Bioscientia Medicina : Journal of Biomedicine and Translational Research

Shock Management and Hemodynamic Monitoring of Severe Dengue with Fluid Overload: A Case Report

Shinta Asbi — 2024-07-18

Background: Dengue shock syndrome (DSS) is a life-threatening complication of dengue infection characterized by plasma leakage, shock, and organ dysfunction. Fluid management is crucial in DSS, but fluid overload can lead to adverse outcomes. This case report highlights the challenges and strategies in managing DSS with fluid overload.

Case presentation: An 8-year-old girl presented with severe dengue, DSS, encephalopathy, and fluid overload. She had a history of high fever, vomiting, and altered consciousness. Initial management focused on fluid resuscitation, but the patient developed signs of fluid overload. Hemodynamic monitoring using USCOM (Ultrasonic Cardiac Output Monitor) revealed low cardiac output and high systemic vascular resistance. Fluid restriction and inotropic support with epinephrine were initiated. The patient's condition gradually improved, and she was discharged after complete recovery.

Conclusion: This case emphasizes the importance of early recognition and careful monitoring of fluid status in DSS. Hemodynamic monitoring tools like USCOM can aid in guiding fluid management and identifying complications like fluid overload. Prompt intervention with fluid restriction and inotropic support can improve outcomes in DSS patients with fluid overload.

Case of Hypopigmented Mycosis Fungoides: Clinical and Pathological Discrimination from Mimicking Conditions

Suci Leni Mimanda — 2024-07-23

Background: Hypopigmented mycosis fungoides (HMF) is an uncommon variant of mycosis fungoides (MF), a cutaneous T-cell lymphoma. It presents a diagnostic challenge due to its clinical resemblance to various benign dermatological conditions. This case report highlights the importance of a comprehensive approach to diagnosis, incorporating clinical, histopathological, and immunohistochemical findings.

Case presentation: A 48-year-old Indonesian woman presented with a one-year history of progressive, asymptomatic hypopigmented patches on her extremities. Initially misdiagnosed as progressive macular hypomelanosis, the patient's condition did not improve with topical treatments. Clinical examination revealed multiple hypopigmented patches and macules on both extremities, with some lesions exhibiting fine scales. Histopathological examination demonstrated atypical lymphocytes with epidermotropism and Pautrier's microabscesses. Immunohistochemical staining confirmed the presence of CD3+ T-cells, leading to the diagnosis of HMF.

Conclusion: HMF can mimic various dermatological conditions, making diagnosis challenging. A thorough clinical assessment, coupled with histopathological and immunohistochemical evaluation, is crucial for accurate diagnosis and appropriate management. This case underscores the importance of considering HMF in the differential diagnosis of hypopigmented skin lesions, particularly in individuals with persistent or atypical presentations. Early recognition and intervention are essential for optimizing patient outcomes.

Analysis of Risk Factors Related to Malnutrition on Length of Stay Hospitalization: A Single-Center Observational Study at Klungkung General Hospital, Indonesia

I Dewa Gde Wira Saskara — 2024-07-24

Background: Malnutrition is a prevalent issue in hospital settings, significantly impacting patient outcomes and healthcare costs. This study aimed to identify and analyze risk factors associated with malnutrition and its influence on the length of stay (LOS) among hospitalized patients at Klungkung General Hospital, Indonesia.

Methods: A retrospective observational study was conducted, including adult patients admitted to Klungkung General Hospital between January 1, 2023, and December 31, 2023. Malnutrition was assessed using the Subjective Global Assessment (SGA) tool. Patient demographics, medical history, nutritional status, laboratory parameters, and LOS were collected. Univariate and multivariate analyses were performed to identify risk factors associated with malnutrition and its impact on LOS.

Results: A total of 43,949 patients were included in the study, with 1,084 (2.46%) identified as malnutrition. The mean LOS for malnutrition patients was significantly longer than for well-nutrition patients (7.8 days vs. 4.2 days, p < 0.001). Multivariate analysis revealed that age ≥ 60 years (OR 2.31, 95% CI 1.85-2.89), presence of comorbidities (OR 1.75, 95% CI 1.42-2.16), low albumin levels (OR 2.05, 95% CI 1.68-2.50), and inadequate dietary intake (OR 1.98, 95% CI 1.61-2.43) were independent risk factors for malnutrition. Malnutrition was also an independent predictor of prolonged LOS (OR 1.68, 95% CI 1.36-2.07).

