Bioscientia Medicina - Journal of Biomedicine and Translational Research
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A Retrospective Analysis of Clinical Characteristics and Neutrophil-to-Lymphocyte Ratio in Hospitalized Indonesian Patients with Pemphigus Vulgaris and Bullous Pemphigoid: A Single-Center Experience
Get PDFBackground: Comprehensive clinical-epidemiological data on severe autoimmune bullous diseases (ABDs) from Southeast Asian populations are notably scarce. Pemphigus vulgaris (PV) and bullous pemphigoid (BP) are the most common ABDs, and understanding their presentation in diverse ethnic and geographic contexts is crucial for global health equity. This study’s primary aim was to characterize a cohort of hospitalized ABD patients in Central Java, Indonesia, and to secondarily explore the behavior of the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker within this real-world clinical setting.
Methods: A retrospective, cross-sectional study was conducted at a tertiary referral hospital in Surakarta, Indonesia. The study included all patients admitted with a final diagnosis of PV or BP between January 2019 and December 2023. Comprehensive data on demographics, documented comorbidities, duration of hospitalization, and admission hematological parameters were extracted from medical records. Clinical characteristics were compared, and the non-parametric Mann-Whitney U test was used to analyze the difference in NLR. A post-hoc power analysis was performed to contextualize the hematological findings.
Results: This study provides a detailed clinical profile of 30 hospitalized ABD patients. The PV cohort (n=17) was characterized by a younger age of onset (mean age 54.29 ± 14.83 years) and a strong female predominance (70.6%). In contrast, the BP cohort (n=13) was older (mean age 63.08 ± 22.01 years) with a balanced gender distribution. A key finding was that patients with PV had a significantly longer duration of hospitalization than those with BP (13.24 vs. 10.15 days, p < 0.05). The mean NLR was descriptively higher in BP (10.56 ± 7.22) than in PV (9.43 ± 6.14), but this difference was not statistically significant (p = 0.770), a finding consistent with the study’s critically low statistical power of 9.8%.
Conclusion: This study presents a valuable clinical and epidemiological snapshot of hospitalized patients with PV and BP in an underrepresented Indonesian population, highlighting a significantly greater clinical burden for PV as quantified by length of stay. The exploratory analysis of the NLR was inconclusive and should not be interpreted as definitive evidence against its utility. Instead, it serves as a powerful illustration of how the effects of low statistical power and overwhelming, unmeasured confounding from disease severity and corticosteroid treatment present profound challenges to the validation of non-specific biomarkers in complex, real-world clinical scenarios
A Rare Case of Systemic Lupus Erythematosus with Concomitant Inflammatory Bowel Disease: A Diagnostic and Therapeutic Challenge
Get PDFBackground: 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
Get PDFBackground: 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
A Neuroinflammatory Biomarker Profile Associated with Neuropathic Pain in Hansen's Disease: A Systematic Review and Meta-Analysis of S100B, TNF-α, and IL-6
Get PDFBackground: Neuropathic pain (NP) is a severe, chronic complication of Hansen's disease (HD), persisting after antimicrobial therapy and profoundly diminishing quality of life. Its pathophysiology is driven by persistent, complex neuroinflammatory processes within the peripheral nervous system. Circulating biomarkers, especially the glial-derived protein S100B, offer a potential objective window into this underlying pathology. This study aimed to meta-analyze the association between circulating S100B, TNF-α, and IL-6 and the presence of NP in patients with HD.
Methods: A systematic search of PubMed, Scopus, and Web of Science databases was conducted for observational studies published between January 2015 and December 2025 that compared biomarker levels in HD patients with and without NP, diagnosed using validated screening instruments. Data from eligible studies were extracted independently, and methodological quality was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed to compute the pooled standardized mean difference (SMD) with 95% confidence intervals (CIs) for each biomarker.
Results: Seven studies, comprising 812 patients (405 with NP, 407 without NP), met the inclusion criteria. The meta-analysis revealed that serum S100B levels were significantly elevated in HD patients with NP compared to those without (SMD = 1.28, 95% CI [0.95, 1.61], p < 0.001). This finding was accompanied by very high statistical heterogeneity (I² = 78%). Concurrently, the analysis demonstrated significantly higher circulating levels of TNF-α (SMD = 0.89, 95% CI [0.62, 1.16]) and IL-6 (SMD = 0.75, 95% CI [0.48, 1.02]) in the NP group.
Conclusion: This meta-analysis establishes a strong statistical association between a distinct neuroinflammatory biomarker profile—characterized by elevated circulating S100B, TNF-α, and IL-6—and the presence of neuropathic pain in Hansen's disease. S100B, as a marker of Schwann cell distress, is a particularly relevant component of this profile. These findings underscore the pivotal role of neuroinflammation in HD-related NP, although the high heterogeneity and non-specific nature of these systemic markers necessitate a cautious interpretation regarding their immediate clinical applicability
Achieving Resectability in Giant Primary Breast Leiomyosarcoma Via Transarterial Chemoembolization: A Novel Neoadjuvant Strategy
Get PDFBackground: Primary leiomyosarcoma (LMS) of the breast is an exceptionally rare and aggressive non-epithelial malignancy, constituting less than 0.1% of all breast neoplasms. Due to the scarcity of cases, no standardized consensus exists regarding neoadjuvant protocols. Large, locally advanced tumors often present with chest wall fixation, rendering upfront resection difficult or impossible without extensive morbidity. This study explores the novel application of Transarterial Chemoembolization (TACE)—traditionally reserved for hepatic malignancies—as a neoadjuvant strategy to downstage a giant breast LMS.
