Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Beta vulgaris Extract as a Post-Cholecystectomy Dietary Intervention: A Systematic Review of its Effects on Gut Microbial Balance, Bile Acid Metabolism, and E. Coli/Lactobacillus Dynamics
Get PDFBackground: Cholecystectomy, while a common surgical procedure, significantly alters bile acid dynamics and the gut microbiome, potentially leading to an imbalance favoring opportunistic pathogens like Escherichia coli over beneficial bacteria like Lactobacillus. This systematic review investigates the potential of beetroot (Beta vulgaris) extract, rich in betalains and prebiotic fibers, as a dietary intervention to mitigate these post-cholecystectomy microbial shifts.
Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted for studies published between 2013 and 2024. Keywords included "cholecystectomy," "gallbladder removal," "bile acids," "Escherichia coli," "Lactobacillus," "beetroot," "Beta vulgaris," "prebiotic," "gut microbiome," and related terms. Studies investigating the effects of Beta vulgaris (or its constituents) on gut microbial composition, bile acid metabolism, or relevant clinical outcomes in post-cholecystectomy contexts (human or animal models) were included. Quality assessment was performed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials (RCTs) and the ROBINS-I tool for non-randomized studies.
Results: Seven studies met the inclusion criteria: three human RCTs, two animal studies (rats), and two in vitro studies. The human studies were of moderate to high risk of bias. The animal studies had a lower risk of bias but limited direct applicability to humans. The in vitro studies provided mechanistic insights but lacked the complexity of the in vivo environment. Due to the heterogeneity of study designs and outcome measures, a meta-analysis was not feasible. Beetroot extract supplementation (standardized to betalain content) was associated with a significant increase in Lactobacillus abundance (mean increase of 15%, p < 0.05) and a decrease in E. coli abundance (mean decrease of 10%, p < 0.05) in the post-cholecystectomy gut. There was also a shift in bile acid profiles, with an increase in secondary bile acids known to be less inhibitory to Lactobacillus.
Conclusion: While existing evidence is limited, the theoretical basis and preliminary findings suggest that beetroot extract holds promise as a post-cholecystectomy dietary intervention to promote a healthier gut microbiome. Further high-quality, well-powered RCTs are warranted to confirm these potential benefits and elucidate the underlying mechanisms
Unveiling the Antibacterial Potential of Arumanis Mango (Mangifera indica L.) Leaf Extract Against Enterococcus faecalis: A Comparative Study with Melinjo (Gnetum gnemon L.)
Get PDFBackground: Root canal infections, frequently caused by the bacterium Enterococcus faecalis due to its resistance to conventional treatments, present a significant challenge in dental practice. Effective disinfection of the root canal system is crucial for successful endodontic therapy, necessitating the exploration of alternative irrigating solutions. This study aimed to evaluate and compare the in vitro antibacterial efficacy of Arumanis mango (Mangifera indica L.) leaf extract and melinjo (Gnetum gnemon L.) leaf extract against Enterococcus faecalis.
Methods: This in vitro experimental study employed the disc diffusion method to assess the antibacterial activity of ethanolic extracts of Arumanis mango and melinjo leaves against Enterococcus faecalis. The extracts were tested at three different concentrations: 25%, 50%, and 75%. Chlorhexidine 0.2% and distilled water served as positive and negative controls, respectively. The diameter of the inhibition zones around the discs was measured after incubation. Phytochemical screening of both extracts was also conducted.
Results: The phytochemical screening revealed the presence of flavonoids, alkaloids, and tannins in both Arumanis mango and melinjo leaf extracts. However, the antibacterial activity varied significantly. Melinjo leaf extract did not exhibit any measurable inhibitory effect on Enterococcus faecalis at any of the tested concentrations. In contrast, Arumanis mango leaf extract demonstrated significant antibacterial activity at concentrations of 50% and 75%, with mean inhibition zone diameters of 11.73 ± 0.75 mm and 12.90 ± 0.30 mm, respectively. Statistical analysis using the Kruskal-Wallis test and post-hoc Mann-Whitney U test confirmed a significant difference in the antibacterial activity between the Arumanis mango leaf extract at 50% and 75% concentrations and the melinjo leaf extract at all tested concentrations, as well as the distilled water control. The positive control, chlorhexidine 0.2%, showed the largest inhibition zone (15.10 ± 0.10 mm).
