Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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High resolution ultrasonography of thyroid nodules: can ultrasonographic assessment obviate the need for invasive aspiration cytology in ultrasonographically benign lesions?
No full textThe use of high-resolution ultrasound (HRUS) thyroid imaging has resulted in a significant revolution in the treatment of thyroid nodules. The enigma of thyroid nodules has been a blind spot for radiologists for a long period. Reporting a thyroid nodule as benign or malignant is quite difficult and many times not accurate. The American Collage of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) 2017 classification has solved this problem to a large extent. However, the classification needed pathological confirmation for it to be highly accurate. We compared our HRUS-based TIRADS labeling of thyroid nodules with thyroid cytopathology using revised Bethesda classification system. Patients detected with thyroid nodules by HRUS were categorized using ACR-TIRADS and further were taken for fine needle aspiration cytology (FNAC) in our department. The pathological results were compared with the initial TIRADS category of the nodule and the effectiveness of the TIRADS classification in categorizing nodules into benign and malignant was assessed using various statistical variables. The initial USG and the FNAC were performed by a single radiologist with over 10 years of experience. A total of 201 patients underwent HRUS followed by FNAC after obtaining written consent in our department. The thyroid nodules labeled as true benign on ACR-TIRADS (TIRADS 2) were all true benign on Bethesda cytopathology (less than Bethesda III), confirming the high accuracy of HRUS. The diagnostic accuracy of HRUS in cases of ACR-TIRADS 3 nodules was approximately 90.6% with an error rate of 9.4%. Nodules labeled as ACR-TIRADS 4 and 5 had error rates of 47% and 10% in labeling nodules as malignant. The ultrasound-based ACR-TIRADS system can accurately predict the likelihood of specific nodules being benign. There is a strong concordance between Bethesda cytology and ACR-TIRADS classification, particularly for benign nodules. In resource-constrained system like ours, patients with TIRADS 2 and 3 nodules can be safely followed obviating the need for an invasive procedure like FNAC
High-sensitivity C-reactive protein/albumin (hs-CRP/albumin) ratio as a predictor of deterioration of clinical outcome in central nervous system infections
No full textCentral nervous system (CNS) infections such as encephalitis, meningitis, or myelitis have high morbidity and mortality in Indonesia. High sensitivity C-reactive protein (hs-CRP) is a sensitive marker of acute inflammation, while albumin is the most abundant protein component in plasma and cerebrospinal fluid (CSS). Infection triggers an inflammatory response so that an increase in the hs-CRP/albumin ratio (CAR) can be a predictor of worsening clinical outcome in patients with CNS infections. However, studies examining the predictor value of serum and CSF CAR on worsening clinical outcomes of patients are limited, particularly in CNS infections. The purpose of this study was to prove the CAR as a predictor of worsening clinical outcome in patients with CNS infections. It was an observational study using a prospective cohort design. Fifty subjects recruited until October 2021 at Dr. Sardjito General Hospital were involved. The multivariate regression analysis showed that serum CAR (OR=3.604; 95%CI=1.487-8.736; p =0.005) could be a single predictor. However, by combining three variables, namely serum CAR, CSF CAR, and decreased consciousness at admission, could be a stronger predictor of worsening clinical outcome in patients with CNS infection (AUC = 97.1%; 95%CI = 0.929-1.00; p <0.001). The optimal cut-off value for serum CAR was 1.35 (Youden index = 0.88, sensitivity = 96%, specificity = 92%) while for CSF CAR was 0.14 (Youden index = 0.60, sensitivity = 76%, specificity = 84%). In conclusion, a combination predictive model of three variables, namely serum CAR, CSF CAR, and awareness at admission can be a stronger predictor of clinical outcome in patients with CNS infection than serum CAR alone
Papulopustular demodicosis: a case report
