Bioscientia Medicina - Journal of Biomedicine and Translational Research
Not a member yet
1245 research outputs found
Sort by
The Clinical and Pathological Landscape of Pediatric Appendicitis in Central Java, Indonesia: A Retrospective Cohort Study Highlighting a High Burden of Delayed Diagnosis
Get PDFBackground: The timely diagnosis of pediatric appendicitis is a global challenge, particularly in low- and middle-income countries where health system barriers can lead to significant delays and increased morbidity. This study aimed to characterize the clinical and pathological presentation patterns of pediatric appendicitis at a major Indonesian referral center to identify evidence of diagnostic delay and to analyze associated surgical management trends.
Methods: A retrospective cohort study was conducted at Dr. Kariadi General Hospital on all pediatric patients (n=52) who underwent appendectomy between January 2022 and December 2024. Data on demographics, definitive histopathological diagnoses, and surgical approaches were collected and analyzed. The manuscript was prepared in accordance with the STROBE guidelines for observational studies.
Results: The cohort was predominantly male (63.4%), with a peak incidence in the 6–10 year age group (42.3%). The most striking finding was the histopathological diagnosis: a remarkable 48.0% of patients were diagnosed with chronic appendicitis with acute exacerbation, a strong indicator of delayed presentation. Minimally invasive surgery was performed in 48.0% of cases. While a significant association was observed between laparoscopic surgery and a shorter postoperative length of stay (p < 0.001), this finding was subject to significant confounding by indication.
Conclusion: The exceptionally high prevalence of chronic exacerbated appendicitis is the principal finding of this study, serving as a powerful public health signal for systemic delays in the pediatric acute care pathway in this region. While minimally invasive surgery is associated with faster recovery, the more pressing priority is addressing the upstream factors—including public awareness and primary care referral systems—that lead to late surgical presentation and increased cumulative morbidity
Metastatic Medullary Thyroid Carcinoma Mimicking a Primary Soft Tissue Sarcoma of the Shoulder: A Case Report
Get PDFBackground: Medullary thyroid carcinoma (MTC) is a rare neuroendocrine malignancy accounting for 1-5% of thyroid cancers. While often presenting with cervical lymphadenopathy, distant metastasis to bone and soft tissue mimicking a primary sarcoma is exceptionally rare. This report details a case of MTC where the primary diagnostic challenge was a massive, destructive shoulder mass.
Case presentation: A 58-year-old woman presented with a disabling, 20 cm mass in her left shoulder, progressively enlarging over two years. The patient also noted a 30-year history of a stable, asymptomatic neck lump. Magnetic Resonance Imaging (MRI) revealed a large, hypervascular, destructive mass obliterating the scapula and invading surrounding musculature, with a radiological differential diagnosis of a primary soft tissue sarcoma. Laboratory investigation, however, revealed a massively elevated serum calcitonin (>2000 pg/mL) and carcinoembryonic antigen (CEA) (180 ng/mL). A CT-guided core biopsy of the shoulder mass, initially suspected to be a sarcoma, was negative for all sarcoma markers. Instead, it was strongly positive for neuroendocrine (Synaptophysin, Chromogranin A) and thyroid-specific (TTF-1, PAX-8) markers, as well as definitive MTC markers (Calcitonin, CEA). This confirmed the diagnosis of metastatic MTC. Staging was completed as pT3a pN1b M1. The patient underwent total thyroidectomy with bilateral central and left modified radical neck dissection, followed by planned palliative resection of the shoulder metastasis and systemic therapy with a selective RET inhibitor.
Conclusion: This case highlights a critical diagnostic pitfall. Metastatic MTC can present as a massive soft tissue neoplasm mimicking a primary sarcoma. In such cases, a systematic diagnostic approach combining serum biomarkers (Calcitonin, CEA) with a comprehensive immunohistochemical panel is essential to establish the correct diagnosis and initiate appropriate, life-extending targeted therapy
Diagnostic Value of Platelet-to-Lymphocyte Ratio Versus Neutrophil-to-Lymphocyte Ratio in Early-Onset Neonatal Sepsis: A Retrospective Analysis in a Limited-Resource Setting
Get PDFBackground: Early-onset neonatal sepsis remains a critical cause of mortality in developing nations. Blood culture, the gold standard, suffers from delay and low sensitivity. While hematologic indices such as neutrophil-to-lymphocyte ratio (NLR) are used in adults, their utility in the first 72 hours of life is confounded by physiological instability. This study evaluates the diagnostic accuracy of the platelet-to-lymphocyte ratio (PLR) compared to NLR, mean platelet volume (MPV), and red cell distribution width (RDW) in early-onset neonatal sepsis.
