Bioscientia Medicina : Journal of Biomedicine and Translational Research

Recurrent Dermatofibrosarcoma Protuberans with Fibrosarcomatous Transformation: A Case Report

Haivan Kusuma Aji — 2024-09-17

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma with a propensity for local recurrence but a low risk of distant metastasis. Fibrosarcomatous transformation (FS-DFSP) is a rare but aggressive variant associated with increased metastatic potential.

Case presentation: We present the case of a 39-year-old male with recurrent DFSP involving the scalp, mandible, and humerus, complicated by fibrosarcomatous transformation and distant metastases to the lungs and bones. The patient underwent multiple excisions, radiation therapy, and systemic treatments including chemotherapy and imatinib, but ultimately experienced disease progression.

Conclusion: This case highlights the challenges in managing recurrent DFSP with fibrosarcomatous transformation. The rarity of this entity necessitates a high index of suspicion for early diagnosis and aggressive multidisciplinary management to improve patient outcomes. Further research is needed to identify effective treatment strategies for this aggressive variant of DFSP.

Selective Amygdalohippocampectomy versus Anterior Temporal Lobectomy in Mesial Temporal Lobe Epilepsy: A Meta-Analysis of Seizure Control and Cognitive Outcomes

Fajar Faisal Putra — 2024-09-17

Background: Mesial temporal lobe epilepsy (MTLE) is a common form of drug-resistant epilepsy often necessitating surgical intervention. The choice between selective amygdalohippocampectomy (SelAH) and anterior temporal lobectomy (ATL) remains a subject of debate, with each procedure offering potential advantages and disadvantages in terms of seizure control and cognitive outcomes.

Methods: A comprehensive literature search was conducted across PubMed, Scopus, and Springer databases to identify studies published between 2013 and September 2024 that compared SELAH and ATL in patients with MTLE. The primary outcomes of interest were seizure freedom rates and changes in cognitive function, particularly IQ scores. A meta-analysis was performed using a random-effects model to pool the results of included studies.

Results: The meta-analysis encompassed 5 studies involving 218 patients with MTLE (105 underwent SelAH, 113 underwent ATL). The pooled results demonstrated a statistically significant reduction in the odds of achieving seizure freedom following ATL compared to SelAH (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.24-0.81, p = 0.008). Regarding cognitive outcomes, no significant difference was observed in Performance IQ (PIQ) between the two groups. However, a trend towards improved Verbal IQ (VIQ) was noted in the SelAH group, although this did not reach statistical significance.

Conclusion: The findings suggest that SelAH may offer superior seizure control compared to ATL in patients with MTLE. While both procedures appear to have comparable effects on PIQ, SelAH may be associated with a trend towards better preservation or even improvement in VIQ. The choice between SelAH and ATL should be individualized based on patient-specific factors, including preoperative cognitive profile and the relative importance of seizure control versus cognitive preservation.

Factors Affecting the Response of Triple-Negative Breast Cancer (TNBC) to Neoadjuvant Chemotherapy: A Meta-Analysis

Haivan Kusuma Aji — 2024-09-17

Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with limited treatment options. Neoadjuvant chemotherapy (NAC) is often used to downstage tumors before surgery, but response rates vary. This meta-analysis aims to identify factors that influence TNBC’s response to NAC.

Methods: PubMed, Embase, and Cochrane Library databases were searched (2018-2024) for studies evaluating factors associated with TNBC response to NAC. Data on patient demographics, tumor characteristics, NAC regimens, and response rates were extracted. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models.

Results: Twenty-three studies (n=4,512 patients) were included. Younger age (OR 1.82, 95% CI 1.35-2.46), smaller tumor size (OR 0.58, 95% CI 0.41-0.82), lower clinical stage (OR 0.39, 95% CI 0.27-0.56), and absence of lymph node involvement (OR 0.42, 95% CI 0.31-0.57) were associated with improved pathological complete response (pCR) rates. NAC regimens containing platinum agents (OR 2.15, 95% CI 1.54-2.99) and immune checkpoint inhibitors (OR 1.78, 95% CI 1.23-2.58) also showed higher pCR rates.

Conclusion: This meta-analysis identified several factors associated with improved TNBC response to NAC, including younger age, smaller tumor size, lower clinical stage, absence of lymph node involvement, and use of platinum-based or immunotherapy-containing NAC regimens. These findings can inform patient selection and treatment optimization for NAC in TNBC.

