Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Synergistic Attenuation of the TNF-α/NF-κB Inflammatory Axis in Colorectal Carcinogenesis: Lactococcus lactis D4 as a Mucosal-Protective Adjuvant to Capecitabine
Full text linkBackground: Capecitabine serves as a standard chemotherapeutic agent for colorectal cancer, but its clinical efficacy is frequently hindered by severe gastrointestinal toxicity and incomplete suppression of the inflammatory tumor microenvironment. We evaluated the synergistic potential of Lactococcus lactis D4, a probiotic strain isolated from traditional fermented buffalo milk, as an immunonutritional adjuvant to Capecitabine in a 1,2-dimethylhydrazine-induced colorectal cancer rat model.
Methods: Sprague-Dawley rats were maintained on a standardized AIN-93G diet and induced with 1,2-dimethylhydrazine. Animals were randomized into Negative Control, Cancer Control, L. lactis D4 monotherapy, Capecitabine monotherapy, and Combination therapy. Treatments were administered for 14 days. We assessed cachexia, macroscopic microadenoma multiplicity, and TNF-α expression utilizing immunohistochemistry. Synergy was mathematically validated using the Coefficient of Drug Interaction.
Results: The Combination group significantly prevented chemotherapy-induced cachexia, demonstrating a 2.1% weight gain compared to a 4.5% weight loss in the Capecitabine monotherapy group (p < 0.05). Macroscopic microadenomas were rapidly reduced in the combination group. Furthermore, the combination therapy synergistically suppressed colonic TNF-α protein expression (Coefficient of Drug Interaction = 0.83). Additionally, L. lactis D4 entirely mitigated capecitabine-induced mucositis.
Conclusion: L. lactis D4 functions as a highly potent adjuvant to Capecitabine. It prevents cachexia, protects mucosal architecture, and exerts a mathematically proven synergistic suppression of the TNF-α inflammatory axis
Catastrophic Zone I Open Globe Injury: Pathophysiological Insights and Staged Surgical Triumphs in a Case of Corneal Rupture, Lens Extrusion, and "Blackball" Hyphema
Full text linkBackground: Complex open globe injuries (OGIs) involving the simultaneous destruction of multiple anterior segment structures represent a formidable challenge in ophthalmic traumatology. These injuries necessitate a staged surgical approach to restore ocular integrity and optimize the potential for visual rehabilitation.
Case presentation: A 44-year-old male presented with a severe Zone I OGI in the left eye from a high-velocity projectile stone. His initial best-corrected visual acuity was limited to light perception. Examination revealed an 8-mm corneal rupture with uveal prolapse, complete anterior extrusion of the crystalline lens, and a Grade IV "blackball" hyphema. The Ocular Trauma Score (OTS) was calculated as 1, predicting a very poor visual outcome. Immediate primary repair involved anterior vitrectomy, lensectomy, hyphema evacuation, and corneal suturing. After a six-month stabilization period, a secondary scleral-fixated intraocular lens (IOL) was implanted using a double-needle Yamane technique.
Conclusion: Despite the devastating nature of the initial injury and a grim prognosis as per the OTS, a principled, staged surgical strategy resulted in a final best-corrected visual acuity of 20/50. This case highlights that adherence to damage-control principles—prioritizing anatomical restoration in the primary surgery and deferring refractive correction—can lead to unexpectedly favorable functional outcomes in the most severe categories of ocular trauma
Ecthyma Contagiosum (Orf Virus) Masquerading as Subcorneal Pustular Dermatosis: A Diagnostic Pitfall in an Adolescent
Full text linkBackground: Ecthyma contagiosum (Orf) is a zoonotic viral infection caused by a Parapoxvirus, typically presenting as a self-limiting, solitary cutaneous lesion on the hands of occupationally exposed individuals. Atypical, multifocal, or pustular presentations can pose a significant diagnostic challenge, mimicking various inflammatory dermatoses.
Case presentation: We present the case of a 17-year-old female with no direct animal contact who developed a progressive, widespread, and painful pustular eruption on her extremities over three weeks. The clinical presentation was highly suggestive of Subcorneal Pustular Dermatosis (SPD), prompting treatment with systemic corticosteroids, which led to clinical worsening. A delayed epidemiological history revealed an environmental link to a nearby goat farm and a family cluster of similar, milder lesions. A diagnostic punch biopsy was pivotal, revealing viral cytopathic effects, including extensive ballooning degeneration and epidermal necrosis, inconsistent with SPD. Subsequent bacterial culture confirmed superinfection with Enterobacter cloacae ssp. cloacae. The diagnosis was established by the pathognomonic histopathological findings.
