Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Predicting Intensive Care Admission in Children with Acute Asthma: A Meta-Analysis of Predictive Models
Get PDFBackground: Acute asthma is a common cause of pediatric emergency department visits and hospitalizations. Early identification of children at high risk of requiring intensive care unit (ICU) admission is crucial for optimal management and resource allocation. This meta-analysis aimed to evaluate the performance of predictive models for ICU admission in children presenting with acute asthma.
Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between 2013 and 2024 that developed or validated predictive models for ICU admission in children with acute asthma. Studies reporting sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were included. Methodological quality was assessed using the QUADAS-2 tool. Pooled estimates of diagnostic accuracy were calculated using a random-effects model.
Results: Six studies (n = 2,850 children) met the inclusion criteria. The predictive models included clinical features (respiratory rate, oxygen saturation, accessory muscle use), lung function measures (peak expiratory flow rate), and blood gas analysis. Pooled sensitivity ranged from 0.71 (95% CI 0.59-0.82) to 0.78 (95% CI 0.72-0.83), specificity from 0.79 (95% CI 0.75-0.83) to 0.86 (95% CI 0.78-0.91), and AUROC from 0.79 (95% CI 0.72-0.86) to 0.88 (95% CI 0.84-0.92).
Conclusion: Several predictive models demonstrate moderate to high accuracy in identifying children with acute asthma at risk of ICU admission. However, heterogeneity in model performance highlights the need for further research to validate existing models in diverse populations and develop more robust tools to guide clinical decision-making
Intraoperative Frozen Section Diagnosis of Adenoid Cystic Carcinoma of the Minor Salivary Gland: A Case Report
Get PDFBackground: Adenoid cystic carcinoma (ACC) is a rare malignant tumor of the salivary glands known for its slow growth, invasive behavior, and propensity for perineural invasion. The diagnosis of ACC can be challenging, especially during intraoperative frozen section consultation. This case report highlights the crucial role of frozen section diagnosis in guiding surgical management and ensuring tumor-free margins, which are critical for patient prognosis.
Case presentation: A 44-year-old male presented with a slow-growing, occasionally painful nodule on his upper lip, without facial numbness or other systemic symptoms. A frozen section examination was performed intraoperatively to assess the lesion and determine the margin status. The frozen section revealed malignancy, characterized by tumor cell proliferation in tubular, cribriform, and solid patterns, all hallmarks of ACC, along with perineural invasion. A wide excision was performed, and subsequent frozen sections of the surgical margins confirmed they were free of tumor. The diagnosis of ACC was confirmed on histopathological examination of the paraffin block.
Conclusion: This case underscores the importance of frozen section diagnosis in the management of ACC of the minor salivary glands. The accurate assessment of the lesion and margin status during surgery allows for appropriate surgical decision-making, ensuring complete tumor removal and minimizing the risk of recurrence
Gut Microbiota in Chronic Kidney Disease: A Narrative Literature Review
Get PDFChronic kidney disease (CKD) is a growing public health problem related to loss of kidney function and cardiovascular disease as the main causes of morbidity and mortality in CKD. It is known that CKD is associated with intestinal dysbiosis. There is an influence of the gut microbiota on the gut-kidney axis and it works reciprocally: on the one hand, CKD significantly changes the composition and function of the gut microbiota. On the other hand, gut microbiota is able to manipulate the processes that cause the emergence and progression of CKD through inflammatory, endocrine and neurological pathways. Understanding the complex interactions between gut and kidney microbiota may provide novel nephroprotective interventions to prevent the progression of CKD by therapeutically targeting balance of gut microbiota composition
Spinal Anesthesia with Ultrasonography (USG) Marker in Morbidly Obese Pregnant Women Undergoing Cesarean Section Surgery: A Case Report
Get PDFBackground: Spinal anesthesia is a regional anesthesia technique used to provide analgesia or numbness in the lower part of the body. This technique has long been employed in childbirth and cesarean section surgeries due to its numerous advantages for pregnant women. Obese pregnant patients often have increased adipose tissue in the back area, making it challenging to identify the appropriate interspinous space.
Case presentation: A 26-year-old primigravida at 38 weeks of gestation with morbid obesity, standing at 158 cm tall and weighing 140 kg, with a body mass index (BMI) of 56.1 kg/m², underwent cesarean section surgery under spinal anesthesia. The identification of the spinal needle insertion site was performed using pre-procedural ultrasound (USG) marker at the L3-L4 level, with heavy bupivacaine 0.5% 12.5 mg used as the anesthetic agent. The surgery lasted for 1 hour and 20 minutes, with stable hemodynamics and a blood loss of 450 ml. A female infant was delivered, weighing 3080 grams, with a length of 50 cm and an APGAR score of 8-9-10.