Hyperhomocysteinemia in Chronic Kidney Disease: A Meta-Analysis

Muthia Faurin — 2024-09-18

Background: Hyperhomocysteinemia, an elevated level of homocysteine in the blood, has been implicated in the progression of chronic kidney disease (CKD). This meta-analysis aims to comprehensively evaluate the association between hyperhomocysteinemia and CKD and its potential impact on clinical outcomes.

Methods: This study systematically searched electronic databases (PubMed, Embase, Cochrane Library) for studies published between 2018 and 2024 investigating the relationship between hyperhomocysteinemia and CKD. Studies reporting data on the association between hyperhomocysteinemia and CKD progression, cardiovascular events, or mortality were included. We extracted relevant data and performed a meta-analysis using random-effects models.

Results: The meta-analysis included 25 studies comprising 5,672 patients with CKD. Hyperhomocysteinemia was significantly associated with an increased risk of CKD progression (pooled odds ratio [OR] 1.85, 95% confidence interval [CI] 1.52-2.24), cardiovascular events (pooled OR 1.63, 95% CI 1.31-2.02), and all-cause mortality (pooled OR 1.48, 95% CI 1.17-1.87) in CKD patients. Subgroup analyses revealed a consistent association across different CKD stages and etiologies.

Conclusion: Hyperhomocysteinemia is an independent risk factor for CKD progression, cardiovascular events, and mortality. Monitoring and managing hyperhomocysteinemia may represent a potential therapeutic target to improve outcomes in CKD patients.

Folic Acid Supplementation for Blood Pressure Reduction in Hypertension: A Meta-Analysis

Andreafika Kusumaningtyas Harqiqi — 2024-09-18

Background: Hypertension is a major risk factor for cardiovascular disease. While antihypertensive medications are the cornerstone of treatment, adjunctive therapies like folic acid supplementation have gained attention for their potential to lower blood pressure. This meta-analysis aims to comprehensively assess the impact of folic acid supplementation on blood pressure in hypertensive individuals.

Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library) was conducted from January 2018 to December 2023 to identify randomized controlled trials (RCTs) evaluating the effect of folic acid supplementation on blood pressure in adults with hypertension. Data on systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were extracted. A random-effects model was used to pool data, and heterogeneity was assessed using the I² statistic.

Results: Twenty-three RCTs involving 2,853 hypertensive participants were included. Folic acid supplementation was associated with a significant reduction in SBP (mean difference [MD] -2.93 mmHg, 95% confidence interval [CI] -4.11 to -1.75, p < 0.00001), DBP (MD -1.87 mmHg, 95% CI -2.63 to -1.11, p < 0.00001), and MAP (MD -2.21 mmHg, 95% CI -3.01 to -1.41, p < 0.00001) compared to placebo or control. Subgroup analyses revealed that the blood pressure-lowering effect of folic acid was more pronounced in individuals with low baseline folate levels, those with higher baseline blood pressure, and in studies with longer durations of supplementation.

Conclusion: Folic acid supplementation appears to be a safe and effective adjunctive therapy for reducing blood pressure in hypertensive individuals. These findings support the potential role of folic acid in improving cardiovascular outcomes in this population.

The Impact of Occupational Ergonomics on the Prevalence of Low Back Pain in Tailoring Professions: A Systematic Literature Review

Ni Putu Ayu Diah Pramesti — 2024-09-18

Background: Low back pain (LBP) is a prevalent musculoskeletal disorder affecting individuals across various occupations, including tailoring. Tailors often engage in prolonged sitting, repetitive movements, and awkward postures, which can contribute to the development of LBP. This systematic review aims to investigate the impact of occupational ergonomics on the prevalence of LBP in tailoring professions.

Methods: A comprehensive search of electronic databases (PubMed, Scopus, Web of Science) was conducted to identify relevant studies published between 2018 and 2024. Studies that examined the relationship between ergonomic factors and LBP among tailors were included. Data extraction and quality assessment were performed independently by two reviewers.

Results: A total of 25 studies met the inclusion criteria. The findings consistently demonstrated a significant association between poor ergonomic conditions and an increased prevalence of LBP among tailors. Prolonged sitting, awkward postures, repetitive movements, and inadequate workstation design were identified as key risk factors. Additionally, the review highlighted the positive impact of ergonomic interventions, such as adjustable workstations and training programs, in reducing the prevalence and severity of LBP.

Conclusion: This systematic review provides compelling evidence that occupational ergonomics plays a crucial role in the prevalence of LBP among tailors. Implementing ergonomic interventions and promoting proper work practices can significantly reduce the burden of LBP in this population, leading to improved worker health and productivity.

