Bioscientia Medicina : Journal of Biomedicine and Translational Research

Serum Nerve Growth Factor as a Biomarker for Chemotherapy-Induced Peripheral Neuropathy: A Cross-Sectional Study

Rifki Irsyad — 2025-03-10

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment. Nerve growth factor (NGF) plays a crucial role in neuronal health and has been implicated in CIPN development. This study investigated the relationship between serum NGF levels and CIPN in cancer patients undergoing chemotherapy.

Methods: A cross-sectional study was conducted on 60 cancer patients receiving chemotherapy at Dr. M. Djamil General Hospital Padang, Indonesia, from June to October 2024. Serum NGF levels were measured, and CIPN was assessed using the Toronto Clinical Scoring System (TCSS). The relationship between NGF and CIPN was analyzed using the Mann-Whitney test.

Results: The median serum NGF level was significantly lower in patients with CIPN (n=43) compared to those without CIPN (n=17) (103.26 pg/ml vs. 148.91 pg/ml, p=0.029). No significant association was found between chemotherapy regimens and CIPN or NGF levels.

Conclusion: Lower serum NGF levels are associated with CIPN in cancer patients undergoing chemotherapy. NGF may serve as a potential biomarker for CIPN, aiding in early detection and management. Further research is needed to explore the clinical utility of NGF as a predictive and monitoring tool for CIPN.

Argon Plasma Coagulation in Bronchoscopy: A Safe and Effective Treatment for Airway Obstruction

Anggi Rizki Utami Nasution — 2025-03-11

Background: Airway obstruction can significantly impair a patient's quality of life and even become life-threatening. Traditional treatment options, such as surgery or laser therapy, can be invasive and associated with significant complications. Argon plasma coagulation (APC) has emerged as a minimally invasive alternative for treating airway obstruction. APC uses ionized argon gas to deliver controlled thermal energy, allowing for precise tissue coagulation and ablation. This meta-analysis aims to evaluate the safety and efficacy of APC in treating airway obstruction.

Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases. Studies published between 2013 and 2024 that evaluated the use of APC in bronchoscopy for airway obstruction were included. The primary outcomes were the success rate of APC in achieving airway patency and the incidence of complications.

Results: Seven studies (n=342 patients) met the inclusion criteria. The pooled success rate of APC in achieving airway patency was 91% (95% CI, 87-94%). The overall incidence of complications was 8% (95% CI, 5-11%), with minor bleeding being the most common.

Conclusion: This meta-analysis demonstrates that APC is a safe and effective treatment for airway obstruction. It offers a high success rate in restoring airway patency with a low risk of complications. APC is a valuable tool for pulmonologists in managing patients with airway obstruction.

Sternotomy and Pericardiectomy in a Patient with Constrictive Pericarditis and Multiple Comorbidities: A Case Report

Dedy Chandra Hariyono — 2025-03-11

Background: Constrictive pericarditis is a serious condition that can lead to heart failure. It is characterized by a thickened and scarred pericardium, which restricts the heart's ability to fill and pump blood effectively. The condition is often caused by infections, such as tuberculosis, but can also be caused by other factors, such as radiation therapy, heart surgery, or autoimmune diseases. A pericardiectomy, a surgical procedure to remove the thickened pericardium, is the definitive treatment for constrictive pericarditis.

Case presentation: This case report describes a 57-year-old male patient with constrictive pericarditis and multiple comorbidities, including recent tuberculosis, pleural effusion, ascites, and cholelithiasis. The patient presented with symptoms of shortness of breath, swollen legs, and a swollen stomach. After a thorough evaluation, including imaging studies, the diagnosis of constrictive pericarditis was confirmed. The patient underwent a sternotomy and pericardiectomy procedure, which was successful in relieving his symptoms and improving his cardiac function.

Conclusion: This case report highlights the successful management of constrictive pericarditis in a patient with multiple comorbidities. The case also emphasizes the importance of early diagnosis and timely intervention in patients with constrictive pericarditis.

The Effect of High-Intensity Interval Training on Interleukin-6 Levels in Hypertensive Individuals: A Systematic Review and Meta-Analysis

Ainnaya Natin Ristanti — 2025-03-12

Background: High-intensity interval training (HIIT) has emerged as a time-efficient exercise modality with potential benefits for hypertensive individuals. Interleukin-6 (IL-6), a cytokine with both pro- and anti-inflammatory properties, has been implicated in the development and progression of hypertension. This meta-analysis aimed to investigate the effect of HIIT on IL-6 levels in hypertensive individuals.

Methods: A systematic search of electronic databases (PubMed, Scopus, Web of Science) was conducted to identify relevant studies published between 2013 and 2024. Studies were included if they met the following criteria: (1) randomized controlled trials; (2) included hypertensive participants; (3) compared HIIT to a control group (no exercise or moderate-intensity continuous training); (4) measured circulating IL-6 levels; and (5) provided sufficient data for meta-analysis. Data were extracted and pooled using a random-effects model.

Results: Seven studies met the inclusion criteria, comprising a total of 328 participants. The meta-analysis revealed a significant decrease in IL-6 levels following HIIT compared to the control group (standardized mean difference [SMD] = -1.27, 95% confidence interval [CI] = (-1.81 to -0.73, p = 0.002). Subgroup analysis showed that HIIT interventions lasting ≥ 8 weeks were associated with a greater reduction in IL-6 levels compared to shorter interventions.

Conclusion: HIIT appears to be an effective exercise modality for reducing IL-6 levels in hypertensive individuals. This finding suggests that HIIT may have anti-inflammatory effects and could be a valuable non-pharmacological strategy for managing hypertension.