Conclusion: The use of USG markers can assist in determining the precise location for spinal anesthesia injection, thereby reducing complications from repeated needle insertions
Correlation of Soluble Programmed Death Ligand-1 (sPD-L1) with Alpha-Fetoprotein Levels as a Predictor of Prognosis in Hepatocellular Carcinoma Patients
Get PDFBackground: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and one of the leading causes of cancer death worldwide. Chronic hepatitis B virus infection is the most common etiology of HCC. Programmed death ligand-1 (PD-L1) is a protein that is overexpressed on the surface of tumor cells, which can be detected in serum (sPD-L1). Elevated sPD-L1 concentrations in the plasma of cancer patients are associated with poor prognosis in HCC patients, as indicated by increased AFP levels. There have been no previous studies examining the correlation of sPD-L1 levels with AFP in HCC patients. The aim of the study was to determine the correlation of sPD-L1 and AFP as predictors of prognosis in HCC patients.
Methods: The research is an observational study with a cross-sectional design to see the correlation of sPD-L 1 with serum alpha-fetoprotein levels in HCC patients at Dr. Mohammad Hoesin General Hospital Palembang starts from April to July 2023. Measurement of sPD-L1 levels and serum AFP levels is carried out using ELISA examination.
Results: Of the 28 subjects studied, HCC patients were more commonly found in men (89.29%) aged 18-60 years (75%). sPD-L1 and AFP values were found to be increased in the advanced stages of HCC. The sPD-L1 value is directly proportional to the serum AFP value.
Conclusion: There is a strong positive correlation between sPD-L1 levels and serum AFP levels caused by hepatitis B in HCC patients, so the higher the sPD-L1, the higher the serum AFP levels
The Role of High Sensitivity C-Reactive Protein as an Inflammation Predictor in Cardiovascular Diseases
Get PDFInflammation can be measured by analyzing the levels of inflammatory markers, such as High Sensitivity C-reactive Protein (hs-CRP). This protein plays a crucial role as a strong independent predictor indicating the risk of cardiovascular. The hs-CRP can measure the levels of C-reactive protein with high sensitivity, making it a highly responsive marker to acute-phase inflammation. The presence of hs-CRP serves as an inflammation indicator that can predict the potential occurrence of heart attacks, strokes, peripheral artery diseases, and sudden death due to Acute Coronary Syndrome (ACS). Produced by the liver in response to inflammation, hs-CRP is nonspecific and can elevate various types of inflammation, including infections and chronic inflammatory conditions in cardiovascular. This study is a literature review using secondary data from related research. The hs-CRP has a very high sensitivity and specificity level compared to CRP as an inflammation marker. Therefore, hs-CRP serves not only as a diagnostic tool but also as a strong predictor of inflammation, capable of predicting cardiovascular risk
Analysis of Probiotic Role in Non-Alcoholic Fatty Liver Disease (NAFLD) Management: A Meta-Analysis
Get PDFBackground: Non-alcoholic fatty liver disease (NAFLD) is an increasing global health problem. Probiotics have emerged as a potential therapy for NAFLD, but evidence for their efficacy remains mixed. This meta-analysis aims to evaluate the effectiveness of probiotics in the management of NAFLD.
Methods: A comprehensive literature search was performed on PubMed, Embase, Cochrane Library, and Web of Science databases until December 2023. Randomized controlled trials (RCTs) evaluating the effects of probiotics in NAFLD patients were included. The main outcomes evaluated were changes in liver enzymes (ALT, AST), insulin resistance index (HOMA-IR), and hepatic steatosis score. Meta-analysis was performed using a random effects model, and heterogeneity was assessed using the I² statistic.
Results: Twenty-five RCTs involving 1845 patients met inclusion criteria. Meta-analysis showed that probiotics significantly reduced ALT (MD -8.45; 95% CI -12.67 to -4.23; p<0.0001) and AST (MD -6.89; 95% CI -10.11 to -3.67; p<0.0001) levels compared with placebo. Significant reductions were also observed in HOMA-IR (MD -0.68; 95% CI -1.02 to -0.34; p<0.0001) and hepatic steatosis scores (SMD -0.45; 95% CI -0.71 to -0.19; p=0.0008). Subgroup analysis showed that the effects of probiotics were more pronounced in patients with NAFLD non-alcoholic steatohepatitis (NASH) and those receiving multi-strain probiotics.
Conclusion: This meta-analysis provides strong evidence that probiotics have beneficial effects on biochemical and imaging parameters in NAFLD patients. Probiotics may be considered as an adjunct therapy for NAFLD, especially in patients with NASH. However, more research is needed to determine the optimal probiotic strain, dosage, and duration of treatment
The Impact of COVID-19 Pandemic on Vitiligo Patient Visits in Tertiary Hospital: A Retrospective Study
Get PDFBackground: Vitiligo, a common depigmenting skin disorder, has an estimated prevalence of 0.5–2% of the population worldwide. The COVID-19 pandemic lockdown measures significantly affected the readiness of vitiligo patients to contact dermatologists. The aim of this study is to describe vitiligo patient visits during a pandemic situation.
