Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Systemic Metastase in Late Management of Group D Retinoblastoma: A Case Report
Get PDFBackground: Retinoblastoma (RB) is a common malignancy that affects children and is fatal if left untreated. This case report aims to raise awareness the importance of starting therapy immediately in RB patients.
Case presentation: A girl aged 1 year 9 months, came with complaints that her left eye (LE) appeared white for 2 weeks. Anterior segment examination was normal. On funduscopic examination, optic nerve was difficult to evaluate, covered by a mass, multiple mass scars on the retina, a size of > 6 mm at the posterior pole, and vitreous seeding. Ultrasound examination and CT scan showed an intraocular mass with calcification. The patient was diagnosed with group D intraocular LE RB and was planned for enucleation but was postponed due to cost constraints. The patient came back after 1 year and was diagnosed with extraocular LE RB stage IVB.
Conclusion: Early diagnosis without adequate therapy leads to tumor spread and reduces patient survival
A Rare Primary Breast Angiosarcoma with Bone Metastasis: A Case Report
Get PDFBackground: Angiosarcoma is a rare and aggressive malignant tumor originating from endothelial cells. Primary breast angiosarcoma (PBA) is exceedingly uncommon, accounting for less than 1% of all breast malignancies. Bone metastasis from PBA is even rarer, making it a unique clinical entity.
Case presentation: We present the case of a 37-year-old woman who initially presented with a rapidly enlarging breast mass. A biopsy confirmed the diagnosis of PBA, and she underwent a modified radical mastectomy followed by radiotherapy. Seventeen months later, she developed progressive lower extremity weakness and urinary and bowel incontinence. Imaging revealed a spinal metastasis at the Th4-Th6 level. Biopsy and immunohistochemistry confirmed metastatic angiosarcoma. The patient underwent laminectomy and posterior stabilization.
Conclusion: This case highlights the rarity and aggressive nature of PBA with bone metastasis. It emphasizes the importance of early detection, comprehensive treatment, and long-term surveillance in managing this challenging disease. Further research is needed to understand the underlying mechanisms and develop effective therapeutic strategies for PBA with bone metastasis
Analysis of Risk Factors and The Impact of Nitric Oxide (NO) and Carbon Monoxide (CO) Levels on Lung Function: A Comparative Study of Palm Oil Factory Workers and the Community in Kuantan Mudik District, Riau, Indonesia
Get PDFBackground: Air pollution, particularly from industrial sources like palm oil factories, poses a significant risk to respiratory health. This study aimed to investigate the impact of nitric oxide (NO) and carbon monoxide (CO) exposure on lung function in palm oil factory workers and compare it to the lung function of individuals in the surrounding community.
Methods: A cross-sectional study was conducted in Kuantan Mudik District, Riau, Indonesia. One hundred palm oil factory workers with a minimum of two years of employment and 100 community members not occupationally exposed to NO and CO were recruited. Lung function was assessed using spirometry, and NO and CO levels were measured using specialized analyzers. Participants completed the European Community Respiratory Health Survey (ECRHS) questionnaire, and demographic and clinical data were collected. Statistical analyses included univariate, bivariate, and multivariate logistic regression.
Results: Factory workers exhibited significantly higher levels of NO (p=0.000) and a higher prevalence of restrictive lung function (17%) compared to the community members (3%). Multivariate analysis identified NO exposure as the most significant risk factor for restrictive lung function (p=0.005). Each unit increase in NO was associated with a 1.12-fold increased risk of restrictive lung function. CO exposure, age, gender, smoking history, and the use of personal protective equipment (PPE) were not significantly associated with lung function impairment in this study.
Conclusion: Occupational exposure to NO in palm oil factories is a significant risk factor for restrictive lung function impairment. Regular monitoring of NO levels and the implementation of effective control measures are crucial to protect the respiratory health of palm oil factory workers
Concurrent Hiatal Hernia, Gastric Polyp, and Lupus Nephritis in an Adolescent: A Case Report
Get PDFBackground: The coexistence of hiatal hernia (HH), gastric polyp, and lupus nephritis in an adolescent patient presents a unique clinical challenge, demanding a multidisciplinary approach to diagnosis and management. This case report aims to highlight the complexities involved in addressing these concurrent conditions and their implications for patient care.