Conclusion: Malnutrition is a significant problem at Klungkung General Hospital, associated with increased LOS. Early identification of risk factors and implementation of targeted nutritional interventions are crucial to improve patient outcomes and reduce healthcare costs.

Meta-Analysis of Effective Management Strategies for Malignant Central Airway Obstruction

Septriana Putri — 2024-07-24

Background: Malignant central airway obstruction (MCAO) significantly impacts the quality of life and prognosis of patients with advanced lung cancer or metastatic disease. This meta-analysis aims to evaluate the effectiveness and safety of various management strategies for MCAO.

Methods: A systematic search of PubMed, Embase, and Cochrane databases from 2018 to 2024 was conducted to identify randomized controlled trials (RCTs) and observational studies comparing different MCAO management approaches. Primary outcomes included improvement in airway patency, dyspnea scores, and survival. Secondary outcomes included procedural complications and quality-of-life measures. A random-effects model was used to pool data, and heterogeneity was assessed using the I² statistic.

Results: A total of 25 studies (15 RCTs, 10 observational studies), encompassing 3456 patients, were included in the meta-analysis. Interventions assessed were rigid bronchoscopy with various modalities (e.g., laser therapy, cryotherapy, electrocautery, balloon dilation, stenting), external beam radiation therapy (EBRT), brachytherapy, and systemic therapy. Rigid bronchoscopy: Significantly improved airway patency and dyspnea scores compared to supportive care alone (OR 2.86, 95% CI 1.95-4.18; p<0.001). Stenting: Demonstrated superior airway patency and symptom relief compared to other bronchoscopic interventions (OR 1.73, 95% CI 1.21-2.48; p=0.003). EBRT/Brachytherapy: Offered moderate symptom improvement but with higher complication rates than bronchoscopic interventions (OR 1.39, 95% CI 1.05-1.85; p=0.021). Systemic therapy (chemotherapy/immunotherapy): Provided limited benefit in terms of airway patency but may impact overall survival in specific tumor types.

Conclusion: Rigid bronchoscopy, particularly with stenting, is the most effective initial management strategy for MCAO, providing rapid symptom relief and airway recanalization. EBRT/brachytherapy can be considered as adjuncts or alternatives in select cases. Further research is needed to determine the optimal combination and sequencing of therapies for different tumor types and stages.

Giant Gartner’s Duct Cyst Mimicking Pelvic Organ Prolapse: A Rare Case Report

Citra Utami Effendy — 2024-07-25

Background: Gartner’s duct cysts are benign vaginal cysts originating from embryological remnants. While usually asymptomatic, larger cysts can mimic pelvic organ prolapse, leading to misdiagnosis and delayed treatment. This case emphasizes the importance of accurate diagnosis and appropriate surgical intervention in managing large GDCs.

Case presentation: A 43-year-old woman presented with a protruding vaginal mass, initially mistaken for pelvic organ prolapse. Examination revealed a large Gartner’s duct cyst on the posterior vaginal wall. Surgical excision and marsupialization were performed, confirming the diagnosis.

Conclusion: This case highlights the importance of thorough evaluation in women presenting with vaginal masses. Large Gartner’s duct cysts, though rare, can mimic pelvic organ prolapse, necessitating accurate diagnosis and appropriate surgical intervention.

Effectiveness of Dipeptidyl Peptidase IV Inhibitors in the Management of Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Joas Vinsensius Davian — 2024-07-29

Background: Chronic obstructive pulmonary disease (COPD) is a major global health issue. Recent research suggests dipeptidyl peptidase IV (DPP-IV) inhibitors, primarily used in diabetes management, may have beneficial effects on lung function and inflammation in COPD. This meta-analysis aims to assess the efficacy and safety of DPP-IV inhibitors in COPD.

Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted from January 2018 to June 2024. Randomized controlled trials (RCTs) comparing DPP-IV inhibitors with placebo or standard COPD therapy in patients with COPD were included. Data on lung function (FEV1), quality of life, exacerbations, and adverse events were extracted. Meta-analyses were performed using random-effects models.

Results: Ten RCTs involving 4,520 patients were included. DPP-IV inhibitors were associated with a significant improvement in FEV1 compared to placebo or standard therapy (mean difference: 55 ml, 95% CI: 30-80 ml, p<0.001). Quality of life scores also showed a trend toward improvement. The rate of moderate-to-severe exacerbations was significantly lower in the DPP-IV group (risk ratio: 0.75, 95% CI: 0.60-0.93, p=0.008). Adverse events were similar between groups.

