Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Menthol-Camphor-Thymol-Eucalyptus Compound as a Novel Adjuvant Therapy in Fluconazole-Treated Candida parapsilosis Onychomycosis: A Case Report
Get PDFBackground: Onychomycosis, a fungal infection of the nail apparatus, presents a therapeutic challenge due to its recalcitrant nature and the limitations of current antifungal regimens, including potential side effects and prolonged treatment durations. Candida parapsilosis is an increasingly recognized, yet less commonly reported, yeast pathogen in onychomycosis, particularly in immunocompromised individuals or those with specific comorbidities. The exploration of effective, safe, and accessible adjuvant therapies is crucial to enhance treatment outcomes. This report details the use of an over-the-counter menthol-camphor-thymol-eucalyptus compound as an adjuvant to oral fluconazole.
Case presentation: A 69-year-old male, a gold washer by occupation with a two-month history of rheumatoid arthritis (RA) treated with methotrexate, hydroxychloroquine, methylprednisolone, and celecoxib, presented with a four-month history of yellowish-brown discoloration, uneven texture, and brittleness of both thumb nails. Dermatological examination revealed onychodystrophy, subungual hyperkeratosis, and yellowish-brown discoloration of the bilateral thumb nail plates. Dermoscopy confirmed these findings. Fungal culture of nail clippings identified Candida parapsilosis. The patient was treated with oral fluconazole 150 mg weekly for three months and twice-daily topical application of menthol-camphor-thymol-eucalyptus compound under plastic occlusion. Significant clinical improvement in nail color and texture, with no onycholysis, was observed at the 6-week follow-up. At the 3-month evaluation, fungal culture was negative, and liver function tests remained within normal limits.
Conclusion: This case demonstrates the successful use of a menthol-camphor-thymol-eucalyptus compound as an adjuvant to oral fluconazole in treating Candida parapsilosis onychomycosis in an elderly patient with RA. The combination therapy was well-tolerated and led to clinical and mycological resolution, suggesting a promising, accessible, and cost-effective adjunctive therapeutic strategy
High-Flow Nasal Cannula versus Non-Invasive Positive Pressure Ventilation in Adults with Acute Hypoxemic (Type 1) Respiratory Failure: A Meta-Analysis of Efficacy, Intubation Rates, and Mortality
Get PDFBackground: Acute hypoxemic respiratory failure (AHRF), or Type 1 respiratory failure, is a common life-threatening condition characterized by severe impairment in arterial oxygenation. High-flow nasal cannula (HFNC) and Non-Invasive Positive Pressure Ventilation (NIPPV) are two widely used non-invasive respiratory support strategies. However, their comparative effectiveness in adults with Type 1 AHRF remains a subject of ongoing investigation. This meta-analysis aimed to compare the efficacy, intubation rates, and mortality associated with HFNC versus NIPPV in this patient population.
Methods: A systematic search of PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted for randomized controlled trials (RCTs) published between January 2014 and December 2024. Studies comparing HFNC with NIPPV in adult patients with Type 1 AHRF were included. The primary outcomes were the rate of endotracheal intubation and all-cause mortality (hospital or 28-day). Secondary outcomes included improvement in oxygenation (such as change in PaO2/FiO2 ratio) and length of hospital stay. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias tool. Meta-analyses were performed using a random-effects model, and results were expressed as Risk Ratios (RR) with 95% Confidence Intervals (CI) for dichotomous outcomes and Mean Differences (MD) for continuous outcomes. Heterogeneity was assessed using the I² statistic.
Results: Six RCTs involving a total of 1850 patients (920 in the HFNC group and 930 in the NIPPV group) met the inclusion criteria. The overall risk of bias in the included studies was moderate. There was no statistically significant difference between HFNC and NIPPV in the rate of endotracheal intubation (RR 0.92, 95% CI 0.75-1.13; I²=28%; 6 studies) or all-cause mortality (RR 0.88, 95% CI 0.69-1.12; I²=15%; 6 studies). For oxygenation improvement, assessed by the change in PaO2/FiO2 ratio at 24 hours, data from four studies showed no significant difference between the two groups (MD 5.8 mmHg, 95% CI -8.5 to 20.1 mmHg; I²=45%). Hospital length of stay was also comparable. Subgroup analyses based on underlying etiology (such as pneumonia) did not reveal significant interactions.