Conclusion: The findings of this study indicate that the ethanolic extract of Arumanis mango (Mangifera indica L.) leaves possesses significant in vitro antibacterial activity against Enterococcus faecalis, suggesting its potential as a natural alternative irrigating solution in endodontic treatment. Conversely, under the conditions of this study, melinjo (Gnetum gnemon L.) leaf extract did not demonstrate any antibacterial effect against this specific bacterium. Further research is warranted to explore the clinical efficacy and safety of Arumanis mango leaf extract in root canal disinfection
Systemic Inflammatory Response and Chemotherapy Efficacy in Non-Small Cell Lung Cancer: An Analysis of the Platelet-to-Lymphocyte Ratio as a Predictive Biomarker
Get PDFBackground The variable response to chemotherapy in non-small cell lung cancer (NSCLC) necessitates accessible biomarkers for prognostic stratification. The platelet-to-lymphocyte ratio (PLR), a marker of systemic inflammation, is a promising candidate. This study evaluates the predictive value of pre-treatment PLR for chemotherapy response in an Indonesian NSCLC cohort, a population underrepresented in biomarker research.
Methods: A retrospective cohort study was conducted on 59 adult patients with advanced-stage NSCLC at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Patients receiving first-line platinum-based chemotherapy were included. The association between baseline hematological markers and chemotherapy response (Partial Response [PR], Stable Disease [SD], Progressive Disease [PD]) was analyzed using the Kruskal-Wallis test, with Dunn's test for post-hoc comparisons. Receiver Operating Characteristic (ROC) curve analysis was used to determine the predictive accuracy and an optimal cut-off value for PLR.
Results: Statistically significant differences in median PLR were found across all response groups (p-value <0.0001). Post-hoc analysis confirmed a graded response, with the PLR of the PD group being significantly higher than that of both the SD and PR groups. ROC analysis demonstrated good predictive accuracy for PLR in discriminating responders (PR) from non-responders (SD+PD), yielding an Area Under the Curve (AUC) of 0.86. A PLR cut-off of 185 was identified, showing high sensitivity and specificity.
Conclusion: In this cohort, pre-treatment PLR was a statistically robust predictor of chemotherapy response, with a clear dose-response relationship and good predictive accuracy. PLR reflects the crucial balance between tumor-driven inflammation and host immunity, and its elevation signals a biological state that is resistant to standard chemotherapy. This simple, inexpensive biomarker holds considerable potential as a component of a multi-faceted prognostic model for NSCLC
The Triglyceride-Glucose Index: A Potential Simple Screening Tool for Insulin Resistance in Young Adults
Get PDFBackground: Insulin resistance is a key factor in the development of metabolic diseases, which are increasingly prevalent in young adults. Early detection is crucial for timely intervention. The triglyceride-glucose (TyG) index, calculated from fasting triglyceride and glucose levels, has emerged as a potential alternative to the more complex homeostasis model assessment of insulin resistance (HOMA-IR). This study aimed to evaluate the agreement between the TyG index and HOMA-IR in detecting insulin resistance in young adults.
Methods: A cross-sectional study was conducted on 102 non-diabetic young adults (aged 18-22 years). Fasting blood samples were collected to measure triglyceride, glucose, and insulin levels. The agreement between the TyG index and HOMA-IR was assessed using the Kappa coefficient.
Results: The median age of the participants was 20 years, with 65.7% being female. The prevalence of insulin resistance was 79.4% based on the TyG index (cut-off value of 4.25) and 43.1% based on HOMA-IR (cut-off value of 2.2). The agreement between the two indices was slight (Kappa = 0.155, p = 0.001).
Conclusion: The TyG index showed a higher prevalence of insulin resistance compared to HOMA-IR in this population. However, the agreement between the two indices was low. Further research is needed to validate the TyG index as a screening tool for insulin resistance in young adults
Clinical Characteristics, Outcomes, and Predictors of Severity in Acute Eosinophilic Pneumonia (AEP): A Meta-analysis
Get PDFBackground: Acute eosinophilic pneumonia (AEP) is a rare, potentially life-threatening respiratory illness characterized by rapid onset of symptoms, diffuse pulmonary infiltrates, and marked eosinophilia in bronchoalveolar lavage (BAL) fluid. This meta-analysis aimed to synthesize published data to provide robust estimates of clinical characteristics, outcomes, and predictors of severity in patients diagnosed with AEP.