Methods: A retrospective observational study was conducted on 55 neonates (25 septic, 30 symptomatic non-septic controls) at a tertiary center in Indonesia. Sepsis was defined by clinical criteria and C-reactive protein positivity, independent of complete blood count parameters, to avoid incorporation bias. Diagnostic performance was assessed using Mann-Whitney U tests, receiver operating characteristic curve analysis, and multivariable logistic regression to control for confounders, including asphyxia.
Results: The median PLR was significantly lower in the sepsis group compared to controls (32.6 [IQR 3.4–100.4] versus 71.1 [IQR 45.3–82.9]; p = 0.016). Conversely, NLR (p = 0.80), MPV (p = 0.163), and RDW (p = 0.422) showed no significant discrimination. PLR yielded an area under the curve of 0.724. At a cut-off of equal to or less than 40.5, determined by the Youden Index, PLR demonstrated a sensitivity of 68.0%, specificity of 73.3%, positive likelihood ratio of 2.55, and negative likelihood ratio of 0.44. Multivariable regression confirmed PLR as an independent predictor (Adjusted Odds Ratio 0.96; 95% CI 0.93–0.99; p = 0.038) after adjusting for birth asphyxia.
Conclusion: PLR demonstrates superior discriminative ability over NLR for early-onset sepsis in this cohort. The distinct inverse PLR phenomenon reflects sepsis-induced thrombocytopenia and bone marrow suppression. While not a standalone diagnostic tool, PLR serves as a valuable, zero-cost adjunctive marker for risk stratification in resource-limited settings
The Hepatotoxicity and Adherence Advantage of Short-Course Rifapentine/Isoniazid (3HP) over Stratified Isoniazid Monotherapy (6H/9H): A Systematic Review and Meta-Analysis
Get PDFBackground: The global strategy to eliminate tuberculosis hinges critically on neutralizing the latent reservoir. For decades, the standard of care has been daily Isoniazid monotherapy for 6 or 9 months. However, the effectiveness of this regimen is historically compromised by poor adherence due to its duration and significant rates of hepatotoxicity, particularly in older adults. The 3-month once-weekly regimen of Rifapentine plus Isoniazid offers a promising alternative, yet a consolidated high-level analysis comparing it specifically against stratified Isoniazid monotherapy across diverse high-risk groups was necessary to justify global policy shifts.
Methods: We conducted a systematic review and meta-analysis of eight pivotal studies, including large-scale randomized controlled trials and programmatic surveillance studies. Outcomes included prevention of active tuberculosis, Grade 3/4 hepatotoxicity, and treatment completion. Data were pooled using a random effects model to account for clinical heterogeneity. Subgroup analyses stratified comparators by duration and administration method.
Results: The analysis of over 10,000 participants revealed that the short-course regimen was non-inferior to isoniazid monotherapy for tuberculosis prevention (Pooled Risk Ratio 0.54; 95% CI 0.30–0.97). Crucially, the Rifapentine-based regimen demonstrated a profound reduction in grade 3/4 hepatotoxicity compared to Isoniazid monotherapy (Pooled Risk Ratio 0.16; 95% CI 0.08–0.32), with the benefit most pronounced in elderly populations. Treatment completion was significantly higher in the short-course group (Pooled Risk Ratio 1.25; 95% CI 1.15–1.36), with programmatic data confirming adherence exceeding 85% even under self-administration.
