Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Unmasking the Culprit: Successful Restoration of Menstrual Function in a Case of Secondary Amenorrhea Due to Tuberculous Endometritis Mimicking Polycystic Ovary Syndrome
Get PDFBackground: Secondary amenorrhea presents a significant diagnostic challenge in gynecology. While Polycystic Ovary Syndrome (PCOS) is a common cause, rare etiologies like tuberculous endometritis can be overlooked, especially in patients with features suggestive of PCOS. This phenomenon, known as diagnostic overshadowing, can lead to delayed diagnosis and irreversible reproductive consequences.
Case presentation: A 35-year-old nulligravid woman with a diagnosis of Class I Obesity presented with a five-year history of secondary amenorrhea and a desire for fertility. Her clinical and initial ultrasonographic findings were suggestive of PCOS. However, persistent amenorrhea despite hormonal therapy prompted further investigation. Hysteroscopy revealed a fibrotic uterine cavity with micropolyps, and subsequent endometrial biopsy with histopathology, polymerase chain reaction (PCR), and culture confirmed a diagnosis of tuberculous endometritis. The patient was successfully treated with a six-month anti-tuberculosis regimen, cyclical progestin therapy, and a structured lifestyle modification program. Following treatment, she experienced a significant weight loss, resumption of regular menstrual cycles, and marked improvement in endometrial and ovarian ultrasound parameters.
Conclusion: This case underscores the critical importance of a comprehensive diagnostic evaluation for secondary amenorrhea, including endometrial sampling, even when a common diagnosis like PCOS is suspected. It highlights the potential for tuberculous endometritis to mimic PCOS and demonstrates the efficacy of a multidisciplinary approach in restoring menstrual and potentially reproductive function. Clinicians in tuberculosis-endemic regions must maintain a high index of suspicion for this insidious pathology to prevent long-term morbidity
The Bidirectional Relationship Between Obstructive Sleep Apnea and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Systematic Review and Meta-Analysis of Longitudinal Studies
Get PDFBackground: Obstructive sleep apnea (OSA) and metabolic dysfunction-associated steatotic liver disease (MASLD) are highly prevalent, interconnected metabolic disorders. While their cross-sectional association is established, the temporal and potentially causal relationship remains unclear. This study aimed to quantitatively synthesize longitudinal evidence on the bidirectional risk between OSA and MASLD.
Methods: We systematically searched PubMed, Scopus, and Web of Science (January 1st, 2015 - July 1st, 2025) for longitudinal cohort studies in adults assessing the OSA-MASLD relationship. Two reviewers independently selected studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale (NOS). The primary analysis, pre-specified for studies using objective diagnostics (Polysomnography/Imaging), utilized a random-effects model to pool hazard ratios (HR). Heterogeneity was quantified with the I2 statistic.
Results: The search identified 2,148 articles, with six longitudinal studies (185,432 participants) meeting eligibility criteria. Four studies (116,298 participants) assessed incident MASLD, while two (69,134 participants) assessed incident OSA. The primary meta-analysis of two studies using objective diagnostics found that baseline OSA was associated with a significantly increased risk of incident MASLD (pooled HR: 2.29; 95% CI: 1.93-2.71; I2=35%). A secondary analysis including two studies using administrative codes yielded a pooled HR of 1.87 (95% CI: 1.51-2.32), though with substantial heterogeneity (I2=78%). For the reverse direction, a narrative synthesis of two studies suggests MASLD increases the risk of incident OSA; an exploratory pooled analysis yielded an HR of 1.65 (95% CI: 1.39-1.96; I2=45%), a finding to be interpreted with caution due to the small study number.
