Bioscientia Medicina - Journal of Biomedicine and Translational Research
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The Impact of RNA Interference on Atherosclerotic Plaque Progression: A Meta-Analysis of Preclinical Studies
Get PDFBackground: Atherosclerosis, a chronic inflammatory disease characterized by the buildup of plaque within arteries, remains a leading cause of cardiovascular morbidity and mortality. RNA interference (RNAi) has emerged as a promising therapeutic strategy for atherosclerosis by targeting genes involved in plaque formation and progression. This meta-analysis aimed to evaluate the efficacy of RNAi in preclinical models of atherosclerosis.
Methods: A systematic search of PubMed, Embase, and Web of Science databases was conducted from January 2013 to December 2023 to identify preclinical studies investigating the impact of RNAi on atherosclerotic plaque progression. Studies utilizing various RNAi modalities (siRNA, miRNA mimics/inhibitors, shRNA) targeting different genes involved in atherosclerosis were included. The primary outcome was plaque size reduction. Secondary outcomes included changes in plaque composition, lipid profiles, and inflammatory markers. A random-effects model was used to pool data and calculate standardized mean differences (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic.
Results: Seven preclinical studies met the inclusion criteria, encompassing a total of 210 animals. RNAi interventions significantly reduced atherosclerotic plaque size compared to controls (SMD -1.51; 95% CI -2.36 to -0.66; p<0.00001; I²=12%). Analysis of secondary outcomes revealed favorable effects of RNAi on plaque composition, with a significant decrease in lipid content and an increase in collagen content. Furthermore, RNAi significantly improved lipid profiles by reducing total cholesterol and LDL-cholesterol levels. A significant reduction in inflammatory markers, such as TNF-α and IL-6, was also observed.
Conclusion: This meta-analysis provides compelling evidence supporting the therapeutic potential of RNAi in attenuating atherosclerotic plaque progression in preclinical models. RNAi effectively reduced plaque size, improved plaque stability, and modulated lipid metabolism and inflammation
Streptokinase or Alteplase for Acute Limb Ischemia? A Meta-Analysis
Get PDFBackground: Acute limb ischemia (ALI) is a vascular emergency that necessitates prompt and effective treatment to restore blood flow and prevent limb loss. Thrombolytic therapy, particularly with agents like streptokinase and alteplase, plays a pivotal role in ALI management. This meta-analysis and systematic review aimed to compare the efficacy and safety of streptokinase and alteplase in treating ALI.
Methods: A comprehensive search of PubMed, Embase, Science Direct, and the Cochrane Library databases was conducted up to August 13, 2024, to identify relevant studies. The inclusion criteria encompassed clinical trials involving patients diagnosed with ALI who received either streptokinase or alteplase as the initial thrombolytic treatment. The quality of the included studies was rigorously assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the Methodological Index for Non-Randomized Studies (MINOR) criteria. A meta-analysis was performed using the Mantel-Haenszel random-effects model to calculate risk ratios (RRs) with their corresponding 95% confidence intervals (CIs).
Results: The final analysis included 20 studies, encompassing both qualitative and quantitative assessments. A comparative analysis of streptokinase and alteplase for limb salvage at 30 days revealed a significant advantage in favor of alteplase, with a relative risk ratio (RR) of 0.78 (95% CI 0.69-0.88, I² = 0%). Furthermore, streptokinase was associated with a higher rate of primary amputation, with an RR of 2.54 (95% CI 1.50-4.32, I² = 0%) compared to alteplase. The use of streptokinase also correlated with a higher risk of complications, including major bleeding (RR 1.75, 95% CI 0.04-84.30, I² = 77%) and minor bleeding (RR 1.41, 95% CI 0.60-3.32, I² = 0%).
Conclusion: The findings of this meta-analysis underscore the superior efficacy of alteplase in achieving limb salvage in ALI, coupled with a more favorable safety profile. The preferential use of alteplase in clinical practice is recommended, particularly in patients with severe ischemia. However, careful patient selection and close monitoring are crucial when streptokinase therapy is considered
Accidental Organophosphate Poisoning in a Child: A Case Report Highlighting the Importance of Early Recognition and Treatment
Get PDFBackground: Organophosphate (OP) poisoning is a significant global health concern, especially in developing countries where these chemicals are widely used in agriculture and household pest control. Children are particularly susceptible to accidental OP poisoning due to their inquisitive nature and immature physiology. This case report presents a child with acute muscarinic symptoms following accidental ingestion of an OP insecticide, emphasizing the importance of early recognition and treatment.
Case presentation: A 9-year-old boy presented to the emergency department with vomiting, decreased consciousness, and respiratory distress 6 hours after accidentally ingesting an OP insecticide (Baygon) stored in a drinking bottle at home. He exhibited classic muscarinic symptoms, including miosis, hypersalivation, hyperlacrimation, stridor, and wheezing. The patient was treated with atropine and supportive care, resulting in the complete resolution of his symptoms.