Conclusion: DPP-IV inhibitors may be a promising adjunctive therapy in COPD management, improving lung function, and quality of life, and reducing exacerbations. Further research is warranted to confirm these findings and investigate long-term effects.

Ocular Manifestations and Risk Factors of HIV in a Single-Center Observational Study at Dr. M. Djamil General Hospital, Padang, Indonesia

Havilah Zeki Rosa — 2024-08-01

Background: Human immunodeficiency virus (HIV) infection is associated with various ocular manifestations, impacting visual health and quality of life. This study aimed to investigate the spectrum of ocular manifestations and their associated risk factors in HIV-positive individuals at Dr. M. Djamil General Hospital, Padang, Indonesia.

Methods: This single-center observational study included HIV-positive patients presenting with ocular complaints at Dr. M. Djamil General Hospital between 2019 and 2021. Comprehensive ophthalmic examinations were conducted, and data on demographics, HIV disease stage, CD4⁺T-cell count, antiretroviral therapy (ART) status, and ocular findings were collected. Statistical analysis was performed to identify associations between risk factors and specific ocular manifestations.

Results: A total of 149 HIV-positive patients were included in the study, with 7 (4.7%) presenting with ocular manifestations. The most common ocular manifestation was cytomegalovirus (CMV) retinitis (57.1%), followed by retinal nerve fiber layer (RNFL) thinning (42.9%). Other manifestations included visual field disturbances and herpes zoster ophthalmicus (HZO). Low CD4⁺ T-cell count (<200 cells/μL) was significantly associated with CMV retinitis (p < 0.05).

Conclusion: CMV retinitis and RNFL thinning were the predominant ocular manifestations in this HIV-positive cohort. Low CD4⁺ T-cell count emerged as a significant risk factor for CMV retinitis. Early detection and prompt management of ocular manifestations are crucial to prevent visual impairment in HIV-positive individuals.

Risk Factors Associated with Intraocular Pressure and the Correlation of Central Corneal Thickness to Actual Intraocular Pressure in Myopia Patients

Hadwer Wicaksono Pandjaitan — 2024-08-01

Background: Myopia, a prevalent refractive error, is associated with an increased risk of glaucoma, a leading cause of irreversible blindness. Central corneal thickness (CCT) is a key factor in glaucoma assessment, as thinner corneas can lead to underestimation of intraocular pressure (IOP). This study aimed to investigate the correlation between CCT and actual IOP in myopic patients, considering various risk factors that may influence IOP.

Methods: This cross-sectional study included myopic patients aged 20-25 years. Participants underwent comprehensive ophthalmic examinations, including visual acuity assessment, autorefraction, CCT measurement using optical coherence tomography (OCT), and Goldmann applanation tonometry for IOP measurement. IOP values were corrected for CCT. Statistical analysis was performed using ANOVA, Pearson correlation tests, and multivariate regression analysis to identify independent risk factors for elevated IOP.

Results: A total of 78 eyes from 78 participants were analyzed. The mean CCT was significantly thinner in moderate myopia compared to mild myopia and emmetropia (p = 0.000). While IOP was lower in moderate myopia, the actual IOP, after CCT correction, was not significantly different among the groups (p = 0.078). A strong positive correlation was found between CCT and IOP (r = 0.737, p = 0.000), and a moderate negative correlation was observed between CCT and actual IOP (r = -0.492, p = 0.000). Multivariate regression analysis identified axial length (p = 0.021) and family history of glaucoma (p = 0.038) as independent risk factors for elevated IOP.

Conclusion: This study highlights the importance of CCT assessment in myopic patients, as thinner corneas can mask elevated IOP. Regular eye examinations, including CCT and IOP measurements, are crucial for early detection and management of glaucoma in this high-risk population. Axial length and family history of glaucoma were identified as independent risk factors for elevated IOP, emphasizing the need for comprehensive risk assessment in myopic individuals.

Effectiveness of Airway Management Strategies in Critically Ill Patients: A Meta-Analysis

Ricko Yorinda Putra — 2024-08-05

Background: Airway management is a cornerstone of critical care, but the optimal strategies for critically ill patients remain debated. This meta-analysis aimed to evaluate the effectiveness of various airway management techniques in critically ill patients.

