Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Successful Management of Schizoaffective Disorder (Manic Type) in a Pregnant Woman with Electroconvulsive Therapy: A Case Report
Get PDFBackground: Schizoaffective disorder is a chronic mental health condition characterized by the presence of both psychotic and mood symptoms. Managing schizoaffective disorder during pregnancy presents unique challenges due to the potential risks of pharmacotherapy to the developing fetus. This case report describes the successful management of a pregnant woman with schizoaffective disorder (manic type) using electroconvulsive therapy (ECT).
Case presentation: A 31-year-old woman, G2P1A0 with a gestational age of 26 weeks, was admitted to the psychiatric ward with symptoms of mania and psychosis, including disorganized behavior, threats of violence, suspicious delusions, auditory hallucinations, and visual illusions. Her symptoms had worsened after discontinuation of her antipsychotic medication due to pregnancy. She was diagnosed with schizoaffective disorder, manic type. Due to the potential risks of antipsychotic medication to the fetus, ECT was initiated. The patient responded well to ECT, with a significant reduction in her manic and psychotic symptoms. She was able to continue her pregnancy safely, and delivered a healthy baby at term.
Conclusion: This case report highlights the effectiveness and safety of ECT in managing schizoaffective disorder during pregnancy. ECT can be considered a valuable treatment option for pregnant women with severe mental illness when the risks of pharmacotherapy outweigh the benefits
Surfactant Therapy in Meconium Aspiration Syndrome: A Case Report
Get PDFBackground: Meconium aspiration syndrome (MAS) is one of many causes of respiratory distress in newborns. Data regarding MAS in Indonesia is still very limited, but a study revealed MAS is related to a high mortality rate. The latest study revealed surfactant therapy is related to better clinical outcomes in MAS cases. This study aimed to present a case of a baby with meconium aspiration syndrome given bolus surfactant therapy.
Case presentation: A day-old baby was referred to our emergency department with respiratory distress, delivered by cito caesarean section due to cephalopelvic disproportion with premature rupture of membranes. The baby didn’t cry immediately; bluish skin and green amniotic fluid were found. The baby was already intubated from the referring hospital, and the physical examination revealed rales on both lungs with severe work of breath. Chest radiography revealed patchy opacities in the right lung hemisphere, suggesting MAS. Echocardiography revealed a small patent ductus arteriosus, and head ultrasonography revealed mild brain oedema. The baby received bolus bovine surfactant therapy at 16 hours of age, delivered through an endotracheal tube. Clinical improvement was observed, and supplementary oxygen was reduced gradually. The baby was able to maintain good oxygenation without supplemental oxygen by day 12th and was able to breastfeed and drink from the bottle. He was discharged with good condition.
Conclusion: Surfactant therapy can become a safe and effective treatment modality in MAS. Further study is still needed regarding time, method, and types of surfactants used in MAS management
A 56-Year-Old Man with an Unusual Projectile Trajectory of Gunshot Wound at Head and Neck Region: A Rare Case Report
Get PDFBackground: Gunshot injuries to the neck are linked to a substantial risk of high mortality and morbidity due to the presence of critical vascular and vital structures. However, there are rare instances where a bullet trajectory through the neck region avoids damaging these vital structures. In this context, we report a specific case involving a 56-year-old male who presented to the emergency department with a gunshot wound to the right maxilla through the left anterior neck region.
Case presentation: During the examination, a hematoma was observed in the left neck without an apparent entrance wound. The occurrence of a bullet injury to the neck without affecting any vital structures is exceptionally uncommon. Effectively managing patients with high-velocity penetrating injuries to the head and neck entails prioritizing tasks such as securing the airway, controlling hemorrhage, and promptly addressing any residual traumatic deformities for optimal outcomes. The presented case involves a gunshot injury to the head and neck, and a comprehensive review of the literature is provided.
