Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Malignant Lesion on Intraoperative Frozen Section with Histopathology Feature Alveolar Soft Part Sarcoma: A Case Report
Get PDFBackground: Alveolar soft part sarcoma (ASPS) are slow-growing inert soft tissue masses, but fast-growing masses are also reported. Because the cancer tissue is rich in blood vessels, distant metastasis is easy to occur through the blood tract, and lung metastasis is the most common. The diagnosis of ASPS should be combined with histopathology examination because of its rarity and often misdiagnosed, especially in unusual sites.
Case presentation: A 22-year-old female came to the oncology surgery polyclinic at Dr. M. Djamil General Hospital Padang with a chief complaint of a lump in her left thigh since 1 year ago and has been getting enlarged in the last 6 months. The lump has been painful for the last 2 months. Upon an intraoperative frozen section examination, it was concluded that the lesion was malignant. Then, the tissue was prepared from formalin fixed paraffin embedded (FFPE), and the lesion was diagnosed as alveolar soft part sarcoma.
Conclusion: In the case of ASPS, surgical management has an important role. The goal of the intraoperative frozen section of this patient is to determine whether the lesion is benign or malignant. There is a need for histological examination, collaboration, and optimal communication between pathologists and surgeons to avoid limitations and pitfalls examination
Aspergilloma Mimicry of Lung Cancer: A Case Report
Get PDFBackground: Aspergilloma and lung cancer have similar risk factors, clinical features, and supporting features. Special supporting examinations are needed to rule out the differential diagnosis of aspergilloma.
Case presentation: A 52-year-old male patient with coughing up blood and risk factors for smoking had a chest X-ray and computed tomography scan (CT scan) of the thorax and found a picture of a lung tumor. Bronchoscopy was carried out, and a bronchial lavage culture was carried out for the impression of Aspergillosis, given 1x150 mg of fluconazole for 6 months with improved clinical results and chest radiographs as well as negative sputum culture results.
Conclusion: This patient showed the condition of aspergilloma mimicking lung cancer
Rheumatic Heart Disease in East of Bali Indonesia
Get PDFBackground: Rheumatic heart disease remains to be the most acquired heart disease among people aged <25 years. Despite improvements in high sociodemographic countries, low and low-middle sociodemographic countries have been less successful in lowering the burden of RHD.1 However, data of patient with RHD is still lacking in Indonesia, especially in Bali. Karangasem is a rural area, one of the regencies in the eastern part of Bali.
Methods: This retrospective study was performed between January 2023 and January 2024 at two hospitals in Karangasem Regency, Karangasem Regional General Hospital and BaliMed Karangasem Hospital. These two hospitals were the only hospital in Karangasem regency. The study population comprised all patients who were diagnosed with RHD. Patient characteristics and echocardiographic parameters were collected retrospectively from medical records.
Results: Data from 101 patients with RHD were collected. They were predominantly female (73.3%) young adults (mean ages 41.97 years), graduated from primary school (58.4%), unemployed (26.7%), and mostly from the Karangasem subdistrict (34.7%). Mitral stenosis and mitral regurgitation were the same counts (65.3%), with mixed valve lesions (mitral and aortic) as the most common lesion (45.5%). Fifty-eight patients (57.4%) had secondary tricuspid regurgitation, with 6 patients with TR V-Max >3.4m/s. Atrial fibrillation was a common complication (47.5%). Most patient with RHD had preserved Left Ventricular Ejection Fraction (LVEF >50%). Only a quarter of patients had reduced RV contractility (TAPSE <17mm). All of the patients with AF were given warfarin. All under 40-year-old patients were given a benzathine penicillin G injection. Only 7 patients had a history of valve surgery.
Conclusion: Mixed valve lesion (mitral and aortic) was the most observed condition of valve lesion in RHD with the same count of mitral stenosis and mitral regurgitation. Characteristic of patients in this study were predominantly female, young adult, graduated from primary school, unemployed, had preserved LV function, normal RV contractility, high prevalence of AF with all prescribed warfarin, all of under 40 years were given antibiotics prophylaxis
Analysis of Risk Factors and Predictors of Endoscopic Findings in Patients with Gastrointestinal Disorders: A Single Center Observational Study at Sanjiwani General Hospital, Gianyar, Bali, Indonesia
Get PDFBackground: Gastrointestinal disorders are a common health problem in Indonesia. Endoscopy is an important procedure in diagnosing and managing this disorder. This study aims to analyze risk factors and predictors of endoscopic findings in patients with gastrointestinal disorders at regional hospitals in Bali.
Methods: This research is an analytical observational study with a cross-sectional design. The research subjects were patients with gastrointestinal disorders who underwent endoscopy at regional hospitals in Bali during the period January 2022 to December 2023. Data was collected through medical records and interviews. Data analysis was carried out using the Chi-square test and logistic regression.