Methods: A systematic literature search was conducted in PubMed, Embase, Scopus, and Web of Science databases for studies published between January 1st, 2014, and December 31st, 2024. Inclusion criteria specified observational studies reporting on clinical features, diagnostic findings, and clinical outcomes in patients meeting standard AEP diagnostic criteria. Data extraction and quality assessment (using the Newcastle-Ottawa Scale) were performed independently by two reviewers. Pooled proportions and means were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic. Potential predictors of MV requirement were evaluated by pooling odds ratios (ORs) where available.
Results: Six studies met the inclusion criteria, comprising a total of 315 patients diagnosed with AEP. The pooled mean age was 29.5 years (95% CI: 26.8-32.2), with a predominance of male patients (pooled proportion: 78%, 95% CI: 71%-84%, I²=45%). A strong association with recent smoking initiation or change was confirmed (pooled proportion: 85%, 95% CI: 78%-91%, I²=55%). Common presenting symptoms included dyspnea (95%), fever (92%), and cough (88%). While peripheral eosinophilia was variable at presentation (pooled mean: 650 cells/µL, 95% CI: 450-850), BAL eosinophilia was markedly elevated (pooled mean percentage: 42%, 95% CI: 37%-47%, I²=78%). The pooled proportion of patients requiring mechanical ventilation was substantial (38%, 95% CI: 30%-46%, I²=68%). Overall in-hospital mortality remained low (pooled proportion: 1.8%, 95% CI: 0.5%-3.5%, I²=0%). Significant heterogeneity was observed for most pooled estimates. Factors significantly associated with an increased likelihood of requiring mechanical ventilation included a shorter time from symptom onset to presentation (<3 days) (pooled OR: 3.1, 95% CI: 1.8-5.3, I²=35%) and higher initial C-reactive protein (CRP) levels (analyzed descriptively due to varied reporting).
Conclusion: This meta-analysis confirms that AEP typically affects young male smokers and presents acutely with severe respiratory symptoms. Despite variable peripheral eosinophilia, marked BAL eosinophilia is a diagnostic hallmark. A significant proportion requires mechanical ventilation, highlighting the potential severity. However, mortality is low with appropriate treatment, typically corticosteroids. Very acute onset and higher inflammatory markers may predict the need for ventilatory support, warranting close monitoring in these patients. Further research with standardized reporting is needed to refine predictors and optimize management strategies
Six-Minute Walk Test Performance in Non-Dialysis Chronic Kidney Disease: An Observational Study from a Tertiary Hospital Setting
Get PDFBackground: Functional capacity dramatically declines in non-dialysis chronic kidney disease (CKD-ND), impacting patient prognosis and quality of life. Accurate, practical assessment is crucial for timely intervention. This study evaluated functional capacity using Six-Minute Walk Test (6MWT) and explored associated clinical factors in Indonesian CKD-ND patients.
Methods: We conducted a cross-sectional study at RSUP Dr. M. Djamil Padang, enrolling 44 patients with CKD stages 3-5 not on dialysis. Using purposive sampling, we collected 6MWT distance (6MWD) following ATS guidelines and extracted demographic/clinical data (age, gender, BMI, eGFR, etiology) from medical records. Functional capacity, expressed as Metabolic Equivalents (METs), was estimated from 6MWD and patient data using the Nury formula. Descriptive statistics summarized the findings.
Results: The cohort (54.5% male, mean age 56-65 years) predominantly had advanced CKD (43.2% Stage 5) and hypertension etiology (45.4%). Functional capacity was severely impaired: mean 6MWD was low (Men: 291m, Women: 255m), and a striking 70.5% of patients exhibited low functional capacity (<3.0 METs). No participants achieved high capacity (>6.0 METs). Lower mean 6MWD and a higher prevalence of low METs were distinctly observed in patients with lower eGFR and advanced age.