Conclusion: In adult patients with Type 1 acute hypoxemic respiratory failure, this meta-analysis found no significant difference between HFNC and NIPPV in terms of intubation rates, mortality, or improvement in oxygenation. Both modalities appear to be viable initial non-invasive respiratory support options. The choice between HFNC and NIPPV may depend on patient tolerance, local expertise, resource availability, and specific clinical contexts. Further large-scale, high-quality RCTs are warranted to confirm these findings and explore effects in specific patient subgroups
A Distinctive Clinical Phenotype of Discoid Lupus Erythematosus in Papuanese Women: A 5-Year Analysis of Dyspigmentation, Scarring, and Malar Predilection
Get PDFBackground: Discoid lupus erythematosus (DLE), the most common form of chronic cutaneous lupus, exhibits significant clinical variability influenced by ethnicity. While disparities in presentation are recognized, data from unique indigenous populations such as the Papuanese in East Indonesia remain scarce. This study aimed to characterize the clinical and sociodemographic features of DLE in this specific cohort to identify its potentially distinctive phenotype.
Methods: A five-year retrospective analysis of clinical databases was conducted at the Department of Dermatology and Venereology at a tertiary referral hospital in Jayapura, Papua, Indonesia. All patients clinically diagnosed with DLE by board-certified dermatovenereologists between January 2019 and December 2023 were included. Sociodemographic and clinical data, including lesion morphology, location, and management, were systematically collected and analyzed using descriptive statistics.
Results: A total of 22 patients meeting the criteria were identified. The cohort demonstrated remarkable homogeneity; all patients were of Papuanese ethnicity and female (100.0%). The majority were in the 26-35 age group (40.9%), with a mean age of 29.4 years, and half were farmers (50.0%). Clinically, lesions were universally present on the nose and/or malar area (100.0%). The most common morphological triad was dyspigmentation, scarring, and telangiectasia, observed in 81.8% of patients. All patients reported photosensitivity and were managed with photoprotection and topical steroids.
Conclusion: DLE I n Papuanese women presents as a distinctive, highly uniform clinical phenotype characterized by an exclusive female predilection, a strong association with sun exposure, and a universal malar distribution with a high propensity for disfiguring dyspigmentation and scarring. These findings underscore the necessity of culturally competent, early, and aggressive management strategies to mitigate long-term sequelae in this vulnerable population
Impact of Donation Frequency on Iron Stores and Hemoglobin Levels in Regular Blood Donors
Get PDFBackground: Regular blood donation, while crucial for healthcare systems, can lead to iron deficiency and anemia in donors. This study investigated the impact of donation frequency on iron stores and hemoglobin levels in regular blood donors.
Methods: A cross-sectional study was conducted on 82 regular blood donors at the blood transfusion unit of Dr. M. Djamil General Hospital from February to April 2024. Participants underwent pre-transfusion screening, including a questionnaire on donation frequency and iron supplement use. Blood samples were collected during donation, and serum ferritin, hemoglobin, and erythrocyte indices (MCV, MCH, MCHC) were measured if the C-reactive protein (CRP) test was negative. Data were analyzed using the Kruskal-Wallis test.
Results: The mean age of the donors was 31 years, with the majority being female (56.1%). The most common donation frequency was 6-10 times (34.15%). None of the donors reported using iron supplements. Serum ferritin levels showed significant differences among female donors based on donation frequency (p=0.004) but not among male donors (p=0.114). Hemoglobin levels also differed significantly among female donors (p=0.002), but not among male donors (p=0.213). Significant differences were observed in MCV and MCH values in both male and female donors (p<0.001 and p=0.001, respectively), but not in MCHC values (p=0.135).
Conclusion: Donation frequency significantly impacts iron stores and hemoglobin levels in female blood donors but not in male donors. Regular monitoring of iron stores, particularly in female donors, is crucial to prevent iron deficiency and anemia
The Role of Mount Lawu Propolis in Modulating Oxidative Stress and Angiogenic Factors During the Proliferation Phase of Wound Healing
Get PDFBackground: The skin, the body's largest and first-line defense organ, is crucial for protection against environmental aggressors, thermoregulation, fluid balance, immune surveillance, sensory perception, and the intricate process of wound healing. This study investigated the modulatory role of Mount Lawu propolis extract on Malondialdehyde (MDA), a marker of oxidative stress, and Vascular Endothelial Growth Factor (VEGF), a key mediator of angiogenesis, during the critical proliferation phase of wound healing.
Methods: A post-test-only control group design experimental study was conducted using twenty-four male rats (Rattus norvegicus). Following the creation of standardized full-thickness skin excision wounds, the rats were divided into four groups (n=6 per group): a control group receiving no propolis, and three treatment groups receiving topical applications of 200mg/kgBB (Group 1), 400mg/kgBB (Group 2), and 800mg/kgBB (Group 3) ethanol propolis extract daily for seven days. MDA and VEGF expression in granulated tissue samples were evaluated using immunohistochemistry and semi-quantitatively scored. Statistical analysis involved the Kruskal-Wallis non-parametric test, followed by the Mann-Whitney test due to non-normal data distribution.
