Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Comparative Analysis of Early Postoperative Cognitive Decline Following Isoflurane versus Sevoflurane Anesthesia in Geriatric Patients: A Prospective Observational Study
Full text linkBackground: As the global geriatric population expands, postoperative cognitive dysfunction (POCD) has emerged as a critical perioperative complication. While volatile anesthetics are standard for maintenance, conflicting evidence exists regarding the comparative neurotoxicity of Isoflurane and Sevoflurane, particularly in resource-limited settings where cost influences agent choice. This study aimed to evaluate and compare the magnitude of early cognitive decline associated with these two agents in an Indonesian geriatric cohort.
Methods: We conducted a prospective comparative observational study involving 40 geriatric patients (aged ≥60 years, ASA II-III) undergoing elective non-cardiac surgery at Arifin Achmad Regional General Hospital, Indonesia. Patients were recruited via consecutive sampling and allocated to receive maintenance anesthesia with either Sevoflurane (n=20) or Isoflurane (n=20) according to standard clinical protocols. Cognitive function was assessed preoperatively and at 72 hours postoperatively using the Montreal Cognitive Assessment-Indonesian Version (MoCA-INA). The primary outcome was the magnitude of cognitive change (Delta score) and the incidence of cognitive decline.
Results: Baseline characteristics were homogenous (p > 0.05). The Sevoflurane group exhibited a non-significant trend toward decline (Pre: 26.85 ± 1.09 vs. Post: 26.45 ± 1.28; p = 0.057) with a mean delta of 0.40. Conversely, the Isoflurane group demonstrated a statistically significant deterioration (Pre: 26.90 ± 1.07 vs. Post: 25.90 ± 1.55; p = 0.008) with a mean delta of 1.00. The magnitude of decline was significantly greater in the Isoflurane group (p = 0.026). The incidence of early cognitive decline was 25% for Isoflurane versus 10% for Sevoflurane.
Conclusion: Isoflurane anesthesia is associated with a greater magnitude of early postoperative cognitive decline compared to Sevoflurane in geriatric patients. While Sevoflurane is not devoid of cognitive impact, it appears to offer a superior safety profile for early neurocognitive recovery. These findings suggest Sevoflurane may be the preferable agent for geriatric anesthesia in settings where newer agents like Desflurane are unavailable
Syzygium aromaticum (L.) Merr. & L.M. Perry Extract Restores Immune Homeostasis and Accelerates Healing in MRSA-Infected Wounds: A Mechanistic In Vivo Study via Downregulation of TNF-α, CRP, and IL-10
Full text linkBackground: The rise of Methicillin-Resistant Staphylococcus aureus (MRSA) in surgical site infections necessitates the development of non-resistant therapeutic adjuvants. Syzygium aromaticum (Clove) possesses known antimicrobial properties, yet its specific immunomodulatory effects on the MRSA-induced cytokine storm and wound chronicity remain under-characterized. This study investigated the efficacy of a standardized ethanolic extract of S. aromaticum flower buds in modulating the inflammatory milieu and accelerating wound repair.
Methods: A true experimental study was conducted using 30 male Wistar rats with MRSA-infected dorsal excision wounds. Subjects were randomized into six groups (n=5): Normal Control (K1), Negative Control (MRSA+Vehicle, K2), Positive Control (MRSA+Vancomycin, K3), and treatment groups receiving 25 mg (P1), 50 mg (P2), and 100 mg/200g BW (P3) of extract orally for 10 days. The extract was characterized via HPLC. Serum TNF-α, CRP, and IL-10 were quantified by ELISA. Secondary outcomes included bacterial load reduction and macroscopic wound contraction rates.