From Patches to Plaques: A Diagnostic Challenge in a Case of Erythroderma Secondary to Pityriasis Rubra Pilaris

Lian Kamilah — 2025-03-14

Background: Erythroderma, a dramatic and potentially life-threatening condition characterized by fiery redness engulfing over 90% of the skin's surface, presents a formidable diagnostic challenge due to its myriad underlying causes. Among these, pityriasis rubra pilaris (PRP), a rare inflammatory skin disorder, stands out with its distinctive features and often perplexing presentation. This case unveils the intricate diagnostic journey of a young man whose erythroderma masked an underlying PRP, further complicated by the subtle interplay of stress.

Case presentation: An 18-year-old male presented with a one-month history of alarming erythroderma accompanied by distressing itching, fever, and sleep disturbances. Adding to the complexity, he exhibited characteristic 'nappes claires' – islands of normal skin amidst the erythrodermic sea – a hallmark of PRP. Palmoplantar keratoderma, alopecia areata, and ectropion further painted an intriguing clinical picture. Histopathological examination revealed the telltale 'checkboard' pattern, confirming PRP as the culprit. Notably, the patient's history revealed a compelling link between stress and disease exacerbation, adding a psychosomatic dimension to the case. Systemic corticosteroids and methotrexate, alongside topical emollients, brought about significant clinical improvement, underscoring the importance of early diagnosis and targeted treatment.

Conclusion: This case underscores the critical need to consider PRP in the labyrinth of erythroderma diagnoses, particularly when 'nappes claires' and a history of stress are intertwined. By shining a light on the diagnostic subtleties and therapeutic nuances of PRP-associated erythroderma, this report empowers clinicians to navigate the complexities of this rare and challenging condition, ultimately improving patient outcomes and quality of life.

The Role of Mount Lawu Propolis in Modulating Oxidative Stress and Angiogenic Factors During the Proliferation Phase of Wound Healing

Muhammad Apri Rajab — 2025-03-18

Background: The skin, the body's largest and first-line defense organ, is crucial for protection against environmental aggressors, thermoregulation, fluid balance, immune surveillance, sensory perception, and the intricate process of wound healing. This study investigated the modulatory role of Mount Lawu propolis extract on Malondialdehyde (MDA), a marker of oxidative stress, and Vascular Endothelial Growth Factor (VEGF), a key mediator of angiogenesis, during the critical proliferation phase of wound healing.

Methods: A post-test-only control group design experimental study was conducted using twenty-four male rats (Rattus norvegicus). Following the creation of standardized full-thickness skin excision wounds, the rats were divided into four groups (n=6 per group): a control group receiving no propolis, and three treatment groups receiving topical applications of 200mg/kgBB (Group 1), 400mg/kgBB (Group 2), and 800mg/kgBB (Group 3) ethanol propolis extract daily for seven days. MDA and VEGF expression in granulated tissue samples were evaluated using immunohistochemistry and semi-quantitatively scored. Statistical analysis involved the Kruskal-Wallis non-parametric test, followed by the Mann-Whitney test due to non-normal data distribution.

Results: MDA levels showed a significant reduction (p<0.05) in Group 2 (400mg/kgBB propolis) compared to the control, indicating a dose-specific antioxidant effect. VEGF expression demonstrated a significant increase (p<0.05) in all propolis-treated groups (Groups 1, 2, and 3) compared to the control, confirming the pro-angiogenic potential of propolis. Notably, the highest VEGF expression was observed in Group 3 (800mg/kgBB propolis).

Conclusion: Mount Lawu ethanol propolis extract effectively modulated both oxidative stress and angiogenesis during the proliferation phase of wound healing in this rat model. A 400mg/kgBB/day dose of propolis optimally reduced MDA expression, while propolis at all doses, particularly 800mg/kgBB/day, significantly enhanced VEGF expression. These findings suggest propolis as a promising therapeutic agent to enhance wound healing by mitigating oxidative stress and promoting angiogenesis.

Unveiling the Antibacterial Potential of Arumanis Mango (Mangifera indica L.) Leaf Extract Against Enterococcus faecalis: A Comparative Study with Melinjo (Gnetum gnemon L.)

Shieny Lokanata — 2025-03-26

Background: Root canal infections, frequently caused by the bacterium Enterococcus faecalis due to its resistance to conventional treatments, present a significant challenge in dental practice. Effective disinfection of the root canal system is crucial for successful endodontic therapy, necessitating the exploration of alternative irrigating solutions. This study aimed to evaluate and compare the in vitro antibacterial efficacy of Arumanis mango (Mangifera indica L.) leaf extract and melinjo (Gnetum gnemon L.) leaf extract against Enterococcus faecalis.

Methods: This in vitro experimental study employed the disc diffusion method to assess the antibacterial activity of ethanolic extracts of Arumanis mango and melinjo leaves against Enterococcus faecalis. The extracts were tested at three different concentrations: 25%, 50%, and 75%. Chlorhexidine 0.2% and distilled water served as positive and negative controls, respectively. The diameter of the inhibition zones around the discs was measured after incubation. Phytochemical screening of both extracts was also conducted.

Results: The phytochemical screening revealed the presence of flavonoids, alkaloids, and tannins in both Arumanis mango and melinjo leaf extracts. However, the antibacterial activity varied significantly. Melinjo leaf extract did not exhibit any measurable inhibitory effect on Enterococcus faecalis at any of the tested concentrations. In contrast, Arumanis mango leaf extract demonstrated significant antibacterial activity at concentrations of 50% and 75%, with mean inhibition zone diameters of 11.73 ± 0.75 mm and 12.90 ± 0.30 mm, respectively. Statistical analysis using the Kruskal-Wallis test and post-hoc Mann-Whitney U test confirmed a significant difference in the antibacterial activity between the Arumanis mango leaf extract at 50% and 75% concentrations and the melinjo leaf extract at all tested concentrations, as well as the distilled water control. The positive control, chlorhexidine 0.2%, showed the largest inhibition zone (15.10 ± 0.10 mm).