Conclusion: This case highlights the importance of early recognition and prompt management of OP poisoning in children. Atropine remains the cornerstone of treatment for muscarinic symptoms, and supportive care is crucial to prevent complications. Public health interventions aimed at educating parents and caregivers about the safe storage and handling of OP insecticides are essential to prevent accidental poisoning in children
Pleural Amebiasis Mimicking Pleural Effusion: A Case Report
Get PDFBackground: Pleural amebiasis is a rare manifestation of extraintestinal amebiasis, primarily occurring due to the rupture of an amebic liver abscess into the pleural space. We present an unusual case of pleural amebiasis in an elderly woman without any evidence of liver involvement.
Case presentation: A 78-year-old female presented with a two-month history of progressive dyspnea, cough, and right-sided chest pain. She had a history of consuming raw vegetables. Examination revealed right-sided pleural effusion, which was confirmed by chest radiography and thoracic ultrasound. Pleural fluid analysis showed exudative effusion and microscopic examination demonstrated the presence of Entamoeba histolytica trophozoites. Despite the absence of a liver abscess on abdominal ultrasound, the patient was diagnosed with pleural amebiasis based on the pleural fluid findings. She was successfully treated with metronidazole and drainage of the pleural fluid.
Conclusion: This case highlights the importance of considering pleural amebiasis as a differential diagnosis in patients with pleural effusion, even in the absence of liver involvement. Early diagnosis and prompt treatment with metronidazole and drainage are crucial for a favorable outcome
p63 Expression in Ductal Carcinoma In Situ (DCIS) of the Breast and Its Correlation with Histopathological Grading and Morphological Variants
Get PDFBackground: Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer with varying potential for progression to invasive carcinoma. Myoepithelial cells (MECs) play a role in preventing this progression, and their absence is a hallmark of invasive disease. The p63 protein is a myoepithelial marker that can be assessed by immunohistochemistry (IHC). This study aimed to evaluate the relationship between p63 expression in MECs, the grade of DCIS, and the morphological subtype of DCIS.
Methods: A cross-sectional study was conducted on 35 cases of DCIS diagnosed at the Anatomical Pathology Laboratory of Dr. M. Djamil General Hospital Padang. Paraffin blocks were collected, and Hematoxylin and Eosin (H&E) slides were reviewed to confirm the diagnosis and determine the histopathological grading (low, intermediate, and high) and morphological variants (comedo and non-comedo) of DCIS. Paraffin blocks were re-cut for p63 immunohistochemical staining. The extent of p63 expression was classified as complete or incomplete.
Results: The majority of DCIS cases were high grade (54.3%) and of the non-comedo subtype (68.4%). All cases with complete p63 expression were of low histologic grade, while all cases with incomplete p63 expression were of high histologic grade. The results of the Chi-square test showed a statistically significant relationship between p63 expression and histopathological grading (p<0.001). There was no statistically significant relationship between p63 expression and morphological variant.
Conclusion: The absence of p63 expression in DCIS is associated with high histologic grade. This finding suggests that p63 IHC may be a useful adjunct in evaluating DCIS
A Meta-Analysis Comparing the Effectiveness of Uterine-Sparing Procedures versus Hysterectomy for Adenomyosis: Patient-Reported Outcomes and Fertility Preservation
Get PDFBackground: Adenomyosis is a benign gynecological condition that can cause significant morbidity, including dysmenorrhea, menorrhagia, and pelvic pain. Hysterectomy has been the traditional treatment for adenomyosis, but uterine-sparing procedures (USPs) are increasingly being considered, especially for women who desire fertility preservation. This meta-analysis compared the effectiveness of USPs versus hysterectomy for adenomyosis, focusing on patient-reported outcomes (PROs) and fertility preservation.
Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted for studies published between 2013 and 2024, comparing USPs (e.g., laparoscopic or hysteroscopic adenomyomectomy, uterine artery embolization) with hysterectomy for adenomyosis. Studies reporting PROs (dysmenorrhea, menorrhagia, pelvic pain, quality of life) and fertility outcomes (pregnancy rate, live birth rate) were included. Random-effects models were used to pool data and assess heterogeneity.
Results: Six studies (n = 1248 patients) met the inclusion criteria. USPs were associated with significantly lower rates of major complications (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.23-0.54, p<0.0001) and shorter hospital stays (mean difference -2.73 days, 95% CI -3.29 to -2.17, p<0.0001) compared to hysterectomy. PROs, including dysmenorrhea, menorrhagia, and pelvic pain, significantly improved in both groups, with no significant difference between USPs and hysterectomy. Fertility preservation was significantly higher in the USP group (OR 3.9, 95% CI 3.02-5.03, p<0.0001).
Conclusion: USPs offer a safe and effective alternative to hysterectomy for adenomyosis, with comparable improvements in PROs and significantly higher rates of fertility preservation. This information can guide clinicians and patients in shared decision-making regarding the optimal treatment approach
Deep Mycosis in Central Java, Indonesia: Occupational Risk Factors and Diagnostic Challenges in a Single Center Dr. Moewardi General Hospital
Get PDFBackground: Deep mycosis, a spectrum of invasive fungal infections affecting deeper tissues, poses significant diagnostic and therapeutic challenges, particularly in tropical regions like Central Java, Indonesia. This study aimed to investigate the epidemiological trends, occupational risk factors, and diagnostic challenges associated with deep mycosis in this region.
