Bioscientia Medicina : Journal of Biomedicine and Translational Research

Argon Plasma Coagulation for Proctitis: A Meta-Analysis

2024-10-29T06:56:42+00:00

Background: Proctitis, encompassing various etiologies, significantly diminishes patient quality of life. Argon plasma coagulation (APC) has emerged as a potential therapeutic modality, yet its efficacy and safety profile remain to be fully elucidated. This meta-analysis aimed to rigorously evaluate the effectiveness and safety of APC across diverse proctitis subtypes.

Methods: A comprehensive search of PubMed, Embase, and the Cochrane Library databases was conducted, spanning 2013 to 2023, to identify pertinent studies. Randomized controlled trials (RCTs) and observational studies comparing APC with alternative treatments or placebo in proctitis management were included. The primary outcome was clinical improvement, defined as symptom reduction or amelioration of endoscopic findings. Secondary outcomes encompassed adverse events and quality of life metrics.

Results: A total of 15 studies (5 RCTs and 10 observational studies) encompassing 2042 patients met the inclusion criteria. APC demonstrated a significant association with clinical response improvement compared to other treatments or placebo (OR 2.58, 95% CI 2.14-3.12, p<0.001). Subgroup analysis revealed APC's efficacy in both radiation-induced and non-radiation-induced proctitis. Adverse event incidence was comparable between APC and other treatments, with no significant differences in severe complications.

Conclusion: APC appears to be an effective and safe therapeutic option for various proctitis subtypes, warranting consideration in clinical practice.

Prolonged Hospital Stays in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients: The Role of Comorbid Conditions

2024-10-29T06:56:47+00:00

Background: Continuous ambulatory peritoneal dialysis (CAPD) is a widely used treatment for end-stage renal disease (ESRD), but it is associated with frequent hospitalizations that can significantly impact patients' quality of life and increase healthcare costs. This study aimed to investigate the influence of comorbid conditions on the length of hospital stay (LOS) in CAPD patients.

Methods: A retrospective cohort study was conducted on CAPD patients admitted to Dr. Kariadi General Hospital Semarang between January 1^st, 2023, and December 31^st, 2023. Data on demographics, comorbidities, and LOS were extracted from medical records. The Charlson Comorbidity Index (CCI) was used to assess comorbidity burden. Multivariable linear regression analysis was performed to identify predictors of prolonged LOS, defined as exceeding the median LOS.

Results: The study included 52 CAPD patients with a median LOS of 18 days (range: 1-72 days). Patients with comorbidities had a significantly longer LOS compared to those without comorbidities (20.25 ± 12.88 days vs. 12.50 ± 3.63 days, p = 0.045). The presence of comorbidities was significantly associated with prolonged LOS (odds ratio [OR] 2.87, 95% confidence interval [CI] 1.15-7.16, p = 0.023), as were older age (OR 1.05, 95% CI 1.01-1.09, p = 0.012) and peritonitis as the primary reason for hospitalization (OR 3.54, 95% CI 1.38-9.08, p = 0.008).

Conclusion: Comorbid conditions are significant contributors to prolonged hospital stays in CAPD patients. These findings underscore the importance of effectively managing comorbidities in this population to optimize healthcare resource utilization and improve patient outcomes.

Ozonated Aloe Vera: A Novel Topical Agent for Improved Wound Healing and Reduced Scar Formation on TGF-β Modulation Invivo Study

2024-10-29T06:56:24+00:00

Background: Chronic wounds and impaired wound healing represent a significant healthcare burden. Aloe vera has been recognized for its therapeutic potential in wound healing, and the combination with ozone, and ozonated aloe vera, may offer synergistic effects. This study investigated the effects of ozonated aloe vera oil on wound healing and scar formation, focusing on TGF-β modulation in a rat model.

Methods: Full-thickness skin defects were created on 50 Sprague Dawley rats, which were randomly divided into five groups: (1) control (untreated), (2) aloe vera oil, (3) ozonated aloe vera oil (600 mg/ml ozone), (4) ozonated aloe vera oil (1200 mg/ml ozone), and (5) ozonated aloe vera oil (1800 mg/ml ozone). Wound healing was assessed macroscopically by measuring wound area reduction and microscopically by evaluating TGF-β expression through immunohistochemical staining on days 3, 7, and 14.