Conclusion: The findings of this study indicate that the ethanolic extract of Arumanis mango (Mangifera indica L.) leaves possesses significant in vitro antibacterial activity against Enterococcus faecalis, suggesting its potential as a natural alternative irrigating solution in endodontic treatment. Conversely, under the conditions of this study, melinjo (Gnetum gnemon L.) leaf extract did not demonstrate any antibacterial effect against this specific bacterium. Further research is warranted to explore the clinical efficacy and safety of Arumanis mango leaf extract in root canal disinfection.

A Rare Presentation of Choledochal Cyst in a Six-Month-Old Infant: Diagnostic and Surgical Challenges

Dita Novia Wulansari — 2025-03-19

Background: Choledochal cysts (CCs) are rare congenital anomalies of the biliary tree, characterized by cystic dilation of the intrahepatic and/or extrahepatic bile ducts. While the classic triad of abdominal pain, jaundice, and a palpable abdominal mass is well-described, the presentation in infants can be subtle and often involves diagnostic and surgical challenges. This case report describes a rare presentation of a Todani Type 1 choledochal cyst in a six-month-old infant who presented primarily with abdominal distension, highlighting the diagnostic pathway and surgical management.

Case presentation: A six-month-old female infant presented with a two-month history of progressive abdominal distension. There was a history of pale stools at two months of age that lasted for one week. Physical examination revealed a well-nourished infant with icteric skin and sclera and a distended abdomen with a palpable, mobile mass measuring 7x5 cm. Laboratory investigations revealed hyperbilirubinemia and elevated liver enzymes. Abdominal ultrasound and subsequent CT scan with contrast confirmed the presence of a Todani Type 1 choledochal cyst. The infant underwent successful surgical excision of the cyst and Roux-en-Y hepaticojejunostomy. The postoperative period was uneventful, and the patient was discharged in stable condition. Follow-up at one month showed good recovery and no signs of complications.

Conclusion: This case highlights an atypical presentation of a Todani Type 1 choledochal cyst in a young infant, where the primary symptom was abdominal distension rather than the classic triad. Early diagnosis through imaging modalities like ultrasound and CT scan, followed by complete surgical excision and Roux-en-Y reconstruction, resulted in a favorable outcome. This case underscores the importance of considering choledochal cysts in the differential diagnosis of abdominal distension in infants, even in the absence of jaundice or pain.

Comprehensive Rehabilitation Improves Motor Function and Independence in a Patient with Left Hemiparesis Post-Ischemic Stroke: A Case Report

Tasia Irma Endriani — 2025-03-19

Background: Stroke remains a leading cause of disability worldwide, with ischemic stroke being the predominant type. Left-sided hemiparesis resulting from ischemic stroke significantly impairs motor function and activities of daily living, necessitating comprehensive rehabilitation interventions. This case report details the journey of a 72-year-old female patient who experienced left hemiparesis due to an ischemic stroke and underwent a comprehensive rehabilitation program.

Case presentation: A 72-year-old female patient presented with sudden onset weakness in her upper and lower left limbs following an ischemic stroke. Initial assessments revealed significant impairments in motor function, balance, and self-care abilities, classifying her as having a moderate disability according to the Barthel Index. The rehabilitation program included passive and active range of motion exercises, functional mobilization techniques, resistance and balance training, infrared therapy, psychological support, and patient education.

Conclusion: The comprehensive rehabilitation strategy implemented in this case resulted in significant improvements in the patient's motor function, balance, confidence, and independence in performing daily activities. This case underscores the crucial role of tailored and comprehensive rehabilitation programs in enhancing recovery and improving the quality of life for individuals following an ischemic stroke.

From Tradition to Translation: A Systematic Review on the Pharmacological Actions of Eugenol Extracted from Ocimum Plants in Oxidative Stress, Inflammation, and Diabetes Mellitus

Pande Ayu Naya Kasih Permatananda — 2025-03-19

Background: Ocimum species, commonly known as basil, have a rich history in traditional medicine for various ailments. Eugenol, a primary bioactive compound found in several Ocimum species, has garnered significant scientific attention for its potential therapeutic properties. This systematic review aimed to comprehensively evaluate the pharmacological actions of eugenol extracted from Ocimum plants in the context of oxidative stress, inflammation, and diabetes mellitus.

Methods: A systematic literature search was conducted across major scientific databases for studies published between 2013 and 2024 that investigated the effects of eugenol derived from Ocimum plants on oxidative stress, inflammation, and diabetes mellitus. The search strategy included keywords such as "eugenol," "Ocimum," "antioxidant," "anti-inflammatory," and "antidiabetic." Inclusion criteria for studies involving in vitro, in vivo, and clinical studies that specifically examined the pharmacological actions of eugenol extracted from Ocimum species in the aforementioned conditions. Data on study design, intervention, outcomes, and key findings were extracted and synthesized narratively.

Results: The review identified ten key studies that met the inclusion criteria. These studies collectively suggested that eugenol extracted from Ocimum plants exhibited significant antioxidant activity by scavenging free radicals and enhancing endogenous antioxidant enzymes. Furthermore, eugenol demonstrated anti-inflammatory effects by modulating pro-inflammatory cytokines and inhibiting key inflammatory pathways such as NF-κB and COX. In the context of diabetes mellitus, studies indicated that eugenol could improve glucose metabolism by enhancing insulin sensitivity, protecting pancreatic beta cells, and inhibiting carbohydrate metabolizing enzymes.