No full textPrimary demodicosis is an infestation of Demodex colonization >5 mites/cm2 without pre-existing or concomitant inflammatory skin disease. Primary demodicosis is divided into 3 variants i.e. spinulata, papulopustular and nodulocystic. Several topical and systemic agents are used in the Demodex facial treatment. A 22 y.o. man complained of acne on his face three months ago. On physical examination, there were pustules, multiple erythematous papules, ice pick atrophic scars, and box and rolling scars. KOH examination found the Demodex number > 5 mites/cm2. No spores were found. The patient received oral and topical metronidazole therapy. Papulopustular demodicosis is a follicular inflammation caused by Demodex mites. The inflammatory stage shows a predilection for the perioral, periorbital, and periauricular regions. According to the pattern of morphology and localization of the centrofacial area, some cases of demodicosis are often referred to as Rosacea-like (rosaceiform) demodicosis. The treatment goals are to reduce the overall number of mites and treat the underlying condition. This paper reports a case of papulopustular demodicosis of the face. The diagnosis was made by history taking and physical examination using the diagnostic criteria for demodicosis. Clinical improvement was obtained after oral and topical metronidazole therapy for two weeks
Facial nerve paralysis in nasopharyngeal carcinoma: a case report
No full textNasopharyngeal carcinoma (NPC) is cancer originating from the mucosal lining of nasopharynx, with the highest predilection in the fossa of Rosenmüller. One-fifth of NPC cases have cranial nerve complications. The location of Rosenmüller's fossa which is adjacent to foramen lacerum and middle base of the cranium allows the tumor to extend directly into the cranium and surrounding cranial nerves. This paper reported a case of facial nerve paralysis in NPC. A 55-year-old man came to the Ear-Nose-Throat (ENT) Clinic at Dr. Kariadi General Hospital, Semarang with complaints of facial pain on the right side, headache, a lump on the left neck, fullness in ears, and nosebleed. However, the patient did not complain of double vision. After a thorough history taking, physical examination, radiology, and histopathology tests, the patient was diagnosed with WHO 3 ECOG I T3N2M0 stage III NPC with House Brackmann III facial nerve paresis at the level of Mastoid segment. The patient was treated using chemotherapy treatment by an ENT specialist with a chemotherapy regimen of paclitaxel-cisplatin for 6 cycles. In conclusion, although rare, NPC can cause facial nerve paralysis.
Effects of combination of alcohol and Cinnamomum burmannii essential oil against Klebsiella pneumoniae resistance
No full textAlcohol-based antiseptics are widely used in the COVID-19 pandemic to prevent the transmission of infections, including bacterial infections. However, bacterial resistance to the alcohol-based antiseptics is begun reported. Klebsiella pneumonia resistance is one of the bacterial resistances that is prioritized by the WHO to be overcome. Cinnamomum burmannii essential oil, containing cinnamaldehyde and eugenol, was investigated for antimicrobial activity. This study aimed to evaluate the synergistic effect of the combination of alcohol and C. burmannii essential oil in inhibiting bacterial growth. Ethanol 80% in a combination with C. burmannii essential oil at concentrations of 1, 2, and 3% v/v were evaluated against K. pneumoniae using the Kirby-Bauer disc diffusion method. Test was repeated three times in independent experimental. Inhibition zone diameter (IZD, mm) and antimicrobial index (AI, %) were determined and analyzed using Kruskal-Wallis test continued the Mann-Whitney test. The combination of ethanol and C. burmannii essential oil was sensitive to K. pneumoniae, meanwhile, ethanol 80% was not more sensitive. The IZD of the combination solution at 1, 2, and 3% concentration were 6.7±0.19, 9.0±0.58, and 11.0±1.15mm, respectively (p<0.05). The AI of the combination solution at concentrations of 1, 2, and 3% v/v were 7.04±2.04, 30.53±6.79, and 51.64±12.91%, respectively (p<0.05). In conclusion, the combination of ethanol 80% and C. burmannii essential oil active against K. pneumoniae which resistant to the ethanol
Malignant bilateral ovarian steroid cell tumor without androgenic manifestation: an unusual finding
No full textSteroid cell tumor is a rarest ovarian neoplasm, classified as a pure stromal tumor and mostly is unilateral. Even though this tumor can exhibit malignant behavior but the morphology of cells showed benign characteristics which can become a diagnosis pitfall especially in the frozen section. Moreover patient without any hormonal imbalance or virilizing signs could make the diagnosis process more difficult. Here we reported a case bilateral steroid cell tumor of the ovary in a 42 y.o. unmarried woman without any virilization or hirsutism symptoms. Abdominal ultrasonography and computed tomography (CT) scan revealed a right ovarian solid tumor accompanied by ascites and right pleural effusion. There was significantly