Successful Management of Complex Intestinal Tuberculosis with Ileal Perforation: A Case Report

Maryella Ernestien Thioluna — 2024-09-19

Background: Intestinal tuberculosis (ITB) with ileal perforation represents a formidable challenge in the realm of extrapulmonary tuberculosis. This case report underscores the complexities inherent in managing such cases, highlighting the critical need for a multidisciplinary approach that integrates pharmacological and surgical interventions.

Case presentation: A 57-year-old male presented with a history of both pulmonary and intestinal tuberculosis, complicated by ileal perforation. He had previously undergone a six-month course of anti-tuberculosis treatment and a laparotomy for ileal perforation repair. The patient's current presentation included abdominal pain, nausea, and vomiting, indicative of obstructive ileus. Diagnostic assessments revealed elevated inflammatory markers and imaging confirmed partial obstructive ileus and active pulmonary tuberculosis. The patient was managed with extended anti-tuberculosis therapy and intravenous antibiotics, resulting in significant clinical improvement and enhanced quality of life.

Conclusion: This case report emphasizes the importance of early detection, comprehensive assessment, and individualized treatment plans in managing complex ITB cases. The successful outcome achieved in this case underscores the efficacy of a multidisciplinary approach that combines pharmacological and surgical interventions.

Predicting Conversion to Open Cholecystectomy: A Validation Study of the Difficult Laparoscopic Cholecystectomy Scoring System

Muhammad Hafidh Komar — 2024-09-20

Background: Laparoscopic cholecystectomy (LC) has become the gold standard for managing symptomatic gallstone disease. However, a subset of patients requires conversion to open cholecystectomy (OC) due to intraoperative difficulties. The difficult laparoscopic cholecystectomy scoring system (DLCSS) has been proposed to predict the likelihood of conversion. This study aimed to validate the DLCSS in a single-center setting and assess its predictive accuracy for conversion to OC.

Methods: A retrospective analysis was conducted on patients who underwent LC at Dr. Mohammad Hoesin General Hospital Palembang, Indonesia, between January and December 2023. Preoperative, intraoperative, and postoperative data were collected. The DLCSS was calculated for each patient, and its correlation with conversion to OC was analyzed using statistical methods.

Results: A total of 30 patients were included in the study. The conversion rate to OC was 3.3%. Statistical analysis revealed a weak negative correlation between the DLCSS and conversion to OC (r = -0.318, p = 0.087), suggesting that higher DLCSS scores were associated with a slightly increased likelihood of conversion, although this association was not statistically significant.

Conclusion: The DLCSS demonstrated limited predictive value for conversion to OC in our single-center study. Further research with larger sample sizes and diverse patient populations is needed to confirm the utility of the DLCSS in predicting conversion and to identify additional factors that may contribute to intraoperative difficulties during LC.

Immunological Implications of Gold Weight Implantation for Lagophthalmos: A Systematic Review

Elza Iskandar — 2024-09-23

Background: Gold weight implantation is a well-established surgical intervention for lagophthalmos, a condition characterized by incomplete eyelid closure. While generally safe and effective, gold implants can elicit immune responses, potentially leading to complications. This systematic review aims to comprehensively evaluate the immunological implications of gold weight implantation in lagophthalmos treatment.

Methods: A systematic search of PubMed and ScienceDirect databases was conducted, encompassing studies published from 2000 to June 2024. Keywords included "gold weight implant" and "gold implant AND eyelid." Studies reporting quantitative data on immune responses to gold implants were included. Data extracted included study design, patient demographics, implant characteristics, follow-up duration, complications, and long-term outcomes.

Results: Thirteen studies met the inclusion criteria, encompassing a total of 340 patients (370 eyelids). Reported complications included hypersensitivity reactions (11.9%), lymphoma (0.6%), infection (1.2%), extrusion (8.1%), and nonspecific inflammatory reactions (4.3%). Hypersensitivity reactions were mediated by T-cell and B-cell responses, leading to chronic inflammation. Lymphoma cases highlighted the potential for chronic inflammation to trigger lymphoproliferative disorders. Infections were infrequent but could necessitate implant removal. Extrusion rates varied, influenced by implant size and placement. Nonspecific inflammatory reactions were observed, often requiring implant removal or steroid treatment.

Conclusion: Gold weight implantation can trigger diverse immune responses, ranging from mild inflammation to severe hypersensitivity and lymphoma. Careful patient selection, meticulous surgical technique, and vigilant postoperative monitoring are crucial to minimize complications. Further research is warranted to elucidate the precise mechanisms underlying these immune responses and develop strategies for their prevention and management.

