Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Navigating a Life-Threatening Airway Emergency: Clinical Diagnosis and Surgical Management of Ludwig's Angina in a Resource-Limited Setting
Get PDFBackground: Odontogenic abscesses, common in clinical practice, possess the potential to escalate into life-threatening emergencies. The contiguous spread of polymicrobial infections into the deep fascial spaces of the neck can precipitate Ludwig's angina, a rapidly progressive cellulitis of the floor of the mouth characterized by acute airway compromise. This report details the diagnosis and management of such a case, emphasizing the critical role of clinical acumen when gold-standard diagnostic modalities are unavailable.
Case presentation: A 43-year-old male presented with a one-week history of progressive, painful swelling of his right mandible, accompanied by fever and trismus. The working diagnosis was Ludwig's angina secondary to an odontogenic abscess originating from the mandibular right second molar (tooth #47). Despite an initial radiological report erroneously noting an issue with tooth #37, all clinical evidence pointed to a right-sided pathology. Diagnosis was established through physical examination and basic radiography, which confirmed significant soft tissue swelling. Management involved immediate surgical incision and drainage under general anesthesia, aggressive intravenous antibiotic therapy, and meticulous postoperative care. The causative tooth was subsequently extracted. The patient experienced a complete resolution of symptoms and a full functional recovery.
Conclusion: Ludwig's angina remains a formidable surgical emergency. This case underscores that even with limited diagnostic resources, a decisive diagnosis based on strong clinical findings, followed by prompt and aggressive surgical decompression, is paramount to preventing mortality and ensuring a favorable patient outcome
Platelet-Rich Plasma for Burn Wound Healing in Preclinical Models: A Systematic Review of Efficacy and Biomolecular Mechanisms
Get PDFBackground: Burn injuries represent a major global health issue, with complex pathophysiology that often leads to significant morbidity. Platelet-rich plasma (PRP) has been identified as a potential therapeutic agent due to its high concentration of growth factors that promote tissue renewal. This review synthesizes preclinical evidence on the efficacy of PRP for burn wounds.
Methods: This systematic review followed PRISMA guidelines, searching PubMed, Scopus, and ScienceDirect for animal studies on PRP for burn wounds. The primary outcomes were wound healing, fibroblast scores, and VEGF/EGF levels. The SYRCLE tool was used for risk of bias assessment.
Results: Eleven studies involving 526 animals were included. The risk of bias across studies was generally high or unclear, primarily due to poor reporting of randomization and blinding. Macroscopically, PRP was reported to accelerate wound closure in partial-thickness burns within 4-7 days and in full-thickness burns from day 8 onward. On a biomolecular level, PRP was associated with increased fibroblast scores and elevated tissue concentrations of VEGF and EGF from the first day post-treatment (P<0.05 in multiple studies).
Conclusion: While the included studies suggest PRP may enhance healing, definitive conclusions are precluded by the high risk of bias and methodological heterogeneity across the preclinical evidence base
The Rhomboid Flap for Facial Reconstruction Following Basal Cell Carcinoma Excision: A Case Report on Achieving Optimal Aesthetic and Functional Outcomes
Get PDFBackground: Reconstruction of the lower eyelid following oncologic surgery presents a formidable challenge due to the region's unique anatomy and functional importance. The primary goal is to restore the lamellar structure while avoiding ectropion, a complication with significant functional and aesthetic consequences. This report details the successful application of a rhomboid flap, a classic transposition flap, for a moderate-sized defect in this high-risk anatomical subunit.
Case presentation: A 75-year-old male farmer presented with a 2x1 cm nodular basal cell carcinoma on his left lower eyelid. After surgical excision with 4 mm margins, a superolaterally based rhomboid flap was designed to close the defect. The procedure was performed under local anesthesia. The postoperative course was uncomplicated. Objective functional assessment at 12 weeks confirmed a normal lower lid position with margin-to-reflex distance 2 (MRD2) symmetrical to the contralateral eye and no evidence of ectropion or lagophthalmos. The cosmetic outcome was assessed as favorable using the Patient and Observer Scar Assessment Scale (POSAS), and the patient reported high satisfaction (5/5 on a Likert scale).