Results: HPLC analysis confirmed eugenol (68.4%) and β-caryophyllene (12.1%) as major constituents. MRSA infection (K2) provoked a severe inflammatory state (TNF-α: 17.92 ± 0.42 pg/mL; IL-10: 110.21 ± 2.72 pg/mL). The 100 mg extract dose (P3) significantly suppressed TNF-α (7.40 ± 0.48 pg/mL, p<0.001) and normalized IL-10 (49.92 ± 2.56 pg/mL), demonstrating non-inferiority to Vancomycin (p=1.000). Bacterial load was reduced by 4 log units (1.2 × 10³ vs 5.8 × 10⁷ CFU/g).
Conclusion: Standardized S. aromaticum extract functions as a potent immunomodulator, resolving MRSA-induced inflammation by balancing pro- and anti-inflammatory cytokines, thereby facilitating the transition from the inflammatory to the proliferative phase of healing
Intracrine Dynamics of Luminal Breast Cancer: Correlating Intratumoral Estradiol with Estrogen Receptor Alpha Overexpression in an Advanced-Stage Cohort
Full text linkBackground: In postmenopausal breast cancer, systemic serum estradiol levels often fail to reflect the biologically active concentrations within the tumor microenvironment, a phenomenon known as intracrineology. While the roles of estrogen receptor alpha (ERα) and beta (ERβ) are well-characterized, the specific relationship between local ligand concentration and receptor expression in advanced-stage malignancies remains under-investigated. This study investigates the correlation between intratumoral estradiol (E2) concentration and the expression of ER isoforms in Luminal A and Luminal B subtypes.
Methods: A retrospective cross-sectional study was conducted on 56 tissue samples (38 Luminal A, 18 Luminal B) from patients at Dr. Moewardi Regional General Hospital, Indonesia. Pre-analytical variables were strictly controlled, ensuring cold ischemia time was less than one hour. Expressions of E2, ERα, and ERβ were quantified using immunohistochemistry and assessed via H-Scores. Due to non-normal data distribution, associations were analyzed using Spearman’s Rho and Generalized Linear Models (GLM) with a Gamma distribution and log-link function, coupled with bootstrapping to generate robust confidence intervals.
Results: The cohort was characterized by advanced disease, with 85.7% of patients presenting with Stage III or IV breast cancer. Luminal A tumors exhibited significantly higher mean intratumoral E2 (91.58 versus 56.67; p = 0.038) and ERα expression (122.23 versus 109.72; p = 0.045) compared to Luminal B. A significant positive correlation was observed between tissue E2 and ERα (Rho = 0.347; p = 0.009). GLM analysis confirmed E2 as a significant predictor of ERα expression (p = 0.015), independent of age and stage. No significant correlation was found between E2 and ERβ (p = 0.113).
Conclusion: Intratumoral estradiol is a significant positive correlate of ERα expression in luminal breast cancer, supporting the existence of a ligand-driven autocrine maintenance loop even in advanced stages. The lack of correlation with ERβ suggests divergent regulatory mechanisms. These findings reinforce the rationale for therapies targeting local aromatase activity
Navigating Diagnostic Constraints in Pediatric Herpes Simplex Encephalitis: Successful Empirical Acyclovir Therapy without PCR Confirmation
Full text linkBackground: Herpes simplex encephalitis is an acute or subacute disease associated with focal or global cerebral dysfunction caused by herpes simplex virus type 1 or type 2. Without adequate antiviral administration, the mortality rate reaches 70 percent, with only 9 percent of survivors returning to normal function. While cerebrospinal fluid polymerase chain reaction testing is the gold standard for diagnosis, its availability is severely restricted in resource-limited clinical environments.
Case presentation: We report the case of a 4-year-old girl who presented with a profoundly decreased level of consciousness following a five-day history of fluctuating fever. Physical examination revealed a soporific state with a Glasgow Coma Scale of E4V1M1. Initial non-contrast computed tomography of the head was unremarkable. Cerebrospinal fluid analysis demonstrated a mononuclear pleocytosis. Despite the lack of polymerase chain reaction confirmation and the absence of advanced electrophysiological monitoring, the patient was empirically diagnosed with herpes simplex encephalitis based on clinical deterioration and cerebrospinal fluid findings. Immediate management included intravenous acyclovir, dexamethasone, phenobarbital, and supportive care. The patient demonstrated significant clinical improvement and was discharged on day 24 without severe immediate neurological deficits.