Conclusion: This systematic review provided a comprehensive overview of the pharmacological actions of eugenol extracted from Ocimum plants in mitigating oxidative stress, inflammation, and diabetes mellitus. The findings from the included studies supported the traditional uses of Ocimum species and highlighted the therapeutic potential of eugenol as a natural agent in managing these conditions. Further well-designed clinical trials are warranted to validate these preclinical findings and translate them into clinical applications.

Ocular Involvement as the Primary Presentation of Suspected Systemic Lupus Erythematosus: A Case of Bilateral Papilledema and Macular Edema

Junetta Airene Priskila Taba — 2025-03-20

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease known for its varied clinical presentations, often affecting multiple organ systems. Ocular involvement is common in SLE, but posterior segment manifestations like papilledema are rare, occurring in only about 1% of SLE patients. This case report details a unique instance of bilateral papilledema and macular edema as the primary presentation of suspected SLE in a young female patient.

Case presentation: A 24-year-old female presented with a one-week history of sudden-onset blurry vision in both eyes. Ophthalmological examination revealed reduced visual acuity (6/45 in both eyes), bilateral optic disc swelling, and macular edema. Further investigations, including Optical Coherence Tomography (OCT) and Magnetic Resonance Imaging (MRI), confirmed macular edema and optic nerve sheath distention. A positive Antinuclear Antibody (ANA) test suggested an autoimmune etiology. Lumbar puncture results were normal, ruling out idiopathic intracranial hypertension. The patient was diagnosed with bilateral papilledema and macular edema, with suspected underlying SLE. Prompt treatment with high-dose corticosteroids and acetazolamide led to significant clinical improvement.

Conclusion: This case highlights the rarity of bilateral papilledema and macular edema as initial presenting features of suspected SLE. It emphasizes the importance of thorough ophthalmological examination and relevant investigations in patients with sudden vision loss. Early recognition of such rare presentations is crucial to prevent potentially sight-threatening complications. This case underscores the need for a multidisciplinary approach for accurate diagnosis and management of complex presentations of systemic autoimmune diseases.

Unmasking BRASH Syndrome: A Rare and Reversible Cause of Cardiovascular Collapse in the Elderly

Milhan El-Yamani Karim — 2025-03-20

Background: BRASH syndrome (Bradycardia, Renal failure, AV nodal blockade, Shock, and Hyperkalemia) is an increasingly recognized but still underdiagnosed condition, particularly in elderly patients with multiple comorbidities and those taking AV nodal blocking agents. It represents a synergistic interplay between these factors, leading to a potentially life-threatening state of cardiovascular collapse. This case report aims to highlight the clinical presentation, diagnostic challenges, and successful management of BRASH syndrome in an elderly female patient.

Case presentation: A 65-year-old female with a history of stage 4 chronic kidney disease and congestive heart failure (ejection fraction of 65%) presented to the emergency department with worsening vomiting over the past week, generalized weakness, dizziness, and palpitations. Her medication list included amlodipine, bisoprolol, candesartan, nitrokaf, furosemide, and aminoral. On examination, she was hypotensive with a blood pressure of 90/60 mmHg and bradycardic with a heart rate of 40 beats per minute. An electrocardiogram (ECG) revealed a junctional escape rhythm with a heart rate of 38 beats per minute and a left bundle branch block. Laboratory investigations showed severe hyperkalemia (potassium 8.1 mmol/L), hyponatremia (sodium 113 mmol/L), elevated creatinine (4.06 mg/dL), and urea (112.3 mg/dL).

Conclusion: This case underscores the importance of recognizing BRASH syndrome as a distinct clinical entity, especially in elderly patients with pre-existing cardiac and renal conditions who are on AV nodal blocking medications. Prompt diagnosis and management, focusing on correcting hyperkalemia, discontinuing offending medications, and providing supportive care, can lead to favorable outcomes and prevent potentially fatal complications. Increased awareness and further research are crucial for establishing standardized guidelines for the diagnosis and management of this underrecognized syndrome.

Efficacy of Hematopoietic Stem Cell Transplantation with CCR5Δ32 Homozygous Donors in Achieving Sustained HIV-1 Remission: A Systematic Literature Review

Paishal Mizan — 2025-03-20

Background: The pursuit of a cure for Human Immunodeficiency Virus type 1 (HIV-1) infection has led to the exploration of innovative therapeutic strategies. Hematopoietic stem cell transplantation (HSCT) from donors homozygous for the CCR5Δ32 mutation, which confers resistance to HIV-1 infection, has emerged as a promising approach following the notable cases. This study aimed to evaluate the efficacy of HSCT with CCR5Δ32 homozygous donors in achieving sustained HIV-1 remission.

Methods: A systematic search of major electronic databases, including PubMed, Scopus, and Web of Science, was conducted for studies published between 2013 and 2024 that reported on the outcomes of HIV-1 positive individuals who underwent HSCT with CCR5Δ32 homozygous donors. The primary outcome of interest was sustained HIV-1 remission, defined as the absence of detectable viral load in the absence of antiretroviral therapy (ART) for a period of at least 12 months post-transplantation. Data on patient characteristics, transplantation procedures, conditioning regimens, graft-versus-host disease (GVHD), and duration of remission were extracted and synthesized.

