4%) and young adults (15-24 years) constituted the majority, with RTI accounting for 74.78% of all mechanisms. While pediatric (0-4 years) and geriatric (≥65 years) groups were prone to falls, the most critical finding concerned pre-hospital delays. Despite reduced traffic density, only 3.23% of patients arrived within the golden hour (<1 hour). The majority (40.42%) arrived between 5-12 hours, and a significant cohort (17.44%) experienced delays exceeding 12 hours, indicating persistent systemic barriers to rapid care regardless of road conditions.
Conclusion: The pandemic successfully suppressed TBI volume through mobility restrictions but failed to improve pre-hospital admission times. The persistence of significant delays (>5 hours) for the vast majority of patients highlights that the barriers to the golden hour in Indonesia are structural rather than traffic-dependent. Future trauma systems must address these pre-hospital inefficiencies to improve outcomes