Case presentation: We present the case of a 40-year-old female presenting with a rapidly enlarging, painless, giant mass in the right breast measuring 19 x 18 x 15 cm. Clinical and radiological evaluation (CT Thorax) revealed a heterogeneous, hypervascular mass fixed to the pectoralis major muscle, classified as BIRADS 5. Core needle biopsy confirmed high-grade Leiomyosarcoma. Due to the tumor’s size and fixation to the chest wall, the patient underwent preoperative TACE using 35 mg Doxorubicin followed by embolization of the supplying branches of the right internal mammary and thoracoacromial arteries. Post-procedure, the tumor volume significantly decreased (downsized to approx. 15 cm), and critically, the mass detached from the chest wall, becoming mobile. The patient subsequently underwent a successful total mastectomy with clear margins (R0 resection).
Conclusion: TACE offers a promising, minimally invasive neoadjuvant alternative for hypervascular, giant breast sarcomas. By inducing tumor necrosis and reducing vascularity, TACE can facilitate resectability in initially fixed tumors, potentially converting inoperable cases into candidates for R0 resection while minimizing intraoperative blood loss
Sporadic Coexistence of Multiple Trichoepitheliomas and Solitary Neurofibroma: Mimicking Brooke–Spiegler Syndrome
Get PDFBackground: The simultaneous presentation of multiple adnexal tumors and neural sheath tumors on the face typically heralds a genodermatosis, most notably Brooke–Spiegler syndrome (BSS) or neurofibromatosis type 1 (NF1). The sporadic, non-syndromic coexistence of these entities in the same anatomical region is a diagnostic pitfall that challenges the principle of parsimony.
Case presentation: We report the case of a 24-year-old Asian female presenting with a 12-month history of 18 disseminated, skin-colored papules restricted to the centrofacial region, followed by the rapid development of a 3.0 cm solitary tumor on the right buccal region. Dermoscopic evaluation revealed a dichotomy in tumor morphology: the papules exhibited ivory-white backgrounds with multiple rosette signs and milia-like cysts, while the buccal tumor displayed a structureless pink pattern with absence of pigment networks. Detailed physical examination ruled out cutaneous stigmata of NF1. Histopathological analysis confirmed the diagnosis of multiple trichoepitheliomas and a solitary localized neurofibroma based on characteristic morphological features, including papillary mesenchymal bodies and mast cell presence. Immunohistochemistry was not utilized due to setting-specific resource limitations.
Conclusion: This case underscores the potential for sporadic benign tumors to mimic syndromic phenotypes (phenocopies). It highlights the critical importance of recognizing key hematoxylin and eosin morphological markers and clinical signs to establish accurate diagnoses in resource-limited settings where molecular genetics and immunohistochemical staining are unavailable
Colchicine as a Strategic Therapeutic Alternative for Dengue-Associated Acute Pericarditis: Navigating the Hemorrhagic Risk
Get PDFBackground: Dengue infection remains a pervasive arboviral disease in tropical regions, manifesting with a spectrum of clinical severities ranging from undifferentiated fever to life-threatening shock and severe hemorrhage. While cardiac involvement such as myocarditis is documented, acute pericarditis is an underrecognized complication that poses a unique therapeutic dilemma. The standard first-line anti-inflammatory treatment for pericarditis, specifically non-steroidal anti-inflammatory drugs (NSAIDs), is relatively contraindicated in dengue due to the inherent coagulopathy and thrombocytopenia associated with the disease.
Case presentation: We report a case of a 53-year-old male presenting with high-grade fever, retro-orbital pain, and severe chest discomfort characteristic of pleuritis. Physical examination revealed a distinct pericardial friction rub and relative bradycardia (56 bpm). Laboratory analysis confirmed dengue infection with significant leukopenia (1.7 x 10³/µL), thrombocytopenia (49 x 10³/µL), and elevated liver transaminases. Electrocardiography (ECG) demonstrated diffuse ST-segment elevation, while echocardiography showed preserved ejection fraction (67.7%) without pericardial effusion. Diagnosed with dengue-associated acute pericarditis, the patient was ineligible for NSAIDs due to the high risk of gastrointestinal hemorrhage. He was successfully managed with low-dose Colchicine (0.5 mg daily) alongside standard supportive care. Rapid resolution of chest pain and normalization of ECG findings were observed within 48 hours without hemorrhagic complications.