Conclusion: This systematic review of longitudinal data provides the strongest evidence to date supporting a significant, bidirectional relationship between OSA and MASLD. The presence of objectively-diagnosed OSA more than doubles the risk of developing future MASLD. These findings provide a strong rationale for implementing mutual, risk-stratified screening and developing integrated management strategies to disrupt the vicious cycle linking these two common and morbid conditions
Rigid Esophagoscopy for an Impacted Kaffir Lime in the Proximal Esophagus: A Case Report and Discussion of a Unique Mechanical-Chemical Injury
Get PDFBackground: Esophageal food bolus impaction is a common otolaryngological emergency. However, impaction by a large, whole citrus fruit is exceedingly rare and presents unique diagnostic and therapeutic challenges, particularly concerning the object's size, radiolucency, and potential for causing both mechanical and chemical mucosal injury.
Case presentation: We present the case of a 42-year-old male with acute-onset dysphagia and hypersalivation after ingesting a whole kaffir lime. Laryngoscopy revealed pooled secretions in the pyriform sinus, a key indicator of high esophageal obstruction, despite non-contributory plain radiography. The patient underwent emergent rigid esophagoscopy under general anesthesia. A 36 mm kaffir lime was identified at 15 cm from the incisors and successfully extracted en bloc using alligator grasping forceps. Post-extraction evaluation revealed localized mucosal excoriation without evidence of deep laceration or perforation. The patient recovered fully with no long-term sequelae.
Conclusion: This case highlights the successful management of a rare and challenging esophageal foreign body. It underscores the diagnostic primacy of clinical findings over negative radiography for radiolucent objects and demonstrates the distinct advantages of rigid esophagoscopy—superior airway control, a wider operating channel, and use of robust instrumentation—for large, solid foreign bodies lodged in the proximal esophagus. In this instance, the impaction did not lead to severe complications within 24 hours, but prompt removal is essential to mitigate the risks of pressure necrosis and chemical esophagitis
Ocular Vascular Occlusion Following COVID-19 and Travel Vaccinations: A Systematic Review and Exploration of Immuno-Thrombotic Mechanisms
Get PDFBackground: Ocular vascular occlusion is a rare, vision-threatening emergency. While typically associated with systemic vascular comorbidities, reports have emerged suggesting a temporal link to various vaccinations. This review aims to synthesize the evidence on ocular vascular occlusion following both COVID-19 and non-COVID travel vaccinations to characterize its clinical spectrum and explore shared pathophysiological underpinnings.
Methods: A systematic search adhering to PRISMA 2020 guidelines was conducted in PubMed, Scopus, Cochrane Library, and ProQuest for studies published from January 1st, 2013, to August 1st, 2024. All study designs reporting ocular vascular occlusion temporally associated with COVID-19 or travel immunizations were included. Data on demographics, vaccine type, clinical presentation, and outcomes were extracted. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and the Joanna Briggs Institute (JBI) checklist for case reports.
Results: From an initial 1,348 records, 12 studies met the inclusion criteria, encompassing case reports, series, and large database analyses. These studies described ocular vascular occlusion in individuals aged 15 to 86 years. A significant temporal clustering was observed, with the majority of individual cases occurring within seven days post-vaccination. Central retinal vein occlusion (CRVO) was the most reported subtype. A large retrospective cohort study reported a more than two-fold increased hazard for retinal occlusion post-vaccination compared to unvaccinated cohorts (HR 2.19, 95% CI 1.85-2.59, p<0.001). Both mRNA and adenoviral vector COVID-19 vaccines, as well as various travel vaccines including Zostavax, Yellow Fever, and Meningococcal B, were implicated.
Conclusion: This review characterizes a consistent temporal association between a diverse range of vaccines and subsequent ocular vascular occlusion, suggesting it is a rare but potential adverse event. The clustering of onset times and involvement of different vaccine platforms point towards a common underlying immuno-thrombotic mechanism. These findings highlight the need for clinical vigilance for acute visual changes post-vaccination, while underscoring that the absolute risk remains exceedingly low compared to the clear benefits of vaccination
The Synergistic Impact of Astrocyte Reactivity and Vitamin D Deficiency on Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis
Get PDFBackground: Post-stroke cognitive impairment (PSCI) is a common, debilitating outcome of ischemic stroke. Glial Fibrillary Acidic Protein (GFAP), marking astrocyte reactivity, and Vitamin D, a neuro-immunomodulatory steroid, are independently linked to PSCI. This study aimed to quantify the synergistic impact of elevated serum GFAP and concurrent Vitamin D deficiency on PSCI risk.