Conclusion: This case report illustrates the successful use of a rhomboid flap for a moderate-sized lower eyelid defect, resulting in a favorable functional and aesthetic outcome without complications in the short-term follow-up period. The technique successfully restored tissue volume and preserved normal eyelid function, critically preventing ectropion. It supports the rhomboid flap as a robust and reliable option in the reconstructive surgeon's toolkit for this challenging anatomical area
Gray Patch Tinea Capitis by Microsporum canis in a Child: A Case Report Highlighting Environmental Risk Factors and Diagnostic Nuances
Get PDFBackground: Tinea capitis, a dermatophytosis of the scalp, is a leading cause of hair loss in children. Its successful management hinges on understanding its complex etiology, including host susceptibility and pathogen virulence. Microsporum canis, a zoophilic fungus, is a primary causative agent, yet its transmission pathways and diagnostic markers are not fully elucidated.
Case presentation: A 3-year-old female presented with a two-week history of progressive, pruritic alopecia. Clinical history was notable for the absence of animal contact but revealed significant environmental exposure at a hair salon. Dermatological examination showed multiple, well-demarcated, alopecic patches with fine scaling, characteristic of gray patch tinea capitis. While Wood's lamp examination was negative, trichoscopy revealed comma hairs and Morse code-like hairs, suggesting fungal infection. Microscopic examination of hair shafts confirmed an ectothrix invasion pattern, and fungal culture definitively identified Microsporum canis. The patient achieved complete resolution following a six-week course of oral griseofulvin and adjuvant topical ketoconazole.
Conclusion: This case demonstrates that indirect fomite transmission from environmental reservoirs like hair salons is a critical risk factor for zoophilic tinea capitis, independent of animal contact. It further establishes trichoscopy as an essential tool for accurate, rapid diagnosis when classic signs, such as Wood's lamp fluorescence, are absent, thereby optimizing patient management and public health outcomes
The Lethal Nexus: Sarcopenic Obesity and the Prospective Risk of All-Cause and Cardiovascular Mortality in Older Adults-A Systematic Review and Meta-Analysis of Longitudinal Cohort Studies
Get PDFBackground: The concurrent presence of excess adiposity and low muscle mass, termed sarcopenic obesity (SO), is an emerging geriatric syndrome hypothesized to confer a greater mortality risk than either condition alone. However, the precise magnitude of this risk remains poorly quantified. This systematic review and meta-analysis aimed to synthesize evidence from longitudinal cohort studies to determine the association between SO in older adults and the risk of all-cause and cardiovascular mortality.
Methods: A systematic search was conducted in PubMed, Embase, and Scopus for longitudinal cohort studies published between January 2015 and August 2025 that evaluated mortality risk in older adults (mean age ≥60 years) with SO. The primary outcomes were all-cause and cardiovascular mortality. A random-effects model was used to pool Hazard Ratios (HRs) and 95% Confidence Intervals (CIs). Heterogeneity was assessed using the I2 statistic.
Results: From 2,450 records identified, eight cohort studies met the inclusion criteria, encompassing 45,280 community-dwelling older adults with a mean follow-up of 8.2 years. Compared to a reference group of non-sarcopenic, non-obese individuals, sarcopenic obesity was associated with a significantly increased risk of all-cause mortality (Pooled HR: 1.58, 95% CI: 1.42–1.76, p < 0.0001). The risk for cardiovascular mortality, assessed in six studies, was even more pronounced (Pooled HR: 1.75, 95% CI: 1.55–1.98, p < 0.0001). Moderate heterogeneity was observed for the all-cause mortality analysis (I2 = 55%), which was partially explained by differences in diagnostic criteria.
Conclusion: Sarcopenic obesity is a potent predictor of both all-cause and cardiovascular mortality in older adults, conferring a risk substantially greater than a healthy state. These findings underscore the critical need for routine screening and targeted interventions to address this lethal combination of poor body composition in aging populations
Beyond the Floor: Traumatic Medial Rectus Entrapment in a Medial Orbital Wall Fracture Presenting with Diplopia and Retinal Hemorrhage
Get PDFBackground: Medial orbital wall fractures with extraocular muscle entrapment represent a significant but less common variant of orbital trauma compared to floor fractures. These injuries pose a diagnostic and management challenge, with the potential for severe, long-term functional deficits and life-threatening systemic complications if not addressed promptly. This report details a case of medial rectus muscle entrapment complicated by a concurrent posterior segment injury.
