Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Primary Furlow Palatoplasty for Delayed Repair of Veau Type I Cleft Palate in an Adolescent: Surgical Challenges and Bio-functional Outcomes
Get PDFBackground: Cleft palate is a pervasive congenital craniofacial anomaly characterized by the failure of palatal shelf fusion, resulting in a persistent communication between the oral and nasal cavities. While developed healthcare systems mandate repair between 9 and 12 months, delayed presentation in adolescence remains a distinct clinical entity in developing regions. These cases are surgically complex due to maxillary skeletal maturity, tissue fibrosis, and wider cleft gaps compared to infant cases. The primary surgical objective is to seal the defect and restore the velopharyngeal sphincter to prevent hypernasality. This study evaluates the efficacy and physiological advantages of the Furlow double opposing Z-plasty technique in a high-risk delayed primary repair scenario.
Case presentation: We report the management of a 14-year-old male presenting with an uncorrected non-syndromic incomplete cleft palate. Preoperative assessment revealed severe hypernasality and audible nasal air emission. Clinical examination confirmed a Veau Type I defect confined to the soft palate with a bifid uvula. Primary palatoplasty was executed using the Furlow technique. The procedure successfully recruited lateral tissue for palatal lengthening and achieved transverse muscle reorientation without the need for lateral relaxing incisions.
Conclusion: The intervention resulted in complete anatomical closure with no evidence of wound dehiscence, hemorrhage, or oronasal fistula formation. The Furlow technique proved to be a feasible and safe modality for Veau Type I defects in adolescents, effectively addressing the vertical pharyngeal gap and restoring the sphincter mechanism's anatomy
Stratifying Neurological Severity in Acute Ischemic Stroke: The Independent and Combined Prognostic Value of Admission D-Dimer and High-Sensitivity C-Reactive Protein
Get PDFBackground: Early risk stratification in acute ischemic stroke (AIS) is critical for optimizing patient management. The roles of inflammation and thrombosis in stroke pathophysiology suggest that high-sensitivity C-reactive protein (hs-CRP) and D-Dimer may serve as valuable prognostic biomarkers. This study aimed to evaluate the independent and combined value of admission D-Dimer and hs-CRP levels for predicting neurological severity in AIS patients.
Methods: We conducted a prospective, cross-sectional study at Haji Adam Malik General Hospital, Medan, Indonesia, involving 60 consecutive AIS patients. Neurological severity was assessed upon admission using the National Institutes of Health Stroke Scale (NIHSS), with patients categorized into moderate (NIHSS 5-18) and severe (NIHSS >18) groups. Plasma D-Dimer and serum hs-CRP levels were quantified. Statistical analyses included the Mann-Whitney U test, Spearman's correlation, Receiver Operating Characteristic (ROC) curve analysis, and multivariate logistic regression to determine the independent predictive value of the biomarkers.
Results: Of the 60 patients, 31 (51.7%) were classified as having severe stroke. Both D-Dimer and hs-CRP levels were significantly higher in the severe group compared to the moderate group (D-Dimer: median 3220 ng/mL vs. 670 ng/mL, P<0.001; hs-CRP: median 5.6 mg/dL vs. 0.9 mg/dL, P<0.001). ROC analysis demonstrated strong predictive performance for severe stroke, with an Area Under the Curve (AUC) of 0.89 (95% CI: 0.81-0.97) for D-Dimer and 0.83 (95% CI: 0.72-0.94) for hs-CRP. A combined model incorporating both biomarkers yielded a superior AUC of 0.92 (95% CI: 0.85-0.99). In multivariate logistic regression, both elevated D-Dimer (Odds Ratio [OR]: 6.8, 95% CI: 2.1-22.5, P=0.001) and hs-CRP (OR: 4.5, 95% CI: 1.5-13.8, P=0.008) remained independent predictors of severe stroke after adjusting for age and gender.
Conclusion: Admission levels of D-Dimer and hs-CRP are powerful, independent prognostic markers for neurological severity in patients with acute ischemic stroke. Their use, particularly in combination, could enhance early risk stratification and guide clinical decision-making
Histamine-2 Receptor Antagonist for Gastric Bleeding Prophylaxis in Low-Risk Critically Ill Children: A Randomized Trial of Ranitidine
Get PDFBackground: The utility of stress ulcer prophylaxis (SUP) in critically ill children is a subject of ongoing debate, particularly in patients who do not present with classic high-risk features for stress-related mucosal disease (SRMD). This study aimed to evaluate the efficacy of ranitidine for preventing gastric bleeding in a heterogeneous cohort of critically ill children.