Methods: Following PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted for prospective cohort studies (2015-2025) assessing acute serum GFAP, 25-hydroxyvitamin D (25(OH)D), and subsequent cognitive outcomes in ischemic stroke patients. Quality was assessed using the Newcastle-Ottawa Scale. A meta-analysis of seven studies (n=3,850) was performed using a random-effects model to calculate pooled odds ratios (ORs) for PSCI across four biomarker-defined groups. A formal test for synergistic interaction was conducted by assessing the departure from additivity of effects on the log-odds scale.
Results: Seven high-quality studies were included. Compared to the reference group (Normal GFAP/Sufficient Vitamin D), the pooled OR for PSCI was 2.18 (95% CI: 1.85-2.57) for high GFAP alone and 1.95 (95% CI: 1.65-2.30) for Vitamin D deficiency alone. For the dual-biomarker group (High GFAP/Deficient Vitamin D), the pooled OR was 4.75 (95% CI: 3.98-5.67). This observed risk was significantly greater than the 3.13 OR expected from a purely additive model (p for interaction < 0.001), confirming a significant synergistic effect. Sensitivity analysis showed the effect was most pronounced in patients with moderate-to-severe strokes (NIHSS > 5).
Conclusion: Elevated serum GFAP and Vitamin D deficiency synergistically increase the risk of PSCI, particularly in patients with more severe strokes. The interplay between acute astroglial injury and compromised systemic neuroprotection appears to be a critical determinant of cognitive outcomes. While confounding by patient frailty requires further study, this dual-biomarker profile identifies a high-risk subgroup and highlights a key pathophysiological interaction
Vitamin D Supplementation is Associated with Attenuated Ocular Surface Oxidative Stress in Mild Thyroid Eye Disease: A Preliminary Interventional Study
Get PDFBackground: Thyroid eye disease (TED) is an autoimmune orbitopathy where inflammation drives significant oxidative stress, contributing to patient morbidity. Malondialdehyde (MDA), a lipid peroxidation product, is a key biomarker of this oxidative damage. While vitamin D has known systemic immunomodulatory effects, its capacity to mitigate local oxidative stress on the ocular surface in TED is poorly understood. This study aimed to investigate the association between oral vitamin D supplementation and tear film MDA levels in patients with mild TED.
Methods: A prospective, single-center, quasi-experimental pre-post study without a control group was conducted on 15 patients diagnosed with mild, active TED (Clinical Activity Score ≤3). Participants received 1000 IU of oral cholecalciferol (Vitamin D3) daily for 21 consecutive days. The primary outcome was the change in tear film MDA concentration, measured by ELISA. Secondary outcomes included serum 25-hydroxyvitamin D [25(OH)D] levels and clinical ocular surface parameters (Ocular Surface Disease Index [OSDI], Tear Break-Up Time [TBUT], Schirmer's I test).
Results: A statistically significant reduction in mean tear film MDA levels was observed, decreasing from a baseline of 8.69 ± 4.15 ng/L to 5.70 ± 1.56 ng/L post-intervention (p<0.001). This was accompanied by a significant increase in mean serum 25(OH)D levels from 18.2 ± 5.9 ng/mL to 29.8 ± 6.4 ng/mL (p<0.001). Significant improvements were also noted in OSDI scores (p=0.002) and TBUT (p=0.005). The reduction in tear film MDA showed a significant negative correlation with the increase in serum 25(OH)D (r = -0.68, p=0.005).