Conclusion: The patient’s steroid therapy was immediately ceased, and targeted antibiotic therapy was initiated, leading to complete resolution. This case highlights the Orf virus as a critical clinical chameleon and a diagnostic pitfall for generalized pustular eruptions. It underscores the necessity of a high index of suspicion for zoonoses, even in non-occupational settings, and confirms the indispensable role of histopathology in differentiating viral cytopathy from sterile neutrophilic dermatoses to prevent iatrogenic harm from inappropriate immunosuppression
Therapeutic Plasma Exchange as Adjuvant Rescue Therapy for Weil’s Disease-Associated Acute Liver Failure in a Hemodialysis-Dependent Patient: A Case Report
Full text linkBackground: Weil’s disease, the severe form of leptospirosis, manifests as a triad of jaundice, renal failure, and hemorrhage. In patients with pre-existing end-stage renal disease (ESRD), the management of superimposed acute liver failure (ALF) is exceptionally challenging due to altered pharmacokinetics, fluid intolerance, and the inability of standard hemodialysis to clear protein-bound hepatic toxins.
Case presentation: We present a 32-year-old anuric male with ESRD on maintenance hemodialysis who presented with fever, jaundice, and altered mental status following floodwater exposure. He developed severe metabolic encephalopathy (GCS E2V2M4), profound coagulopathy (INR 6.04), and hyperbilirubinemia (Total Bilirubin 18.31 mg/dL). Following the failure of broad-spectrum antibiotics and sustained low-efficiency dialysis (SLED) to halt clinical deterioration, two sessions of therapeutic plasma exchange (TPE) were initiated as salvage therapy. The intervention utilized 100% fresh frozen plasma (FFP) replacement to address hemostatic failure. TPE resulted in rapid biochemical clearance and clinical stabilization. Post-intervention, the INR decreased from 6.04 to 1.57 (74% reduction), Total bilirubin declined from 18.31 to 5.57 mg/dL (69.5% reduction), and platelet counts recovered from 45,000 to 142,000/µL. Neurological status normalized (GCS 15) within 48 hours of the second session.
Conclusion: TPE served as an effective bridge to recovery by clearing albumin-bound toxins and restoring coagulation factors in a high-risk patient where standard renal replacement was insufficient
Nuclear β-Catenin Accumulation Correlates with Poor Survival in Undifferentiated Nasopharyngeal Carcinoma: A Retrospective Cohort Study in an Endemic Region
Full text linkBackground: Nasopharyngeal carcinoma (NPC) is highly endemic in Indonesia, characterized by a prevalence of undifferentiated subtypes and late-stage presentation. While the Epstein-Barr virus (EBV) is a primary driver, the limitations of TNM staging in predicting individual outcomes necessitate the identification of molecular biomarkers. This study investigates the prognostic utility of aberrant Wnt/β-catenin signaling, specifically nuclear accumulation, in predicting overall survival (OS).
Methods: A retrospective cohort study was conducted on 44 patients diagnosed with undifferentiated NPC at Dr. Kariadi General Hospital, Indonesia, between 2020 and 2024. Immunohistochemistry (IHC) for β-catenin was performed, with scoring specifically targeting nuclear and cytoplasmic reactivity (excluding physiological membranous staining) using the Allred system. Clinicopathological variables, including TNM staging (AJCC 8th edition), were analyzed. Survival analysis utilized Kaplan-Meier curves and multivariate Cox Proportional Hazards regression.
Results: The cohort exhibited advanced disease, with 81.8% of patients presenting at Stage III or IV. Nuclear β-catenin overexpression (moderate-to-strong) was observed in 97.7% of cases. Strong nuclear expression was significantly associated with advanced T-stage (p=0.032) and distant metastasis (p=0.045). Kaplan-Meier analysis revealed a significant reduction in 5-year overall survival for the strong expression group (0%) compared to the weak/moderate group (p < 0.001). In multivariate analysis adjusted for age and TNM stage, strong β-catenin expression remained a significant predictor of mortality (Hazard Ratio: 2.15; 95% CI: 1.05–4.42; p=0.036), alongside Stage IV disease.