Methods: A single-center, prospective, open-label, randomized controlled trial was conducted in a tertiary Pediatric Intensive Care Unit (PICU) in Indonesia. Children aged 1 month to 18 years admitted to the PICU were randomized to receive either intravenous ranitidine (1 mg/kg/dose twice daily) or standard care without prophylaxis for five days. The primary outcome was the incidence of overt gastric bleeding. Post-hoc power analysis and multivariable logistic regression were performed to contextualize the findings.
Results: From 243 patients screened, 60 were randomized (30 per group). The cohort was predominantly composed of infants (60.0%) with respiratory distress. Overt gastric bleeding occurred in 1 of 30 patients (3.3%) in the ranitidine group versus 3 of 30 patients (10.0%) in the control group. This difference was not statistically significant (Relative Risk [RR] 0.33; 95% CI 0.04–3.11; p=0.612). After adjusting for a baseline imbalance in age, the odds of bleeding remained non-significantly lower in the ranitidine group (Adjusted Odds Ratio [aOR] 0.29; 95% CI 0.03–3.20). The study was found to be severely underpowered (16% power), and none of the bleeding events were clinically significant.
Conclusion: In this small, underpowered trial of predominantly low-risk critically ill children, ranitidine did not significantly reduce the incidence of overt gastric bleeding. These findings, while limited by significant methodological weaknesses, do not support the routine use of SUP in similar pediatric populations and underscore the critical need for larger, more definitive trials to inform evidence-based risk-stratification strategies
Diagnostic Performance of Imaging Modalities in Persistent or Recurrent Hyperparathyroidism: A Network Meta-Analysis of 18F-Fluorocholine PET/CT, 4D-CT, and Scintigraphy
Get PDFBackground: The surgical management of persistent or recurrent primary hyperparathyroidism (PHPT) is critically dependent on accurate preoperative localization of ectopic or residual hyperfunctioning glands within a scarred anatomical field. While 18F-Fluorocholine Positron Emission Tomography/Computed Tomography (18F-FCH PET/CT), four-dimensional computed tomography (4D-CT), and 99mTc-Sestamibi scintigraphy are employed, a definitive evidence-based hierarchy to guide their use is absent. This study aimed to establish this hierarchy by comparing their diagnostic performance through a network meta-analysis.
Methods: A systematic search of PubMed, Embase, and Scopus was conducted for comparative studies published between January 2015 and August 2025 evaluating these modalities in persistent/recurrent PHPT. A Bayesian bivariate network meta-analysis was performed to calculate pooled sensitivities and specificities on both a per-patient and per-lesion basis. Modalities were ranked using Surface Under the Cumulative Ranking (SUCRA) scores. Methodological quality, inconsistency, and heterogeneity were formally assessed.
Results: Seven studies involving 687 patients were included. On a per-patient analysis, 18F-FCH PET/CT demonstrated the highest sensitivity at 94.1% (95% Credible Interval [CrI]: 89.8%–97.5%), significantly outperforming 4D-CT (82.5%; 95% CrI: 75.1%–88.9%) and scintigraphy with SPECT/CT (60.3%; 95% CrI: 51.2%–69.1%). Specificities were uniformly high. Per-lesion analysis confirmed this hierarchy. SUCRA rankings identified 18F-FCH PET/CT as the superior modality for both per-patient (98.7%) and per-lesion (99.1%) detection. No significant network inconsistency was detected.
Conclusion: 18F-FCH PET/CT exhibits superior diagnostic accuracy for localizing culprit parathyroid glands in persistent or recurrent PHPT. Its performance, grounded in robust metabolic targeting that overcomes the challenges of a reoperative field, supports its positioning as the primary imaging modality in this setting. These findings advocate for a revision of current diagnostic algorithms to enhance surgical planning and improve patient outcomes
Destructive Thyroiditis: A Rare and Perplexing Complication of Lithium Therapy in Bipolar Disorder
Get PDFBackground: Lithium is a cornerstone therapy for Bipolar I Disorder, yet its use necessitates vigilant monitoring for adverse drug reactions (ADRs). While lithium-induced hypothyroidism is a well-documented complication, the emergence of thyrotoxicosis secondary to destructive thyroiditis is a rare and diagnostically challenging event. This report presents a systematic analysis of a case of suspected lithium-induced thyroiditis notable for its paradoxical clinical presentation as a severe depressive episode.