increased of Ca 125 level (1138 U/mL) and normal level of testosterone (0.10 ng/mL). Frozen section was done from the right ovarium mass and ascites fluid, the result was benign. From the total abdominal hysterectomy and bilateral salpingo-oophorectomy tissues, histological picture showed diffuse and nests tumor separated by thin fibrous connective tissue with small round centered nuclei, mild atypia, and abundant pale cytoplasm. Large area of necrosis was found especially in the right ovarian tumor, tumor implant to the right fallopian tube and in the uterine serous layer. Periodic acid-Schiff (PAS) stain was negative in more than half tumor cells population. Immunostaining for Melan-A and Calretinin were focally positive, with Ki-67 labeling index ± 5%, and negative for cytokeratin 7 (CK7), cytokeratin 20 (CK20) and smooth muscle actin (SMA). Based on the tumor size, necrosis area, tumor implantation, and immunohistochemistry profiles, we conclude that were malignant steroid cell tumor. Currently, the patient is undergoing postoperative recovery and planned for platinum-based chemotherapy. A careful correlation between clinical and radiological findings, as well as histopathological results, is always essential, as is amply demonstrated by this particular case
Correlation of neutrophil ratio to lymphocyte levels before therapy with the incidence of metastasis, lymph node involvements, in urothelial type muscle invasive bladder cancer in Indonesia
No full textBladder cancer is cancer originated from the bladder mucosa or urothelium. Bladder cancer is the 9th most common malignancy worldwide and the most common malignancy of the urinary tract. Studies show that cancer triggers an inflammatory response, which causes changes in circulating inflammatory cells. Examination of neutrophils and lymphocytes is an inexpensive examination, reproducible, and easily obtained. Neutrophil to lymphocyte ratio (NLR) values have been used in several studies to evaluate the inflammatory response that occurs in tumors. In urology, the importance of NLR has been recognized in predicting progression and aggressiveness in urothelial bladder tumors, kidney cancer (RCC/renal cell carcinoma), and upper tract urothelial carcinoma (UTUC). This study was a cross-sectional study obtained retrospectively by evaluating the medical records of patients diagnosed with muscle-invasive bladder cancer (MIBC) at Dr. Sardjito General Hospital, Yogyakarta, Indonesia from January 2017 to December 2019. The NLR data were categorized into NLR 2.5. As much as 150 patients with bladder cancer were included in this study, with a mean age of 56.43 ± 13.60 years. In the comparison of NLR values and the incidence of metastasis, there were 15 people (20%) with NLR values 2.5 had metastasis (p = 0.003). In the comparison of NLR values and nodule involvement, there were 25 (33.3%) patients with NLR 2.5 (p = 0.021). This study showed that patients with metastatic bladder tumors and lymph node involvement had a significantly higher NLR value. It can be concluded the NLR value can be used to predict the metastatic level and lymph node involvement in patients with bladder tumors. Even though it is not a specific marker of inflammation, the NLR examination is simple, affordable, easy to obtain, and widely available
Potential secondary metabolite analysis of soil Streptomyces sp. GMR22 and antibacterial assay on Porphyromonas gingivalis ATCC 33277
No full textInfectious diseases caused by oral pathogenic bacteria are currently a serious problem due to the increasing incidence of antimicrobial resistance. Streptomyces sp. GMR22, a soil actinobacterium which has large-genome size. In previous studies, it was known to have antifungal, and antibiofilm activity on Candida albicans. However, its antibacterial activity on oral pathogenic bacterium, Porphyromonas gingivalis is not clear. This study aimed to identify potential active compound based on genome mining analysis and to evaluate the antibacterial activity of GMR22 extract on P. gingivalis ATCC 33277. Potential active compounds and biosynthesis gene clusters were analysis using antiSMASH version 5. Antibacterial activity assay was carried out by the microdilution method on P. gingivalis ATCC 33277. Based on genome mining analysis polyketide synthase (PKS), the Streptomyces sp. GMR22 is the abundant BGCs (35%) and has large-predicted compounds which have antibiotic-antibacterial activity (22.9%). On antibacterial assay, chloroform extract of GMR22 at 7.8 – 62.5 µg/mL has high antibacterial activity on P. gingivalis compared to other extracts. Soil Streptomyces sp. GMR22 bacterium has biotechnological potential to produce active compounds for antibacterial