Case presentation: A 16-year-old girl with a history of systemic lupus erythematosus (SLE) and lupus nephritis presented with recurrent abdominal pain. Esophagogastroduodenoscopy (EGD) revealed a hiatal hernia and an esophageal polyp. The patient underwent laparoscopic gastrofundoplication for the hiatal hernia, and the polyp was subsequently removed via polypectomy. Histopathological examination confirmed a hyperplastic gastric polyp. The patient's postoperative course was complicated by electrolyte imbalances and dysphagia, which were managed successfully.
Conclusion: This case underscores the importance of a thorough diagnostic workup in adolescents with SLE presenting with gastrointestinal symptoms. The concurrent presence of HH, gastric polyp, and lupus nephritis necessitates a multidisciplinary approach involving gastroenterologists, surgeons, rheumatologists, and other specialists. Careful attention to potential complications, such as electrolyte imbalances and dysphagia, is crucial for optimal patient outcomes
Recurrent Dermatofibrosarcoma Protuberans with Fibrosarcomatous Transformation: A Case Report
Get PDFBackground: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma with a propensity for local recurrence but a low risk of distant metastasis. Fibrosarcomatous transformation (FS-DFSP) is a rare but aggressive variant associated with increased metastatic potential.
Case presentation: We present the case of a 39-year-old male with recurrent DFSP involving the scalp, mandible, and humerus, complicated by fibrosarcomatous transformation and distant metastases to the lungs and bones. The patient underwent multiple excisions, radiation therapy, and systemic treatments including chemotherapy and imatinib, but ultimately experienced disease progression.
Conclusion: This case highlights the challenges in managing recurrent DFSP with fibrosarcomatous transformation. The rarity of this entity necessitates a high index of suspicion for early diagnosis and aggressive multidisciplinary management to improve patient outcomes. Further research is needed to identify effective treatment strategies for this aggressive variant of DFSP
Folic Acid Supplementation for Blood Pressure Reduction in Hypertension: A Meta-Analysis
Get PDFBackground: Hypertension is a major risk factor for cardiovascular disease. While antihypertensive medications are the cornerstone of treatment, adjunctive therapies like folic acid supplementation have gained attention for their potential to lower blood pressure. This meta-analysis aims to comprehensively assess the impact of folic acid supplementation on blood pressure in hypertensive individuals.
Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library) was conducted from January 2018 to December 2023 to identify randomized controlled trials (RCTs) evaluating the effect of folic acid supplementation on blood pressure in adults with hypertension. Data on systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were extracted. A random-effects model was used to pool data, and heterogeneity was assessed using the I² statistic.
Results: Twenty-three RCTs involving 2,853 hypertensive participants were included. Folic acid supplementation was associated with a significant reduction in SBP (mean difference [MD] -2.93 mmHg, 95% confidence interval [CI] -4.11 to -1.75, p < 0.00001), DBP (MD -1.87 mmHg, 95% CI -2.63 to -1.11, p < 0.00001), and MAP (MD -2.21 mmHg, 95% CI -3.01 to -1.41, p < 0.00001) compared to placebo or control. Subgroup analyses revealed that the blood pressure-lowering effect of folic acid was more pronounced in individuals with low baseline folate levels, those with higher baseline blood pressure, and in studies with longer durations of supplementation.
Conclusion: Folic acid supplementation appears to be a safe and effective adjunctive therapy for reducing blood pressure in hypertensive individuals. These findings support the potential role of folic acid in improving cardiovascular outcomes in this population
Hydropneumothorax Secondary to Community-Acquired Pneumonia with Broncholith: A Case Report
Get PDFBackground: Community-acquired pneumonia (CAP) is a common respiratory infection that can lead to serious complications, including hydropneumothorax, a condition characterized by the presence of both air and fluid in the pleural cavity.
Case presentation: We present the case of a 76-year-old male who presented to the emergency department with a one-week history of shortness of breath, dry cough, and low-grade fever. He had no prior surgeries, history of tuberculosis, comorbid conditions, or significant pulmonary diseases. Physical examination revealed crackles, decreased breath sounds on auscultation, and hyperresonance on percussion of the right hemithorax. Laboratory investigations demonstrated leukocytosis and neutrophilia. Chest radiography showed consolidation consistent with pneumonia, and subsequent computed tomography (CT) confirmed the diagnosis of right hydropneumothorax with pleural effusion and a broncholith in the right basal lobar bronchus. The patient was treated with intravenous antibiotics and underwent water seal drainage (WSD). He made a full recovery and was discharged home.