Results: Ozonated aloe vera oil significantly accelerated wound healing compared to the control and aloe vera oil alone groups (p < 0.05). The highest ozone concentration (1800 mg/ml) showed the most rapid wound closure and the lowest TGF-β expression on day 14 (p < 0.05). Histological analysis revealed enhanced collagen organization and reduced inflammatory cell infiltration in ozonated aloe vera oil treated wounds.

Conclusion: Ozonated aloe vera oil effectively promotes wound healing and reduces scar formation in a rat model. The modulation of TGF-β signaling plays a crucial role in these effects. Ozonated aloe vera oil holds promise as a novel topical agent for improved wound management.

Handgrip Strength: An Early Warning Sign for Mobility Decline? A Meta-Analysis of Diagnostic Accuracy Studies

2024-10-29T06:56:18+00:00

Background: Mobility limitations significantly impact the quality of life of older adults. Early identification of individuals at risk is crucial for timely intervention. This meta-analysis investigates the diagnostic accuracy of handgrip strength (HGS) in predicting future mobility decline in older adults.

Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted for diagnostic accuracy studies published between 2018 and 2024, evaluating the ability of baseline HGS to predict incident mobility limitations in older adults (≥60 years). Mobility limitations were defined as difficulties in performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs). The primary outcomes were sensitivity, specificity, and diagnostic odds ratio (DOR) of HGS for predicting mobility decline. A bivariate random-effects model was used to pool data.

Results: Seven diagnostic studies with a total of 3,870 participants were included. The pooled sensitivity of HGS for predicting mobility decline was 0.72 (95% CI: 0.65-0.78), and the pooled specificity was 0.70 (95% CI: 0.66-0.74). The pooled DOR was 4.85 (95% CI: 3.21-7.32), indicating good discriminatory ability.

Conclusion: This meta-analysis demonstrates that HGS has moderate sensitivity and specificity for predicting future mobility decline in older adults. HGS assessment can be a valuable tool for identifying individuals at risk, although further research is needed to determine optimal cut-off points and combine HGS with other risk factors for improved prediction.

The Impact of RNA Interference on Atherosclerotic Plaque Progression: A Meta-Analysis of Preclinical Studies

2024-10-29T06:56:10+00:00

Background: 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

2024-10-29T06:56:06+00:00

Background: 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

2024-10-29T16:36:16+00:00

Background: 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.

Preeclampsia Risk in Bali, Indonesia: The Role of Maternal Body Mass Index (BMI) and Gestational Weight Gain (GWG)

2024-10-29T16:36:02+00:00

Background: Preeclampsia, a hypertensive disorder of pregnancy, significantly contributes to maternal and infant mortality and morbidity globally, including in Indonesia. Pre-pregnancy obesity and excessive gestational weight gain (GWG) are established risk factors for preeclampsia. This study investigated the association between pre-pregnancy body mass index (BMI) and GWG with the incidence of preeclampsia in Bali, Indonesia.

Methods: A case-control study was conducted at a Maternal Hospital in Bali, Indonesia, from May 2023 to May 2024. The study included 429 pregnant women: 143 with preeclampsia (cases) and 286 without (controls). Data were collected from medical records. BMI was categorized using Asia-Pacific criteria, and GWG was assessed based on the 2009 Institute of Medicine (IOM) guidelines. Logistic regression analysis was performed to determine the associations, adjusting for maternal age, education, and occupation.

Results: Obesity class II (BMI ≥ 30 kg/m²) and obesity class I (BMI 25.0-29.9 kg/m²) were significantly associated with an increased risk of preeclampsia, with adjusted odds ratios (AOR) of 2.90 (95% CI: 1.19-7.08) and 2.78 (95% CI: 1.60-4.81), respectively, compared to women with normal weight. Excessive GWG was also significantly associated with preeclampsia (AOR 2.53; 95% CI: 1.48-4.33) compared to adequate GWG.

Conclusion: Maternal obesity and excessive GWG are significant risk factors for preeclampsia in Bali, Indonesia. These findings underscore the importance of pre-pregnancy counseling and interventions to manage weight and promote healthy GWG to reduce the burden of preeclampsia.