Methods: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted from January 2018 to December 2023. Studies comparing different airway management strategies (e.g., endotracheal intubation, laryngeal mask airway, video laryngoscopy) in critically ill adults were included. Primary outcomes were successful airway establishment, time to airway securement, and complications (e.g., hypoxia, aspiration). Meta-analyses were performed using random-effects models, and the risk of bias was assessed.

Results: Twenty-three studies (n=5,894 patients) were included. Video laryngoscopy was associated with a higher success rate of first-pass intubation compared to direct laryngoscopy (OR 1.85, 95% CI 1.43-2.40, p<0.001). No significant differences were found in overall complications between video laryngoscopy and direct laryngoscopy (OR 0.92, 95% CI 0.68-1.24, p=0.59). In patients with difficult airways, video laryngoscopy demonstrated a reduced risk of complications compared to direct laryngoscopy (OR 0.63, 95% CI 0.41-0.97, p=0.04).

Conclusion: Video laryngoscopy is a safe and effective alternative to direct laryngoscopy, particularly in critically ill patients with predicted difficult airways. Further research is needed to determine the optimal airway management strategy in specific subgroups of critically ill patients.

Complete Neurological Recovery Following 360-Degree Decompression and Fusion for T11 Giant Cell Tumor: A Case Report

Rieva Ermawan — 2024-08-08

Background: Giant cell tumors (GCTs) are benign but locally aggressive bone tumors that rarely affect the spine. The thoracic spine is an even rarer location for GCTs, and their presentation with paraplegia poses a significant challenge. This case report describes the successful surgical management of a T11 GCT-causing paraplegia, highlighting the importance of early diagnosis and aggressive surgical intervention.

Case presentation: A 27-year-old female presented with acute paraplegia and a history of chronic lower back pain. Imaging revealed a destructive lesion in the T11 vertebral body with spinal cord compression. The patient underwent a 360-degree decompression, en bloc tumor resection, and posterior spinal fusion. Histopathological analysis confirmed the diagnosis of GCT. The patient experienced complete neurological recovery within five days postoperatively and remained symptom-free at the 5-year follow-up.

Conclusion: This case demonstrates the feasibility of achieving complete neurological recovery in patients with T11 GCT and paraplegia through aggressive surgical intervention. Early diagnosis and complete tumor resection followed by spinal stabilization are crucial for optimal outcomes.

Effectiveness of Drug Allergy Management: A Meta-Analysis

Yanuar Surya Saputra Poedjijo — 2024-08-12

Background: Drug allergies pose a significant challenge in clinical practice, impacting patient safety and treatment options. This meta-analysis aims to evaluate the effectiveness of various drug allergy management strategies, including desensitization, graded challenges, and alternative medications.

Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library) was conducted from 2018 to 2024. Randomized controlled trials (RCTs) and observational studies assessing drug allergy management interventions were included. The primary outcome was the successful administration of the culprit drug without allergic reactions. Secondary outcomes included adverse events and quality of life. Data were extracted and pooled using random-effects models.

Results: A total of 32 studies (15 RCTs, 17 observational studies) encompassing 4,215 patients were included. Desensitization protocols demonstrated a high success rate (89%) in enabling the administration of culprit drugs. Graded challenges also showed promising results (75% success rate). The use of alternative medications was associated with a lower risk of allergic reactions but may compromise treatment efficacy in some cases.

Conclusion: This meta-analysis highlights the effectiveness of drug allergy management strategies, particularly desensitization and graded challenges. These interventions offer promising avenues to overcome drug allergies and optimize patient care. Further research is needed to explore long-term outcomes and refine management protocols.

Prevalence and Analysis of Risk Factors for RAI-Refractory Thyroid Cancer Patients: A 5-Year Retrospective Analysis from a Single Institution in Indonesia

Syifa Azizah Putri — 2024-08-12

Background: Radioactive iodine (RAI) therapy is a cornerstone in the management of differentiated thyroid cancer (DTC). However, a subset of patients develops RAI-refractory disease, characterized by the inability to concentrate radioiodine, leading to limited treatment options and a poorer prognosis. This study aimed to investigate the prevalence and identify potential risk factors associated with RAI-refractory DTC in an Indonesian population.

Methods: A retrospective analysis was conducted on patients diagnosed with DTC and treated with RAI at a single tertiary care center in Indonesia between 2019 and 2023. Data on demographics, clinical characteristics, tumor features, and treatment outcomes were collected. RAI-refractoriness was defined as the absence of iodine uptake on diagnostic whole-body scans after cumulative RAI activity of 600 mCi or more. Bivariate and multivariate analyses were performed to identify risk factors for RAI-refractoriness.

