Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Bronchoscopy Diagnostic Procedures in Central and Peripheral Lesions: A Narrative Literature Review
Get PDFBronchoscopy is a medical procedure that provides tracheobronchial visualization by placing a bronchoscope and is carried out by a competent doctor. Bronchoscopy is the main interventional procedure used in determining the diagnosis and staging of cancer patients and plays a role in interstitial lung disease and infections. The basic principle of bronchoscopy sampling is carried out with a combination of rinsing, brushing, needle aspiration and biopsy. Cryobiopsy has advantages over conventional forceps biopsy and electrocautery because it can produce tissue without artifacts. Navigated bronchoscopy techniques have facilitated peripheral lung tumor biopsies that have better diagnostic yield than conventional transbronchial biopsies. The combination of navigation bronchoscopy with an ultrathin bronchoscope for peripheral lesions is more effective than either modality
Multiple Choledochal Cysts: A Case Report
Get PDFBackground: Choledochal cysts (CC) are congenital dilatations of the biliary tree, characterized by varying degrees of cystic dilatation at various segments of the biliary tract (extrahepatic or intrahepatic), may be detected at any age and in any portion of the bile duct. This study was aimed to present the management of multiple choledochal cyst case.
Case presentation: A 9 year old boy was brought by his mother to the emergency department at Dr. M. Djamil General Hospital Padang with chief complaint abdominal pain that’s getting worse 2 weeks before admission. Abdominal pain first complained by the patient since age of 4, the pain was felt all over stomach area, not localized, not radiated, not corelated with meal time, colicky, relieved with paracetamol. USG results: Choledochal cyst, Helicobacter pylori infection, elevated liver enzymes due to suspect suppression of choledochal cyst. Abdominal CT-Scan with contrast results: Intrahepatic and extrahepatic choledochal cyst (type IV A).
Conclusion: Patients was diagnosed with multiple choledochal cysts, diffuse peritonitis, Helicobacter pylori infection, and familial short stature
Characteristics of Triple Negative Subtype Breast Cancer in Dr. Hasan Sadikin General Hospital for 5 Years (2019-2023): An Observational Study
Get PDFBackground: Triple-negative breast cancer has a percentage of 15% to 20% in breast cancer patients at the time of first diagnosis. Guidelines from St. Gallen guidelines, the American Society of Clinical Oncology, and the American College of Pathology state that triple-negative breast cancer is breast cancer with ER and PR expression <1%. As an aggressive subtype, outcomes are poor when compared with hormone receptor-positive.
Methods: This research is an observational study. The research subjects in this study were triple-negative breast cancer patients in Dr. Hasan Sadikin General Hospital, Surgical Oncology division, West Java, Indonesia, from October 2018 - November 2023. There were 702 research subjects who would be studied. Characteristics of triple-negative breast cancer were taken from medical records.
Results: The results showed that the average age of the subjects was 47 years. Based on histology, the most common was Invasive Carcinoma of no special type (86.75%), followed by Invasive lobular carcinoma (7.26%), medullary carcinoma (1.7%), micropapillary carcinoma (0.99%), metaplastic carcinoma (2.36%) and the least amount is Pleomorphic invasive lobular carcinoma (0.71%). The side of the breast affected is not significant, and the highest grade is 3. The involvement of lymph node metastases is due to aggressive tumor subtypes and lymphovascular invasion. Lymphovascular invasion is known to be a negative prognostic factor. It is a late stage for metastasis and local recurrence.
Conclusion: Triple-negative breast cancer is breast cancer that has histopathological heterogeneity; most of the tumors are grade 3 and have significant metastases in regional lymph nodes. There is no significant relationship between grading and regional lymph node metastases. there is a significant relationship between lymphovascular invasion and regional lymph nodes metastases
Estimated Glomerular Filtration Rate in Pediatric Patients with β-Thalassemia Major: A Single-Center Observational Study at Dr. M. Djamil General Hospital, Padang, Indonesia
Get PDFBackground: Patients with β-thalassemia major can experience impaired kidney function. Impaired kidney function can occur without symptoms and before serious manifestations appear, so early markers are needed to detect kidney damage. Estimated glomerular filtration rate (eGFR) is a calculation to detect early impairment of kidney function and is widely accepted as an indicator in determining overall kidney function. This study aims to determine the estimated glomerular filtration rate in pediatric patients with β-thalassemia major.
