Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Dietary BCAAs (Branched Chain Amino Acids) and Cognitive Function: Implications for Nutritional Interventions in Elderly Populations
Full text linkBackground: The aging process is often accompanied by a decline in cognitive function, impacting memory, attention, and decision-making. Malnutrition, including protein deficiency, is recognized as a contributing factor to cognitive decline in elderly populations. Branched-chain amino acids (BCAAs), essential amino acids obtained solely from dietary sources, play a pivotal role in various physiological processes, including neurotransmitter synthesis and protein synthesis in the brain. This study aims to investigate the relationship between serum BCAA levels and cognitive function in elderly individuals.
Methods: A cross-sectional study was conducted on 25 elderly subjects (age > 60 years) in Padang, Indonesia. Serum BCAA levels were measured using High-Performance Liquid Chromatography (HPLC), and cognitive function was assessed using the Montreal Cognitive Assessment - Indonesian version (MoCA-Ina). Statistical analysis was performed to determine the correlation between BCAA levels and MoCA-Ina scores.
Results: The mean serum levels of total BCAAs, leucine, isoleucine, and valine in the elderly subjects were 0.40 ± 0.15 mM, 0.09 ± 0.06 mM, 0.05 ± 0.02 mM, and 0.26 ± 0.10 mM, respectively. The median MoCA-Ina score was 23 (range: 8-27), indicating a significant proportion of participants with cognitive impairment. Statistical analysis revealed no significant correlation between total BCAA levels and MoCA-Ina scores (r = 0.071, p = 0.735). However, a moderate positive correlation was observed between isoleucine levels and MoCA-Ina scores (r = 0.344, p = 0.092), although not statistically significant.
Conclusion: This study suggests that serum BCAA levels, particularly isoleucine, may have implications for cognitive function in elderly populations. Further research with a larger sample size and longitudinal design is warranted to elucidate the complex relationship between dietary BCAAs, serum BCAA levels, and cognitive health in aging individuals
Neurovascular Inflammation and Oxidative Stress Markers in Chronic Migraine: Is Nitric Oxide the Key Link to Severity?
Full text linkBackground: Nitric oxide (NO), a ubiquitous signaling molecule, has been implicated in migraine pathophysiology through mechanisms including vasodilation, neurogenic inflammation, and oxidative stress. However, its specific relationship with the clinical severity of chronic migraine required further elucidation. This study aimed to investigate the association between serum NO levels and the severity of chronic migraine in a cohort of female patients.
Methods: An observational study employing a cross-sectional design was conducted between July 2024 and November 2024 at Neurology Clinics and Community Healthcare Centers in Padang City, Indonesia. Fifty-one female chronic migraineurs, diagnosed according to ICHD-3 criteria, were enrolled using consecutive sampling. Patients with specific comorbidities, pregnancy, breastfeeding, or Medication Overuse Headache (MOH) were excluded. Migraine severity during an ictal phase was assessed using the Migraine Severity Scale (MIGSEV). Venous blood samples were collected during migraine attacks (ictal phase), and serum NO levels were quantified using a colorimetric method. The association between NO levels and MIGSEV scores was analyzed using the Kruskal-Wallis test, followed by post-hoc Mann-Whitney U tests. Statistical significance was set at p < 0.05.
Results: The study included 51 female chronic migraineurs with a median age of 33 years. Migraine severity distribution was: 10 (19.6%) mild, 26 (51.0%) moderate, and 15 (29.4%) severe. The overall median serum NO level was 74.8 nmol/ml (range: 32.20 - 169.15 nmol/ml). Median NO levels demonstrated a positive gradient with increasing migraine severity: mild group 47.31 nmol/ml (range: 34.85 - 67.15), moderate group 88.45 nmol/ml (range: 32.20 - 167.45), and severe group 96.71 nmol/ml (range: 65.45 - 169.15). The Kruskal-Wallis test revealed a statistically significant difference in NO levels across the severity groups (p < 0.01). Post-hoc analyses confirmed significant differences between the mild and moderate groups (p < 0.01) and between the mild and severe groups (p < 0.01).