Results: A total of 194 patients with DTC were included in the study. The prevalence of RAI-refractoriness was 90%. The median age at diagnosis was 55 years (range 18-82), and 72% were female. Papillary thyroid carcinoma was the most common histological subtype (92%). In bivariate analysis, older age at diagnosis (p=0.02), male gender (p=0.04), and the presence of distant metastases at diagnosis (p<0.001) were significantly associated with RAI-refractoriness. In multivariate analysis, only the presence of distant metastases remained an independent predictor of RAI-refractoriness (odds ratio 3.8, 95% confidence interval 1.5-9.2, p=0.003).

Conclusion: RAI-refractoriness is a significant clinical challenge in the management of DTC, with a high prevalence observed in this Indonesian cohort. The presence of distant metastases at diagnosis emerged as a strong predictor of RAI-refractoriness. Further research is needed to elucidate the underlying mechanisms of RAI-refractoriness and develop novel therapeutic strategies for this patient population.

Primary Malignant Melanoma of the Hard Palate: A Rare Case Report

Syifa Azizah Putri — 2024-08-12

Background: Primary malignant melanoma of the oral cavity is an uncommon and aggressive malignancy with a poor prognosis. The hard palate is a rare site for primary melanoma, and early diagnosis is often challenging due to its asymptomatic nature in the initial stages.

Case presentation: We present the case of a 58-year-old female who presented with a pigmented lesion on the right hard palate and a neck mass. The lesion had been present for a year and had gradually increased in size. The neck mass had appeared three months prior and was associated with pain. Imaging and biopsy confirmed the diagnosis of malignant melanoma with cervical lymph node metastasis. The patient underwent wide excision with right hemimaxillectomy and modified radical neck dissection type II, followed by planned postoperative radiation therapy.

Conclusion: This case highlights the importance of considering melanoma in the differential diagnosis of pigmented oral lesions. Early diagnosis and aggressive treatment are crucial for improving outcomes in this rare but aggressive malignancy. The use of adjuvant therapies, such as radiation and targeted therapy, may be beneficial in select cases.

Meta-Analysis of Corticosteroids in the Management of Sepsis: Evaluating Efficacy and Safety

Astrid Harvindra — 2024-08-13

Background: Sepsis remains a significant cause of morbidity and mortality worldwide. Corticosteroids have been used in sepsis management, but their efficacy and safety remain debated. This meta-analysis aims to evaluate the effectiveness of corticosteroids in sepsis management.

Methods: A comprehensive search of PubMed, Embase, and Cochrane Library was conducted to identify randomized controlled trials (RCTs) published from 2018 to 2024 evaluating corticosteroid use in sepsis. The primary outcome was mortality. Secondary outcomes included length of hospital stay, duration of mechanical ventilation, and adverse events. Data were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic.

Results: Twenty-one RCTs (n=12,350 patients) were included. Corticosteroid therapy was associated with a significant reduction in mortality (risk ratio [RR] 0.87, 95% confidence interval [CI] 0.79-0.96, p=0.004). There was also a significant reduction in the length of hospital stay (mean difference [MD] -1.5 days, 95% CI -2.3 to -0.7, p<0.001) and duration of mechanical ventilation (MD -1.2 days, 95% CI -1.9 to -0.5, p<0.001). No significant increase in adverse events was observed.

Conclusion: This meta-analysis suggests that corticosteroid therapy is associated with a significant reduction in mortality, length of hospital stay, and duration of mechanical ventilation in patients with sepsis. The benefits appear to outweigh the risks. Corticosteroids should be considered as part of the standard of care in sepsis management.

Surgical Management of Facial Basal Cell Carcinoma: A Case Report Emphasizing the Need for Individualized Margin Assessment

Aulia Ulfa — 2024-08-21

Background: Basal cell carcinoma (BCC) is the most common form of skin cancer, and its incidence is steadily increasing. While surgical excision remains a cornerstone of BCC treatment, achieving complete tumor clearance while preserving healthy tissue and ensuring optimal cosmetic outcomes can be challenging, particularly in the facial region. This case report underscores the importance of individualized margin assessment in BCC excision.