Case presentation: A 33-year-old female with a 10-year history of Bipolar I Disorder, stable on lithium for two years, was admitted with a severe depressive episode and active suicidal ideation. The onset of her psychiatric decompensation was temporally correlated with a diagnosis of thyrotoxicosis (suppressed TSH <0.005 uIU/mL; elevated FT4 >7.77 ng/dL). A formal causality assessment using the Naranjo Adverse Drug Reaction Probability Scale yielded a score of 6, indicating a "probable" relationship between lithium and the thyroiditis. Critically, the thyrotoxic state, which conventionally mimics mania, presented atypically as severe depression.
Conclusion: This case of probable lithium-induced destructive thyroiditis, presenting paradoxically with severe depression, underscores the critical need for a high index of suspicion for iatrogenic endocrinopathies in patients on lithium who exhibit any mood destabilization. A systematic approach to ADR assessment is essential to guide appropriate clinical management in such complex presentations
FOLFOX vs. FOLFIRI in Colorectal Adenocarcinoma: A Retrospective Study of Treatment Patterns, Side Effects, and Treatment Response
Get PDFBackground: Colorectal adenocarcinoma (CRC) is a prevalent malignancy with a high recurrence rate, necessitating multimodal treatment strategies. Chemotherapy regimens like FOLFOX (folinic acid, fluorouracil, oxaliplatin) and FOLFIRI (folinic acid, fluorouracil, irinotecan) are crucial components of this approach. This study aimed to analyze treatment patterns, side effects, and treatment response of FOLFOX and FOLFIRI in a real-world cohort of CRC patients.
Methods: A retrospective observational study was conducted on CRC patients who received FOLFOX or FOLFIRI between January 2020 and December 2023. Data on demographics, disease stage, chemotherapy regimen, side effects, comorbidities, and treatment response were collected from electronic medical records.
Results: A total of 146 patients were included. The majority were male (57.5%) with a mean of age 58.4 years. Most tumors were located in the rectum and sigmoid (75.3%), with over 50% of patients presenting with stage IV disease. FOLFIRI was the most common regimen (45.9%), followed by FOLFOX (36.3%). Common side effects included nausea, vomiting, decreased appetite, and hair loss. Hypertension was the most prevalent comorbidity. A total of 79.5% of patients were alive after chemotherapy.
Conclusion: This study provides insights into the real-world treatment patterns and outcomes of FOLFOX and FOLFIRI in CRC patients. The choice of regimen appears to be influenced by factors such as disease stage and patient characteristics. Further research is needed to compare the efficacy and safety of these regimens and identify optimal treatment strategies for specific patient subgroups
Novel Insights into the Pathophysiology of Coronary Slow Flow Phenomenon: The Role of Triglycerides-Glucose Index and Electrocardiogram Risk Score in Subclinical Atherosclerosis
Get PDFBackground: Coronary slow flow phenomenon (CSFP) is characterized by delayed distal coronary vessel opacification without significant epicardial coronary stenosis. The underlying mechanisms of CSFP remain unclear, but subclinical atherosclerosis is a likely contributor. This study investigated the relationship between the Triglycerides-Glucose Index (TyG), Electrocardiogram Risk Score (ERS), and carotid intima-media thickness (CIMT) in CSFP patients.
Methods: This cross-sectional study involved 31 patients diagnosed with CSFP at Dr. Mohammad Hoesin General Hospital Palembang. CSFP was determined based on coronary blood flow slowdown on angiography. Data collection included anamnesis, physical examination, laboratory tests, echocardiography, and CIMT measurement. Statistical analysis was performed using SPSS 27.
Results: The majority of CSFP patients were male (51.6%) with a mean age of 50.87 ± 13.94 years. Dyslipidemia was the most prevalent risk factor (77.4%), followed by hypertension (35.5%), smoking (22.6%), and diabetes mellitus (6.5%). Statistical analysis revealed significant positive correlations between TyG index and CIMT (r = 0.445, p = 0.012), and between ERS and CIMT (r = 0.476, p = 0.007).