Conclusion: This study reveals profound functional limitations in Indonesian CKD-ND patients well before dialysis initiation. Lower eGFR and older age were strongly associated with poorer performance. The 6MWT effectively quantifies this impairment, highlighting its utility for routine screening and emphasizing the urgent need for functional assessment and rehabilitation strategies in CKD-ND management
Impact of Exercise Modalities on Blood Pressure, Cardiorespiratory Fitness, and Resting Heart Rate in Hypertension: A Meta-Analysis
Get PDFBackground: Hypertension represents a critical global health challenge and a leading modifiable risk factor for cardiovascular morbidity and mortality. Sedentary behavior is a significant contributor to its prevalence. While exercise is a cornerstone of hypertension management, the comparative efficacy of different exercise modalities—aerobic training (AT), resistance training (RT), and combination training (CT)—on key cardiovascular parameters requires continued synthesis. This meta-analysis aimed to quantitatively evaluate the impact of AT, RT, and CT on systolic blood pressure (SBP), diastolic blood pressure (DBP), cardiorespiratory fitness (CRF) assessed via maximal oxygen consumption (VO2max), and resting heart rate (RHR) in adults with hypertension.
Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Cochrane Library, and ScienceDirect databases for randomized controlled trials (RCTs) published between January 1st, 2014, and January 1st, 2025. Inclusion criteria encompassed RCTs involving adults diagnosed with hypertension undergoing AT, RT, or CT interventions for at least 8 weeks, reporting changes in SBP, DBP, VO2max, or RHR. Two independent reviewers performed study selection, data extraction, and quality assessment using the Cochrane Risk of Bias tool. Standardized mean differences (SMD) with 95% confidence intervals (CI) were pooled using random-effects models due to anticipated heterogeneity. Heterogeneity was assessed using the I² statistic.
Results: Seven RCTs, encompassing 410 participants with hypertension, met the inclusion criteria. The included studies were predominantly parallel-group RCTs, with durations ranging from 8 to 16 weeks. Meta-analysis indicated that AT resulted in a statistically significant overall reduction in blood pressure compared to RT (Overall BP SMD: -2.55; 95% CI: -4.97, -0.13; p = 0.04). Furthermore, AT demonstrated significantly greater improvements in VO2max (SMD: -4.84; 95% CI: -7.00, -2.68; p < 0.0001) and RHR (SMD: -3.08; 95% CI: -4.75, -1.42; p = 0.0003) compared to RT. The overall pooled effect for VO2max and RHR combined significantly favored AT (Overall SMD: -3.74; 95% CI: -5.06, -2.42; p < 0.00001). Limited data (two studies) suggested that combination training might offer superior blood pressure reduction compared to RT and potentially AT, but these findings require cautious interpretation due to the small number of studies. Significant heterogeneity was observed in the blood pressure analyses (I² > 88%), whereas heterogeneity was low to moderate for VO2max and RHR analyses.
Conclusion: This meta-analysis indicated that aerobic training provided superior benefits in reducing overall blood pressure, improving cardiorespiratory fitness (VO2max), and lowering resting heart rate compared to resistance training alone in adults with hypertension. Combination training showed potential, particularly for blood pressure control, warranting further high-quality research with larger sample sizes. These findings underscore the importance of incorporating structured exercise, particularly aerobic training, into comprehensive hypertension management strategies
The Differential Risk of Intraoperative Floppy Iris Syndrome (IFIS) with Tamsulosin versus Other α1-Adrenergic Antagonists: A Systematic Review and Comparative Meta-Analysis
Get PDFBackground: α1-adrenergic antagonists are a cornerstone therapy for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Their association with intraoperative floppy iris syndrome (IFIS) during cataract surgery is well-established, yet the comparative risk between the highly α1A-selective agent tamsulosin and other α1-blockers has not been adequately quantified in a meta-analysis. This study aimed to synthesize the evidence to determine the magnitude of this differential risk.
Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Embase, Scopus, and the Cochrane Library through September 2025. We included comparative studies reporting IFIS incidence in adults on α1-blockers undergoing cataract surgery. Data were independently extracted by two reviewers. The primary outcome was the pooled Odds Ratio (OR) for IFIS, calculated using a random-effects model. Heterogeneity was assessed with the I² statistic.
Results: The search yielded 1,218 records, with six studies comprising 10,878 patients meeting the inclusion criteria. The incidence of IFIS was 18.7% in the tamsulosin group versus 2.9% in the comparator group (other α1-blockers or control). Tamsulosin was associated with a significantly greater risk of IFIS (Pooled OR = 4.28, 95% CI: 2.91–6.31, p < 0.00001). This corresponds to an absolute risk increase of 15.8% and a Number Needed to Harm (NNH) of 7, suggesting one additional case of IFIS occurs for every seven patients treated with tamsulosin instead of a different agent. Moderate heterogeneity was noted (I² = 62%).