Programmed Death-Ligand 1 (PD-L1) and Ki-67 Labeling Index: Correlation with Tumor Grade and Recurrence

2024-10-30T16:36:32+00:00

Background: Meningiomas are common primary brain tumors with variable clinical behavior. While most are benign, a subset exhibits aggressive characteristics and a high recurrence rate. This study aimed to investigate the association of Programmed Death-Ligand 1 (PD-L1) and Ki-67 labeling index with histopathological grade and recurrence in meningioma.

Methods: A retrospective study was conducted on 139 cases of meningioma diagnosed between January 2020 and December 2023. PD-L1 expression was evaluated using immunohistochemistry (IHC) and scored using the combined positive score (CPS). Ki-67 labeling index was determined as the percentage of tumor cells with positive nuclear staining. The association of PD-L1 and Ki-67 with histopathological grade and recurrence was analyzed.

Results: PD-L1 expression was positive in 66.7% of cases and was significantly associated with recurrence (p = 0.006). A higher Ki-67 labeling index (>4%) was observed in 68.9% of cases and was also significantly associated with recurrence (p = 0.013). No significant association was found between PD-L1 expression or Ki-67 labeling index and histopathological grade.

Conclusion: PD-L1 expression and Ki-67 labeling index may serve as potential prognostic markers for predicting recurrence in meningioma. Further studies are needed to validate these findings and explore their potential therapeutic implications.

Efficacy and Safety of Intrapleural Fibrinolytic Therapy in Empyema Thoracis: A Meta-Analysis of Clinical Outcomes

2024-10-31T16:36:52+00:00

Background: Empyema thoracis is a severe pulmonary condition characterized by pus accumulation in the pleural space. Intrapleural fibrinolytic therapy is used adjunctively to break down loculations and facilitate lung re-expansion. This meta-analysis evaluated the efficacy and safety of this treatment in adults with empyema thoracis.

Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted (January 2013 - December 2023) for randomized controlled trials (RCTs) comparing intrapleural fibrinolytics with placebo or no fibrinolytic therapy in adults with empyema. Primary outcomes were treatment success (radiographic improvement and/or clinical resolution), duration of hospital stay, and mortality. Secondary outcomes included major bleeding and bronchopleural fistula. Data were pooled using a random-effects model, and risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) were calculated.

Results: Six RCTs (n=623 patients) met the inclusion criteria. Intrapleural fibrinolytic therapy showed a significantly higher treatment success rate than the control (RR 1.42, 95% CI 1.18-1.72, p=0.001) and significantly reduced hospital stay (MD -2.84 days, 95% CI -3.36 to -2.33, p<0.001). No significant difference in mortality was found (RR 0.95, 95% CI 0.46-1.93, p=0.93). The incidence of major bleeding and bronchopleural fistula was similar between the groups.

Conclusion: Intrapleural fibrinolytic therapy significantly improves treatment success and reduces hospital stays without increasing mortality or major complications. These findings support its use as an adjunctive therapy for drainage in managing empyema thoracis in adults.

Propolis Extract Attenuates NF-κB Activation and Chronic Kidney Disease Progression in a Rat Model: Potential Surgical Adjuvant?

2024-10-31T16:36:37+00:00

Background: Chronic kidney disease (CKD) is a global health concern often complicated by cardiovascular diseases like atherosclerosis. Both conditions share an inflammatory pathogenesis, with nuclear factor kappa B (NF-κB) playing a central role. Propolis, a natural bee product with anti-inflammatory properties, has shown potential in mitigating CKD progression. This study aimed to investigate the effects of propolis extract on NF-κB activation in a rat model of CKD, exploring its potential benefits as a surgical adjuvant.

Methods: Male white rats (Rattus norvegicus) were divided into three groups: a control group, a CKD group, and a CKD+Propolis group receiving propolis extract (200 mg/kg body weight) daily for 20 days. CKD was induced using the unilateral ureteral obstruction (UUO) method. NF-κB levels were measured weekly using ELISA.

Results: Propolis extract significantly reduced NF-κB levels in the CKD+Propolis group compared to the CKD group (p<0.05). This effect was consistently observed across all time points, indicating a sustained reduction in NF-κB activation with propolis treatment.