Case presentation: We present the case of a 52-year-old male with a nodular BCC on his left cheek. The lesion was excised with a 5mm margin under local anesthesia. Histopathological examination revealed incomplete excision, with residual tumor cells at the peripheral margin. The patient underwent a second excision with wider margins, achieving complete tumor clearance.

Conclusion: This case highlights the limitations of standard margin guidelines in BCC excision. Factors such as tumor subtype, location, size, and patient characteristics should be considered when determining appropriate surgical margins. The use of intraoperative margin assessment techniques and adjuvant therapies may be beneficial in select cases.

Matrix Metalloproteinases as Biomarkers for Ischemic Stroke: A Systematic Review

Putri Ulya Rachman — 2024-08-26

Background: Ischemic stroke, a leading cause of mortality and disability worldwide, occurs due to the disruption of blood flow to the brain, resulting in neuronal damage and death. Matrix metalloproteinases (MMPs), a family of zinc-dependent endopeptidases, play a crucial role in the pathophysiology of ischemic stroke by degrading the extracellular matrix and contributing to blood-brain barrier disruption, inflammation, and neuronal cell death. This systematic review aims to comprehensively evaluate the current evidence regarding the potential of MMPs as biomarkers for ischemic stroke diagnosis, prognosis, and therapeutic monitoring.

Methods: A systematic search of electronic databases (PubMed, Embase, and Cochrane Library) was conducted to identify relevant studies published between 2018 and 2024. Studies investigating the association between MMPs and ischemic stroke in human subjects were included. Data extraction and quality assessment were performed independently by two reviewers.

Results: The search yielded 2,182 articles, of which 8 studies met the inclusion criteria. The included studies evaluated various MMPs, including MMP-2, MMP-3, MMP-9, and MMP-12, in different biological samples (serum, plasma, cerebrospinal fluid, and brain tissue) from ischemic stroke patients. The majority of studies reported elevated levels of MMPs in ischemic stroke patients compared to healthy controls, with MMP-9 being the most extensively studied. Furthermore, several studies demonstrated a correlation between MMP levels and stroke severity, functional outcome, and the risk of hemorrhagic transformation.

Conclusion: The findings of this systematic review suggest that MMPs, particularly MMP-9, hold promise as potential biomarkers for ischemic stroke. However, further research is needed to validate their clinical utility and to explore their potential as therapeutic targets.

Rare Presentation of Non-Tuberculous Mycobacteria: A Case of Lung Infection with Pleural Effusion

Nadia Ventiani — 2024-08-28

Background: Non-tuberculous mycobacteria (NTM) are environmental organisms that can cause pulmonary infections, particularly in individuals with predisposing conditions. While NTM lung disease is increasingly recognized, pleural effusion as a complication remains uncommon, posing diagnostic and therapeutic challenges. This case emphasizes the importance of a high index of suspicion, comprehensive microbiological investigations, and bronchoscopy in the diagnosis of NTM lung disease with pleural effusion.

Case presentation: We present the case of a 55-year-old male farmer with a history of smoking, who presented with progressive dyspnea, cough, and constitutional symptoms. Initial investigations suggested tuberculosis, but sputum tests were negative. Chest imaging revealed a right pleural effusion and cavitary lung lesions. Pleural fluid analysis showed an exudative pattern with elevated adenosine deaminase (ADA) but negative for acid-fast bacilli. Bronchoscopy with bronchoalveolar lavage culture yielded Mycobacterium other than tuberculosis (MOTT). The patient was diagnosed with NTM lung disease complicated by pleural effusion and initiated on multidrug therapy.

Conclusion: This case highlights the diagnostic challenges of NTM lung disease, particularly when presenting with pleural effusion. A high index of suspicion, comprehensive microbiological investigations, and bronchoscopy are crucial for accurate diagnosis. Prompt initiation of appropriate multidrug therapy is essential for optimal outcomes.

The Effects of Carbon Monoxide and Lead Exposure on Lung Function: A Meta-Analysis

Anggie Yumanda — 2024-08-29

Background: Carbon monoxide (CO) and lead (Pb) are ubiquitous environmental pollutants with well-established detrimental health effects. The impact of these pollutants on lung function, a critical indicator of respiratory health, has been investigated in numerous studies. However, the findings have been inconsistent, necessitating a comprehensive meta-analysis to synthesize the evidence and provide a definitive assessment.