Results: Five case studies met the inclusion criteria. These studies predominantly involved individuals with advanced HIV-1 infection who also had hematological malignancies necessitating HSCT. All patients received allogeneic HSCT from donors with the CCR5Δ32/Δ32 genotype. Conditioning regimens varied but generally included chemotherapy with or without total body irradiation. Graft-versus-host disease was a common complication, ranging from mild to severe. Sustained HIV-1 remission, defined by the interruption of ART with undetectable viral load, was achieved in most reported cases for varying durations. Data, based on the patterns observed in these five cases, suggested that approximately 60-80% of patients receiving HSCT from CCR5Δ32 homozygous donors might achieve at least 12 months of ART-free HIV-1 remission, with a smaller subset achieving long-term remission beyond 5 years.

Conclusion: HSCT with CCR5Δ32 homozygous donors demonstrated a significant potential for achieving sustained HIV-1 remission in a select group of individuals, primarily those with hematological malignancies.

Perioperative Blood Glucose Levels as a Predictor of Hospital Length of Stay in Complicated Appendicitis: A Prospective Cohort Study

Satrio Sarwo Trengginas — 2025-03-24

Background: Complicated appendicitis presents significant management challenges. Perioperative blood glucose levels are emerging as potential prognostic indicators in surgery. This study aimed to evaluate the correlation between perioperative blood glucose levels and hospital length of stay in patients with complicated appendicitis.

Methods: This prospective cohort study was conducted at Dr. Moewardi General Hospital, Indonesia, from October 2020 to October 2021. We enrolled 49 adult patients with complicated appendicitis. Preoperative and postoperative blood glucose levels were measured. The primary outcome was hospital length of stay. Spearman’s correlation and ROC curve analyses were performed.

Results: Significant positive correlations were found between hospital length of stay and preoperative blood glucose (r=0.324, p=0.023), postoperative blood glucose (r=0.484, p=0.000), age (r=0.324, p=0.023), and surgical site infection (r=0.360, p=0.011). Postoperative blood glucose showed the strongest correlation. ROC analysis identified a postoperative blood glucose level >123 mg/dL as a cut-off for prolonged hospitalization (>3 days), with 65.2% sensitivity and 65.4% specificity (AUC=0.71).

Conclusion: Perioperative blood glucose levels significantly correlate with hospital length of stay in complicated appendicitis, with postoperative levels showing the strongest association. Monitoring postoperative blood glucose may help predict and potentially reduce the duration of hospitalization.

Traumatic Femoral Arteriovenous Fistula Mimicking Chronic Venous Insufficiency with Concurrent Iliac and Femoral Artery Aneurysms: A Case Report

Tommy Kuswara — 2025-03-25

Background: Traumatic arteriovenous fistulas (AVFs), constituting approximately 2.5% of emergency vascular cases, present diagnostic challenges due to their obscure nature. This report describes two cases of traumatic AVFs caused by gunshot wounds.

Case presentation: A 61-year-old male presented with right lower extremity pain and swelling, following a gunshot wound four months prior. Clinical findings included discoloration, edema, vein swelling, and pain from the femoral to pedis regions. CT angiography revealed multiple aneurysms from the lower abdominal aorta to the right common iliac arteries, stenosis in the right external iliac artery, and reduced blood perfusion. Additional findings were tubular aneurysms in the external and internal right iliac arteries and a combination saccular-tubular aneurysm in the right femoral artery. A second, separate case also involved a traumatic AVF from a gunshot wound.

Conclusion: Traumatic AVFs, particularly those resulting from gunshot wounds, can be difficult to diagnose early due to their rarity and obscure presentation. Early diagnosis is crucial to prevent disease progression and improve clinical outcomes. Open surgical SFA bypass has a good outcome, proven by ultrasound examination that there is good blood flow in the distal artery.

The Efficacy of NeuroAid™ (MLC601) in Modulating NF-κB Expression and Improving Outcomes in Traumatic Brain Injury: A Preclinical Study

Dedy Chandra Hariyono — 2025-04-07

Background: Traumatic brain injury (TBI) represents a significant global health concern, leading to substantial mortality and long-term disability. The intricate pathophysiology of TBI involves primary mechanical damage followed by a cascade of secondary injury events, including neuroinflammation, apoptosis, and oxidative stress. The nuclear factor kappa B (NF-κB) signaling pathway plays a pivotal role in orchestrating the inflammatory response post-TBI and has emerged as a potential therapeutic target. This preclinical study aimed to investigate the efficacy of NeuroAid™ (MLC601), a traditional herbal medicine, in modulating NF-κB expression and improving outcomes in a rat model of TBI.

Methods: This study employed a true experimental in vivo design with a post-test only control group. Male Wistar rats (n=18) were randomly divided into two groups: a control group (n=9) subjected to TBI via a weight-drop method, and an experimental group (n=9) subjected to the same TBI procedure followed by intraperitoneal administration of NeuroAid™ (MLC601) at a dose of 2.5 mg/kg body weight at 5 minutes, 8 hours, and 16 hours post-injury. NF-κB expression in brain tissue samples collected 1 hour after the final dose was assessed using immunohistochemistry and quantified by an immunoreactivity score considering both the intensity and percentage of NF-κB expression.

Results: Immunohistochemical analysis revealed the presence of NF-κB expression in both the nucleus and cytoplasm of neurons in both the control and experimental groups. While the experimental group treated with NeuroAid™ (MLC601) exhibited a lower average immunoreactivity score (0.93) compared to the control group (1.29), the difference in NF-κB expression between the two groups was not statistically significant (p = 0.122).

Conclusion: In this preclinical study using a Wistar rat model of TBI, the administration of NeuroAid™ (MLC601) did not result in a statistically significant reduction in NF-κB expression compared to the untreated control group. Although a trend towards lower NF-κB expression was observed in the NeuroAid™-treated group, further research with larger sample sizes, different dosages, and extended treatment durations is warranted to fully elucidate the potential therapeutic effects of NeuroAid™ (MLC601) in the management of traumatic brain injury.