Conclusion: This case underscores the utility of Colchicine as a safe, effective, and strategic alternative to NSAIDs for managing acute pericarditis in thrombocytopenic dengue patients. Early recognition of the pericarditis triad in dengue is crucial to prevent mismanagement, and Colchicine should be considered a cornerstone of therapy in this specific clinical context
Nanostructured Garcinia mangostana Extract Modulates RANKL Signaling and Calcium Homeostasis to Enhance Fracture Healing in Diabetic Bone: A Systematic Review of In Vivo Evidence
Get PDFBackground: Diabetic fracture healing is often impaired due to chronic hyperglycemia, oxidative stress, and inflammation, leading to dysregulation of bone remodeling. Receptor activator of nuclear factor kappa-Β ligand (RANKL) and calcium homeostasis are critical regulators of this process. Garcinia mangostana (mangosteen) extract, particularly in nanostructured form, has shown promise in modulating these pathways. This systematic review evaluates the in vivo evidence for the effects of nanostructured G. mangostana extract on RANKL signaling, calcium levels, and bone healing outcomes in diabetic fracture models.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase databases from January 2013 to May 2024. Studies were included if they utilized in vivo diabetic animal models with induced fractures, administered nanostructured G. mangostana extract, and assessed outcomes related to RANKL expression, calcium levels (serum or bone), and/or bone healing parameters (histology). Risk of bias was assessed using the SYRCLE's tool. Data were extracted and synthesized narratively.
Results: Seven studies met the inclusion criteria. All studies used rodent models (rats or mice) with induced type 1 or type 2 diabetes. Nanostructured G. mangostana extract, primarily containing xanthones, was administered via various routes (oral gavage, intraperitoneal injection). The majority of studies (6 out of 7) reported a significant decrease in RANKL expression and/or an increase in the osteoprotegerin (OPG)/RANKL ratio in the fracture callus of treated animals compared to diabetic controls. Serum calcium levels were generally normalized (5 out of 7 studies) in treated groups. Furthermore, treated animals exhibited improved histological evidence of enhanced callus formation and remodeling (all 7 studies). Risk of bias varied across studies, with some limitations in blinding and allocation concealment.
Conclusion: Nanostructured G. mangostana extract shows significant potential for improving fracture healing in diabetic bone by modulating RANKL signaling and calcium homeostasis. Further high-quality, pre-clinical studies are warranted to optimize dosage, delivery methods, and to fully elucidate the underlying mechanisms before clinical translation
Challenges in Intensive Care Management of a Patient with Retropharyngeal Abscess and Mediastinal Extension: A Case Report
Get PDFBackground: Retropharyngeal abscess (RPA) is a serious infection of the deep neck space that can extend to the mediastinum, leading to life-threatening complications. This case report highlights the challenges in managing a patient with RPA and mediastinal extension in the intensive care unit (ICU).
Case presentation: A 44-year-old male with a history of diabetes mellitus presented with pain, difficulty opening the mouth, and fever. Imaging revealed a retropharyngeal abscess extending to the mediastinum. The patient underwent surgical drainage and was admitted to the ICU for postoperative management. Challenges encountered included airway management, hemodynamic instability, sepsis, and ventilator weaning. The patient required a multidisciplinary approach involving anesthesiologists, intensivists, infectious disease specialists, and surgeons.
Conclusion: RPA with mediastinal extension is a challenging condition requiring prompt diagnosis, aggressive treatment, and meticulous intensive care management. A multidisciplinary approach is crucial for successful outcomes
Thermally Oxidized Cooking Palm Oil-Induced Histopathological Alterations in Brain, Heart, Liver, and Kidney: A Systematic Review of Lipid Peroxidation and Inflammatory Mechanisms
Get PDFBackground: Repeated heating of cooking palm oils at high temperatures generates various toxic compounds, including lipid peroxidation products. These compounds are implicated in various diseases through oxidative stress and inflammation. This systematic review aims to evaluate the histopathological effects of thermally oxidized cooking oil (TOCO) consumption on the brain, heart, liver, and kidney, focusing on the roles of lipid peroxidation and inflammation.
Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science databases using predefined keywords and inclusion/exclusion criteria. Studies published between 2013 and 2024 investigating the histopathological effects of TOCO on the specified organs were included. Data on histopathological changes, markers of lipid peroxidation (malondialdehyde [MDA], 4-hydroxynonenal [4-HNE]), and inflammatory markers (TNF-α, IL-1β, IL-6) were extracted.
Results: Seven studies met the inclusion criteria. The data revealed consistent histopathological changes across all four organs. In the brain, neuronal degeneration, astrogliosis, and microglial activation were observed. The heart exhibited cardiomyocyte hypertrophy, fibrosis, and inflammatory cell infiltration. The liver showed hepatocyte necrosis, steatosis, and inflammation. The kidneys presented with tubular necrosis, glomerular damage, and interstitial fibrosis. Elevated levels of MDA and 4-HNE were consistently reported in all affected tissues, along with increased expression of TNF-α, IL-1β, and IL-6.
Conclusion: Consumption of TOCO induces significant histopathological damage in the brain, heart, liver, and kidney. The observed damage is strongly associated with increased lipid peroxidation and inflammatory responses. These findings highlight the potential health risks associated with consuming repeatedly heated cooking oils and underscore the need for public health awareness and strategies to mitigate these risks