Recurrent Giant Parasagittal Meningioma WHO Grade I: A Case Report Highlighting the Challenges of Management and the Role of Molecular Markers

Sheila Sumargo — 2024-09-24

Background: Meningiomas are common intracranial tumors, but their recurrence, especially in giant parasagittal locations, presents significant management challenges. This case report underscores these challenges and emphasizes the potential role of molecular markers in improving prognostication and treatment strategies.

Case presentation: A 31-year-old female presented with recurrent giant parasagittal meningioma WHO Grade I. She underwent multiple surgeries and embolizations due to persistent tumor regrowth despite histologically benign features. The tumor's location, size, and involvement of critical structures posed surgical difficulties, highlighting the limitations of current management approaches.

Conclusion: This case emphasizes the need for a more nuanced understanding of meningioma recurrence beyond histological grading. Molecular markers may offer valuable insights into tumor behavior and guide personalized treatment decisions, potentially improving outcomes for patients with recurrent meningiomas.

Delayed-Onset Surgical Site Infection after Sphenoid Wing Meningioma Resection: A Case Report Highlighting Diagnostic and Management Challenges

Sheila Sumargo — 2024-09-25

Background: Surgical site infections (SSIs) following craniotomy, while uncommon, pose significant risks. Delayed-onset infections can present diagnostic and management challenges. We report a case of delayed-onset SSI after sphenoid wing meningioma resection, emphasizing the importance of vigilance and prompt intervention.

Case presentation: A 26-year-old male underwent craniotomy for a right sphenoid wing meningioma. He presented 13 days post-operatively with a fluctuant swelling at the surgical site. Imaging revealed a subgaleal and epidural abscess. He underwent craniectomy, debridement, and antibiotic therapy, resulting in complete resolution.

Conclusion: Delayed-onset SSIs after craniotomy necessitate a high index of suspicion. Early diagnosis and aggressive management, including surgical debridement and appropriate antibiotics, are crucial for optimal outcomes.

Mechanical Properties of Macaca fascicularis Amniotic Membrane and Duramater: A Potential Biomaterial for Dural Defect Closure

Hendrikus Masang Ban Bolly — 2024-09-26

Background: The amniotic membrane (AM), a versatile biomaterial with inherent stem cells and extracellular matrix, has shown promise in various tissue engineering applications. Its potential as a dural substitute, particularly in addressing dural defects and preventing cerebrospinal fluid (CSF) leakage, has garnered increasing interest. However, a comprehensive understanding of the mechanical properties of non-human primate (NHP) AM, especially in relation to human AM, remains elusive. This knowledge gap hinders the optimal utilization of NHP models, such as Macaca fascicularis, in translational research for dural repair. This study aimed to characterize the mechanical properties of fresh Macaca fascicularis AM and dura mater and to investigate the influence of fetal gender, gestational age, and parity on AM mechanics.

Methods: Sixteen fresh preparation amniotic membranes of Macaca fascicularis were obtained at the elective caesarean section that was already free of several infections, and three fresh preparation of dura mater of the same species were studied. The membranes were cut in specific sizes and then loaded at the Flavigraph (Textechno, Herbert Stein GmbH & Co.KG, Moenchengladbach, Germany) machine. The Young’s modulus, ultimate tensile strength, elongation at break, maximum elongation, and toughness of the amniotic membrane and dura mater were recorded and compared based on the fetal gender, gestational ages, and frequency of pregnancy.

Results: This is the first report of mechanical properties of Macaca fascicularis amniotic membrane and dura mater. There are no statistically significant differences in mechanical properties of the amniotic membrane between the fetal gender, gestational age, and the frequency of pregnancy in fresh preparation amniotic membrane. The elasticity of the dura mater is seven times stiffer than the AM and the tensile strength of the dura mater is three times bigger than the AM, and the dura mater toughness is eight times bigger than the amniotic membrane.

Conclusion: Our findings have shown the mechanical properties of Mf AM are not dependent on factors of fetal gender, gestational age, and frequency of pregnancy. This work provides an explanation of the physical properties of fresh preparation AM as the consideration to be used as allograft biomaterial in the dura mater substitution procedure.

Successful Management of Panuveitis and Associated Complications in a Patient with Clinical Stage III HIV: A Case Report

Ikhsan Amanda Putra — 2024-09-26

Background: Human immunodeficiency virus (HIV) infection can lead to a myriad of ocular complications, including panuveitis, an inflammatory condition affecting the entire uvea and surrounding structures. The management of panuveitis in HIV patients is complex, often requiring a multidisciplinary approach to address both the underlying immunodeficiency and the ocular inflammation.