Results: A total of 1074 patients were included in this study. The mean age of patients was 45.3 years (SD 15.2). The most common endoscopic finding was gastritis (35.2%), followed by gastric ulcer (15.8%) and esophagitis (12.4%). Risk factors that were significantly associated with endoscopic findings were age > 45 years (OR 1.78; 95% CI 1.23-2.57), male gender (OR 1.54; 95% CI 1.11- 2.14), history of smoking (OR 2.31; 95% CI 1.65-3.24), and history of use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR 1.98; 95% CI 1.39-2.82).
Conclusion: Age > 45 years, male gender, smoking history, and history of NSAID use are risk factors that are significantly associated with endoscopic findings in patients with gastrointestinal disorders at regional hospitals in Bali
Hyperhomocysteinemia in Chronic Kidney Disease: A Meta-Analysis
Get PDFBackground: Hyperhomocysteinemia, an elevated level of homocysteine in the blood, has been implicated in the progression of chronic kidney disease (CKD). This meta-analysis aims to comprehensively evaluate the association between hyperhomocysteinemia and CKD and its potential impact on clinical outcomes.
Methods: This study systematically searched electronic databases (PubMed, Embase, Cochrane Library) for studies published between 2018 and 2024 investigating the relationship between hyperhomocysteinemia and CKD. Studies reporting data on the association between hyperhomocysteinemia and CKD progression, cardiovascular events, or mortality were included. We extracted relevant data and performed a meta-analysis using random-effects models.
Results: The meta-analysis included 25 studies comprising 5,672 patients with CKD. Hyperhomocysteinemia was significantly associated with an increased risk of CKD progression (pooled odds ratio [OR] 1.85, 95% confidence interval [CI] 1.52-2.24), cardiovascular events (pooled OR 1.63, 95% CI 1.31-2.02), and all-cause mortality (pooled OR 1.48, 95% CI 1.17-1.87) in CKD patients. Subgroup analyses revealed a consistent association across different CKD stages and etiologies.
Conclusion: Hyperhomocysteinemia is an independent risk factor for CKD progression, cardiovascular events, and mortality. Monitoring and managing hyperhomocysteinemia may represent a potential therapeutic target to improve outcomes in CKD patients
Mechanical Properties of Macaca fascicularis Amniotic Membrane and Duramater: A Potential Biomaterial for Dural Defect Closure
Get PDFBackground: The amniotic membrane (AM), a versatile biomaterial with inherent stem cells and extracellular matrix, has shown promise in various tissue engineering applications. Its potential as a dural substitute, particularly in addressing dural defects and preventing cerebrospinal fluid (CSF) leakage, has garnered increasing interest. However, a comprehensive understanding of the mechanical properties of non-human primate (NHP) AM, especially in relation to human AM, remains elusive. This knowledge gap hinders the optimal utilization of NHP models, such as Macaca fascicularis, in translational research for dural repair. This study aimed to characterize the mechanical properties of fresh Macaca fascicularis AM and dura mater and to investigate the influence of fetal gender, gestational age, and parity on AM mechanics.
Methods: Sixteen fresh preparation amniotic membranes of Macaca fascicularis were obtained at the elective caesarean section that was already free of several infections, and three fresh preparation of dura mater of the same species were studied. The membranes were cut in specific sizes and then loaded at the Flavigraph (Textechno, Herbert Stein GmbH & Co.KG, Moenchengladbach, Germany) machine. The Young’s modulus, ultimate tensile strength, elongation at break, maximum elongation, and toughness of the amniotic membrane and dura mater were recorded and compared based on the fetal gender, gestational ages, and frequency of pregnancy.
Results: This is the first report of mechanical properties of Macaca fascicularis amniotic membrane and dura mater. There are no statistically significant differences in mechanical properties of the amniotic membrane between the fetal gender, gestational age, and the frequency of pregnancy in fresh preparation amniotic membrane. The elasticity of the dura mater is seven times stiffer than the AM and the tensile strength of the dura mater is three times bigger than the AM, and the dura mater toughness is eight times bigger than the amniotic membrane.
Conclusion: Our findings have shown the mechanical properties of Mf AM are not dependent on factors of fetal gender, gestational age, and frequency of pregnancy. This work provides an explanation of the physical properties of fresh preparation AM as the consideration to be used as allograft biomaterial in the dura mater substitution procedure. 
An Unusual Case of Self-Inserted Rectal Foreign Body: Successful Management with Manual Extraction Under Spinal Anesthesia
Get PDFBackground: Rectal foreign bodies (RFBs) are an uncommon presentation to the emergency department (ED), often encountered by emergency medicine, surgery, and internal medicine specialists. Their management can be challenging, ranging from simple manual extraction to complex surgical interventions.