Conclusion: In this preliminary, uncontrolled study, short-term oral vitamin D supplementation was associated with a significant attenuation of ocular surface oxidative stress in patients with mild TED. These findings provide initial biochemical evidence for the potential localized benefits of vitamin D and support the need for larger, placebo-controlled randomized trials to validate its role as a safe adjunctive therapy for managing the ocular surface component of this disease
Therapeutic Keratoplasty for Severe, Travel-Associated Fungal Keratitis: A Meta-Analysis of Globe Salvage and Visual Acuity Outcomes
Get PDFBackground: Severe, travel-associated fungal keratitis represents a formidable diagnostic and therapeutic challenge, often progressing to corneal perforation despite aggressive medical therapy. Therapeutic keratoplasty (TK) is frequently required to preserve globe integrity. However, its efficacy in this specific, epidemiologically distinct cohort of patients remains poorly quantified. This meta-analysis aimed to synthesize the available evidence on globe salvage and visual acuity outcomes following TK for severe fungal keratitis acquired during international travel.
Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2015 and December 2024, reporting outcomes of TK for travel-associated fungal keratitis. The primary outcome was the proportion of cases achieving globe salvage, defined as the avoidance of enucleation or evisceration. The secondary outcome was the mean improvement in Best-Corrected Visual Acuity (BCVA) measured in LogMAR units. Data were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic.
Results: Seven retrospective case series met the inclusion criteria, comprising a total of 102 eyes. The included studies were geographically diverse, with patient travel histories predominantly linked to tropical and subtropical regions in Southeast Asia and South America. The pooled proportion for globe salvage was 89.2% (95% Confidence Interval [CI]: 82.5% to 94.1%). There was low to moderate heterogeneity among the studies for this outcome (I² = 31%, p=0.19). The pooled mean improvement in BCVA from pre-operative assessment to final follow-up was 1.21 LogMAR (95% CI: 0.98 to 1.44). Substantial heterogeneity was observed for the visual acuity outcome (I² = 78%, p<0.001). The most commonly identified fungal genera were Fusarium and Aspergillus.
Conclusion: Therapeutic keratoplasty demonstrates a high rate of anatomical success, effectively salvaging the globe in the vast majority of patients with severe, travel-associated fungal keratitis. While visual acuity is significantly improved, the final outcomes remain guarded and are highly variable. These findings underscore the critical role of TK in the management of this sight-threatening condition and highlight the need for strategies to improve post-operative visual prognosis
The Nexus of Comorbid Thyroid Dysfunction, Developmental Trauma, and Marital Distress in Severe Depression: A Case Study of an Integrative Bio-Psycho-Social-Spiritual Approach
Get PDFBackground: The management of major depressive disorder (MDD) is frequently complicated by the presence of medical comorbidities and profound psychosocial stressors. This complexity creates a significant risk for "diagnostic overshadowing," where one clinical issue may mask others, leading to incomplete treatment. This case report illustrates a systematic diagnostic and therapeutic pathway for a patient whose severe depression represents a confluence of biological, psychological, and social determinants.
Case presentation: We present the case of a 50-year-old female with Severe Major Depressive Disorder, Recurrent Episode (F32.2), whose functional impairment was profound (GAF=40). A systematic diagnostic inquiry revealed a nexus of pathology: previously misidentified hypothyroidism (TSH > 100 µIU/mL), comorbid metabolic syndrome (BMI 31.2 kg/m², HbA1c 7.8%); a significant history of developmental trauma (Adverse Childhood Experiences Score ≥ 4); and acute, severe marital distress involving recurrent spousal infidelity. Informed consent was obtained after assessing her capacity, with family collaboration.
Conclusion: The patient was managed using an integrative bio-psycho-social-spiritual framework. This multidimensional approach involved concurrent medical stabilization, psychopharmacological treatment (Sertraline), and a phase-oriented, trauma-informed psychotherapy. The integration of culturally congruent mind-body practices was essential for building the therapeutic alliance. This holistic strategy resulted in significant, quantifiable improvement in depressive symptoms (BDI-II score decreased from 32 to 18) and functional outcomes. This case underscores the necessity of a systematic, multi-domain assessment to avert clinical error and demonstrates a replicable methodology for treating complex presentations of severe depression
The Eye as a Window to Systemic Hemodynamics: A Novel Approach to Estimating Central Venous Pressure via Tonometry in Sepsis
Get PDFBackground: Effective hemodynamic management in sepsis is critical, yet current practices are constrained by the risks and interpretive challenges of invasive central venous pressure (CVP) monitoring. The clinical utility of CVP is debated, fueling the search for safer alternatives. This study investigates a novel approach, exploring intraocular pressure (IOP) as a non-invasive surrogate for CVP, predicated on the direct anatomical link between the ocular venous drainage system and the central circulation.