Conclusion: The 3-month Rifapentine/Isoniazid regimen offers a superior safety profile and significantly higher treatment completion rates compared to Isoniazid monotherapy while maintaining equivalent efficacy. The regimen’s ability to minimize liver injury while maximizing adherence supports its adoption as a preferred standard of care, particularly for older adults
Vitamin D Levels in Epilepsy Patients at the Neurology Polyclinic, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
Get PDFBackground: In epilepsy patients, treatment is often lifelong and anti-epileptic drugs (AEDs) can be divided into two general groups, namely drugs that affect cytochrome P-450 (CYP-450) such as carbamazepine, phenytoin, primidone, or valproic acid, and those that affect minimal cytochrome P-450 such as gabapentin, vigabatrin, levetiracetam, oxcarbazepine, or topiramate. AEDs include various drugs that can cause a decrease in vitamin D levels. Therefore, this study was aimed at examining vitamin D levels in epilepsy patients who took AEDs at the neurology polyclinic at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.
Methods: This research is a descriptive study with a cross-sectional design using primary data obtained from the results of patient examinations using laboratory tests and secondary data from medical records.
Results: As many as 78% (14 subjects) who received monotherapy had vitamin D levels below normal, and 16 subjects, or 76%, who received polytherapy had vitamin D levels below normal (p = 0.907). A total of 13 (72%) subjects who received phenytoin had vitamin D levels below normal, as well as 5 (63%) subjects who received carbamazepine and 12 (92%) subjects who received other therapies (p = 0.235). A total of 12 (67%) subjects who received therapy for 1-3 years and 18 (86%) subjects who received therapy > 3 years had vitamin D levels below normal (p = 0,406).
Conclusion: Vitamin D deficiency is a crucial problem in epilepsy patients receiving AED therapy, where more than 75% of patients have vitamin D deficiency. In this study, vitamin D deficiency did not have a significant relationship with the type of therapy (monotherapy or polytherapy) or the type of drug used. used, duration of therapy, and frequency of sun exposure
Challenges in Diagnosing and Managing Uterus Didelphys: A Case Report
Get PDFBackground: This medical case report provides an insightful examination of a 22-year-old pregnant woman with uterus didelphys, a rare congenital anomaly of the Müllerian ducts. The introduction section sets the stage by discussing the embryological origins of congenital uterine anomalies and their varied clinical manifestations. It emphasizes the challenges in detecting these conditions due to their often asymptomatic nature and highlights their significant impact on reproductive health, including increased risks of miscarriage, preterm labor, and perinatal mortality.
Case presentation: The case report segment details the patient’s clinical presentation, initially misdiagnosed as an ectopic pregnancy, later revealed to be an intrauterine pregnancy coexisting with uterus didelphys. The diagnosis was substantiated by her history of irregular menstruation, lower abdominal pain since menarche, and a previously diagnosed ovarian cyst, illustrating the critical role of a thorough medical history in guiding diagnosis. The discussion section delves into the implications of uterus didelphys on fertility and pregnancy outcomes, advocating for individualized management strategies and highlighting the psychological impact of such congenital anomalies. It underscores the necessity of a multidisciplinary approach to care involving obstetricians, radiologists, and reproductive specialists.
Conclusion: The conclusion emphasizes the importance of clinical awareness, meticulous history-taking, and personalized care in the management of uterus didelphys. It calls for further research to enhance understanding and improve outcomes in reproductive medicine, stressing the complexity of diagnosing and managing pregnancies in women with Müllerian anomalies and the need to consider congenital uterine anomalies in differential diagnoses, particularly in young women with atypical gynecological histories
Serum High Mobility Group Box 1 (HMGB1) Protein Levels and Cognitive Function in Epilepsy Patients: A Cross-Sectional Study
Get PDFBackground: Epilepsy is a neurological disease with a high incidence rate. Cognitive decline is one of the consequences of recurrent seizures. Neuroinflammation is closely related to the development of epilepsy and cognitive impairment. An increase in the expression and translocation of High Mobility Group Box 1 (HMGB1) from the nucleus to the extracellular space has been observed in epilepsy patients and experimental animal models. This study aimed to investigate the relationship between serum HMGB1 levels and cognitive function in epilepsy patients.
Methods: This cross-sectional observational study involved 45 epilepsy patients. Cognitive function was assessed using the Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina), and serum HMGB1 levels were measured using the ELISA technique. The relationship between cognitive function and HMGB1 levels was analyzed using the Kruskal-Wallis test, with a significance level set at p < 0.05.