Case presentation: A 19-year-old male presented to the ED with lower abdominal and anal pain. He admitted to self-inserting a plastic bottle into his rectum for autoerotic purposes. A physical examination revealed a palpable tubular mass in the rectosigmoid region, confirmed by a pelvic X-ray. The patient successfully underwent manual transanal extraction of the foreign body under spinal anesthesia, with no complications.
Conclusion: This case highlights the importance of a thorough history and physical examination in patients presenting with RFBs. Prompt diagnosis and appropriate management, including manual extraction when feasible, can lead to successful outcomes
Programmed Death-Ligand 1 (PD-L1) and Ki-67 Labeling Index: Correlation with Tumor Grade and Recurrence
Get PDFBackground: Meningiomas are common primary brain tumors with variable clinical behavior. While most are benign, a subset exhibits aggressive characteristics and a high recurrence rate. This study aimed to investigate the association of Programmed Death-Ligand 1 (PD-L1) and Ki-67 labeling index with histopathological grade and recurrence in meningioma.
Methods: A retrospective study was conducted on 139 cases of meningioma diagnosed between January 2020 and December 2023. PD-L1 expression was evaluated using immunohistochemistry (IHC) and scored using the combined positive score (CPS). Ki-67 labeling index was determined as the percentage of tumor cells with positive nuclear staining. The association of PD-L1 and Ki-67 with histopathological grade and recurrence was analyzed.
Results: PD-L1 expression was positive in 66.7% of cases and was significantly associated with recurrence (p = 0.006). A higher Ki-67 labeling index (>4%) was observed in 68.9% of cases and was also significantly associated with recurrence (p = 0.013). No significant association was found between PD-L1 expression or Ki-67 labeling index and histopathological grade.
Conclusion: PD-L1 expression and Ki-67 labeling index may serve as potential prognostic markers for predicting recurrence in meningioma. Further studies are needed to validate these findings and explore their potential therapeutic implications
Efficacy and Safety of Intrapleural Fibrinolytic Therapy in Empyema Thoracis: A Meta-Analysis of Clinical Outcomes
Get PDFBackground: Empyema thoracis is a severe pulmonary condition characterized by pus accumulation in the pleural space. Intrapleural fibrinolytic therapy is used adjunctively to break down loculations and facilitate lung re-expansion. This meta-analysis evaluated the efficacy and safety of this treatment in adults with empyema thoracis.
Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted (January 2013 - December 2023) for randomized controlled trials (RCTs) comparing intrapleural fibrinolytics with placebo or no fibrinolytic therapy in adults with empyema. Primary outcomes were treatment success (radiographic improvement and/or clinical resolution), duration of hospital stay, and mortality. Secondary outcomes included major bleeding and bronchopleural fistula. Data were pooled using a random-effects model, and risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) were calculated.
Results: Six RCTs (n=623 patients) met the inclusion criteria. Intrapleural fibrinolytic therapy showed a significantly higher treatment success rate than the control (RR 1.42, 95% CI 1.18-1.72, p=0.001) and significantly reduced hospital stay (MD -2.84 days, 95% CI -3.36 to -2.33, p<0.001). No significant difference in mortality was found (RR 0.95, 95% CI 0.46-1.93, p=0.93). The incidence of major bleeding and bronchopleural fistula was similar between the groups.
Conclusion: Intrapleural fibrinolytic therapy significantly improves treatment success and reduces hospital stays without increasing mortality or major complications. These findings support its use as an adjunctive therapy for drainage in managing empyema thoracis in adults
Prevalence and Risk Factors of Diabetic Retinopathy in a Tertiary Hospital in Padang, Indonesia
Get PDFBackground: Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes, leading to vision impairment and blindness. This study aimed to determine the prevalence and risk factors associated with DR among patients attending a tertiary care center in Padang, Indonesia.
Methods: A cross-sectional study was conducted at the eye polyclinic of Dr. M. Djamil General Hospital, Padang, Indonesia, from October 2020 to March 2021. Patients diagnosed with diabetes who underwent a comprehensive ophthalmological examination were included. Data collected included demographics, duration of diabetes, cholesterol levels, and DR status (classified as non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR)).
Results: A total of 200 patients with diabetes were included. The prevalence of DR was 55%, with 40% having NPDR and 15% having PDR. Multivariate analysis revealed that longer diabetes duration (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.2-2.7, p=0.004), higher cholesterol levels (OR 2.5, 95% CI 1.5-4.1, p=0.001), and older age (OR 1.1, 95% CI 1.0-1.2, p=0.03) were independently associated with the presence of DR.
Conclusion: DR is highly prevalent among diabetic patients in tertiary care center Padang, Indonesia. Longer diabetes duration, elevated cholesterol, and older age are significant risk factors for DR. Early detection and management of these risk factors are crucial to prevent vision loss in this population