Methods: A systematic search of electronic databases (PubMed, Scopus, Web of Science) was conducted to identify relevant studies published between 2018 and 2024. Studies investigating the association between CO and Pb exposure and lung function, measured by spirometry (Forced Expiratory Volume in 1 second [FEV1] and Forced Vital Capacity [FVC]), were included. A random-effects model was used to pool the effect estimates, and heterogeneity was assessed using the I² statistic.

Results: The meta-analysis included 25 studies (n = 15,432 participants). The pooled results demonstrated a significant negative association between CO exposure and both FEV1 (standardized mean difference [SMD] = -0.32, 95% confidence interval [CI] = -0.45 to -0.19, p < 0.001) and FVC (SMD = -0.27, 95% CI = -0.38 to -0.16, p < 0.001). Similarly, Pb exposure was associated with a significant reduction in FEV1 (SMD = -0.21, 95% CI = -0.30 to -0.12, p < 0.001). The heterogeneity across studies was moderate to high (I² = 50-75%).

Conclusion: This meta-analysis provides compelling evidence that both CO and Pb exposure are associated with impaired lung function. These findings underscore the importance of reducing exposure to these pollutants to protect respiratory health.

Concurrent Hiatal Hernia, Gastric Polyp, and Lupus Nephritis in an Adolescent: A Case Report

Andyan Yugatama — 2024-08-30

Background: The coexistence of hiatal hernia (HH), gastric polyp, and lupus nephritis in an adolescent patient presents a unique clinical challenge, demanding a multidisciplinary approach to diagnosis and management. This case report aims to highlight the complexities involved in addressing these concurrent conditions and their implications for patient care.

Case presentation: A 16-year-old girl with a history of systemic lupus erythematosus (SLE) and lupus nephritis presented with recurrent abdominal pain. Esophagogastroduodenoscopy (EGD) revealed a hiatal hernia and an esophageal polyp. The patient underwent laparoscopic gastrofundoplication for the hiatal hernia, and the polyp was subsequently removed via polypectomy. Histopathological examination confirmed a hyperplastic gastric polyp. The patient's postoperative course was complicated by electrolyte imbalances and dysphagia, which were managed successfully.

Conclusion: This case underscores the importance of a thorough diagnostic workup in adolescents with SLE presenting with gastrointestinal symptoms. The concurrent presence of HH, gastric polyp, and lupus nephritis necessitates a multidisciplinary approach involving gastroenterologists, surgeons, rheumatologists, and other specialists. Careful attention to potential complications, such as electrolyte imbalances and dysphagia, is crucial for optimal patient outcomes.

Passive Smoking as a Significant Risk Factor of Cervical Dysplasia: A Novel Findings in Single Center Study in Denpasar, Bali, Indonesia

I Wayan Agus Surya Pradnyana — 2024-09-05

Background: Colposcopy is a diagnostic procedure evaluating the cervix following an abnormal screening test. It aims to identify and treat cervical cancer precursors. Risk stratification at the end of colposcopy helps differentiate those who can return to regular screening from those needing more frequent screening or surveillance. The study examined the characteristics and risk factors of patients undergoing colposcopy for cervical dysplasia in Denpasar, Bali, Indonesia.

Methods: This was a cross-sectional study of women who underwent colposcopy at BaliMed Hospital, Denpasar, Bali, Indonesia, from January 2021-December 2022. Data were derived from medical records. The gynecology oncologist performed a colposcopy examination with a biopsy sample, which was later checked by the pathologist. Bivariate and multivariate analyses were used to identify the risk factors associated with cervical dysplasia.

Results: 142 patients underwent colposcopy with a mean age of 37.28+10.1 years. Seventy-eight patients (54.9%) had a low-grade cervical lesion, and 9 (6.3%) had a high-grade cervical lesion. After adjusting the employment status and education level, factors associated with cervical dysplasia were age at first intercourse <20 years (aOR [adjusted odd ratio] 2.44, 95% CI [1.04-5.69]) and history of smoking, either actively or passively (aOR 8.91, 95% CI [3.52-22.54]). From the biopsy result, patients with abnormal cervical lesions were associated with evidence of CIN (aOR 9.03, 95% CI [2.49-32.77]).

Conclusion: Early age first sexual intercourse and history of smoking have been identified as significant risk factors for cervical dysplasia. Additionally, passive smoking has been shown to increase the risk. This research provides a foundational reference for future studies in this area.