Conclusion: This study demonstrated a significant positive association between serum Nitric Oxide levels, measured during the ictal phase, and the severity of chronic migraine in female patients. Higher NO levels were correlated with greater migraine severity, suggesting NO may play a crucial role in the mechanisms underlying migraine intensity and potentially serve as a biomarker reflecting the clinical burden of chronic migraine
Kawasaki Disease in a Preschooler: A Case Study on Timely Diagnosis and IVIG (Intravenous Immunoglobulin) Intervention
Full text linkBackground: Kawasaki disease (KD) is an acute, systemic vasculitis predominantly affecting young children and represents the leading cause of acquired heart disease in developed nations. Diagnostic challenges, particularly in resource-limited settings like Indonesia, contribute to underdiagnosis and delayed treatment.
Case presentation: We report the case of a 3-year-8-month-old Indonesian male who presented with a five-day history of high-grade fever, polymorphous rash, bilateral non-purulent conjunctival injection, oropharyngeal changes (strawberry tongue, dry cracked lips), and unilateral cervical lymphadenopathy. These features fulfilled the classic diagnostic criteria for KD. Laboratory investigations revealed mild normocytic anemia and a markedly elevated erythrocyte sedimentation rate (ESR). Initial electrocardiogram showed sinus tachycardia without conduction abnormalities. Echocardiography performed during the acute phase was essential for baseline assessment and monitoring. The patient received timely administration of high-dose intravenous immunoglobulin (IVIG) (2 g/kg) and high-dose aspirin within the optimal treatment window.
Conclusion: This case underscores the paramount importance of early clinical recognition based on established criteria and prompt initiation of IVIG therapy in mitigating the risk of CAA in children with KD. Despite successful treatment in this instance, the challenges of underdiagnosis and variable clinical presentations, including incomplete forms, persist globally, particularly in regions like Indonesia. Continued research into KD pathogenesis, improved diagnostic markers, management of IVIG resistance, and long-term cardiovascular surveillance protocols are crucial for optimizing patient outcomes
Predictive Accuracy of the Placenta Accreta Index (PAI) for Histopathological Severity in Placenta Accreta Spectrum Disorders: A Prospective Cohort Study
Full text linkBackground: Placenta accreta spectrum disorder (PASD) represents a range of conditions characterized by abnormal placental adherence and invasion into the uterine wall, posing significant risks of maternal morbidity and mortality, primarily due to severe hemorrhage. The incidence has risen, largely attributed to increasing rates of cesarean deliveries. Prenatal diagnosis is crucial for optimal management. The Placenta Accreta Index (PAI), an ultrasound-based scoring system, was developed to aid in prenatal risk assessment. This study aimed to evaluate the predictive accuracy and correlation of PAI scores with final histopathological findings in patients with suspected PASD at a tertiary hospital in Riau, Indonesia.
Methods: A descriptive-analytical study with prospective data collection was conducted over six months (July-December 2024) at Arifin Achmad Regional General Hospital Pekanbaru. The study included 29 pregnant women diagnosed with placenta previa totalis and suspected PASD based on clinical and initial ultrasound findings. Patients underwent transabdominal Doppler ultrasonography between 32-34 weeks of gestation to calculate the PAI score. Following delivery (primarily via cesarean hysterectomy), placental and uterine specimens underwent histopathological examination to determine the definitive PASD classification (accreta, increta, percreta). Correlation between PAI scores and pathological severity was assessed using the Spearman correlation test. Logistic regression was used to evaluate PAI as a predictor of pathological outcomes. Sensitivity and specificity were calculated using a PAI cut-off score of ≥6. Statistical significance was set at p < 0.05.
