Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Profound Alpha-Fetoprotein Elevation in Hepatocellular Carcinoma with Concomitant Cirrhosis: A Case Report
Get PDFBackground: Hepatocellular carcinoma (HCC) is a primary liver cancer that often arises in the setting of chronic liver disease, most commonly cirrhosis. Alpha-fetoprotein (AFP) is a tumor marker frequently elevated in HCC, but its diagnostic performance varies. We present a case of HCC with concomitant cirrhosis and a significant elevation of AFP.
Case presentation: A 30-year-old male presented with hematemesis, abdominal distension, and jaundice. He had a history of heavy alcohol consumption. Physical examination revealed anemia, icterus, hepatomegaly, and palmar erythema. Laboratory investigations showed elevated AFP (>400 IU/mL), reactive hepatitis B surface antigen (HBsAg), anemia, coagulopathy, and liver dysfunction. Imaging studies confirmed HCC and cirrhosis. This case highlights the diagnostic value of AFP in HCC, particularly when combined with clinical and imaging findings. The patient's history of alcohol abuse and HBsAg positivity are well-established risk factors for both cirrhosis and HCC. The marked elevation of AFP, along with the characteristic imaging features, strongly supported the diagnosis of HCC.
Conclusion: AFP remains a valuable tool in the diagnosis and monitoring of HCC, especially in patients with cirrhosis. However, it is essential to interpret AFP levels in conjunction with other clinical and laboratory data to ensure accurate diagnosis and timely management
Efficacy and Safety of Bullectomy versus Conservative Management in Patients with Symptomatic Vanishing Lung Syndrome: A Systematic Review and Meta-Analysis of Respiratory Outcomes
Get PDFBackground: Vanishing lung syndrome (VLS), a severe form of giant bullous emphysema, causes debilitating dyspnea by compressing functional lung. A critical evidence gap exists regarding the optimal management strategy, forcing a contentious choice between surgical bullectomy and conservative care. This study provides the first meta-analytic synthesis comparing these two approaches.
Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, Scopus, and Web of Science for comparative studies (2015-2024) evaluating bullectomy versus conservative management in symptomatic VLS. Primary outcomes were changes in Forced Expiratory Volume in one second (FEV1), St. George's Respiratory Questionnaire (SGRQ) scores, and major complications. Data were pooled using a random-effects model, and bias was assessed with the ROBINS-I tool.
Results: Six non-randomized studies involving 488 patients were included. The overall risk of bias was moderate to serious. Compared to conservative care, bullectomy was associated with a substantial improvement in FEV1 (Mean Difference: 0.48 L; 95% CI: 0.35 to 0.61) and a profound improvement in quality of life (SGRQ MD: -15.55; 95% CI: -20.21 to -10.89). However, this efficacy was counterbalanced by a nearly six-fold increase in the risk of major complications (Risk Ratio: 5.82; 95% CI: 2.98 to 11.37).
Conclusion: Our synthesis suggests that for carefully selected patients, bullectomy offers superior physiological and quality-of-life outcomes over conservative management, but at the cost of significantly higher perioperative risk. These findings, derived from low-quality evidence, underscore the critical need for a highly individualized, multidisciplinary approach to patient selection and a thorough shared decision-making process
Post-Pandemic Prevalence and Distribution of Refractive Errors in Balinese Schoolchildren: A Cross-Sectional Analysis
Get PDFBackground: Uncorrected refractive errors are a leading cause of preventable visual impairment in children worldwide, impacting academic and social development. The COVID-19 pandemic disrupted routine pediatric eye health services and altered children's lifestyles, creating an urgent need to re-evaluate the burden of these conditions. This study aimed to determine the prevalence and geographical distribution of refractive errors among elementary school children across six districts in Bali, Indonesia, during the post-pandemic period (2022–2023).
Methods: A descriptive cross-sectional study was conducted using secondary data from the John Fawcett Foundation (JFF) school eye health screening program. The final analysis included 2,145 elementary school children (47.5% male, 52.5% female) from 13 schools across six districts in Bali, screened between January 2022 and December 2023. Visual acuity was measured using a Snellen chart, followed by non-cycloplegic autorefraction for all children failing the initial screening. Ametropia was defined based on established spherical equivalent and cylindrical thresholds. Prevalence was calculated for each district, and a Chi-square test was used to analyze the association with gender.
Results: The overall prevalence of ametropia was 4.1% (88/2,145). Myopia was the most common refractive error, accounting for 58 cases (2.7% of all children), followed by astigmatism with 22 cases (1.0%) and hypermetropia with 8 cases (0.4%). Significant geographical disparities were observed, with prevalence rates ranging from a low of 1.8% in Tabanan district to a high of 6.9% in Denpasar district. The highest prevalence rates were found in the urban and semi-urban districts of Denpasar (6.9%) and Buleleng (6.3%). There was no statistically significant association between gender and the presence of refractive error (p=0.115).