Methods: A retrospective descriptive study, using secondary data obtained from Dr. M. Djamil General Hospital Padang medical records during the period of 2019–2021.
Results: During the pandemic (2020-2021), a total of 7 in 2020 and 19 in 2021 new vitiligo patient have been consulted. The ratio of male/female for two years was 16/10. The age of group 26-24 years had more frequently visited. A total 6 patients had segmental vitiligo and 16 patients had non segmental vitiligo. A total 4 patient had unstable vitiligo. During the pandemic, there were various vitiligo therapy such as oral and topical corticosteroid, topical immunomodulator, phototherapy, and punch grafting surgery. Compare to before the pandemic situation in 2019, a total 25 new vitiligo patient have been consulted in our outpatient clinic. Compared to 2019, the number of visits decrease significantly 72% in 2020 and 24% in 2021.
Conclusion: The pandemic COVID-19 had an unprecedented impact on number of vitiligo patient visits to the tertiary hospitals. This condition may affect visits and patient compliance. There were significant reductions in the number of outpatient visits due to pandemic COVID-19
The Profile of Sinonasal Tumors with Orbital Involvement in Dr. M. Djamil General Hospital, Padang, Indonesia: A 10-Year Overview
Get PDFBackground: Sinonasal tumors are rare tumors, either malignant or benign, that vary greatly based on the origin and primary tumor location in the sinonasal tract. The close anatomical relationship between the sinonasal tract and the orbital cavity makes orbital involvement very common (50%-80%) in sinonasal tumors, and this indicates a negative prognostic factor in sinonasal malignancy. The purpose of this study is to demonstrate the profile of sinonasal tumors with orbital involvement in our center.
Methods: Retrospective study from oncology subdivision files and medical records from January 2011 – December 2020. Collected data including age, gender, the clinical manifestations of orbital involvement, primary location, histopathology, and management of sinonasal tumors.
Results: There were 35 patients examined by the oncology subdivision either directly came or consulted from the ENT department, consisting of 18 (51.4%) males and 17 (48.6%) females. The age of patients ranged from 11 to 83 years old. with the most common age groups being 41-50 and 51-60 (25.7% in each age group). The majority of the patients (77.1%) had presented with proptosis. Maxillary sinus was the most common (45.7%) primary site of tumors, and squamous cell carcinoma was the most common (51.4%) histopathology found. Most of the patients (37.1%) were treated with a combination of chemotherapy and radiotherapy.
Conclusion: Orbital involvement commonly occurs in malignant sinonasal tumors with proptosis as a major clinical presentation. A combination of chemotherapy and radiotherapy was the most common practice management because the tumors were unresectable at the time of presentation
Overview of Pelvic Ring Fracture Patients: Observational Study in the Emergency Department at Dr. Kariadi General Hospital, Semarang, Indonesia
Get PDFBackground: Although the incidence of pelvic fractures is only 7% of all trauma, the mortality reaches 21.5%. Management of pelvic fractures remains a challenge because it is often a polytrauma that requires multidisciplinary management and large resources. Knowledge of the characteristics of patients with pelvic fractures is expected to help in management and reduce mortality.
Methods: This observational study was conducted retrospectively with a population and sample of all pelvic fracture patients in the emergency room at Dr. Kariadi Hospital Semarang for the period January 2021 to December 2023. The characteristics observed included gender, age, fracture classification, etiology, trauma score, fracture pattern, and management. and output. The data obtained is then presented descriptively.
Results: A total of 34 patients with pelvic fractures were recorded in this study. There were 16 male patients and 18 female patients. A total of 3 patients were less than 17 years old, 19 patients were 17-34 years old, 7 patients were 35-52 years old and 3 patients were more than 52 years old. The most common cause of pelvic fractures was traffic accidents (KLL) with 28 patients, followed by work accidents (4 patients) and other trauma (2 patients). Based on the Young-Burgess classification, the most common pelvic fracture pattern was LC1 (11 patients), followed by APC1 (3 patients), APC2 (4 patients), APC3 (3 patients), LC2 (2 patients), LC3 (6 patients), VS (4 patients), and CM (1 patient). A total of 4 patients had an ISS score of 1-8, 8 patients had an ISS score of 9-15, 9 patients had an ISS score of 16-25, and 13 patients had an ISS score of more than 25. The most common accompanying injury was long bone fracture (15 patients), head injury in 10 patients, abdominal trauma in 9 patients, and thorax trauma in 4 patients. Operative treatment was carried out in 21 patients, while 13 other patients were treated non-operatively. Of the 34 patients, 8 patients died and 26 others were discharged in good condition.
Conclusion: Most pelvic fractures occur at the age of 17-34 years and the most common cause is KLL. All pelvic fracture patients had concomitant injuries and the majority of patients had unstable fractures that required operative treatment. Mortality due to pelvic fracture and/or accompanying injuries is 23.5%