Results: MDA levels showed a significant reduction (p<0.05) in Group 2 (400mg/kgBB propolis) compared to the control, indicating a dose-specific antioxidant effect. VEGF expression demonstrated a significant increase (p<0.05) in all propolis-treated groups (Groups 1, 2, and 3) compared to the control, confirming the pro-angiogenic potential of propolis. Notably, the highest VEGF expression was observed in Group 3 (800mg/kgBB propolis).
Conclusion: Mount Lawu ethanol propolis extract effectively modulated both oxidative stress and angiogenesis during the proliferation phase of wound healing in this rat model. A 400mg/kgBB/day dose of propolis optimally reduced MDA expression, while propolis at all doses, particularly 800mg/kgBB/day, significantly enhanced VEGF expression. These findings suggest propolis as a promising therapeutic agent to enhance wound healing by mitigating oxidative stress and promoting angiogenesis
Comprehensive Rehabilitation Improves Motor Function and Independence in a Patient with Left Hemiparesis Post-Ischemic Stroke: A Case Report
Get PDFBackground: Stroke remains a leading cause of disability worldwide, with ischemic stroke being the predominant type. Left-sided hemiparesis resulting from ischemic stroke significantly impairs motor function and activities of daily living, necessitating comprehensive rehabilitation interventions. This case report details the journey of a 72-year-old female patient who experienced left hemiparesis due to an ischemic stroke and underwent a comprehensive rehabilitation program.
Case presentation: A 72-year-old female patient presented with sudden onset weakness in her upper and lower left limbs following an ischemic stroke. Initial assessments revealed significant impairments in motor function, balance, and self-care abilities, classifying her as having a moderate disability according to the Barthel Index. The rehabilitation program included passive and active range of motion exercises, functional mobilization techniques, resistance and balance training, infrared therapy, psychological support, and patient education.
Conclusion: The comprehensive rehabilitation strategy implemented in this case resulted in significant improvements in the patient's motor function, balance, confidence, and independence in performing daily activities. This case underscores the crucial role of tailored and comprehensive rehabilitation programs in enhancing recovery and improving the quality of life for individuals following an ischemic stroke
Cardiac Myosin Inhibitors in Hypertrophic Cardiomyopathy: A Head-to-Head Network Meta-Analysis of Mavacamten and Aficamten
Get PDFBackground: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by myocardial hypercontractility. Mavacamten and aficamten are first-in-class cardiac myosin inhibitors that have demonstrated efficacy in treating obstructive HCM. However, in the absence of direct head-to-head randomized controlled trials (RCTs), their comparative effectiveness and safety remain unquantified. We aimed to indirectly compare the efficacy and safety of mavacamten and aficamten in patients with obstructive HCM.
Methods: We conducted a systematic review and Bayesian network meta-analysis of RCTs. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to December 2024. Eligible studies were RCTs comparing mavacamten or aficamten with placebo in adults with obstructive HCM. The primary efficacy outcomes were the change from baseline in post-exercise left ventricular outflow tract (LVOT) gradient and the change in peak oxygen consumption (pVO₂). The primary safety outcome was the incidence of left ventricular ejection fraction (LVEF) reduction to <50%.
Results: Seven RCTs involving 1,025 patients were included. In the network meta-analysis, both aficamten (Mean Difference [MD], -50.8 mmHg; 95% Credible Interval [CrI], -61.2 to -40.4) and mavacamten (MD, -44.9 mmHg; 95% CrI, -53.7 to -36.1) were significantly more effective than placebo in reducing post-exercise LVOT gradient. The indirect comparison between the two agents did not reveal a statistically significant difference (MD, -5.9 mmHg; 95% CrI, -17.8 to 6.0). For pVO₂, both mavacamten and aficamten showed significant improvement over placebo, with no significant difference between them. The odds of LVEF dropping below 50% were numerically higher with mavacamten compared to aficamten, but the difference was not statistically significant (Odds Ratio [OR], 1.52; 95% CrI, 0.65 to 3.54).
Conclusion: Mavacamten and aficamten are both highly effective in improving hemodynamic and functional parameters in patients with obstructive HCM. While our indirect comparison did not establish the superiority of one agent over the other, it provides foundational evidence for clinicians. Definitive conclusions await direct head-to-head clinical trials
Unmasking the Primary: The Role of 99mTc-Sestamibi SPECT/CT in a Case of Carcinoma of Unknown Primary with Suspected Lung Origin
Get PDFBackground: Carcinoma of unknown primary (CUP) is a challenging clinical diagnosis, representing histologically confirmed metastatic cancer where the primary tumor site remains unidentified after a standard diagnostic workup. While 18F-FDG PET/CT is recommended by current guidelines, its accessibility is limited in many regions. This report explores the diagnostic utility of Technetium-99m (99mTc)-Sestamibi Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) as a valuable alternative.