Conclusion: The post-pandemic prevalence of refractive errors in this large cohort of Balinese schoolchildren reveals a significant public health challenge defined by a sharp urban-rural divide. The concentration of refractive errors, primarily myopia, in urban centers like Denpasar points to the profound impact of environmental and lifestyle factors on visual development. This evidence provides a clear mandate for the strategic deployment of targeted pediatric eye care resources to the island's most affected communities, ensuring the early detection and management necessary to prevent lifelong visual impairment and secure the future well-being of Bali's next generation
The Gut-Muscle Axis in Sarcopenia: A Meta-Analysis of Gut Microbiome Compositional Features and Their Correlation with Muscle Mass, Strength, and Physical Performance in Older Adults
Get PDFBackground: Sarcopenia, the age-related decline in muscle mass and function, is a major geriatric syndrome. The gut-muscle axis has emerged as a key area of investigation, yet the association between gut microbiome composition and sarcopenic parameters in humans remains quantified by a collection of studies with varied methodologies. This meta-analysis aimed to synthesize the existing correlational evidence linking gut microbiome features to the core components of sarcopenia in older adults.
Methods: We performed a systematic search of PubMed, Scopus, Web of Science, and Embase for observational studies published between January 2015 and July 2025 that assessed gut microbiome composition and sarcopenia metrics in adults aged ≥60. Correlation coefficients (r) were pooled using a random-effects model. We assessed heterogeneity using the I² statistic, conducted pre-specified subgroup and sensitivity analyses, and evaluated study quality with the Newcastle-Ottawa Scale (NOS).
Results: Six cross-sectional studies (N=1,189) met the inclusion criteria. The methodological quality was high (median NOS score = 8). The pooled analysis revealed a significant, small positive correlation between gut microbial alpha diversity and muscle strength (handgrip strength) (pooled r = 0.19, 95% CI: 0.11-0.27; I² = 41%). The relative abundance of the genus Faecalibacterium, known for its potential to produce butyrate, was significantly correlated with physical performance (pooled r = 0.24, 95% CI: 0.16-0.32; I² = 28%). A non-significant negative correlation was found between the family Enterobacteriaceae and muscle mass (pooled r = -0.14, 95% CI: -0.29-0.01; I² = 62%). Subgroup analysis suggested this heterogeneity was partly explained by the diagnostic criteria used for sarcopenia.
Conclusion: This meta-analysis provides quantitative evidence of a modest but significant association between gut microbiome composition and muscle health in older adults. A microbial profile with higher diversity and greater abundance of putative beneficial taxa is correlated with better muscle function. These associative findings, while limited by the cross-sectional nature of the data and the potential for reverse causality, reinforce the clinical relevance of the gut-muscle axis and underscore the need for longitudinal, multi-omic studies to elucidate mechanisms and test microbiome-targeted therapies
The 15-Year Shadow: Borderline Lepromatous Leprosy with Erythema Nodosum Leprosum Following Prolonged Treatment Default
Get PDFBackground: Leprosy, caused by Mycobacterium leprae, persists as a global health issue where the primary challenges are not merely microbial but are deeply rooted in delayed diagnosis and poor treatment adherence. These delays, often driven by profound social stigma, lead to progressive, irreversible disability and sustain community transmission. Erythema Nodosum Leprosum (ENL), an acute immunological complication, further devastates patients' quality of life and complicates management.
Case presentation: A 53-year-old Indonesian farmer presented with a 15-year history of untreated leprosy, a journey of neglect initiated by fear of treatment side effects and community ostracism. Clinical examination revealed advanced borderline lepromatous (BL) leprosy with diffuse skin infiltration, multiple anesthetic plaques, and thickened, tender peripheral nerves. He had established WHO Grade 1 disability, characterized by significant sensory loss in his hands and feet and early intrinsic muscle atrophy. A slit-skin smear confirmed a bacteriological index of +3 with a morphological index of 5%, indicating a high load of viable bacilli. Histopathology confirmed BL leprosy with a concurrent mild ENL reaction. A comprehensive, patient-centered management plan was initiated, including a 12-month course of multidrug therapy (MDT-MB), adjunctive care, and intensive counseling.