Conclusion: Gunshot injuries to the head and neck are complex and serious, demanding swift and thorough medical attention. The case emphasizes the significance of post-surgery monitoring for potential complications, contributing valuable insights to the ongoing discourse on managing such injuries
Combination Procedure for Acne Scars Revision, Is It Needed?
Get PDFBackground: The treatment of acne scars is a problem for dermatologist. Varied morphology of acne scars makes the treatment more difficult. Combination technique has high efficacy than monotherapy. The challenge is how to select best combination procedure for scar revision.
Case presentation: A 43-year-old male present with acne scars since 5 years ago. Dermatological findings revealed atrophic acne scars (ice pick, boxcar, rolling) types on forehead, nose and cheeks. Diagnosis established as moderate atrophic acne scars with global acne scarring system (GASS) is 21. Patient treated with blunt canula subcision, hyaluronic acid (HA) filler, microneedling radiofrequency, 90% trichloroacetic acid chemical reconstruction of skin scars (TCA CROSS) and application of salmon polydeoxyribonucleotide (PDRN). Patient also received topical 0.05% retinoic acid, 4% niacinamide, and sunscreen for daily. After 10 days, there is flattening and disappear of ice pick and boxcar, elevating of rolling scar, GASS score is 15. Blunt cannula subcision and HA filler is safe, effective for rolling scar through fibrous band breaking and prevent re-adhesion. Microneedling RF is effective for boxcar, otherwise 90% TCA CROSS preferrable for ice pick scars. This combination procedure leading cellular necrosis in epidermis, collagen in dermis, and stimulate regeneration. Application of Salmon PDRN may promote wound healing, hydrate the epidermis, and prevent dyschromia.
Conclusion: Combination of subcision, dermal filler, microneedling radiofrequency, 90% TCA CROSS, and Salmon PDRN has high efficacy for scar revision through collagen remodelling and acceleration wound healing
Burn Wound and Traumatic Inhalation due to Marapi Volcano Eruption
Get PDFBackground. Burns can be caused by various etiologies, including heat and chemicals from volcanic eruptions. Mount Marapi was a commonly visited hiking site prior to its eruption on December 3th 2023.
Case Presentation. This case reports a 19 year old woman with severe full thickness burns, covering 40.5% of total body surface area (TBSA) with inhalation trauma caused by inhaled volcanic ash from the Mount Marapi's eruption. Airway assessment was done through bronchoscopy examination.While being treated in the burn unit, the patient's overall condition deteriorated, so the patient was moved to the intensive care unit (ICU). Severe burns usually can cause circulatory disruption and trigger systemic inflammatory responses. Meanwhile, inhalation injury and sepsis also contributes to a higher risk of death in burn patients. Burns with inhalation trauma require specific treatment procedures.
Conclusion. This study summarizes the experience of treating victim of the Mount Marapi eruption and multidisciplinary approach to achieve optimal patient care
The Role of Anti-PD 1 (Programmed Cell Death-1) (Pembrolizumab) in Hepatocellular Carcinoma: A Narrative Literature Review
Get PDFHepatocellular carcinoma (HCC) is a malignant tumor originating from liver cells, HCC occurs in around 85% of patients diagnosed with cirrhosis. Treatment options for HCC consider liver function, extrahepatic spread, invasiveness, and the number and size of nodules. HCC therapy options include surgical resection, liver transplantation, tumor ablation, transarterial therapy and systemic chemotherapy. Pembrolizumab is a second-line systemic therapy option for the treatment of HCC after sorafenib therapy. Pembrolizumab is a class of immune checkpoint inhibitors (ICIs) and more specifically works as a programmed cell death-1 (PD-1) inhibitor
Perineural Injection of Mecobalamin Versus Dextrose 5% Against Clinical Changes and Electrophysiological Features of Carpal Tunnel Syndrome Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
Get PDFBackground: Carpal tunnel syndrome (CTS) is a common compression neuropathy with symptoms of pain, tingling, and numbness in the hands. Perineural injections of steroids and mecobalamin have been shown to be effective in relieving CTS symptoms. This study aims to compare the effectiveness of the perineural injection of mecobalamin and 5% dextrose on clinical changes and electrophysiological features in CTS sufferers.