Conclusion: Propolis extract effectively attenuates NF-κB activation in a rat model of CKD, suggesting its potential as an adjunctive therapy for CKD management, particularly in the context of surgical interventions. Further research is needed to elucidate the underlying mechanisms and evaluate its efficacy in human subjects.

Pleural Amebiasis Mimicking Pleural Effusion: A Case Report

2024-11-02T16:37:04+00:00

Background: 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.

Hematologic Predictors of Chemotherapy-Induced Neutropenia in Breast Cancer Patients Receiving Anthracycline- or Taxane-Based Chemotherapy

2024-11-04T16:37:21+00:00

Background: Chemotherapy-induced neutropenia (CIN) is a common and serious complication of chemotherapy in breast cancer patients, leading to increased morbidity, mortality, and treatment disruptions. This study aimed to investigate the association between hematologic profiles and the occurrence of CIN in breast cancer patients receiving anthracycline-based or taxane-based chemotherapy.

Methods: A retrospective observational analytic study with a cross-sectional design was conducted using medical records of breast cancer patients treated at the Oncology Surgery Clinic between 2022 and 2023. Sixty patients were included in the study. Hematologic profiles, including hemoglobin and leukocyte counts, were analyzed to assess their association with CIN in both anthracycline- and taxane-based chemotherapy groups.

Results: The majority of patients were aged 15-64 years (86.67%), normoweight (65%), had luminal B subtype (63.3%), and were in the locally advanced breast cancer (LABC) stage (45%). Most patients were non-anemic (Hb ≥12 mg/dL) and leukopenic (71.7% and 80%, respectively). No significant association was found between age, nutritional status, or breast cancer stage and CIN (p > 0.05). However, hemoglobin and leukocyte profiles were significantly associated with CIN in both chemotherapy groups (p < 0.05). No association was found between the type of chemotherapy (anthracycline- or taxane-based) and CIN occurrence.

Conclusion: Anemia (Hb <12 g/dL) and leukopenia are significant predictors of CIN in breast cancer patients, regardless of the chemotherapy regimen. These findings highlight the importance of monitoring hematologic profiles in these patients to identify those at higher risk of CIN and implement appropriate preventive and management strategies.

Hydropneumothorax Secondary to Community-Acquired Pneumonia with Broncholith: A Case Report

2024-11-07T16:40:22+00:00

Background: Community-acquired pneumonia (CAP) is a common respiratory infection that can lead to serious complications, including hydropneumothorax, a condition characterized by the presence of both air and fluid in the pleural cavity.

Case presentation: We present the case of a 76-year-old male who presented to the emergency department with a one-week history of shortness of breath, dry cough, and low-grade fever. He had no prior surgeries, history of tuberculosis, comorbid conditions, or significant pulmonary diseases. Physical examination revealed crackles, decreased breath sounds on auscultation, and hyperresonance on percussion of the right hemithorax. Laboratory investigations demonstrated leukocytosis and neutrophilia. Chest radiography showed consolidation consistent with pneumonia, and subsequent computed tomography (CT) confirmed the diagnosis of right hydropneumothorax with pleural effusion and a broncholith in the right basal lobar bronchus. The patient was treated with intravenous antibiotics and underwent water seal drainage (WSD). He made a full recovery and was discharged home.

Conclusion: This case highlights the importance of considering hydropneumothorax as a potential complication of CAP, even in patients without significant comorbidities. Prompt diagnosis and management, including drainage and antibiotics, are crucial for a favorable outcome.

Impact of Open-Angle Glaucoma Severity on Vision-Related Quality of Life: A Cross-Sectional Study in a Single Center in Indonesia

2024-11-07T16:40:07+00:00

Background: Glaucoma is a progressive optic neuropathy characterized by the gradual loss of retinal ganglion cells (RGCs) and their axons, leading to irreversible visual field loss. This study aimed to investigate the relationship between the severity of primary open-angle glaucoma (POAG) and vision-related quality of life (VRQoL) in a single center in Indonesia.

Methods: A cross-sectional study was conducted at the eye polyclinic of Dr. M. Djamil General Hospital, Padang, Indonesia, from June to August 2024. A total of 54 patients with POAG were included and categorized into mild, moderate, and severe groups based on their cup-to-disc ratio and visual field index (VFI). VRQoL was assessed using the Indonesian version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ 25).