Methods: This research is a descriptive research. Data was taken from pediatric patients with β-thalassemia major who received routine transfusions at the pediatric polyclinic of Dr. M. Djamil General Hospital Padang from January 1st – July 31st 2023. Patients underwent hematology examination, serum ferritin, serum creatinine, and estimated glomerular filtration rate calculations using the Schwartz formula.
Results: A total of 55 children met the research criteria, consisting of 27 boys (49%) and 28 girls (51%). The median serum creatinine level was 0.5 (0.3-0.8) mg/dL with a range with a mean estimated glomerular filtration rate of 167 mL/minute/1.73m2.
Conclusion: Glomerular hyperfiltration occurs in the majority of β-thalassemia major patients, but a decrease i
The Role of Receptor-Interacting Serine/Threonine-Protein Kinase 1 (RIPK1) in CD4+ T Cell Necroptosis in HIV Patients: A Narrative Literature Review
Get PDFThe human immunodeficiency virus (HIV) remains a global health challenge, with its ability to deplete CD4+ T cells, leading to acquired immunodeficiency syndrome (AIDS). While apoptosis has been extensively studied in CD4+ T cell depletion, recent research has highlighted the significant role of necroptosis, a regulated form of necrosis, in this process. Receptor-interacting serine/threonine-protein kinase 1 (RIPK1) has emerged as a central player in necroptosis, regulating both cell death and inflammatory responses. This review delves into the intricate mechanisms by which RIPK1 orchestrates necroptosis in CD4+ T cells during HIV infection. We explore the structural intricacies of RIPK1, its interactions with other signaling molecules, and the downstream events that culminate in necroptotic cell death. Additionally, we discuss the therapeutic potential of targeting RIPK1 to mitigate CD4+ T cell loss and control HIV disease progression. Understanding the multifaceted role of RIPK1 in HIV-induced necroptosis may pave the way for novel therapeutic interventions to combat this devastating disease
Meta-Analysis of Effective Management Strategies for Malignant Central Airway Obstruction
Get PDFBackground: Malignant central airway obstruction (MCAO) significantly impacts the quality of life and prognosis of patients with advanced lung cancer or metastatic disease. This meta-analysis aims to evaluate the effectiveness and safety of various management strategies for MCAO.
Methods: A systematic search of PubMed, Embase, and Cochrane databases from 2018 to 2024 was conducted to identify randomized controlled trials (RCTs) and observational studies comparing different MCAO management approaches. Primary outcomes included improvement in airway patency, dyspnea scores, and survival. Secondary outcomes included procedural complications and quality-of-life measures. A random-effects model was used to pool data, and heterogeneity was assessed using the I² statistic.
Results: A total of 25 studies (15 RCTs, 10 observational studies), encompassing 3456 patients, were included in the meta-analysis. Interventions assessed were rigid bronchoscopy with various modalities (e.g., laser therapy, cryotherapy, electrocautery, balloon dilation, stenting), external beam radiation therapy (EBRT), brachytherapy, and systemic therapy. Rigid bronchoscopy: Significantly improved airway patency and dyspnea scores compared to supportive care alone (OR 2.86, 95% CI 1.95-4.18; p<0.001). Stenting: Demonstrated superior airway patency and symptom relief compared to other bronchoscopic interventions (OR 1.73, 95% CI 1.21-2.48; p=0.003). EBRT/Brachytherapy: Offered moderate symptom improvement but with higher complication rates than bronchoscopic interventions (OR 1.39, 95% CI 1.05-1.85; p=0.021). Systemic therapy (chemotherapy/immunotherapy): Provided limited benefit in terms of airway patency but may impact overall survival in specific tumor types.
Conclusion: Rigid bronchoscopy, particularly with stenting, is the most effective initial management strategy for MCAO, providing rapid symptom relief and airway recanalization. EBRT/brachytherapy can be considered as adjuncts or alternatives in select cases. Further research is needed to determine the optimal combination and sequencing of therapies for different tumor types and stages
Complete Neurological Recovery Following 360-Degree Decompression and Fusion for T11 Giant Cell Tumor: A Case Report
Get PDFBackground: Giant cell tumors (GCTs) are benign but locally aggressive bone tumors that rarely affect the spine. The thoracic spine is an even rarer location for GCTs, and their presentation with paraplegia poses a significant challenge. This case report describes the successful surgical management of a T11 GCT-causing paraplegia, highlighting the importance of early diagnosis and aggressive surgical intervention.