Methods: This research is a pilot study open-label randomized controlled trial conducted at Dr. Mohammad Hoesin General Hospital Palembang. A total of 24 CTS patients were randomly divided into two groups: the mecobalamin group (n=12) and the 5% dextrose group (n=12). Patients in both groups received a single perineural injection.
Results: In the mecobalamin group, there were significant improvements in pain scores (NPRS), Boston carpal tunnel questionnaire (BCTQ) - symptom severity scale (SSS), and functional status scale (FSS) after 2 weeks. In the 5% dextrose group, there were also significant improvements in pain scores and BCTQ-SSS and BCTQ-FSS scores. However, the electrophysiological picture did not change significantly after 2 weeks of perineural injection. Comparison between groups showed significant differences in NPRS, BCTQ-FSS, and sensory amplitude.
Conclusion: Perineural injection of mecobalamin and 5% dextrose is effective in improving clinical symptoms of CTS. Mecobalamin showed better effects on improving NPRS, BCTQ-SSS, and sensory conduction amplitude than 5% dextrose
Management of Thrombocytopenia with Partial Splenic Embolization in Liver Cirrhosis
Get PDFThrombocytopenia is a frequent complication in patients with cirrhosis. Thrombocytopenia is generally divided into mild, moderate, and severe thrombocytopenia. Thrombocytopenia in liver cirrhosis not only increases the risk of bleeding during surgery but can also have an impact on patient management, such as liver biopsy, administration of antiviral therapy, and postponement of elective surgery. The pathophysiology of thrombocytopenia in chronic liver disease can be caused by decreased platelet production, sequestration in the spleen, and increased platelet destruction. Partial splenic embolization (PSE) is one option for treating thrombocytopenia in chronic liver disease. PSE is an effective procedure in treating complications associated with hypersplenism and portal hypertension, such as esophageal varices, pancytopenia, portal hypertensive gastropathy and ascites
A Case Report of 80-Year-Old Male with Total Atrioventricular Block, Acute Decompensated Heart Failure, and Non-ST-Elevation Myocardial Infarction Very High Risk: A Complicated Case in Limited Resources Setting
Get PDFBackground: Cardiovascular disease is still a major problem globally, with high morbidity and mortality rates. The progression of cardiovascular disease is so dynamic that it can leave the patient in a terminal condition. Given the high mortality and morbidity accompanied by rapid disease progression, understanding the appropriate management of each patient with comorbid heart disease is very important.
Case presentation: We report an 80-year-old male with TAVB (Total Atrioventricular Block), ADHF (Acute Decompensated Heart Failure), and NSTEMI (Non-ST-Elevation Myocardial Infarction). The patient was treated and stabilized intensively in our center based on protocol. Due to the rapid progression of the disease, we referred the patient to the tertiary hospital in Bali for further advanced treatment.
Conclusion: The mortality rate in cases of cardiovascular diseases is relatively high, requiring rapid and adequate treatment to provide better clinical outcomes
Invasive Mammary Paget’s Disease Without Underlying Malignancy: A Case Report
Get PDFBackground: Mammary Paget's disease (MPD) with skin invasion is a rare condition that is often associated with an underlying malignancy. However, invasive MPD without malignancy is even rarer and often misdiagnosed.
Case presentation: This report presents the case of a 56-year-old woman who presented with a progressively enlarging scaly erythematous plaque on her left nipple for 6 months. Dermoscopy and histopathological examination confirmed the diagnosis of invasive MPD, but radiological examination did not reveal any malignancy.
Conclusion: Invasive MPD without malignancy is a rare but important entity to recognize. Awareness of this condition can help prevent overdiagnosis and unnecessary treatment