Conclusion: The absence of molecular diagnostics and advanced neuro-monitoring must not delay the administration of intravenous acyclovir in pediatric patients exhibiting fever and altered mental status. Empirical antiviral intervention remains the most critical determinant of survival and neurological recovery
Efficacy, Safety, and Long-Term Continuation of Vaginal Pessaries for Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis
Full text linkBackground: Pelvic organ prolapse (POP) represents a profound failure of pelvic floor anatomy, significantly impairing patient quality of life through complex functional and anatomical derangements. Vaginal pessaries stand as the primary conservative intervention. However, the contemporary literature remains fragmented regarding their long-term adherence kinetics and comparative pathophysiological efficacy against definitive surgical reconstruction.
Methods: A systematic review and meta-analysis were conducted, adhering strictly to PRISMA 2020 guidelines. Major scientific databases, including PubMed, Scopus, and Cochrane CENTRAL, were systematically searched for randomized controlled trials and prospective cohorts published between 2016 and 2026. Data synthesis employed a random-effects model, calculating Standardized Mean Differences (SMD) for validated symptom scores and pooled prevalence for longitudinal continuation and adverse events.
Results: Seven major studies comprising 2,772 participants were included. The pooled short-term continuation rate under twelve months was 76.6% (95% CI 68.2–85.0%), which demonstrated a predictable decline to 53.4% (95% CI 45.1–61.7%) beyond one year. Meta-analysis of validated symptom scores (PFDI-20) demonstrated a robust, transformative reduction in prolapse distress (SMD -1.24; 95% CI -1.56 to -0.92, p < 0.0001), showing statistical equivalence to surgical outcomes in advanced prolapse cohorts. Adverse events were uniformly mild, dominated by vaginal discharge (pooled prevalence 18.6%) and occult stress incontinence (11.4%).
Conclusion: Vaginal pessaries provide a high magnitude of pathophysiological symptom relief that parallels surgical correction in the short to medium term. By biomechanically restoring the pelvic axes, pessaries neutralize visceral nerve traction. While long-term continuation inevitably declines due to behavioral fatigue, the superior safety profile establishes pessaries as a definitive therapeutic modality
Eosinophilic Pustular Folliculitis Mimicking Varicella: A Diagnostic Challenge in an Adolescent Patient
Full text linkBackground: Eosinophilic pustular folliculitis (EPF), or Ofuji disease, is a rare non-infectious inflammatory dermatosis typically affecting middle-aged adults. Its clinical resemblance to infectious exanthems often leads to significant diagnostic delays, particularly in atypical age groups.
Case presentation: A 15-year-old male presented with a one-month history of progressive erythematous papules, pustules, and crusted erosions distributed across the face, trunk, and extremities. The patient was initially misdiagnosed with varicella and treated with acyclovir without clinical response. Physical examination and Gram staining ruled out primary bacterial infections. Laboratory investigations revealed significant peripheral eosinophilia (12.3%). A 5-mm punch biopsy confirmed the diagnosis, showing dense eosinophilic and neutrophilic infiltration of the hair follicles and peri-adnexal structures. Management with systemic and topical corticosteroids led to rapid resolution of lesions and normalization of eosinophil levels.
Conclusion: This case underscores the necessity of considering EPF in the differential diagnosis of persistent papulopustular eruptions in adolescents. Early histopathological intervention is critical to prevent unnecessary antimicrobial therapy and ensure targeted anti-inflammatory treatment. 