Case presentation: We present the case of a 37-year-old male patient with clinical stage III HIV who presented with panuveitis in the right eye (OD) secondary to herpes zoster ophthalmicus (HZO). The patient also had post-herpetic neuralgia, oral candidiasis, and malnutrition. He reported a history of unprotected sexual encounters with multiple partners. The patient's CD4 count was critically low at 15 cells/µL, indicating severe immunosuppression. He was initiated on antiretroviral therapy (ART), prophylactic medications to prevent opportunistic infections, and pain management for post-herpetic neuralgia.

Conclusion: This case highlights the challenges in managing panuveitis and associated complications in patients with advanced HIV infection. Early diagnosis, prompt initiation of ART, and a multidisciplinary approach are crucial for successful management and improving patient outcomes.

Early-Onset Neonatal Sepsis and Respiratory Distress in a Newborn with Congenital Diaphragmatic Hernia: A Case Report

Uji Kuatro Nasution — 2024-09-26

Background: A congenital diaphragmatic hernia (CDH) is a severe birth defect where abdominal organs protrude into the chest cavity through a hole in the diaphragm, often leading to respiratory distress. Neonates with CDH are also at an increased risk of developing early-onset neonatal sepsis (EOS) due to impaired lung development and immune function. This case report describes the challenges in managing a newborn with CDH who developed EOS and respiratory distress shortly after birth.

Case presentation: A 2-day-old infant presented with respiratory distress, including tachypnea, grunting, and retractions. The infant was born full-term via cesarean section with Apgar scores of 5, 7, and 8 at 1, 5, and 10 minutes, respectively. Physical examination revealed decreased breath sounds, dullness to percussion, and decreased fremitus on the left side of the chest. A chest X-ray showed intestinal gas in the left thoracic cavity, confirming the diagnosis of CDH. Laboratory investigations revealed anemia, thrombocytopenia, neutrophilia, lymphocytopenia, and hypocalcemia, suggesting EOS. The infant was admitted to the neonatal high care unit (HCU) and received respiratory support with continuous positive airway pressure (CPAP) and was kept nil per os (NPO). A laparotomy was planned to repair the diaphragmatic hernia. On day 3, the infant developed signs of sepsis and was started on antibiotics. After stabilization, the infant was transferred to the neonatal intensive care unit (NICU) for definitive surgical repair. Post-operatively, the infant received antibiotics, analgesics, and supportive care.

Conclusion: This case highlights the complexities of managing newborns with CDH and EOS. Early recognition and prompt intervention are crucial for improving outcomes in these critically ill infants.

Ultrasound vs Nerve Conduction Studies: A Comparative Analysis in Carpal Tunnel Syndrome Diagnosis

Hasnawi Haddani — 2024-09-30

Background: Carpal tunnel syndrome (CTS) is a prevalent entrapment neuropathy. While nerve conduction studies (NCS) remain the gold standard for diagnosis, ultrasound (USG) offers a non-invasive alternative. This study aimed to compare the diagnostic accuracy of USG and NCS in CTS at Dr. Mohammad Hoesin General Hospital Palembang, Indonesia.

Methods: A cross-sectional study was conducted on patients presenting with CTS symptoms. Demographic and clinical data were collected. NCS and USG assessments were performed, blinded to each other's results. USG measurements included the cross-sectional area at the carpal tunnel inlet (CSAc), proximal to the carpal tunnel (CSAp), and the difference between them (∆CSA). Diagnostic accuracy was calculated, and agreement was assessed using Cohen's kappa.

Results: A total of 86 wrists from 49 patients were included. The mean age was 52 ± 11 years, with a female predominance (86%). The majority had mild CTS based on NCS (55.8%). USG measurements showed mean CSAc of 13.1 ± 3.5 mm², CSAp of 10.6 ± 3.0 mm², and ∆CSA of 2.5 ± 0.9 mm². ∆CSA had the highest sensitivity (92.2%), specificity (88.9%), and accuracy (91.9%), with substantial agreement with NCS (Kappa = 0.65).

Conclusion: USG, particularly using ∆CSA, demonstrates high diagnostic accuracy in CTS, comparable to NCS. It can serve as a valuable tool, especially in settings with limited NCS availability.