Novel Application of a Modified Small T-Plate as an Internal Joint Stabilizer for Chronic Elbow Instability: Technique and Two-Year Results

Wiria Aryanta — 2025-04-07

Background: Chronic elbow instability, particularly following neglected or recurrent dislocations, presents a significant treatment challenge. Restoring stability while preserving functional motion is difficult, especially when standard internal joint stabilizers (IJS) are unavailable. We explored the use of a readily available small T-plate, modified intraoperatively, as a temporary internal hinge stabilizer.

Case presentation: A 33-year-old male presented with chronic left elbow instability and functional impairment persisting for 14 years after an initial injury. Previous treatments, including traditional bone setting and K-wire fixation, had failed, resulting in recurrent dislocations. Surgical exploration revealed significant fibrosis and compromised ligamentous structures. Open reduction was performed, followed by stabilization using a modified small T-plate contoured to act as an internal hinge, maintaining the ulnohumeral joint space. The implant was removed after 4 weeks. At the 24-month follow-up, the patient exhibited excellent functional outcomes, with a stable elbow, substantial improvement in range of motion (Flexion-extension: 4.2°-129.2°; Pronation-supination: 80°), and an excellent Broberg-Morrey score, enabling pain-free daily activities.

Conclusion: This case demonstrated that a modified small T-plate can serve as an effective, low-cost internal hinge joint stabilizer for managing complex chronic elbow instability, particularly in resource-limited settings. It facilitated early controlled motion, promoted stable fibrous tissue healing, and resulted in excellent long-term functional outcomes. This technique presents a viable alternative when standard IJS devices are not accessible.

Programmed Intermittent Epidural Bolus (PIEB) Versus Patient-Controlled Epidural Analgesia (PCEA) with Continuous Basal Infusion for Labor Analgesia: A Meta-Analysis

Nopian Hidayat — 2025-04-08

Background: Maintaining effective labor epidural analgesia while optimizing maternal satisfaction and minimizing drug consumption remains a key objective in obstetric anesthesia. Programmed intermittent epidural bolus (PIEB) techniques have emerged as an alternative to traditional continuous epidural infusion (CEI) combined with patient-controlled epidural analgesia (PCEA). This meta-analysis aimed to compare the efficacy, local anesthetic (LA) consumption, and maternal satisfaction between PIEB regimens (typically combined with PCEA for rescue) and PCEA regimens supplemented with a continuous basal infusion (PCEA+Basal).

Methods: A systematic literature search was conducted for PubMed, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) published between January 2013 and December 2024 comparing PIEB (+/- PCEA) with PCEA+Basal for labor analgesia. Primary outcomes were hourly LA consumption, maternal satisfaction (rated as high/excellent), and need for clinician rescue analgesia (breakthrough pain). Secondary outcomes included pain scores (Visual Analog Scale - VAS), mode of delivery, duration of labor stages, motor blockade incidence, and neonatal outcomes (Apgar scores). Data were extracted from suitable studies identified through the search. A random-effects model was used for meta-analysis using RevMan software. Mean Differences (MD) or Odds Ratios (OR) with 95% Confidence Intervals (CI) were calculated. Heterogeneity was assessed using the I² statistic.

Results: Five studies involving a total of 1158 parturients met the inclusion criteria. The pooled analysis indicated that PIEB regimens were associated with a trend towards lower hourly LA consumption compared to PCEA+Basal (MD: -1.2 mL/hour; 95% CI: -2.5 to 0.1; P=0.07; I²=78%), although heterogeneity was high. Maternal satisfaction rated as 'high' or 'excellent' was significantly more frequent in the PIEB group (OR: 1.85; 95% CI: 1.20 to 2.85; P=0.005; I²=35%). The need for clinician rescue analgesia was numerically lower with PIEB, but the difference did not reach statistical significance (OR: 0.70; 95% CI: 0.45 to 1.10; P=0.12; I²=45%). No significant differences were noted in VAS pain scores during established labor, mode of delivery, or Apgar scores. Incidence of motor block appeared potentially lower with PIEB regimens.

Conclusion: Based on this meta-analysis, PIEB regimens appear promising for labor analgesia, potentially offering comparable efficacy to PCEA+Basal while possibly reducing local anesthetic consumption and enhancing maternal satisfaction. However, significant heterogeneity was observed for some outcomes. High-quality, large-scale RCTs directly comparing optimized PIEB+PCEA protocols with PCEA+Basal infusion are crucial to definitively establish the relative benefits and risks of these techniques.

Neurovascular Inflammation and Oxidative Stress Markers in Chronic Migraine: Is Nitric Oxide the Key Link to Severity?

Aulia Noza — 2025-04-08

Background: 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.

Neuroinflammation and Sleep Dysfunction in Epilepsy: The Role of High Sensitivity C-Reactive Protein

Akmal Irsyadi Iswan — 2025-04-09

Background: Emerging evidence suggests a bidirectional relationship between systemic inflammation and both epilepsy and sleep dysfunction. High-sensitivity C-reactive protein (Hs-CRP), a sensitive marker of low-grade systemic inflammation, is elevated in response to pro-inflammatory cytokines. However, the specific link between Hs-CRP levels and subjective sleep quality within the epilepsy population required further investigation. This study aimed to investigate the relationship between serum Hs-CRP levels and sleep quality in patients diagnosed with epilepsy.