Results: Of the 29 participants, the mean age was 32.83 ± 2.82 years, the mean parity was 3.21 ± 1.05, and a mean number of prior cesarean sections was 1.72 ± 0.70. Histopathology confirmed PASD in all cases: 23 (79.3%) were placenta accreta, 5 (17.2%) were placenta increta, and 1 (3.5%) was placenta percreta. A statistically significant positive correlation was found between PAI score and histopathological severity (Spearman's R = 0.512, p = 0.012). Logistic regression confirmed PAI score as a significant predictor of pathological outcome (β = 3.64, 95% CI 1.301–5.982, p = 0.003). Using a cut-off score of ≥6, PAI demonstrated a sensitivity of 88.6% and specificity of 83.3% for predicting PASD based on the abstract data.
Conclusion: The Placenta Accreta Index (PAI) demonstrated a significant positive correlation with the histopathological severity of Placenta Accreta Spectrum Disorders. PAI serves as a valuable and accurate predictive tool for assessing the degree of placental invasion prenatally. Its use can significantly aid clinicians in risk stratification, surgical planning, and optimizing obstetric management to improve maternal outcomes in this high-risk population
Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective Study on Causative Agents and Patient Profiles in an Indonesian Hospital Setting
Full text linkBackground: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) represent rare, severe mucocutaneous adverse drug reactions characterized by extensive epidermal necrosis and significant morbidity and mortality. Understanding the specific causative agents and patient profiles within local populations is crucial for early diagnosis and management. This study aimed to characterize SJS/TEN cases in a tertiary hospital setting in Indonesia.
Methods: A retrospective descriptive study was conducted using secondary data from medical records of patients diagnosed with SJS, SJS/TEN overlap, and TEN admitted to the inpatient installation of Dr. Moewardi General Hospital, Surakarta, Indonesia, between January 2022 and December 2024. Data collected included demographics (age, gender), comorbidities, diagnosis classification (SJS, SJS/TEN overlap, TEN), suspected causative drugs, length of hospital stay, SCORTEN score, and patient outcome (discharged alive or deceased). Total sampling was employed, excluding records with incomplete data. Data were compiled and analyzed descriptively.
Results: Fifty-one patients were included, with a slight female predominance (52.94%). The largest age group affected was 19-59 years (60.78%). The distribution of diagnoses was SJS (41.18%), SJS/TEN overlap (31.37%), and TEN (27.45%). The mean SCORTEN score for the cohort was 2. The most common suspected causative drug classes were antibiotics (25.71%), followed by analgesic-antipyretics (24.29%), and anticonvulsants (22.86%). Carbamazepine (11.43%) and amoxicillin (10%) were frequent individual culprits. Epilepsy (13.73%) and diabetes mellitus (11.76%) were common comorbidities, although a significant portion (33.33%) had no recorded comorbidity. The mean length of stay was 9 days. Overall mortality was 15.68%, with higher rates observed in TEN (28.57%) compared to SJS (9.52%) and SJS/TEN overlap (12.5%).
Conclusion: SJS/TEN affected predominantly adults, with antibiotics, analgesics, and anticonvulsants being the most implicated drug classes. While mortality was considerable, it appeared lower than some international reports, particularly for TEN. Recognizing common causative agents and patient risk factors, such as specific comorbidities like epilepsy and diabetes, can aid clinicians in early identification and prompt management of these life-threatening conditions
Navigating a Rare Entity: Pancreatic Lipomatosis in a 34-Year-Old Female Without Classical Risk Factors – A Case Report
Full text linkBackground: Pancreatic lipomatosis (PL), characterized by the replacement of pancreatic acinar tissue with mature adipose cells, is an uncommon condition with an etiology that is often not fully understood. It is frequently identified incidentally during imaging studies. The aim of this case report is to contribute to and advance the clinical understanding of this exceedingly rare and atypical presentation of pancreatic lipomatosis.
Case presentation: This report details the case of a 34-year-old female who presented for evaluation of nonspecific, intermittent epigastric discomfort. Her medical history was devoid of significant illnesses, alcohol abuse, or known genetic conditions predisposing to pancreatic disorders. Comprehensive laboratory evaluations, encompassing serum amylase, lipase, liver function tests, lipid profile, and HbA1c, yielded results entirely within normal parameters. Abdominal computed tomography (CT) imaging revealed a striking diffuse, homogeneous fatty replacement of the entire pancreatic parenchyma, a hallmark of total pancreatic lipomatosis. Importantly, there was no evidence of pancreatic ductal dilatation, calcifications, or any discrete pancreatic masses. The patient's management was conservative, involving lifestyle counseling and scheduled periodic monitoring for the potential, though infrequent, development of complications such as exocrine pancreatic insufficiency or secondary diabetes mellitus.