Conclusion: Nuclear accumulation of β-catenin is a prevalent molecular event in Indonesian NPC and serves as a significant prognostic biomarker independent of tumor stage. These findings suggest potential utility for risk stratification and targeted Wnt-inhibitor therapies
The Uncoupling Phenomenon: Dissociation Between Albuminuria and Glomerular Filtration Rate in an Advanced Diabetic Kidney Disease Phenotype
Full text linkBackground: The classical paradigm of diabetic kidney disease (DKD) assumes a synchronous, linear trajectory where increasing albuminuria predicts the decline of glomerular filtration rate (GFR). However, emerging epidemiology suggests these markers may dissociate in advanced disease stages, particularly under modern renoprotective pharmacotherapy. We aimed to investigate this uncoupling phenomenon by evaluating the correlation between urine albumin creatinine ratio (UACR) and estimated GFR (eGFR) in a specific cohort of advanced DKD patients in Indonesia.
Methods: We conducted a cross-sectional analytic study from January to November 2025 at Dr. M. Djamil General Hospital Padang, a tertiary referral center. The study population comprised 30 patients with established DKD, predominantly in CKD Stages 3b and 4. The primary outcome was the Spearman rank correlation (r) between UACR and eGFR, reported with 95% Confidence Intervals (CI). An exploratory sub-analysis compared trends in patients receiving SGLT2 inhibitors (n=12) versus standard care (n=18).
Results: The cohort was elderly (mean age 61.93 years) with critical renal reserve depletion (median eGFR 32.50 mL/min/1.73 m²). Median UACR was 403.90 mg/g, yet exhibited massive heterogeneity (IQR: 170.82–1779.27). Spearman analysis revealed a complete lack of linear correlation between albuminuria and filtration function (r = 0.041; 95% CI: -0.322 to 0.395; p = 0.830). While SGLT2 inhibitor users (n=12) demonstrated numerically lower median UACR than non-users (n=18), the dissociation from eGFR persisted in both subgroups.
Conclusion: We demonstrate a distinct dissociation between albuminuria severity and filtration function in advanced DKD. This uncoupling suggests that in late-stage nephropathy, structural glomerulosclerosis and tubulointerstitial fibrosis progress independently of permeability changes. Consequently, albuminuria cannot serve as a sole surrogate for disease progression in this phenotype, supporting a dual-biomarker strategy where UACR and eGFR are monitored as independent risk factors
The Silent Saboteur: Chronic Refractory Erythema Nodosum Leprosum Perpetuated by Neglected Odontogenic Foci in a Post-RFT Borderline Lepromatous Patient
Full text linkBackground: Erythema nodosum leprosum (ENL) is a severe, immune-complex mediated complication of lepromatous leprosy that can manifest before, during, or after multidrug therapy (MDT). While the primary etiology involves the release of Mycobacterium leprae antigens, the chronicity of ENL is frequently driven by secondary, often occult, triggers. Focal infections, particularly of odontogenic origin, are frequently overlooked in standard dermatological assessments, leading to refractory clinical courses.
Case presentation: We report the case of a 32-year-old male with a history of borderline lepromatous (BL) leprosy who had achieved release from treatment (RFT). The patient presented with severe, chronic, and recurrent ENL characterized by painful erythematous nodules, high-grade fever, and acute neuritis, occurring more than one year post-RFT. Laboratory evaluation revealed significant inflammatory markers, including a C-Reactive Protein level of 172.7 mg/L and leukocytosis. Crucially, intraoral examination identified neglected chronic dental caries (gangrene radix) and generalized periodontal inflammation. Despite medical advice, the patient refused dental intervention. The reactional state was managed with a combination of intravenous methylprednisolone and high-dose oral clofazimine. While cutaneous symptoms improved, the persistence of the focal infection poses a substantial risk for further recurrence.
Conclusion: This case highlights the critical and often underestimated role of odontogenic focal infections as perpetuating factors in chronic ENL. It underscores the necessity for a multidisciplinary approach integrating dentistry and dermatology. We propose that recalcitrant ENL in post-RFT patients should trigger mandatory screening for occult dental infections to disrupt the cycle of systemic inflammation.
 
Intratympanic Corticosteroid Salvage for Pediatric Bilateral Sudden Sensorineural Hearing Loss Complicated by Methylprednisolone-Induced Hypertensive Urgency in an Obese Adolescent
Full text linkBackground: Bilateral sudden sensorineural hearing loss (SSNHL) is a rare otologic emergency, accounting for less than 5% of sudden deafness cases and occurring even less frequently in pediatric populations. Unlike unilateral cases, bilateral involvement strongly implicates systemic etiologies such as autoimmune inner ear disease (AIED). Systemic high-dose corticosteroids are the standard first-line therapy but pose significant risks of toxicity, including hypertensive crisis, particularly in adolescents with metabolic risk factors.