Case presentation: A 67-year-old female presented with musculoskeletal pain. A biopsy of a right ulnar lesion confirmed metastatic carcinoma. Immunohistochemistry (IHC) suggested a possible primary from the lung, breast, or upper gastrointestinal tract. Due to the unavailability of 18F-FDG PET/CT, a 99mTc-Sestamibi whole-body scan with SPECT/CT was performed. The scan identified a metabolically active, malignant-appearing nodule in segment 6 of the left lung and confirmed widespread skeletal metastases. Although a lung biopsy was not feasible due to limited access, the patient was treated with a lung cancer protocol. This resulted in significant clinical improvement.
Conclusion: 99mTc-Sestamibi SPECT/CT served as a critical diagnostic tool in this case of CUP. It successfully identified a suspected pulmonary primary, enabling targeted therapy and leading to a positive clinical outcome. This case highlights the modality's efficacy as a tumor-seeking agent and underscores its essential role in the diagnostic armamentarium for CUP, particularly in resource-limited healthcare settings
Successful Use of Epidural Anesthesia Following Guideline-Based Anticoagulation Bridging for Hip Surgery in a Patient with Acute Pulmonary Embolism: A Case Report
Get PDFBackground: The perioperative management of patients with acute pulmonary embolism (PE) requiring major surgery presents a formidable clinical challenge. Therapeutic anticoagulation, essential for treating PE, is a significant relative contraindication for neuraxial anesthesia due to the risk of spinal hematoma. General anesthesia, however, carries a high risk of hemodynamic collapse in patients with compromised cardiopulmonary reserves. This report describes the successful application of a multidisciplinary, guideline-adherent strategy to manage this complex clinical scenario.
Case presentation: A 56-year-old, obese female (BMI 30 kg/m²) with an extensive history of cardiovascular disease—including hypertensive heart disease, prior myocardial infarction, and an aortic dissection repaired via EVAR—presented with a post-traumatic left hip dislocation. Her presentation was critically complicated by an acute massive pulmonary embolism, diagnosed via echocardiography, which revealed large thrombi in the pulmonary arteries, and confirmed with a chest X-ray showing a Westermark sign. The patient required an open reduction and repair of the hip. A collaborative, multidisciplinary plan was formulated to enable the use of epidural anesthesia. Her anticoagulation with rivaroxaban was stopped five days preoperatively and bridged with a therapeutic infusion of unfractionated heparin (UFH). The UFH was discontinued six hours before the procedure, and surgery proceeded only after confirming normalization of coagulation parameters (INR < 1.5). Epidural anesthesia was successfully administered, providing excellent hemodynamic stability throughout the surgery. The patient was monitored in a cardiac intensive care unit postoperatively, with no neurological or bleeding complications.
Conclusion: This case demonstrates that epidural anesthesia is a viable and potentially superior option for high-risk patients with acute PE, provided that a meticulous, guideline-concordant anticoagulation bridging strategy is implemented. Successful outcomes in such complex cases are predicated on rigorous multidisciplinary planning, patient selection, and vigilant postoperative monitoring. This approach validates current safety guidelines rather than challenging them, showcasing their utility in enabling advanced anesthetic care
Pancreas-Sparing Mucosectomy for a Complex Gastric Duplication Cyst: A Case Report
Get PDFBackground: Gastric duplication (GD) is a rare congenital anomaly, representing 2–9% of all gastrointestinal duplications. These embryologic abnormalities are typically managed by complete surgical resection due to the risk of complications, including malignancy. However, this standard approach becomes perilous when the duplication cyst is intimately adherent to vital organs. We present a case where a large gastric duplication cyst was inseparable from the pancreas, necessitating a deviation from standard management.
Case presentation: An 8-month-old female infant presented with a four-month history of non-bilious vomiting and progressive abdominal distension. A palpable, cystic, 8x5 cm mass was identified in the left upper abdomen. Abdominal ultrasound revealed a loculated, septated cystic lesion, and a barium study demonstrated a significant filling defect on the greater curvature of the stomach. Initial management was delayed as the family sought alternative medicine. Surgical exploration revealed a large gastric duplication cyst arising from the greater curvature, which was found to be densely adherent to the body and tail of the pancreas. To avoid catastrophic pancreatic injury, a complete resection was abandoned in favor of a pancreas-sparing mucosectomy. The entire mucosal lining of the duplication was excised, and the shared muscular wall was preserved and repaired. Postoperatively, the patient had a transient ileus but recovered well, with complete resolution of symptoms. At an 11-day follow-up, she was thriving, feeding well, and had gained significant weight. Histopathology confirmed a benign gastric duplication cyst.
Conclusion: This case highlights that for complex gastric duplication cysts where resection would endanger vital structures, complete mucosal excision is a safe, effective, and organ-preserving surgical alternative. This technique successfully mitigates the risks of both the untreated anomaly and iatrogenic surgical complications, underscoring the importance of surgical judgment and adaptability in managing rare congenital anomalies