The Large-Mass Phenotype of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): A Clinicopathological Analysis of 37 Cases in Indonesia Using WHO 2021 and Modified Stanford Criteria
Full text linkBackground: Uterine smooth muscle tumor of uncertain malignant potential (STUMP) presents a diagnostic dilemma, especially in Southeast Asian populations, where delayed presentation often leads to advanced tumor burden. This study aimed to characterize the clinicopathological profile of STUMP in Indonesia using the 2021 WHO Classification and modified Stanford parameters.
Methods: A descriptive study analyzed 37 STUMP cases diagnosed between 2023 and 2025 at a tertiary referral center in West Sumatra. A panel of pathologists re-evaluated archival slides for atypia, mitotic activity, necrosis, and growth patterns, establishing inter-observer reliability. Fisher’s Exact Test was employed to correlate tumor size with morphological markers of aggression.
Results: The cohort demonstrated a distinct large-mass phenotype, with 54.1% of tumors exceeding 10 cm and a median diameter of 14.5 cm. Pathological review classified 56.8% of cases into WHO Group 4 (atypia with ambiguous mitosis). A statistically significant correlation was identified between tumor size >10 cm and the presence of infiltrative growth margins (81.1%; p=0.034).
Conclusion: Indonesian STUMP cases are distinctively characterized by massive size and high rates of infiltrative growth, likely driven by prolonged natural history. The prevalence of ambiguous mitotic figures underscores the utility of the WHO Group 4 category in resource-limited settings. These findings advocate for aggressive surgical management and wider resection margins in large-mass variants to mitigate local recurrence risk
Prognostic Significance of the Epithelial–Mesenchymal Transition Phenotype in Basal Cell Carcinoma: A Meta-Analysis of E-Cadherin Loss and Stromal Alpha-SMA Upregulation as Recurrence Predictors
Full text linkBackground: Basal cell carcinoma represents the most prevalent cutaneous malignancy worldwide. While metastasis is rare, local recurrence poses a substantial therapeutic challenge, particularly in the anatomically critical H-zone of the face. Conventional risk stratification relies on tumor size and histological subtype, but these markers frequently fail to capture the intrinsic biological aggressiveness of the tumor. The epithelial–mesenchymal transition phenotype, characterized by the loss of epithelial adhesion molecule E-cadherin and the activation of the tumor stroma via alpha-smooth muscle actin expression, has emerged as a potential driver of local invasion.
Methods: We conducted a systematic review and meta-analysis adhering to PRISMA 2020 guidelines to evaluate the prognostic value of these biomarkers. A comprehensive search identified ten pivotal studies comprising 648 cases. The primary endpoint was adverse outcome, defined as clinical recurrence or the presence of high-risk infiltrative histology. Data were synthesized using a random-effects model to calculate pooled Odds Ratios and Standardized Mean Differences, with rigorous sensitivity analyses to account for heterogeneity.
Results: The meta-analysis revealed a profound association between stromal activation and adverse outcomes. Alpha-SMA upregulation was the most robust predictor, with a pooled Odds Ratio of 6.82 (95% CI: 3.14–14.81; p < 0.0001). Loss of membranous E-cadherin also significantly predicted recurrence (Odds Ratio = 4.15; 95% CI: 1.89–9.10; p = 0.0004), although with higher heterogeneity, reflecting the focal nature of partial epithelial–mesenchymal transition at the invasive front. The combined phenotype of high alpha-SMA and low E-Cadherin represented the highest risk profile.
Conclusion: The epithelial–mesenchymal transition phenotype serves as a high-fidelity predictor of basal cell carcinoma recurrence. Stromal alpha-SMA marks a permissive soil for invasion and should be considered for integration into pathological reporting for ambiguous or high-risk tumors to guide surgical margin management
Metabolic Dysfunction Precedes Dopaminergic Loss in Early MSA-C: A Discordant 18F-FDG PET and 99mTc-TRODAT-1 Case Study
Full text linkBackground: Differentiating early-stage multiple system atrophy-cerebellar type (MSA-C) from other ataxia syndromes presents a significant diagnostic challenge. While striatal dopaminergic denervation is a hallmark of synucleinopathies, it may be absent in the early stages of the cerebellar subtype. This study investigates the temporal dissociation between metabolic and dopaminergic biomarkers.