Aspirin's Antiplatelet Effects Promote Arteriovenous Fistula Maturation in Hemodialysis Patients: A Systematic Review

Febrianto Elivas Haba Bunga — 2024-10-01

Background: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, offering superior long-term patency and lower infection rates compared to other options. However, AVF maturation remains a significant challenge. This systematic review aims to evaluate the efficacy of aspirin in promoting AVF maturation and preventing failure in hemodialysis patients.

Methods: A comprehensive search of electronic databases, including ScienceDirect, SpringerLink, PubMed, Cochrane, and ProQuest, was conducted from 2014 to 2024. Studies investigating the impact of aspirin on AVF maturation and failure were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results: Five studies met the inclusion criteria, encompassing a total of 982 participants. Four studies indicated that aspirin significantly enhanced AVF maturation by increasing flow volume and promoting the development of a robust fistula. However, one study found that aspirin did not significantly reduce the risk of thrombosis or AVF failure.

Conclusion: Aspirin appears to be a promising adjunct therapy for promoting AVF maturation in hemodialysis patients. Its antiplatelet effects, primarily through cyclooxygenase inhibition and reduced platelet activation, contribute to improved flow volume and fistula maturation. While the evidence for aspirin's role in preventing AVF failure is mixed, its potential benefits in enhancing maturation warrant further investigation.

Platelet-to-Lymphocyte Ratio as a Potential Diagnostic Marker for Acute Coronary Syndromes in Resource-Limited Settings: A Cross-Sectional Study from Single Center in Banten, Indonesia

Thariq Mubarak — 2024-10-02

Background: Acute coronary syndrome (ACS) poses a significant global health burden, particularly in resource-limited settings where access to advanced diagnostic tools is often constrained. The platelet-to-lymphocyte ratio (PLR), a simple and readily available marker from routine blood tests, has shown promise as a potential diagnostic tool for ACS. This study aimed to evaluate the diagnostic accuracy of PLR in identifying ACS patients in a resource-limited setting in Indonesia.

Methods: A cross-sectional study was conducted at Hermina Periuk Hospital, Tangerang, Banten, Indonesia, between December 2020 and December 2022. Patients presenting to the Emergency Room with a diagnosis of ACS were included. PLR was calculated from complete blood count data, and cardiac troponin I (cTnI) served as the gold standard for ACS diagnosis. The diagnostic performance of PLR in predicting elevated cTnI levels was assessed.

Results: Of the 121 patients initially identified, 39 met the inclusion and exclusion criteria. Elevated PLR values (>116) were observed in 25 patients (64.1%), while 15 patients (38.5%) had elevated cTnI levels. A statistically significant correlation was found between elevated PLR and elevated cTnI (p = 0.018). No significant association was observed between neutrophil-to-lymphocyte ratio (NLR) and elevated cTnI.

Conclusion: PLR demonstrates potential as a diagnostic marker for ACS in resource-limited settings. Its simplicity, accessibility, and cost-effectiveness make it a valuable tool for early identification and risk stratification of ACS patients, particularly in areas with limited access to advanced cardiac diagnostics.

Successful Anesthetic Management for Mandibular Neoplasm Resection in a Patient with Osteogenesis Imperfecta: A Case Report

Andi Riza Mirda Indriani — 2024-10-02

Background: Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by bone fragility and deformities. Patients with mandibular neoplasms and suspected OI require careful anesthetic management to avoid complications. This case report describes the successful anesthetic management of a patient with a mandibular neoplasm and suspected OI.

Case presentation: A 33-year-old man presented with a large mandibular tumor causing airway obstruction and difficulty eating. He had physical features suggestive of OI, including short stature, bone deformities, and abnormal tooth growth. Preoperative evaluation revealed a difficult airway due to the tumor and potential cervical spine instability. Anesthesia was induced with propofol and atracurium after securing the airway via ultrasound-guided tracheostomy under local anesthesia. The tumor was resected successfully, and the patient recovered without complications.

Conclusion: Anesthetic management in patients with suspected OI and mandibular neoplasms requires careful planning and execution. A multidisciplinary approach, including preoperative evaluation, airway management strategies, and close postoperative monitoring, is crucial for successful outcomes.

The Role of Brain-Derived Neurotrophic Factor (BDNF) in the Pathogenesis of Sarcopenia: A Meta-Analysis of Molecular Mechanisms

Edi Susanto — 2024-10-03

Background: Brain-derived neurotrophic factor (BDNF), a neurotrophin crucial for neuronal survival and differentiation, has emerged as a potential key player in sarcopenia development. This meta-analysis aimed to systematically evaluate the molecular mechanisms by which BDNF contributes to sarcopenia.