Methods: A cross-sectional study was conducted involving 40 patients diagnosed with epilepsy attending the neurology clinic at Dr. M. Djamil General Hospital, Padang, Indonesia, between January and February 2025. Patients aged over 17 years diagnosed by a neurologist were included. Serum Hs-CRP levels were quantified using an enzyme-linked immunosorbent assay (ELISA). Sleep quality over the preceding month was assessed using the validated Indonesian version of the Pittsburgh Sleep Quality Index (PSQI). Mann-Whitney U test was employed to analyze the difference in median Hs-CRP levels between patients with good and poor sleep quality. Relationships between baseline characteristics and sleep quality were assessed using Chi-square/Fisher's exact tests for categorical variables and the Mann-Whitney U test for continuous variables.

Results: Forty epilepsy patients (median age 25.5 years, range 17-50; 52.5% female) were enrolled. The median duration of epilepsy was 10 years (range 1-35). A majority of patients exhibited uncontrolled seizures (75%) and were receiving AED polytherapy (60%). Based on PSQI scores, 24 patients (60%) were classified as poor sleepers, while 16 (40%) were good sleepers. A significant difference was observed in median serum Hs-CRP levels between the two groups: patients with good sleep quality had significantly lower median Hs-CRP levels compared to those with poor sleep quality (1,271.50 ng/ml [range 58–5,837] vs. 2,771.50 ng/ml [range 509–27,187], p=0.027). Poor sleep quality was significantly associated with younger age (median 23 vs. 36 years, p=0.039) and AED polytherapy (75% vs. 25%, p=0.018).

Conclusion: This study demonstrated a significant association between elevated serum Hs-CRP levels and poor subjective sleep quality in patients with epilepsy. Epilepsy patients experiencing poor sleep exhibited significantly higher levels of this inflammatory biomarker. These findings underscore the potential role of systemic inflammation in the complex interplay between epilepsy and sleep disturbances, suggesting Hs-CRP could serve as a potential biomarker linking these conditions.

Kawasaki Disease in a Preschooler: A Case Study on Timely Diagnosis and IVIG (Intravenous Immunoglobulin) Intervention

Fitriana Wibowo — 2025-04-09

Background: 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.

The Complex Interplay of Prematurity, Respiratory Distress Syndrome, and Necrotizing Enterocolitis: Insights from a Case Study

Putu Cahya Chandranita — 2025-04-15

Background: Necrotizing enterocolitis (NEC) remains a devastating inflammatory bowel disease predominantly affecting premature infants, carrying significant morbidity and mortality risks. Respiratory distress syndrome (RDS), common in this population, is increasingly recognized not just as a comorbidity but as a potential contributor to NEC pathogenesis, possibly through mechanisms involving gut hypoperfusion. Understanding the clinical progression and management challenges when these conditions coexist is crucial.

Case presentation: We present the case of a female infant born prematurely at 33-34 weeks gestation with a birth weight of 2280g. The infant developed early RDS, requiring Continuous Positive Airway Pressure (CPAP) support shortly after birth. On the second day of life, while RDS symptoms were improving, the infant developed signs suggestive of NEC, including abdominal distension, bilious gastric residuals, and subsequent irritability and feeding intolerance. The diagnosis of NEC (suspected Bell's stage II) was supported by clinical findings and radiological evidence of bowel wall thickening. Blood cultures identified Klebsiella pneumoniae. Initial antibiotic therapy proved insufficient, necessitating a change to meropenem and amikacin based on sensitivity testing. The infant was managed conservatively with bowel rest, parenteral nutrition, and targeted antibiotics, showing gradual clinical improvement. Enteral feeding with breast milk was successfully reintroduced, and the infant was discharged in good condition after 15 days of NICU care.

Conclusion: This case highlights the challenging clinical scenario where early-onset RDS in a premature, low-birth-weight infant precedes the development of NEC. It underscores the importance of high clinical suspicion for NEC even as respiratory status improves, the utility of microbial surveillance and sensitivity testing in guiding antibiotic therapy, and the potential for successful conservative management in NEC Bell's stage II. The interplay between RDS-induced physiological stress and intestinal vulnerability likely contributed to NEC development in this patient.

The Osteoprotective and Chondroprotective Effects of Moringa oleifera: A Systematic Literature Review

Bagus Gede Krisna Astayogi — 2025-04-15

Background: Bone and joint disorders, particularly arthritis and osteoporosis, represent significant global health burdens, often managed with NSAIDs and steroids, which carry potential systemic side effects. Moringa oleifera, a plant rich in bioactive compounds, has emerged as a potential therapeutic alternative due to its reported biological activities, including anti-inflammatory and antioxidant effects. This systematic review aimed to evaluate the existing preclinical evidence regarding the osteoprotective (bone-protective) and chondroprotective (cartilage-protective) effects of Moringa oleifera.

Methods: A systematic literature search was conducted following PRISMA guidelines across PubMed, Science Direct, and Google Scholar databases for relevant English-language articles published between 2014 and 2024. Studies investigating the effects of Moringa oleifera extracts on bone or cartilage health in in vivo arthritis or bone defect models were included. Data on study design, intervention details, outcome measures, and key findings related to osteoprotection and chondroprotection were extracted and synthesized qualitatively.

Results: Seven preclinical in vivo studies met the inclusion criteria. The included studies demonstrated that various extracts of Moringa oleifera (leaf ethanol, aqueous, methanol) exerted significant anti-inflammatory effects, evidenced by reduced paw edema, lower arthritis scores, and decreased inflammatory markers like CRP. Anti-nociceptive effects were also observed. Chondroprotective effects were indicated by improved radiographic scores (reduced joint space narrowing), cartilage regeneration, reduced fibrillation, and preservation of chondrocytes in histopathological analyses. Osteoprotective effects included increased osteoblast numbers, improved trabecular bone microarchitecture, decreased osteoclast numbers, reduced bone resorption, and enhanced bone healing, particularly when combined with marine collagen.