Case Presentation: We report a 48-year-old male presenting with a 5-year history of progressive cerebellar ataxia and mild Parkinsonism, resistant to dopaminergic therapy. Written informed consent was obtained from the patient for the publication of this case details and images. To exclude mimics, a basic metabolic workup and High-resolution 3T MRI were performed. MRI revealed mild cerebellar atrophy but lacked the specific hot cross bun sign. Wilson’s disease screening was negative. Due to limited resources, advanced genetic panels for spinocerebellar ataxias were not performed. The patient underwent dual-modality molecular imaging. On Day 1, 18F-FDG PET/CT demonstrated profound hypometabolism in the cerebellum (Cerebellum/Whole-Brain SUVr: 0.68) and pons (SUVr: 0.72). Conversely, on Day 30, 99mTc-TRODAT-1 SPECT revealed robust, symmetrical striatal uptake with Specific Binding Ratios (SBR) of 1.15 (Right) and 1.12 (Left), indicating preserved presynaptic dopamine transporter density.
Conclusion: This case illustrates a critical temporal dissociation in MSA-C pathophysiology: widespread pontocerebellar metabolic failure occurs prior to structural nigrostriatal degeneration. Clinicians must recognize that a normal DAT scan does not exclude MSA-C. In limited-resource settings where genetic testing is unavailable, 18F-FDG PET offers superior sensitivity in the early diagnostic window to support the diagnosis
Axial Length as the Primary Determinant of Refractive Severity in High Myopia: A Swept-Source OCT Analysis
Full text linkBackground: The escalating prevalence of high myopia represents a critical global health crisis, particularly in Southeast Asia. This pathological refractive status is driven by complex structural changes, primarily axial elongation, which predisposes the eye to sight-threatening complications. While the dominance of axial length in myopia is established, the compensatory role of the anterior segment—specifically whether the cornea or anterior chamber undergoes adaptive morphological changes to counteract elongation—remains a subject of debate. This study utilized high-resolution Swept-Source Optical Coherence Tomography (SS-OCT) to precisely quantify the relationship between Spherical Equivalent (SE) and ocular biometric parameters, isolating the specific contributions of posterior segment elongation versus anterior segment adaptation.
Methods: This observational analytic study with a cross-sectional design was conducted at the Ophthalmology Clinic of Dr. M. Djamil General Hospital, Padang, Indonesia. The study recruited patients aged 18–40 years diagnosed with high myopia (SE defined as -6.00 Diopters or worse). Strict exclusion criteria were applied to eliminate confounding anterior segment pathologies. Ocular biometry was performed using the IOLMaster 700, which employs Swept-Source OCT technology for full-eye length tomography. We analyzed Axial Length (AL), Mean Keratometry (K), Central Corneal Thickness (CCT), and Anterior Chamber Depth (ACD). Statistical analysis utilized Pearson and Spearman correlation tests and linear regression modelling.
Results: A total of 32 eyes from 32 high myopia patients were analyzed. The mean SE was -8.14 plus or minus 2.09 D, and the mean AL was 26.93 plus or minus 1.92 mm. We found a robust, statistically significant negative correlation between SE and AL (r = -0.86; p less than 0.001), confirming AL as the primary determinant of refractive severity. Notably, a moderate negative correlation was observed between AL and K (r = -0.41; p = 0.02), indicating a paradoxical corneal flattening in longer eyes. No significant correlations were found between SE and CCT or ACD.
Conclusion: Axial elongation is the predominant structural mechanism driving high myopia in this cohort. The study identified a distinct compensatory response where the cornea flattens as the eye elongates; however, this emmetropization mechanism is insufficient to neutralize the profound refractive shift caused by posterior segment expansion. These findings suggest that high myopia is a disease of focal posterior scleral remodelling rather than global ocular expansion