Methods: A comprehensive search of PubMed, Scopus, and Web of Science databases was conducted for studies published between 2018 and 2024 investigating the relationship between BDNF and sarcopenia at a molecular level. Studies were included if they met the following criteria: (1) examined BDNF signaling pathways in skeletal muscle; (2) assessed the impact of BDNF on muscle protein synthesis/degradation; (3) explored the role of BDNF in mitochondrial function and oxidative stress in muscle; and (4) investigated the influence of BDNF on muscle fiber type and neuromuscular junction integrity.

Results: A total of 28 studies (n = 1,245 participants) met the inclusion criteria. The meta-analysis revealed that lower BDNF levels were significantly associated with: reduced muscle protein synthesis (SMD = -0.85, 95% CI: -1.12 to -0.58, p < 0.001); increased muscle protein degradation (SMD = 0.62, 95% CI: 0.35 to 0.89, p < 0.001); impaired mitochondrial function (SMD = -0.71, 95% CI: -0.98 to -0.44, p < 0.001); increased oxidative stress (SMD = 0.55, 95% CI: 0.28 to 0.82, p < 0.001); a shift towards fast-twitch muscle fibers (SMD = 0.48, 95% CI: 0.21 to 0.75, p = 0.001); and compromised neuromuscular junction integrity (SMD = -0.92, 95% CI: -1.21 to -0.63, p < 0.001).

Conclusion: This meta-analysis provides compelling evidence that BDNF plays a pivotal role in the pathogenesis of sarcopenia through its multifaceted effects on muscle protein metabolism, mitochondrial function, oxidative stress, fiber type composition, and neuromuscular junction integrity.

Leukopenia as a Prognostic Factor in Severe Community-Acquired Pneumonia with Sepsis: A Case Report

Dandy Irawan — 2024-10-04

Background: Community-acquired pneumonia (CAP) is a major cause of sepsis, and severe CAP with sepsis is associated with significant morbidity and mortality. Leukopenia, a decrease in white blood cell count, has been identified as a potential prognostic factor in sepsis, suggesting a poorer outcome. This case report aims to evaluate the role of leukopenia in predicting the clinical course and outcome of a patient with severe CAP and sepsis.

Case presentation: A 73-year-old male presented with complaints of shortness of breath, cough, fever, and altered mental status. He was diagnosed with severe CAP with sepsis and sepsis-associated encephalopathy (SAE). Laboratory investigations revealed leukopenia. The patient's clinical condition improved over 10 days of treatment, coinciding with an improvement in his white blood cell count.

Conclusion: This case report highlights the potential prognostic value of leukopenia in patients with severe CAP and sepsis. The patient's clinical improvement paralleled the recovery of his white blood cell count, suggesting that leukopenia may serve as a marker of disease severity and treatment response. Further studies are needed to validate these findings and establish the role of leukopenia in the management of severe CAP with sepsis.

Does Long-Term Oxygen Therapy Reduce Exacerbations in Chronic Obstructive Pulmonary Disease? A Meta-Analysis

Fitri Amelia Rizki — 2024-10-07

Background: Chronic obstructive pulmonary disease (COPD) exacerbations contribute significantly to morbidity, mortality, and healthcare costs. While long-term oxygen therapy (LTOT) is a standard treatment for severe resting hypoxemia in COPD, its impact on exacerbations remains unclear. This meta-analysis aimed to evaluate the effect of LTOT on the frequency and severity of COPD exacerbations.

Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted (January 2018 to December 2023) for randomized controlled trials (RCTs) comparing LTOT to no LTOT in COPD patients. The primary outcome was the rate of moderate to severe COPD exacerbations. Secondary outcomes included hospitalization due to exacerbations and all-cause mortality. The risk of bias was assessed using the Cochrane Risk of Bias tool. A random-effects model was used to pool data, and heterogeneity was assessed using the I² statistic.

Results: Nine RCTs with 2,949 participants were included. LTOT was associated with a statistically significant reduction in the rate of moderate to severe exacerbations (Rate Ratio [RR] 0.72; 95% Confidence Interval [CI] 0.67 to 0.78; p < 0.000001), representing an estimated 28% reduction. LTOT also significantly reduced hospitalization for exacerbations (RR 0.69; 95% CI 0.61 to 0.79; p < 0.000001) and all-cause mortality (RR 0.71; 95% CI 0.57 to 0.89; p = 0.003).

Conclusion: LTOT significantly reduces the frequency of moderate to severe COPD exacerbations, related hospitalizations, and all-cause mortality. These findings support LTOT use in eligible COPD patients to improve clinical outcomes.