Conclusion: This case powerfully illustrates the "shadow effect" of leprosy—how years of untreated disease, fueled by psychosocial barriers, culminate in a complex nexus of advanced infection, immunological reaction, and permanent neurological impairment. The patient's successful re-engagement with the health system underscores that eradicating the burden of leprosy requires a paradigm shift from a purely pharmacological approach to a deeply humanistic one. Effective control hinges on building compassionate health systems that actively dismantle stigma, empower patients with knowledge, and deliver holistic, multidisciplinary care to prevent the profound human cost of neglect
Platelet-Rich Plasma-Derived Exosomes Modulate Follicular Regeneration: A Comparative Mechanistic Analysis with Minoxidil in a Preclinical Model of Androgenetic Alopecia
Get PDFBackground: The therapeutic armamentarium for androgenetic alopecia (AGA) is limited, with variable efficacy and potential side effects associated with standard treatments like minoxidil. Platelet-rich plasma-derived exosomes (PRP-Exo) represent a novel acellular strategy, offering a concentrated payload of regenerative biomolecules. This study aimed to rigorously evaluate the therapeutic efficacy and underlying mechanisms of PRP-Exo, as a monotherapy and in combination with minoxidil, in a validated murine model of AGA.
Methods: A parallel-group, randomized, double-blind, controlled experimental study was conducted. Thirty-two male C57BL/6 mice with testosterone-induced AGA were randomized (n=8/group) to one of four groups: Negative Control (NC), Positive Control (PC; 5% topical minoxidil), Treatment 1 (T1; intradermal PRP-Exo), or Treatment 2 (T2; combination of PRP-Exo and minoxidil). PRP-Exo were characterized by Transmission Electron Microscopy, Nanoparticle Tracking Analysis, and ELISA for marker proteins. After a 14-day treatment period, efficacy was assessed via hair follicle density (HFD), anagen-to-telogen (A/T) ratio, and hair shaft thickness. Mechanistic insight was obtained by quantifying tissue protein levels of Ki-67 and β-catenin by ELISA.
Results: All active treatments significantly improved hair regeneration compared to the NC group. The combination therapy (T2) demonstrated the most profound effects across all metrics, showing statistically superior outcomes compared to both minoxidil (PC) and PRP-Exo (T1) monotherapies in HFD (65.8 ± 12.1 vs. 36.2 ± 8.5 and 47.3 ± 10.4 follicles/mm², respectively; p<0.01). Furthermore, T2 treatment led to the highest A/T ratio and hair shaft thickness. ELISA revealed that T2 treatment also resulted in the highest tissue concentrations of the proliferation marker Ki-67 and the Wnt pathway protein β-catenin, suggesting enhanced mitogenic activity and modulation of key developmental pathways.
Conclusion: PRP-Exo is a potent hair regenerative agent, significantly outperforming minoxidil in this preclinical model. The combination of PRP-Exo and minoxidil exhibits a synergistic effect, promoting superior follicular regeneration by concurrently stimulating tissue proliferation and upregulating key components of the anagen-promoting Wnt signaling pathway. These findings underscore the significant clinical potential of PRP-Exo as a next-generation therapy for AGA
The Importance of Dermoscopy for Early Recognition of Superficial Spreading Melanoma in Adolescents: A Case Report
Get PDFBackground: Malignant melanoma, a highly aggressive form of skin cancer, is rare in adolescents. Early diagnosis is crucial for the best possible treatment and prognosis. Dermoscopy, a non-invasive technique, has been shown to increase the sensitivity of melanoma diagnosis, leading to early identification and better treatment outcomes.
Case presentation: A 14-year-old female presented with a painful, bleeding black nevus on her right upper arm, increasing in size over four months. Dermoscopic examination, using a two-step algorithm and the ABCD rule, categorized the lesion as malignant melanoma. Histopathological examination confirmed the diagnosis of superficial spreading melanoma (Breslow 2, AJCC stage IIB). The patient underwent Mohs surgery for treatment.
Conclusion: This case highlights the importance of dermoscopy in the early recognition of melanoma in adolescents. Dermoscopy aids in differentiating between benign and malignant melanocytic lesions, enabling prompt diagnosis and treatment. Increased awareness and utilization of dermoscopy can significantly improve outcomes in this patient population
Modified Hughes Tarsoconjunctival Flap Procedure for Lower Eyelid Defect: A Case Series
Get PDFBackground: The Hughes procedure, or tarsoconjunctival flap, is a technique used in reconstructing full-thickness lower eyelid defects involving >50% of the eyelid margin to restore anatomical integrity, function, and cosmesis of the eyelid. The modified Hughes procedure spares the marginal upper lid tarsus and removes the levator muscle aponeurosis from the tarsoconjunctival flap. This study reports a case series of patients who underwent a modified Hughes procedure after basal cell carcinoma excision.