Case presentation: We report the case of a 17-year-old male (BMI 29.0 kg/m²) presenting with acute, simultaneous bilateral hearing loss (Pure Tone Average [PTA]: Right 82.5 dB, Left 81.25 dB) and severe tinnitus (Tinnitus Handicap Index [THI]: 78). Initial management with high-dose intravenous methylprednisolone (500 mg/day) was complicated on Day 7 by hypertensive urgency (Blood Pressure 150/95 mmHg) and neurological symptoms, necessitating immediate cessation of systemic therapy. Diagnostic investigation was limited by resource availability; however, elevated inflammatory markers supported a presumptive immune-mediated etiology. A salvage protocol was initiated using four weekly cycles of intratympanic Triamcinolone Acetonide. Following therapy, the patient demonstrated slight audiological recovery (PTA stabilized at 65 dB bilaterally) but achieved complete resolution of tinnitus (THI: 0).
Conclusion: This case highlights the critical role of intratympanic corticosteroids as a safe salvage modality when systemic therapy is contraindicated due to toxicity. The dissociation between modest audiometric gain and complete tinnitus resolution suggests successful mitigation of cochlear synaptopathy. The case underscores the necessity of cardiovascular monitoring and BMI-adjusted risk stratification in adolescents receiving high-dose steroids
A Rare Case of Systemic Lupus Erythematosus with Concomitant Inflammatory Bowel Disease: A Diagnostic and Therapeutic Challenge
Full text linkBackground: Systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) are chronic conditions with complex pathophysiologies. While both diseases can affect the gastrointestinal tract, their co-occurrence is rare and presents unique diagnostic and therapeutic challenges. This case report describes a patient with SLE who developed IBD, highlighting the complexities of managing such cases.
Case presentation: A 27-year-old female with a history of SLE presented with hematochezia, abdominal pain, and weight loss. A colonoscopy revealed findings consistent with IBD. The patient's SLE was well-controlled on immunosuppressive therapy, but the addition of IBD required careful medication adjustments to manage both conditions effectively.
Conclusion: The coexistence of SLE and IBD is an uncommon but significant clinical scenario. This case underscores the importance of a thorough evaluation of IBD in SLE patients presenting with gastrointestinal symptoms. Furthermore, it emphasizes the need for a multidisciplinary approach to optimize treatment strategies and improve patient outcomes
Procalcitonin Outperforms NLR as a Sepsis Predictor in Pneumonia Patients: A Cross-Sectional Study from a Tertiary Hospital in Padang, Indonesia
Full text linkBackground: Pneumonia remains a significant cause of morbidity and mortality worldwide, with sepsis being a severe complication. Early identification of sepsis is crucial for prompt treatment and improved outcomes. This study aimed to evaluate the performance of procalcitonin (PCT) and neutrophil-lymphocyte ratio (NLR) as predictors of sepsis in pneumonia patients at a tertiary hospital in Padang, Indonesia.
Methods: A cross-sectional study was conducted on 110 adult pneumonia patients admitted to Dr. M. Djamil General Hospital Padang between 2022 and 2023. Data on demographics, clinical characteristics, NLR, and PCT levels were collected from electronic medical records. Sepsis was defined according to established clinical criteria. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic accuracy of NLR and PCT in predicting sepsis.
Results: The study population had a mean age of 57.72 ± 14.41 years, with 56.4% being male. Of the 110 patients, 73.6% had community-acquired pneumonia (CAP) and 26.4% had hospital-acquired pneumonia (HAP). Sepsis was present in 55.5% of the patients. The median NLR and PCT levels were significantly higher in the sepsis group compared to the non-sepsis group (NLR: 14 vs. 6.6, p=0.002; PCT: 2.17 vs. 0.24, p=0.000). ROC analysis showed that PCT had a higher area under the curve (AUC) compared to NLR (0.724 vs. 0.676), indicating better diagnostic accuracy. The optimal cut-off point for PCT was 0.455, with a sensitivity of 65.6% and specificity of 65.3%. For NLR, the cut-off point was 10.375, with a sensitivity of 63.9% and specificity of 63.3%.
Conclusion: PCT demonstrated superior diagnostic accuracy compared to NLR in predicting sepsis among pneumonia patients in this study. However, NLR remains a valuable tool, especially in resource-limited settings where PCT testing may not be readily available