An Unusual Case of Self-Inserted Rectal Foreign Body: Successful Management with Manual Extraction Under Spinal Anesthesia

Putut Tri Anda — 2024-10-07

Background: Rectal foreign bodies (RFBs) are an uncommon presentation to the emergency department (ED), often encountered by emergency medicine, surgery, and internal medicine specialists. Their management can be challenging, ranging from simple manual extraction to complex surgical interventions.

Case presentation: A 19-year-old male presented to the ED with lower abdominal and anal pain. He admitted to self-inserting a plastic bottle into his rectum for autoerotic purposes. A physical examination revealed a palpable tubular mass in the rectosigmoid region, confirmed by a pelvic X-ray. The patient successfully underwent manual transanal extraction of the foreign body under spinal anesthesia, with no complications.

Conclusion: This case highlights the importance of a thorough history and physical examination in patients presenting with RFBs. Prompt diagnosis and appropriate management, including manual extraction when feasible, can lead to successful outcomes.

Impact of Hatha and Iyengar Yoga on Physical Function and Quality of Life in Knee Osteoarthritis: A Systematic Review

Bagus Gede Krisna Astayogi — 2024-10-07

Background: Osteoarthritis (OA) is a chronic degenerative disorder that primarily affects the articular cartilage of synovial joints. This condition leads to pain, joint stiffness, decreased muscle performance, and decreased aerobic capacity, which can negatively impact a patient's quality of life (QOL) and increase their risk of disability. This systematic review aims to investigate the effectiveness of two non-pharmacological treatment regimens, Hatha yoga, and Iyengar yoga, on QOL, physical function, and mental health in patients with knee OA.

Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A comprehensive search was performed across three electronic databases: PubMed, Google Scholar, and ScienceDirect, to identify eligible studies that examined the beneficial effects of Hatha Yoga and Iyengar Yoga on improving physical function, mental health, and QOL in patients with knee OA.

Results: Out of 61 reports initially identified, 51 were excluded based on the pre-defined inclusion and exclusion criteria. The results of this systematic review suggest that the combination of Hatha Yoga and Iyengar Yoga can enhance physical function, mental health, and QOL in patients with knee OA.

Conclusion: Both Hatha Yoga and Iyengar Yoga can serve as effective complementary treatments alongside conventional treatment to improve the overall well-being of individuals with knee OA.

Is It a Tumor or Not? A Case of Focal Segmental Glomerulosclerosis Secondary to Type 2 Diabetes with a Concomitant Renal Pseudotumor

Rery TF Yuniarti — 2024-10-07

Background: Focal segmental glomerulosclerosis (FSGS) is a histologic pattern of glomerular injury that can be primary or secondary to various conditions, including obesity, diabetes, and hypertension. Renal masses, often detected incidentally, can be benign or malignant, with renal cell carcinoma (RCC) being the most common. This case report presents a patient with FSGS secondary to type 2 diabetes and a concomitant renal pseudotumor, initially suspected to be RCC.

Case presentation: A 60-year-old woman presented with weakness, fever, and weight loss. Imaging revealed a renal mass, initially suspected to be RCC. A kidney biopsy revealed FSGS, and further evaluation confirmed type 2 diabetes. After controlling her diabetes and hypertension, the renal mass regressed, suggesting a pseudotumor.

Conclusion: This case highlights the importance of considering pseudotumors in the differential diagnosis of renal masses, especially in patients with comorbidities such as diabetes. A kidney biopsy can help avoid unnecessary invasive procedures like nephrectomy.

Challenges in the Management of Pulmonary Contusion with Multiple Rib Fractures and Associated Injuries: A Case Report

Liliriawati Ananta Kahar — 2024-10-10

Background: Pulmonary contusion, a common consequence of chest trauma, presents significant management challenges, especially when associated with multiple rib fractures and other injuries. These cases often require intensive care due to the high risk of complications and mortality. This report presents a case of a patient with pulmonary contusion, multiple rib fractures, and cerebral contusion to illustrate the complexities involved in managing such cases.

Case Presentation: A 44-year-old male was admitted to the intensive care unit (ICU) following a motor vehicle accident. He presented with decreased consciousness, multiple rib fractures, severe lung contusion, and cerebral edema. The patient's condition was further complicated by the development of respiratory distress and hemodynamic instability.

Conclusions: The management of pulmonary contusion with multiple rib fractures and associated injuries requires a multidisciplinary approach with careful attention to respiratory support, hemodynamic management, pain control, and early intervention for complications.