Results: The mean VRQoL score was significantly lower in the severe group (60.63 ± 13.04) compared to the moderate (81.79 ± 10.42) and mild (85.04 ± 10.52) groups (p = 0.000). A strong negative correlation was observed between glaucoma severity and VRQoL (r = -0.667, p = 0.000). The social functioning subscale showed the strongest correlation with severity (r = -0.573, p = 0.000).

Conclusion: The severity of POAG significantly impacts VRQoL, with more severe disease associated with lower QoL scores. The social functioning domain appears to be particularly affected. These findings underscore the importance of comprehensive glaucoma management that addresses not only clinical parameters but also the patient's overall quality of life.

Correlation between Troponin I Levels and Location of Acute Myocardial Infarction in ST-Elevation Myocardial Infarction Patients

2024-11-07T16:39:52+00:00

Background: Acute myocardial infarction (AMI) remains a leading cause of mortality in Indonesia. Cardiac troponin I (cTnI) is a highly sensitive and specific biomarker for AMI, and its levels may correlate with infarct location and prognosis. This study investigated the relationship between cTnI levels and the location of myocardial infarction in ST-elevation myocardial infarction (STEMI) patients.

Methods: A cross-sectional study was conducted on 57 STEMI patients admitted to H. Abdul Manap Regional General Hospital in Jambi City from April 2022 to 2024. Patients were consecutively enrolled based on inclusion and exclusion criteria. cTnI levels were measured using a point-of-care testing (POCT) device. The correlation between cTnI levels and infarct location was analyzed using the Pearson correlation test.

Results: The majority of patients were male (78.49%). The highest incidence of AMI was observed in the anterolateral location, with an average cTnI level of 12.16 ng/ml. A strong positive correlation was found between cTnI levels and the location of infarction (r = 0.891, p < 0.05).

Conclusion: Higher cTnI levels are associated with specific AMI locations, particularly anterolateral infarctions. This finding highlights the importance of cTnI measurement in assessing AMI severity and potential prognosis.

Prevalence and Risk Factors of Diabetic Retinopathy in a Tertiary Hospital in Padang, Indonesia

2024-11-09T16:41:46+00:00

Background: Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes, leading to vision impairment and blindness. This study aimed to determine the prevalence and risk factors associated with DR among patients attending a tertiary care center in Padang, Indonesia.

Methods: A cross-sectional study was conducted at the eye polyclinic of Dr. M. Djamil General Hospital, Padang, Indonesia, from October 2020 to March 2021. Patients diagnosed with diabetes who underwent a comprehensive ophthalmological examination were included. Data collected included demographics, duration of diabetes, cholesterol levels, and DR status (classified as non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR)).

Results: A total of 200 patients with diabetes were included. The prevalence of DR was 55%, with 40% having NPDR and 15% having PDR. Multivariate analysis revealed that longer diabetes duration (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.2-2.7, p=0.004), higher cholesterol levels (OR 2.5, 95% CI 1.5-4.1, p=0.001), and older age (OR 1.1, 95% CI 1.0-1.2, p=0.03) were independently associated with the presence of DR.

Conclusion: DR is highly prevalent among diabetic patients in tertiary care center Padang, Indonesia. Longer diabetes duration, elevated cholesterol, and older age are significant risk factors for DR. Early detection and management of these risk factors are crucial to prevent vision loss in this population.

Hyponatremia After Intracranial Hemorrhage: Cerebral Salt Wasting Syndrome (CSWS) or The Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?

2024-11-10T16:42:33+00:00

Background: Hyponatremia is a common electrolyte disorder encountered in neurosurgical patients, often associated with significant morbidity and mortality. This case report highlights the importance of recognizing and appropriately managing cerebral salt wasting syndrome (CSWS), a rare but important cause of hyponatremia in neurosurgical patients, often following intracranial hemorrhage (ICH). Distinguishing CSWS from the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is crucial for appropriate management.