Case presentation: A 21-year-old male presented to the emergency department following a motorcycle accident, sustaining blunt trauma to his left eye. He reported an acute onset of blurred vision and binocular diplopia. Ophthalmic examination revealed a visual acuity of 20/80 in the left eye. There was a manifest esotropia and a profound abduction deficit, with marked restriction of movement on attempted lateral, superolateral, and inferolateral gaze. The forced duction test was positive, confirming mechanical restriction. Funduscopy identified significant retinal hemorrhages. A maxillofacial computed tomography scan confirmed a comminuted fracture of the left medial orbital wall (lamina papyracea) with clear evidence of medial rectus muscle entrapment within the fracture fragments. The patient underwent urgent surgical intervention involving exploration of the medial orbit, careful release of the incarcerated medial rectus muscle, and anatomical reconstruction of the wall with a titanium mini-plate. Intraoperative forced duction testing confirmed complete resolution of the mechanical restriction. Postoperatively, the patient showed free passive ocular motility, although active movement was recovering, and the retinal injuries required continued observation.
Conclusion: This case underscores the critical importance of maintaining a high index of suspicion for medial rectus entrapment in patients presenting with post-traumatic diplopia and an abduction deficit. A thorough clinical examination, particularly the forced duction test, is paramount and often more definitive than imaging alone. Urgent surgical decompression and reconstruction are imperative to prevent permanent strabismus from muscle ischemia and to mitigate the risk of the oculocardiac reflex. Furthermore, the presence of concomitant intraocular injuries, such as traumatic retinopathy, must be diligently assessed as they significantly impact the final visual prognosis
Pharmacological and Interventional Approaches to Ascites Management in Cirrhosis: A Meta-Analysis
Get PDFBackground: Ascites, a common complication of cirrhosis, significantly impacts patient morbidity and mortality. This meta-analysis evaluated the efficacy and safety of various pharmacological and interventional approaches for ascites management in patients with cirrhosis.
Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted from January 2013 to December 2024, identifying randomized controlled trials (RCTs) comparing different pharmacological agents (diuretics, albumin, vasopressin receptor antagonists) and interventional procedures (large-volume paracentesis, transjugular intrahepatic portosystemic shunt [TIPS]) in cirrhotic patients with ascites. The primary outcome was complete ascites resolution. Secondary outcomes included time to ascites recurrence, adverse events, and mortality. A random-effects model was used to pool data, and heterogeneity was assessed using the I² statistic.
Results: Twelve RCTs (n=2848 patients) met the inclusion criteria. Diuretics plus albumin was superior to diuretics alone in achieving complete ascites resolution (OR 2.18, 95% CI 1.65-2.88, p<0.001; I²=38%). Vasopressin receptor antagonists were comparable to diuretics plus albumin in terms of ascites resolution (OR 1.09, 95% CI 0.88-1.35, p=0.42; I²=12%) but associated with a lower incidence of hyponatremia (OR 0.52, 95% CI 0.35-0.78, p=0.002; I²=23%). Large-volume paracentesis was more effective than repeated small-volume paracentesis for ascites control (OR 1.75, 95% CI 1.31-2.34, p<0.001; I²=41%). TIPS was associated with a higher rate of complete ascites resolution compared to large-volume paracentesis (OR 2.45, 95% CI 1.78-3.38, p<0001; I²=35%) but a higher risk of hepatic encephalopathy (OR 2.21, 95% CI 1.48-3.30, p<0.001; I²=15%). Albumin reduced mortality in patients undergoing large-volume paracentesis (OR 0.68, 95% CI 0.49-0.94, p=0.02; I²=0%).
Conclusion: This meta-analysis supports the use of diuretics plus albumin, vasopressin receptor antagonists, large-volume paracentesis, and TIPS for ascites management in cirrhosis, with the choice of therapy individualized based on patient characteristics, ascites severity, and the risk of complications
Procalcitonin Levels in Pulmonary Tuberculosis and Bacterial Pneumonia: A Cross-Sectional Study at a Tertiary Hospital in Indonesia
Get PDFBackground: Pulmonary tuberculosis (TB) and bacterial pneumonia are respiratory infections with high morbidity and mortality rates. Despite having similar clinical symptoms and radiological findings, these conditions require different treatment approaches. Procalcitonin is a potential biomarker to differentiate these conditions, as its levels tend to increase in bacterial infections but not in TB. This study aims to compare procalcitonin levels in patients with pulmonary TB and bacterial pneumonia.