Conclusion: This case highlights the importance of considering hydropneumothorax as a potential complication of CAP, even in patients without significant comorbidities. Prompt diagnosis and management, including drainage and antibiotics, are crucial for a favorable outcome
Hyponatremia After Intracranial Hemorrhage: Cerebral Salt Wasting Syndrome (CSWS) or The Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?
Get PDFBackground: Hyponatremia is a common electrolyte disorder encountered in neurosurgical patients, often associated with significant morbidity and mortality. This case report highlights the importance of recognizing and appropriately managing cerebral salt wasting syndrome (CSWS), a rare but important cause of hyponatremia in neurosurgical patients, often following intracranial hemorrhage (ICH). Distinguishing CSWS from the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is crucial for appropriate management.
Case presentation: A 56-year-old male with a history of hypertension and diabetes mellitus presented with sudden-onset left-sided weakness and decreased consciousness following an ICH. He underwent a ventriculoperitoneal (VP) shunt placement for hydrocephalus. Post-operatively, he developed hyponatremia with elevated urine sodium levels and hypovolemia, suggestive of CSWS. The patient was treated with fluid replacement therapy, including hypertonic saline, and desmopressin, resulting in improvement in his hyponatremia.
Conclusion: CSWS is an important cause of hyponatremia in neurosurgical patients. Prompt diagnosis and appropriate management, including fluid replacement and potentially desmopressin, can improve patient outcomes. This case underscores the need for a high index of suspicion for CSWS in neurosurgical patients presenting with hyponatremia and highlights the importance of careful monitoring and individualized treatment strategies
Early Ischemic Stroke Assessment with ASPECTS: A Case Report Highlighting the Radiologist's Role in a Limited-Resource Setting
Get PDFBackground: Ischemic stroke is a leading cause of morbidity and mortality globally, particularly in resource-limited settings. Non-contrast computed tomography (NCCT) is often the primary imaging modality available in these settings, and the Alberta Stroke Program Early CT Score (ASPECTS) is a crucial tool for assessing early ischemic changes in NCCT. This case report highlights the importance of ASPECTS in guiding clinical decisions and prognostication in a resource-limited setting.
Case presentation: A 79-year-old male presented to the emergency unit at Negara General Hospital, a rural facility in Bali, with acute onset of right-sided hemiparesis and speech difficulty. NCCT showed a hypodense lesion with ill-defined margins in the left insular cortex, left caudate nucleus, left internal capsule, and left frontotemporoparietal lobes, consistent with a subacute cerebral infarction in the middle cerebral artery (MCA) territory, with an ASPECTS score of 2. Due to the extensive ischemic burden and the limited availability of advanced treatment options, conservative management was chosen. The radiologist's interpretation of the ASPECTS score played a critical role in guiding the clinical team's decision-making and informing the patient's family about the prognosis.
Conclusion: ASPECTS is an essential tool for predicting stroke outcomes, with lower scores correlating with larger infarct volumes and poorer prognoses. In resource-limited settings, radiologists play a vital role in interpreting ASPECTS scores to guide clinical management and provide accurate prognostic information to patients and their families
Challenges in the Management of Hypertrophic Pyloric Stenosis in a Malnourished Infant with Pulmonary Tuberculosis: A Case Report
Get PDFBackground: Hypertrophic pyloric stenosis (HPS) is a common cause of gastric outlet obstruction in infants, but its management can be challenging in the presence of comorbidities like malnutrition and pulmonary tuberculosis (PTB). This case report highlights the complexities and considerations in managing an infant with HPS, PTB, and severe malnutrition.
Case presentation: A 6-month-old male infant presented with lethargy, recurrent vomiting, and failure to thrive. He had a history of PTB on anti-tuberculosis treatment and was severely malnourished. Investigations revealed HPS, and he underwent a pyloromyotomy. Postoperatively, he required careful fluid management, nutritional support, and continued anti-tuberculosis therapy.
Conclusion: This case highlights the challenges in managing HPS in an infant with PTB and severe malnutrition. It underscores the importance of a multidisciplinary approach involving pediatricians, surgeons, and nutritionists to ensure optimal outcomes in such complex cases