Conclusion: This meta-analysis provides robust evidence that tamsulosin carries a more than four-fold increased odds of IFIS compared to other α1-blockers. This substantial and clinically meaningful risk, highlighted by an NNH of 7, mandates a risk-stratified approach to BPH management. A patient's present or future ophthalmological needs must be a central factor in the shared decision-making process when selecting an α1-blocker
Spontaneous Respiration Intubation as a Cornerstone of Multidisciplinary Management for Delayed Tracheoesophageal Fistula Repair in a Critically Ill Neonate
Get PDFBackground: The perioperative management of neonates with esophageal atresia and Type C tracheoesophageal fistula (EA/TEF) is exceptionally challenging, particularly in cases of delayed diagnosis complicated by aspiration pneumonia and congenital heart disease. The primary anesthetic risk is catastrophic gastric insufflation and hemodynamic collapse from positive pressure ventilation (PPV) before fistula control. This report details a successful multidisciplinary strategy centered on an airway technique that preserves spontaneous ventilation.
Case presentation: A 16-day-old, 2.5 kg female neonate with Type C EA/TEF presented for surgical repair following a delayed referral. The case was critically complicated by severe aspiration pneumonia (cultures positive for Klebsiella pneumoniae), which was managed with targeted antibiotic therapy, and hemodynamically significant congenital heart defects (2.5 mm patent ductus arteriosus, 3 mm patent foramen ovale). After 48 hours of intensive cardiorespiratory and nutritional optimization in the neonatal intensive care unit (NICU), the patient underwent surgery. To circumvent the life-threatening risks of PPV, an inhalational induction with sevoflurane was performed, maintaining spontaneous ventilation. The airway was secured via direct laryngoscopy without neuromuscular blockade. A right extrapleural thoracotomy, fistula ligation, and primary esophageal anastomosis were successfully performed. Intraoperative lung retraction-induced desaturation was managed with coordinated surgeon-anesthetist maneuvers. The postoperative course was uneventful.
Conclusion: In a high-risk neonate with delayed TEF presentation and profound cardiorespiratory compromise, securing the airway while maintaining spontaneous ventilation is a cornerstone of safe anesthetic practice. This approach, integrated within a comprehensive, multidisciplinary management plan, directly mitigates the risk of gastric perforation and cardiovascular collapse, thereby enabling a successful surgical repair and favorable outcome
Intraoperative Endoscopy as a Navigational Adjunct in Laparoscopic Heller Myotomy for Achalasia: A Consecutive Case Series
Get PDFBackground: Laparoscopic Heller myotomy (LHM) is a primary surgical treatment for esophageal achalasia. Achieving a complete myotomy while avoiding mucosal perforation is paramount for success, yet intraoperative challenges persist. Intraoperative endoscopy (IOE) is recommended by guidelines but remains underutilized. This study aims to illustrate the methodological application and clinical utility of a standardized IOE protocol in LHM.
Methods: This study was a retrospective analysis of a prospectively maintained database of a consecutive series of patients who underwent LHM with routine IOE for achalasia at our institution in 2023. We present three consecutive cases. Preoperative evaluation included esophagography, upper endoscopy, and high-resolution manometry (HRM). The primary outcomes were the adequacy of myotomy, incidence of mucosal perforation, and postoperative symptomatic relief measured by the Eckardt score at three months.
Results: Three female patients (aged 19, 30, and 65) with achalasia (Type I and II) underwent LHM with IOE. The mean preoperative Eckardt score was 9.3 ± 1.5. IOE was successfully used in all cases to: (1) precisely identify the gastroesophageal junction (GEJ) via transillumination, (2) facilitate submucosal dissection through controlled insufflation, (3) confirm mucosal integrity with an air leak test, and (4) verify a patulous GEJ post-myotomy. No mucosal perforations occurred. At three-month follow-up, the mean Eckardt score significantly improved to 0.3 ± 0.6 (p < 0.05). All patients reported resolution of dysphagia and significant improvement in nutritional status.
Conclusion: Our experience with this consecutive series supports the utility of systematic IOE during LHM. It appears to be a valuable tool for enhancing procedural safety, ensuring myotomy adequacy, and achieving optimal short-term functional outcomes. These findings reinforce existing guidelines and should encourage wider adoption of this critical surgical adjunct