Methods: This research employed an observational analytic design with a cross-sectional approach conducted at Dr. Mohammad Hoesin General Hospital (RSMH), Palembang. The study subjects were patients with pulmonary TB and bacterial pneumonia who met the inclusion and exclusion criteria. Procalcitonin levels were measured using ELISA methods. Data were analyzed to determine differences in procalcitonin levels between the two groups.
Results: The study found that procalcitonin levels in bacterial pneumonia patients were significantly higher than those in pulmonary TB patients (p<0.05). These findings indicate that procalcitonin levels can serve as a diagnostic parameter to distinguish between the two conditions.
Conclusion: Procalcitonin levels can be a useful biomarker for differentiating pulmonary TB from bacterial pneumonia. This biomarker is expected to assist clinicians in making more accurate diagnoses and expediting clinical decision-making
Magnesium and Osteoporosis: A Meta-Analysis of the Effects on Bone Turnover Markers, Fracture Incidence, and Quality of Life
Get PDFBackground: Osteoporosis, a prevalent bone disease characterized by reduced bone mineral density (BMD) and increased fracture risk, poses a significant public health challenge. Magnesium, an essential mineral involved in bone metabolism, has emerged as a potential therapeutic agent. This meta-analysis aimed to evaluate the effects of magnesium supplementation on bone turnover markers, fracture incidence, and quality of life in individuals with osteoporosis.
Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted from January 2013 to December 2024 to identify randomized controlled trials (RCTs) investigating the impact of magnesium supplementation on adults diagnosed with osteoporosis. The primary outcomes were changes in bone turnover markers (serum calcium, phosphorus, alkaline phosphatase, and osteocalcin), fracture incidence, and quality of life scores. Standardized mean differences (SMD) and risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models.
Results: Nine RCTs met the inclusion criteria, encompassing a total of 825 participants. Magnesium supplementation demonstrated a significant improvement in bone turnover markers, with a decrease in serum alkaline phosphatase (SMD = -0.35; 95% CI: -0.62, -0.08; p = 0.01) and osteocalcin (SMD = -0.29; 95% CI: -0.51, -0.07; p = 0.009). A trend towards reduced fracture incidence was observed in the magnesium group (RR = 0.72; 95% CI: 0.51, 1.02; p = 0.06). Furthermore, magnesium supplementation significantly improved quality of life scores, as measured by the Osteoporosis Quality of Life Questionnaire (OQLQ) (SMD = 0.41; 95% CI: 0.15, 0.67; p = 0.002).
Conclusion: This meta-analysis provides evidence that magnesium supplementation may have beneficial effects on bone turnover markers and quality of life in individuals with osteoporosis. Although a trend towards reduced fracture incidence was observed, further large-scale RCTs are warranted to confirm this finding
From Antenatal Clue to Postnatal Cure: Surgical Management of a Symptomatic Jejunal Duplication Cyst in an Infant
Get PDFBackground: Alimentary tract duplication cysts represent a rare and challenging subset of congenital anomalies. Their non-specific symptomatology often leads to their misidentification as more common pediatric conditions, making a clear diagnostic pathway essential. With jejunal localization being particularly uncommon, these lesions can range from being asymptomatic to causing life-threatening abdominal emergencies. The evolution of high-resolution prenatal imaging, however, has fundamentally altered their management, enabling proactive postnatal intervention.
Case presentation: A three-month-old female infant, with a history of a non-specific cystic intra-abdominal mass identified on a second-trimester antenatal ultrasound, was referred for progressive abdominal distension and non-bilious vomiting. Postnatal examination revealed a palpable right upper quadrant mass. A contrast-enhanced computed tomography (CT) scan confirmed a 3.9 x 3.9 x 3.3 cm thick-walled jejunal duplication cyst causing partial obstruction. The patient underwent a successful exploratory laparotomy with segmental jejunal resection and primary end-to-end anastomosis. The postoperative course was uneventful, with complete resolution of symptoms. Histopathology confirmed a benign jejunal duplication cyst without heterotopic mucosa.
Conclusion: Jejunal duplication cysts are a critical, albeit rare, consideration in the differential diagnosis of an infant with an abdominal mass or intestinal obstruction. This case serves as a paradigm of modern perinatal care, where an antenatal clue facilitates a planned, definitive postnatal cure. Complete surgical resection remains the gold standard, preventing severe complications and ensuring an excellent long-term prognosis