Results: The mean age of the participants was 28.5 years, with a higher proportion of females. The mean serum HMGB1 level was 22.6 ng/ml. No significant relationship was found between serum HMGB1 levels and cognitive function in epilepsy patients (p = 0.188).
Conclusion: Serum HMGB1 protein levels were not associated with cognitive function in this sample of epilepsy patients
Egg White Extract Supplementation Improves Albumin and IGF-1 Levels in Malnourished Elderly Patients: A Randomized Controlled Trial
Get PDFBackground: Malnutrition is a prevalent issue among the elderly, often leading to hypoalbuminemia (low albumin levels) and decreased serum Insulin-like growth factor 1 (IGF-1) levels. These conditions are associated with increased morbidity and mortality. Egg white extract (EWE) supplementation has shown promise in improving hypoalbuminemia. This study investigated the effects of EWE supplementation on serum albumin and IGF-1 levels in malnourished elderly patients.
Methods: A double-blind randomized controlled trial was conducted, involving 46 malnourished elderly inpatients with hypoalbuminemia. Participants were randomly assigned to receive either EWE (30 grams daily) or a placebo for two weeks. Serum albumin and IGF-1 levels were measured before and after the intervention.
Results: After two weeks, the EWE group showed a significant increase in both serum albumin and IGF-1 levels compared to the placebo group. The mean serum albumin level in the EWE group increased from 2.80 g/dL to 3.7 g/dL, while the placebo group remained unchanged. The mean serum IGF-1 level in the EWE group increased from 1.74 ng/mL to 24.74 ng/mL, while the placebo group experienced a smaller increase. There was a moderate positive correlation between changes in albumin and IGF-1 levels.
Conclusion: EWE supplementation effectively improves serum albumin and IGF-1 levels in malnourished elderly patients with hypoalbuminemia. This intervention may help reduce malnutrition-related complications and improve overall health outcomes in this vulnerable population
Awake Fiberoptic Intubation in a Patient with T4N2M1 Buccal Tumor and Pulmonary Metastasis: A Case Report and Anesthetic Challenges
Get PDFBackground: Advanced buccal cancer with pulmonary metastasis presents significant challenges for airway management due to potential anatomical distortions and respiratory compromise. Awake fiberoptic intubation (AFOI) is often the preferred technique in these cases. This report describes the successful anesthetic management of a patient with a T4N2M1 buccal tumor and lung metastasis using AFOI.
Case presentation: A 64-year-old male with a T4N2M1 buccal tumor and pulmonary metastasis presented for an open biopsy and biopsy of the oral cavity. He had limited mouth opening (Mallampati 2), anemia, and hypoalbuminemia. AFOI was performed using dexmedetomidine and topical lidocaine. General anesthesia was induced with propofol and atracurium and maintained with sevoflurane. Postoperative pain was managed with paracetamol and ketorolac. The patient's recovery was uneventful.
Conclusion: This case highlights the importance of AFOI in securing the airway for patients with advanced buccal cancer and pulmonary metastasis. Meticulous preoperative planning, including optimization of comorbidities and vigilant perioperative monitoring, is essential for successful outcomes in these complex cases
The Role of Hypoxia Inducible Factor (HIF) 1α in the Pathogenesis of Liver Cirrhosis: A Narrative Literature Review
Get PDFThe small changes in oxygen tension that occur during viral hepatitis, metabolic disorders, steatohepatitis, inflammation, and carcinogenesis are sufficient to increase hypoxic response, namely an increase in HIF. HIF is a protein that belongs to the PAS (period circadian protein-aryl hydrocarbon receptor nuclear translocator-single-minded protein) family. HIF regulates the adaptation of cells to oxygen. HIF is a transcription factor containing α and β subunits. The expression of the α subunit is oxygen-dependent, while the β subunit is expressed continuously and independently of oxygen. HIFs regulate various signaling events by binding to specific DNA sequences known as hypoxia response elements (HREs) in target genes, leading to an increase or decrease in their transcription. HIF-1α is a key regulator of hypoxia signaling