Case presentation: A 56-year-old male with a history of hypertension and diabetes mellitus presented with sudden-onset left-sided weakness and decreased consciousness following an ICH. He underwent a ventriculoperitoneal (VP) shunt placement for hydrocephalus. Post-operatively, he developed hyponatremia with elevated urine sodium levels and hypovolemia, suggestive of CSWS. The patient was treated with fluid replacement therapy, including hypertonic saline, and desmopressin, resulting in improvement in his hyponatremia.

Conclusion: CSWS is an important cause of hyponatremia in neurosurgical patients. Prompt diagnosis and appropriate management, including fluid replacement and potentially desmopressin, can improve patient outcomes. This case underscores the need for a high index of suspicion for CSWS in neurosurgical patients presenting with hyponatremia and highlights the importance of careful monitoring and individualized treatment strategies.

Myopia Progression in Children: A Comparative Analysis of Pre-Pandemic and Pandemic Periods

2024-11-14T16:44:08+00:00

Background: The COVID-19 pandemic brought about significant changes in children's lifestyles, including increased screen time and reduced outdoor activities due to school closures and lockdowns. These changes raised concerns about potential myopia progression in children.

Methods: This study compared the spherical equivalent (SE) measurements of children aged 8-17 years from two time visits: one before the pandemic (September 2019 - February 2020) and one during the pandemic (March 2020 - February 2022). Data on family history of myopia, screen time, and outdoor activities were also collected. Paired t-tests were used to analyze the differences in SE between the two visits.

Results: A total of 11 children participated in the study. The mean change in SE was -1.55 D, indicating a significant increase in myopia during the pandemic (p = 0.046). The average daily screen time was 201 minutes, while outdoor activity time was 42 minutes.

Conclusion: The findings suggest a potential corelation between increased screen time, reduced outdoor activities, and myopia progression in children during the pandemic. It is crucial to encourage healthy visual habits, including limiting screen time and promoting outdoor activities, to mitigate the impact of the pandemic on children's vision.

Predicting Intensive Care Admission in Children with Acute Asthma: A Meta-Analysis of Predictive Models

2024-11-17T16:45:30+00:00

Background: Acute asthma is a common cause of pediatric emergency department visits and hospitalizations. Early identification of children at high risk of requiring intensive care unit (ICU) admission is crucial for optimal management and resource allocation. This meta-analysis aimed to evaluate the performance of predictive models for ICU admission in children presenting with acute asthma.

Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between 2013 and 2024 that developed or validated predictive models for ICU admission in children with acute asthma. Studies reporting sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were included. Methodological quality was assessed using the QUADAS-2 tool. Pooled estimates of diagnostic accuracy were calculated using a random-effects model.

Results: Six studies (n = 2,850 children) met the inclusion criteria. The predictive models included clinical features (respiratory rate, oxygen saturation, accessory muscle use), lung function measures (peak expiratory flow rate), and blood gas analysis. Pooled sensitivity ranged from 0.71 (95% CI 0.59-0.82) to 0.78 (95% CI 0.72-0.83), specificity from 0.79 (95% CI 0.75-0.83) to 0.86 (95% CI 0.78-0.91), and AUROC from 0.79 (95% CI 0.72-0.86) to 0.88 (95% CI 0.84-0.92).

Conclusion: Several predictive models demonstrate moderate to high accuracy in identifying children with acute asthma at risk of ICU admission. However, heterogeneity in model performance highlights the need for further research to validate existing models in diverse populations and develop more robust tools to guide clinical decision-making.

A Rare Case of Antithyroid Drug-Induced Lupus Erythematosus, Graves' Disease, and Primary Infertility

2024-11-18T16:46:15+00:00

Background: Drug-induced lupus erythematosus (DILE) is a rare autoimmune disorder that mimics idiopathic lupus erythematosus, triggered by certain medications. This case report presents a patient with DILE induced by methimazole, a commonly used antithyroid drug, along with Graves' disease and primary infertility.

Case presentation: A 41-year-old woman presented with palpitations, a history of Graves' disease treated with methimazole, and primary infertility. She developed lupus-like symptoms including fever, joint pain, and skin rash. Examination revealed tachycardia, tenderness of the right and left knee joints and limited range of motion. Laboratory investigations confirmed hyperthyroidism and autoimmune features consistent with DILE.