Methods: We conducted a prospective, single-center observational study in a tertiary intensive care unit, enrolling 20 adult patients with sepsis and indwelling central venous catheters. High-fidelity measurements of CVP via a pressure transducer and IOP via Perkins applanation tonometry were performed simultaneously. Data were collected at a baseline steady-state and again 15 minutes after a standardized fluid challenge (median volume 300 mL) to assess the dynamic relationship. The association was quantified using Pearson correlation and modeled with simple linear regression.
Results: A strong, statistically significant positive correlation was observed between CVP and IOP at baseline (r=0.756, p=0.001). This physiological coherence was profoundly amplified following the fluid challenge, strengthening to a very strong correlation (r=0.947, p<0.001). The post-challenge data yielded a robust, preliminary predictive model, defined by the equation: CVP (mmHg) = -0.619 + (0.522 x IOP (mmHg)). The slope of this relationship was precisely estimated (95% CI: 0.435 to 0.609). The model demonstrated high predictive power, with post-challenge IOP accounting for 89% of the variance in CVP (R²=0.89).
Conclusion: This pilot investigation provides compelling evidence for a strong and dynamic correlation between IOP and CVP in critically ill patients with sepsis. The findings suggest that ocular tonometry shows significant promise as a non-invasive method for assessing right-sided filling pressures and, more importantly, for tracking the dynamic response to fluid therapy, thereby offering a potential window into venous congestion. While intriguing, these results are from a small cohort. The derived formula is strictly hypothesis-generating and requires extensive validation in larger, more diverse clinical trials before any potential for clinical application can be considered
Whey Protein as an Adjuvant Therapy for Wound Healing and Infection Control: A Systematic Review and Meta-Analysis of Clinical and Preclinical Evidence
Get PDFBackground: Impaired wound healing and subsequent infections represent a significant clinical and economic burden. Nutritional status, particularly high-quality protein provision, is a critical, modifiable determinant of healing outcomes. Whey protein (WP), a rich source of essential amino acids and unique bioactive components, has emerged as a promising adjuvant therapy.
Methods: We conducted a systematic review and meta-analysis adhering to PRISMA guidelines. We searched PubMed, Scopus, and Web of Science from January 2015 to December 2024 for clinical randomized controlled trials (RCTs) and preclinical controlled studies evaluating WP supplementation on wound healing and infection. Rigorous inclusion criteria led to the selection of seven studies (four clinical RCTs, three preclinical) for quantitative synthesis. Data were pooled using a random-effects model to calculate Standardized Mean Differences (SMD) for continuous outcomes and Odds Ratios (OR) for dichotomous outcomes.
Results: The meta-analysis of four clinical RCTs (n=340 patients) demonstrated that WP supplementation significantly accelerated wound healing (SMD = 0.78; 95% CI 0.45, 1.11; p < 0.0001) with moderate heterogeneity (I²=38%). Furthermore, WP significantly reduced the odds of wound infection by 48% (OR = 0.52; 95% CI 0.31, 0.87; p=0.01) with no heterogeneity (I²=0%). Preclinical synthesis (3 studies, n=62 animals) revealed a significant reduction in pro-inflammatory cytokines (TNF-α, IL-6) at the wound site (SMD = -1.15; 95% CI -1.67, -0.63; p < 0.0001).
Conclusion: This meta-analysis provides robust quantitative evidence that whey protein functions as an effective adjuvant therapy, significantly enhancing wound repair and providing clinically relevant infection control. These benefits appear to be mediated by a dual mechanism: providing essential anabolic substrates for tissue repair and exerting potent immunomodulatory and antioxidant effects via bioactive components like lactoferrin and cysteine