Methods: A retrospective study was conducted at a single center, Dr. Moewardi General Hospital, in Central Java, Indonesia, analyzing medical records of patients diagnosed with deep mycosis between 2019 and 2024. Data on demographics, occupation, clinical presentation, diagnostic methods, and treatment outcomes were collected and analyzed.
Results: A total of 12 cases of deep mycosis were identified. The majority of patients were male (75%) and engaged in agricultural activities (50%). Chromoblastomycosis (66.7%) and maduromycosis (25%) were the most common clinical diagnoses. Diagnostic delays were frequent (mean delay: 5.1 months), primarily due to non-specific clinical presentations and limited access to diagnostic facilities.
Conclusion: Deep mycosis predominantly affects individuals involved in agriculture in Central Java, highlighting the need for enhanced awareness and preventive strategies among high-risk occupational groups. Improved diagnostic facilities and healthcare infrastructure are crucial for timely diagnosis and effective management of deep mycosis in resource-constrained settings
Beyond Infection: The Role of Stunting in Tuberculosis Susceptibility and Treatment Outcomes
Get PDFBackground: Tuberculosis (TB) remains a major global health concern, particularly in developing countries. Stunting, a manifestation of chronic malnutrition, is prevalent in these regions and is increasingly recognized as a significant risk factor for TB. This systematic review aims to comprehensively analyze the impact of stunting on TB susceptibility and treatment outcomes.
Methods: A systematic search of PubMed and ScienceDirect databases was conducted for studies published in the last 10 years, focusing on the relationship between stunting and TB. The PRISMA guidelines were followed for article selection and data extraction.
Results: The review identified a significant association between stunting and increased TB risk. Stunted individuals exhibit impaired immune responses, making them more susceptible to TB infection. Moreover, stunting negatively affects TB treatment outcomes, including increased treatment duration, higher relapse rates, and greater mortality risk.
Conclusion: Stunting is a critical determinant of TB susceptibility and treatment outcomes. Addressing stunting through comprehensive nutritional interventions is crucial not only for reducing the burden of malnutrition but also for enhancing TB prevention and control efforts
Primary Malignant Peritoneal Mesothelioma Mimicking Ovarian Carcinoma: A Case Report Highlighting the Importance of Immunohistochemistry
Get PDFBackground: Primary malignant peritoneal mesothelioma (PMPM) is an uncommon and aggressive malignancy arising from the mesothelial lining of the peritoneal cavity. The diagnosis of PMPM is often challenging due to its rarity, nonspecific clinical presentation, and histologic similarities to other malignancies, particularly adenocarcinomas. Immunohistochemistry plays a crucial role in differentiating PMPM from metastatic adenocarcinoma, which is essential for accurate diagnosis, appropriate treatment, and prognostication.
Case presentation: We present the case of a 43-year-old female who presented with abdominal distension, ascites, and weight loss, initially raising suspicion of ovarian carcinoma. However, histopathological examination of the omental tissue revealed a proliferation of epithelial cells with papillary and glandular-like growth patterns. Immunohistochemical staining demonstrated strong positivity for calretinin, a mesothelial marker, while staining for estrogen receptor (ER) and progesterone receptor (PR) was negative, effectively ruling out an ovarian or endometrial origin. The diagnosis of PMPM, epithelioid subtype, was confirmed.
Conclusion: This case underscores the challenges in diagnosing PMPM and highlights the critical role of immunohistochemistry in differentiating it from metastatic adenocarcinoma. Accurate diagnosis is essential for determining appropriate management strategies and providing prognostic information
Biological Reconstruction for Metacarpal Osteofibrous Dysplasia Treatment: A Case Report
Get PDFBackground: Osteofibrous dysplasia is a rare benign bone tumor characterized by abnormal differentiation of fibrous tissue in bone and commonly involves the maxilla, mandible, and tibia and affects children less than 10 years old. Osteofibrous dysplasia affecting the metacarpal is a very rare case. This study presents a case report to present biological reconstruction in the management of metacarpal osteofibrous dysplasia.
Case presentation: A 48-year-old female presented with swelling and pain in her right hand over 1 year. On examination, palpable mass with immobile and hard consistency on the first metacarpal and distal neurovascular within normal limit. Radiographic examination (X-ray and MRI) supports osteofibrous dysplasia. We performed complete resection of the first metacarpal and used a fibular graft to maintain length, followed by arthroplasty of the first metacarpophalangeal joint and arthrodesis of the first carpometacarpal joint. Pathological results showed a Chinese letter appearance with osteoblastic rimming that confirmed osteofibrous dysplasia. After 6 months of follow-up, there is no recurrence, and the functional outcome is excellent (MSTS score 93,33%).
Conclusion: Osteofibrous dysplasia on the metacarpal and affected adult is a very rare case. Treatment with complete resection of the metacarpal, using a fibular graft to maintain bone length, and arthroplasty MCP joint will give good results (MSTS score 93,33%). Follow-up for recurrence is necessary