Conclusion: This case highlights the rare occurrence of DILE induced by methimazole, emphasizing the importance of recognizing and managing this condition in patients receiving antithyroid drugs.

p63 Expression in Ductal Carcinoma In Situ (DCIS) of the Breast and Its Correlation with Histopathological Grading and Morphological Variants

2024-11-18T16:46:00+00:00

Background: 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.

The Use of Trendelenburg Position in the Management of Retropharyngeal Abscess: A Case Report and Clinical Considerations

2024-11-20T16:46:50+00:00

Background: Retropharyngeal abscess (RPA) is a serious deep neck space infection that can lead to life-threatening complications such as airway obstruction, mediastinitis, and sepsis. The Trendelenburg position, where the patient's head is lower than their feet, has been traditionally used in the management of RPA to prevent aspiration of pus in case of abscess rupture. However, the optimal positioning for patients with RPA remains a topic of debate.

Case presentation: A 51-year-old male patient presented to the emergency room with a 5-day history of progressive dysphagia and neck swelling. He was diagnosed with a ruptured retropharyngeal abscess extending to the mediastinum (descending necrotizing mediastinitis). The patient underwent surgical drainage and was subsequently admitted to the intensive care unit (ICU), where he was intubated and mechanically ventilated in the Trendelenburg position. Five days later, the patient developed pneumonia, suspected to be ventilator-associated pneumonia (VAP).

Conclusion: The Trendelenburg position may be considered in the management of RPA to minimize the risk of aspiration. However, it is essential to weigh the potential benefits against the risks, including VAP, and to consider alternative positions such as the lateral Trendelenburg position, which may offer similar benefits with reduced risk. Further research is needed to determine the optimal positioning strategy for patients with RPA.

Successful Management of Schizoaffective Disorder (Manic Type) in a Pregnant Woman with Electroconvulsive Therapy: A Case Report

2024-11-20T16:46:35+00:00

Background: Schizoaffective disorder is a chronic mental health condition characterized by the presence of both psychotic and mood symptoms. Managing schizoaffective disorder during pregnancy presents unique challenges due to the potential risks of pharmacotherapy to the developing fetus. This case report describes the successful management of a pregnant woman with schizoaffective disorder (manic type) using electroconvulsive therapy (ECT).

Case presentation: A 31-year-old woman, G2P1A0 with a gestational age of 26 weeks, was admitted to the psychiatric ward with symptoms of mania and psychosis, including disorganized behavior, threats of violence, suspicious delusions, auditory hallucinations, and visual illusions. Her symptoms had worsened after discontinuation of her antipsychotic medication due to pregnancy. She was diagnosed with schizoaffective disorder, manic type. Due to the potential risks of antipsychotic medication to the fetus, ECT was initiated. The patient responded well to ECT, with a significant reduction in her manic and psychotic symptoms. She was able to continue her pregnancy safely, and delivered a healthy baby at term.

Conclusion: This case report highlights the effectiveness and safety of ECT in managing schizoaffective disorder during pregnancy. ECT can be considered a valuable treatment option for pregnant women with severe mental illness when the risks of pharmacotherapy outweigh the benefits.

The Significance of TGF-β Expression in Predicting Lymphovascular Invasion and Lymph Node Metastasis in Colorectal Cancer

2024-11-21T16:46:56+00:00

Background: Colorectal cancer (CRC) is a major health burden globally. The prognosis of CRC is strongly influenced by the presence of lymphovascular invasion (LVI) and lymph node (LN) metastasis. Transforming growth factor-beta (TGF-β) is a cytokine with a complex role in CRC progression. This study aimed to evaluate the significance of TGF-β expression in predicting LVI and LN metastasis in CRC.

Methods: This cross-sectional study involved 50 patients diagnosed with CRC. The expression of TGF-β was assessed using immunohistochemical staining and the Allred scoring system. The relationship between TGF-β expression and the presence of LVI and LN metastasis was analyzed using the Chi-square test.

Results: High TGF-β expression was significantly associated with both LVI (p = 0.011) and LN metastasis (p = 0.012) in CRC. Patients with high TGF-β expression had a higher risk of LVI and LN metastasis compared to those with low TGF-β expression.

Conclusion: TGF-β expression is a significant predictor of LVI and LN metastasis in CRC. This finding has potential implications for risk stratification and treatment decisions in CRC patients.