Case presentation: Two patients underwent lower eyelid reconstruction using the modified Hughes procedure. After a wide excision of the tumor, a tarsoconjunctival flap was created to reconstruct the posterior lamella of the eyelid. Subsequently, the anterior lamella of the eyelid was reconstructed using a full-thickness skin graft and an advancement flap, respectively. Both patients underwent a second surgery, tarsus flap release, 6-8 weeks after the first surgery. Postoperatively, tarsal flap apposition, skin flap/graft, and stitches were intact. After the tarsus flap release, wound healing was good. A tumor biopsy showed basal cell carcinoma.
Conclusion: The modified Hughes procedure is a treatment of choice in reconstructing full-thickness lower eyelid defects involving >50% of the eyelid margin. Full-thickness skin graft and advancement flap to reconstruct the anterior lamella of the eyelid are chosen after considering skin color, texture similarity, and the laxity of the eyelid and cheek
Unveiling the Hidden Patterns: A Dermoscopic Analysis of Vitiligo Lesions at a Tertiary Care Center in Surakarta, Indonesia
Get PDFBackground: Vitiligo, a common depigmenting disorder, presents with a variety of clinical manifestations. Dermoscopy, a non-invasive skin imaging technique, has emerged as a valuable tool for evaluating pigmentary disorders. This study aimed to analyze the dermoscopic patterns of vitiligo lesions in a cohort of patients at a tertiary care center in Surakarta, Indonesia, and to correlate these patterns with disease stability.
Methods: This cross-sectional study included 20 adult patients diagnosed with vitiligo at the Dermatology and Venereology Outpatient Clinic of Dr. Moewardi Regional General Hospital Surakarta in July 2023. A dermoscopic examination was performed on all patients using a polarized light dermoscope. Dermoscopic features were analyzed and categorized based on the BPLeFoSK criteria (Border, Pigment Network, Lesions, Follicular, Koebner). Disease stability was assessed based on clinical and dermoscopic findings.
Results: The majority of patients were female (75%) and between 21-40 years old (65%). All patients exhibited the characteristic "white glow" under dermoscopy. Other common findings included reduced or absent pigment network (40% each), perifollicular hyperpigmentation (30%), and perilesional hyperpigment (30%). Satellite lesions and micro-Koebner phenomenon, indicative of disease activity, were observed in 10% of patients each. Based on these findings, 80% of patients were classified as having stable vitiligo, while 20% had unstable vitiligo.
Conclusion: Dermoscopy revealed a spectrum of patterns in vitiligo lesions, with the "white glow" being a universal finding. The majority of patients in this cohort had stable vitiligo. Dermoscopy can aid in assessing disease activity and guiding treatment decisions in vitiligo patients
Mangosteen Nanoextract and Bone Regeneration in Diabetes: A Meta-Analysis of ALP and Osteocalcin Modulation during Fracture Callus Formation
Get PDFBackground: Diabetic fracture healing is often impaired, leading to prolonged recovery and increased risk of non-union. Garcinia mangostana L. (mangosteen) possesses anti-inflammatory, antioxidant, and potentially osteogenic properties. This meta-analysis investigates the effect of mangosteen nanoextract on bone regeneration in diabetic fracture models, focusing on the modulation of alkaline phosphatase (ALP) and osteocalcin (OCN) levels during callus formation.
Methods: A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library databases, covering publications from January 2013 to May 2024. Studies evaluating the effects of mangosteen nanoextract on ALP and OCN levels in in vivo diabetic fracture models were included. Data on ALP and OCN levels at various time points during callus formation were extracted. A random-effects model was used to calculate the standardized mean difference (SMD) and 95% confidence intervals (CIs) for ALP and OCN levels between mangosteen nanoextract-treated and control groups. Heterogeneity was assessed using the I² statistic.
Results: Five studies met the inclusion criteria, encompassing a total of 150 diabetic animal models (rats or mice) with induced fractures. Mangosteen nanoextract treatment was associated with a significant increase in ALP levels during the early phase of callus formation (SMD = 1.25; 95% CI: 0.80, 1.70; p < 0.001; I² = 65%). Similarly, OCN levels were significantly higher in the nanoextract-treated group during the later stages of callus formation (SMD = 0.98; 95% CI: 0.55, 1.41; p < 0.001; I² = 58%).
Conclusion: This meta-analysis suggests that mangosteen nanoextract may enhance bone regeneration in diabetic fracture models by modulating ALP and OCN levels, key biomarkers of osteoblast activity and bone formation. Further research, including well-designed clinical trials, is warranted to confirm these findings and translate them into clinical practice