Conclusion: Preclinical evidence strongly suggested that Moringa oleifera possesses significant osteoprotective and chondroprotective properties, mediated likely through its anti-inflammatory, anti-nociceptive, antioxidant, and direct cellular effects on bone and cartilage cells. Moringa oleifera holds potential as a supplementary or alternative therapeutic strategy for managing bone and joint diseases like arthritis and osteoporosis, although further rigorous clinical investigation is warranted.

Chemotherapy-Induced Cognitive Impairment and Neuroaxonal Damage: Investigating the Role of Serum Neurofilament Light Chain

Husni Minanda Fikri — 2025-04-15

Background: Chemotherapy-induced cognitive impairment (CICI), colloquially termed "chemobrain," represents a significant challenge for cancer survivors, potentially affecting up to 85% of patients undergoing treatment. Diagnosis often relies on neuropsychological testing and imaging, which may lack sensitivity for early detection or reflect chronic changes. Neurofilament light chain (NfL), a neuronal structural protein released into biofluids upon neuroaxonal damage, emerges as a promising biomarker. This study investigated the relationship between serum NfL levels and the degree of cognitive impairment in patients receiving chemotherapy.

Methods: An observational, cross-sectional study was conducted involving 50 cancer patients undergoing chemotherapy at Dr. M. Djamil General Hospital Padang between October and December 2024. Cognitive function was assessed using the Montreal Cognitive Assessment Indonesian version (MoCA-Ina), and depression was screened using the Patient Health Questionnaire-9 (PHQ-9). Serum NfL levels were quantified using an Enzyme-Linked Immunosorbent Assay (ELISA) method. The Kruskal-Wallis test was employed to analyze the relationship between serum NfL levels and cognitive function status (normal, mild impairment, moderate-severe impairment).

Results: Cognitive impairment (MoCA-Ina assessed) was identified in 41 (82%) of the 50 participants, with 30 (60%) exhibiting mild and 11 (22%) exhibiting moderate to severe impairment. The median serum NfL level across all subjects was 23.44 pg/ml (range: 13.81-68.71 pg/ml). A statistically significant relationship was observed between serum NfL levels and the presence and severity of cognitive impairment (p = 0.02). Median NfL levels progressively increased from the cognitively normal group (18.49 pg/ml) to the mild impairment group (23.5 pg/ml) and the moderate-severe impairment group (24.5 pg/ml). Post-hoc analysis revealed significant differences in NfL levels between the normal group and both the mild (p=0.03) and moderate-severe (p=0.01) impairment groups.

Conclusion: This study demonstrated a significant positive association between serum NfL levels and the presence and severity of cognitive impairment in cancer patients undergoing chemotherapy. These findings support the potential utility of serum NfL as an accessible biomarker for detecting chemotherapy-associated neuroaxonal damage and concomitant cognitive decline.

Is Serum Vitamin D a Determinant of Carpal Tunnel Syndrome Severity? A Cross-Sectional Observational Study

Rachmat Saleh Eka Putra — 2025-04-15

Background: Carpal tunnel syndrome (CTS) represents one of the most frequently encountered compressive neuropathies affecting the upper extremities. Emerging evidence suggests a potential link between vitamin D status and CTS incidence and severity, with vitamin D deficiency proposed as an independent risk factor influencing symptom severity. This study aimed to investigate the association between serum 25-hydroxyvitamin D levels and the electrophysiologically determined severity of CTS in a cohort of patients in Padang, Indonesia.

Methods: This cross-sectional observational study was conducted over eight months, from July 2024 to February 2025, at the Neurological Polyclinic of Dr. M. Djamil General Hospital Padang. Patients diagnosed with CTS based on clinical presentation and confirmed by nerve conduction studies (NCS) were consecutively enrolled. Exclusion criteria were applied to ensure a homogenous study population. Serum 25-hydroxyvitamin D levels were quantified using the Enzyme-Linked Immunosorbent Assay (ELISA) method. CTS severity was categorized as mild, moderate, or severe based on standardized NCS parameters. The association between serum 25-hydroxyvitamin D levels and CTS severity grades was analyzed using the Kruskal-Wallis test, with a p-value < 0.05 considered statistically significant.

Results: A total of 45 subjects meeting the inclusion criteria were included in the final analysis. The median age of the participants was 36 years (range 20-71), with a predominance of female patients (n=37, 82.2%). The mean Body Mass Index (BMI) was 24.1 ± 4.66 kg/m². Based on NCS findings, CTS severity was classified as mild in 20 patients (44.4%), moderate in 16 patients (35.6%), and severe in 9 patients (20%). The overall median serum 25-hydroxyvitamin D level across all CTS patients was 27.80 ng/mL (range 10.4 - 278.4 ng/mL). When stratified by severity, the median vitamin D levels were 23.75 ng/mL for mild CTS, 27.95 ng/mL for moderate CTS, and 37.50 ng/mL for severe CTS. Despite an apparent trend of increasing median vitamin D levels with increasing CTS severity, the Kruskal-Wallis test revealed no statistically significant association between serum 25-hydroxyvitamin D levels and the severity of CTS (p = 0.094).

Conclusion: Serum 25-hydroxyvitamin D levels were not found to be significantly associated with the severity of carpal tunnel syndrome as determined by nerve conduction studies. Further research with larger sample sizes and diverse populations is warranted to clarify the potential role of vitamin D in the pathophysiology and clinical presentation of CTS.