Case presentation: A 27-year-old female presented with acute paraplegia and a history of chronic lower back pain. Imaging revealed a destructive lesion in the T11 vertebral body with spinal cord compression. The patient underwent a 360-degree decompression, en bloc tumor resection, and posterior spinal fusion. Histopathological analysis confirmed the diagnosis of GCT. The patient experienced complete neurological recovery within five days postoperatively and remained symptom-free at the 5-year follow-up.
Conclusion: This case demonstrates the feasibility of achieving complete neurological recovery in patients with T11 GCT and paraplegia through aggressive surgical intervention. Early diagnosis and complete tumor resection followed by spinal stabilization are crucial for optimal outcomes
Effectiveness of Drug Allergy Management: A Meta-Analysis
Get PDFBackground: Drug allergies pose a significant challenge in clinical practice, impacting patient safety and treatment options. This meta-analysis aims to evaluate the effectiveness of various drug allergy management strategies, including desensitization, graded challenges, and alternative medications.
Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library) was conducted from 2018 to 2024. Randomized controlled trials (RCTs) and observational studies assessing drug allergy management interventions were included. The primary outcome was the successful administration of the culprit drug without allergic reactions. Secondary outcomes included adverse events and quality of life. Data were extracted and pooled using random-effects models.
Results: A total of 32 studies (15 RCTs, 17 observational studies) encompassing 4,215 patients were included. Desensitization protocols demonstrated a high success rate (89%) in enabling the administration of culprit drugs. Graded challenges also showed promising results (75% success rate). The use of alternative medications was associated with a lower risk of allergic reactions but may compromise treatment efficacy in some cases.
Conclusion: This meta-analysis highlights the effectiveness of drug allergy management strategies, particularly desensitization and graded challenges. These interventions offer promising avenues to overcome drug allergies and optimize patient care. Further research is needed to explore long-term outcomes and refine management protocols
The Role of Rituximab in the Management of Heart Failure
Get PDFRituximab is a chimeric monoclonal antibody mice/humans that bind the transmembrane antigen, CD20 specifically. The mechanism of heart failure is mediated by neurohormonal pathways: the renin-angiotensin-aldosterone system (RAAS), the sympathetic nervous system, and the natriuretic peptide system, thereby triggering activation of the immune system. This literature review will discuss the role of B cell targeted therapy, in this case rituximab in the management of heart failure. Modulation of the immune response holds great promise in the 30% of cases of myocarditis where inflammation does not resolve and progression to chronic inflammatory dilated cardiomyopathy occurs. Pharmacologically, rituximab is a monoclonal immunoglobulin G1 antibody drug that is given intravenously. Rituximab targets the CD20 antigen expressed on the surface of mature B lymphocytes, including memory B cells but not on stem cells or plasma cells. In conclusion, rituximab causes a selective and temporary decrease in the CD20+ B cell subpopulation and represents a more specific and targeted approach to B cell-induced disorders including heart failure
Steroid therapy in extrahepatic cholestasis suggestive of biliary atresia: A case report
Get PDFBackground: Biliary atresia is a fibroinflammatory disease obstructing the extrahepatic biliary system. Biliary atresia is the leading cause of cholestasis in infants and the cause of end-stage liver disease in the first two years of life. Surgical treatment with Kasai portoenterostomy has been performed but has not eliminated the need for liver transplantation. The consideration of adjuvant steroid therapy for suppressing the fibro-inflammatory process in the bile ducts may improve the outcome of extrahepatic cholestasis.
Case Presentation: A case of a 2-month 7-day-old boy with a chief complaint of jaundice with suspicion of biliary atresia. Jaundice started 1 week after birth, followed by acholic stools, yellow-brown urine, distended abdomen, hepatomegaly, and visible abdominal veins. Laboratory examination revealed an elevated level of direct bilirubin (cholestasis) in combination with elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and Gamma-glutamyl transferase (GGT), hypoalbuminemia, and reactive of IgG and IgM CMV. A percutaneous liver biopsy was performed and showed extrahepatic cholestasis with mild fibrosis consistent with biliary atresia. The patient was treated with oral methylprednisolone and ursodeoxycholic acid (UDCA). After 12 weeks of therapy, the patient was free of jaundice and darkening of stool color, followed by a normal bilirubin level.
Conclusion: In young infants with extrahepatic cholestasis suggestive of biliary atresia, steroid administration resulted in clinical and laboratory improvement. The involvement of the immune response in the pathogenesis of biliary atresia may suggest new therapeutic targets for biliary atresia, such as steroids for improving the outcome of biliary atresia in young infants.