Conclusion: This case distinctly illustrates the occurrence of extensive pancreatic lipomatosis in a young, otherwise healthy female lacking classical risk factors. The pivotal role of cross-sectional imaging, specifically CT, in accurately diagnosing this benign condition is emphasized, which is crucial for averting misdiagnosis and precluding unnecessary invasive interventions. Enhanced awareness among clinicians is vital for appropriate patient counseling, the implementation of conservative management strategies, and diligent long-term monitoring for any potential metabolic or functional sequelae
The Shadow of Deficiency: Vitamin D Status as a Critical Determinant of Antithyroid Drug Efficacy in Graves’ Disease – Insights from an Indonesian Cohort
Full text linkBackground: Graves' disease (GD), an autoimmune hyperthyroid condition, presents significant management challenges, particularly concerning variable remission rates with antithyroid drugs (ATDs). Vitamin D, with its established immunomodulatory properties, is hypothesized to influence autoimmune processes, including those in GD. However, its precise impact on ATD treatment outcomes in diverse populations, especially in regions like Indonesia with high vitamin D deficiency prevalence, remains insufficiently elucidated.
Methods: This retrospective cohort study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia, analyzing data from 73 newly diagnosed adult GD patients (diagnosed January 2022 - December 2023). Patients had confirmed GD based on hyperthyroidism with orbitopathy or positive TRAb and were followed until May 2025. Baseline serum 25-hydroxyvitamin D [25(OH)D], free T4 (fT4), and TSH levels were recorded. Vitamin D deficiency (VDD) was defined as <20 ng/mL. The primary outcome was non-remission after ATD therapy, defined as failure to achieve stable euthyroidism for ≥6 months on minimal ATD doses. Multivariate Poisson regression was used to assess predictors of non-remission.
Results: Of 73 patients (mean age 36.2 years; 62% female), 55 (75.3%) exhibited VDD. Multivariate analysis identified VDD as a significant independent predictor of non-remission (adjusted Relative Risk [aRR] 11.81; 95% CI 1.88–74.20; p=0.008). Elevated baseline fT4 levels (≥5 ng/dL; aRR 4.61; 95% CI 1.13–18.70; p=0.032) and older age (>48 years; aRR 0.078; 95% CI 0.06–0.95, indicating a protective effect of older age against non-remission) were also significant predictors.
Conclusion: Baseline vitamin D deficiency is a potent independent risk factor for non-remission in Indonesian Graves' disease patients receiving antithyroid drug therapy. These findings underscore the potential importance of assessing and addressing vitamin D status in the management of Graves' disease to optimize therapeutic outcomes
Awake Intubation for a Predicted Difficult Airway in a Patient with Giant Goiter-Induced Tracheomalacia: A Case Report
Full text linkBackground: The management of a predicted difficult airway in patients with giant goiters presents a significant anesthetic challenge. Chronic tracheal compression can lead to secondary tracheomalacia, a condition characterized by tracheal weakness that can precipitate catastrophic airway collapse upon induction of general anesthesia. We present a case where a high index of suspicion for tracheomalacia guided the decision to perform awake tracheal intubation.
Case presentation: A 22-year-old female presented with a massive, non-toxic nodular goiter that had been growing for eight years, causing significant positional dyspnea. Airway assessment revealed a 10x10 cm neck mass with tracheal deviation, indicating a high risk for difficult intubation and ventilation. Preoperative suspicion of tracheomalasia was high due to symptoms and chronicity. The airway was secured using awake intubation with topical and intravenous lidocaine prior to the induction of general anesthesia. The patient underwent a total thyroidectomy. Intraoperative palpation confirmed flaccid tracheal rings, supporting the diagnosis. The endotracheal tube was retained postoperatively, and the patient was monitored in the intensive care unit. She was successfully extubated on the third postoperative day without complications.