Conclusion: TyG and ERS indices are positively correlated with CIMT in CSFP patients. These indices may be useful tools for cardiovascular risk evaluation and early identification of high-risk patients for subclinical atherosclerosis and potential CSFP
Do Ventilator Bundles Reduce Ventilator-Associated Pneumonia? A Meta-Analysis of Randomized Controlled Trials
Get PDFBackground: Ventilator-associated pneumonia (VAP) is a serious complication in mechanically ventilated patients, leading to increased morbidity, mortality, and healthcare costs. Ventilator bundles are evidence-based practices aimed at preventing VAP. This meta-analysis evaluated the effectiveness of ventilator bundles in reducing VAP incidence in critically ill adults.
Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted from January 2013 to December 2024. Randomized controlled trials (RCTs) comparing ventilator bundles to standard care in adult patients receiving mechanical ventilation were included. The primary outcome was the incidence of VAP. Secondary outcomes included mortality, length of intensive care unit (ICU) stay, and duration of mechanical ventilation. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.
Results: Nine RCTs involving 2,850 patients met the inclusion criteria. The implementation of ventilator bundles was associated with a significant reduction in VAP incidence (RR 0.68, 95% CI 0.55-0.84, p=0.0002). Mortality (RR 0.89, 95% CI 0.75-1.05, p=0.16) and duration of mechanical ventilation (mean difference -1.2 days, 95% CI -2.8 to 0.4, p=0.13) did not significantly differ between groups. However, a significant reduction in ICU length of stay was observed in the ventilator bundle group (mean difference -2.1 days, 95% CI -3.5 to -0.7, p=0.004).
Conclusion: This meta-analysis demonstrates that ventilator bundles are effective in reducing VAP incidence in critically ill adults. While no significant impact on mortality was observed, ventilator bundles were associated with a shorter ICU length of stay. These findings reinforce the importance of implementing ventilator bundles as a standard of care in ICUs to improve patient outcomes
Successful Surgical Management of Grade IV Internal Hemorrhoids in a Pediatric Patient: A Case Report
Get PDFBackground: Anorectal malformations are congenital conditions with a range of clinical presentations. They can be associated with portal hypertension or anatomical anomalies that obstruct venous outflow. While anorectal issues are common in pediatrics, their etiology and management can differ significantly from those in adults. This report presents a successful case of pediatric hemorrhoids managed surgically with a satisfactory outcome.
Case presentation: A 4-year-old girl presented with a protruding anal lesion and intermittent constipation, first noticed at age 1. She was born aterm with no abnormalities. Physical examination revealed a 0.5 to 1 cm circular lesion obstructing the anal orifice, diagnosed as a grade-IV internal hemorrhoid. Laboratory results were within normal limits. Due to the severity of the lesion, a Whitehead hemorrhoidectomy was performed. Follow-up showed no complications, such as secondary wound healing, anal stricture, or mucosal ectropion.
Conclusion: Whitehead hemorrhoidectomy is an effective treatment for severe pediatric hemorrhoids, as demonstrated by this case with a complication-free recovery. Accurate surgical technique and vigilant follow-up are key to a successful outcome
A Rare Case of Adult-Onset Still's Disease Presenting with Hypercoagulability and Ocular Vasculitis
Get PDFBackground: Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder characterized by fever, arthritis, rash, and hyperferritinemia. While AOSD commonly presents with systemic and articular manifestations, it can rarely involve other organ systems, including the eye and the coagulation system.
Case presentation: We present a case of an 18-year-old male with AOSD who developed hypercoagulability and ocular vasculitis. The patient presented with high-grade fever, polyarthritis, and the characteristic salmon-pink rash. Laboratory investigations revealed leukocytosis, elevated inflammatory markers, and a significant elevation of serum ferritin. Imaging studies ruled out other diagnoses. During the course of his illness, the patient developed hematomas and was found to have elevated fibrinogen and D-dimer levels, suggestive of hypercoagulability. He also experienced ocular symptoms and was diagnosed with ocular vasculitis. The patient was treated with systemic corticosteroids, methotrexate, and anticoagulation therapy, which led to the resolution of his symptoms.
Conclusion: This case highlights the rare and serious complications of AOSD, including hypercoagulability and ocular vasculitis. Early recognition and prompt treatment are crucial to prevent morbidity and mortality associated with these complications