Conclusion: This case underscores the critical importance of maintaining a high index of suspicion for tracheomalacia in patients with long-standing, giant goiters. Awake tracheal intubation is a cornerstone technique, providing a safe and effective method to secure the airway while preserving spontaneous ventilation, thereby mitigating the risk of life-threatening airway obstruction. A meticulous, multidisciplinary perioperative plan is paramount for optimal patient outcomes
Unmasking Occult Malignancy: The Pivotal Role of the Peripheral Blood Smear in the Initial Diagnosis of Chronic Lymphocytic Leukemia
Full text linkBackground: Chronic lymphocytic leukemia (CLL) is a common hematologic malignancy in adults, frequently discovered incidentally through routine blood tests due to its often nonspecific clinical presentation. In resource-limited settings, fundamental laboratory investigations are crucial for initiating the diagnostic pathway. This report illustrates the critical diagnostic value of the complete blood count and peripheral blood smear in identifying CLL in a patient presenting with vague constitutional symptoms.
Case presentation: A 43-year-old female with a history of type 2 diabetes mellitus presented to a rural hospital with a one-month history of debilitating fatigue, intermittent fever, and loss of appetite. Physical and radiological examinations were unremarkable. However, initial hematological analysis revealed marked leukocytosis (77,910/μL), mild anemia, and thrombocytopenia (54,000/μL). A peripheral blood smear was pivotal, showing an absolute lymphocytosis of 90% with mature-appearing lymphocytes, pleomorphism, and characteristic smudge cells. Following referral, definitive diagnosis was established through flow cytometry, which confirmed a clonal B-cell population (CD19+, CD5+, CD23+, dim CD20+). Bone marrow examination showed extensive infiltration, and molecular studies revealed an unmutated IGHV gene status, placing the patient in a high-risk prognostic category.
Conclusion: This case underscores that even in the absence of advanced diagnostic facilities, a meticulous evaluation of the peripheral blood smear is a powerful and essential tool for unmasking serious underlying hematologic malignancies like CLL. It enables early suspicion, appropriate patient referral, and timely initiation of management, thereby significantly impacting patient outcomes
Navigating a Therapeutic Triad: A Case of Pulmonary Tuberculosis Complicated by Drug-Induced Liver Injury and Prediabetes
Full text linkBackground: The management of pulmonary tuberculosis (TB) is frequently complicated by adverse drug reactions, with drug-induced liver injury (DILI) being one of the most severe. The clinical challenge is significantly amplified in patients with underlying metabolic disorders such as prediabetes, which can impair immune responses and affect treatment outcomes. This report details the complex management of a geriatric patient presenting with this therapeutic triad.
Case presentation: A 67-year-old male with newly diagnosed, drug-sensitive pulmonary tuberculosis developed severe hepatotoxicity ten days after initiating standard first-line anti-tuberculosis therapy. Clinical presentation included jaundice, nausea, and vomiting, with laboratory findings showing a severe hepatocellular injury pattern (SGOT 204 U/L, SGPT 126 U/L) and hyperbilirubinemia (Total Bilirubin 2.6 mg/dL). Concurrently, he was diagnosed with prediabetes (HbA1c 5.9%) and was suffering from severe malnutrition (BMI 15.6 kg/m²). The offending drugs were immediately withdrawn, and supportive therapy was initiated. Following normalization of liver function, a modified anti-tuberculosis regimen was cautiously reintroduced using a stepwise re-challenge protocol that entirely omitted pyrazinamide.
Conclusion: The patient was successfully managed with a modified nine-month regimen of isoniazid, rifampicin, and ethambutol, achieving clinical and biochemical stability without recurrence of liver injury. This case highlights that a meticulous, stepwise approach—involving prompt drug withdrawal, supportive care, and a tailored re-challenge protocol—can lead to successful TB treatment outcomes without recurrence of DILI, even in a patient with multiple converging high-risk factors