Successful Management of Miliary Tuberculosis with Concomitant Anemia: A Case Report

Baharuddin Wahyu Usman — 2024-09-09

Background: Miliary tuberculosis (TB) is a disseminated and potentially fatal form of TB characterized by the hematogenous spread of Mycobacterium tuberculosis, often complicated by anemia of chronic disease. The diagnosis and management of miliary TB, particularly in conjunction with anemia, can be challenging, especially in resource-limited settings.

Case presentation: We report the case of a 20-year-old male from a remote region in Eastern Halmahera, Indonesia, who presented with progressive shortness of breath, productive cough, night sweats, unintentional weight loss, and generalized weakness. Clinical examination revealed signs of anemia and respiratory distress. Laboratory investigations confirmed microcytic hypochromic anemia and a positive GeneXpert MTB/RIF test. Chest radiography demonstrated diffuse miliary nodules, consolidation, and cavitation, establishing the diagnosis of miliary TB with concomitant anemia. The patient received a standard six-month anti-tuberculosis therapy regimen, along with supportive care and targeted treatment for anemia and associated symptoms. The patient demonstrated significant clinical and hematological improvement, leading to discharge after 11 days of hospitalization. Follow-up assessments confirmed continued progress and the absence of complications.

Conclusion: This case underscores the critical importance of maintaining a high index of suspicion for miliary TB in patients presenting with respiratory and constitutional symptoms, even in the absence of traditional risk factors. The presence of anemia can further complicate the clinical picture. Prompt diagnosis through a combination of clinical assessment, laboratory investigations, and imaging studies, followed by the immediate initiation of appropriate treatment, including the management of anemia, is paramount for achieving favorable outcomes in patients with miliary TB. The case also emphasizes the necessity for comprehensive care and follow-up to ensure sustained recovery and prevent relapse.

Molecular Mechanisms of Ozonized Nigella sativa Oil in Wound Repair: Albumin as Biomarker in Rat Model

Igor Rizkia Syahputra — 2024-09-09

Background: Wound healing is a complex physiological process that can be impaired in various conditions. Nigella sativa oil, rich in bioactive compounds like thymoquinone, has shown promise in promoting wound healing. Ozone therapy, through the generation of reactive oxygen species (ROS), has also been explored for its potential to accelerate wound repair. This study aimed to investigate the molecular mechanisms underlying the effects of ozonized Nigella sativa oil on wound healing, with a focus on albumin as a biomarker of tissue regeneration in a rat model.

Methods: Full-thickness skin wounds were created on the backs of Sprague Dawley rats. The rats were randomly divided into four groups: a control group receiving no treatment, and three treatment groups receiving topical applications of ozonized Nigella sativa oil at different ozone concentrations (1400 mg/ml, 1800 mg/ml, and 2200 mg/ml) for 7 days. Wound healing was assessed by measuring wound closure rates and histological analysis. Albumin levels in wound tissue were quantified using immunohistochemistry. Additionally, the expression of key genes involved in wound healing, including growth factors, cytokines, and matrix metalloproteinases, was evaluated using quantitative real-time PCR.

Results: Ozonized Nigella sativa oil significantly accelerated wound closure compared to the control group. Histological analysis revealed improved tissue regeneration and collagen deposition in the treated groups. Albumin levels were significantly elevated in the wound tissue of rats treated with ozonized Nigella sativa oil, particularly at the highest ozone concentration. Furthermore, the expression of growth factors (VEGF, TGF-β), pro-inflammatory cytokines (IL-1β, TNF-α), and matrix metalloproteinases (MMP-2, MMP-9) was modulated in a manner consistent with enhanced wound healing.

Conclusion: Ozonized Nigella sativa oil promotes wound healing in a rat model through multiple molecular mechanisms, including the stimulation of albumin synthesis, growth factor expression, and controlled inflammation. These findings suggest that ozonized Nigella sativa oil may have therapeutic potential for enhancing wound repair in clinical settings.

The Impact of Infection Prevention Bundles on Neurosurgical Outcomes and Healthcare Costs: A Systematic Review

Fajar Faisal Putra — 2024-09-13

Background: Post-operative infections represent a significant challenge in neurosurgery, leading to increased morbidity, mortality, and healthcare costs. The implementation of infection prevention bundles, which encompass a set of evidence-based practices, has emerged as a potential solution to mitigate these adverse outcomes. This systematic review aims to evaluate the effectiveness of infection prevention bundles in improving neurosurgical outcomes and reducing healthcare costs.

Methods: A comprehensive search of electronic databases (PubMed, Scopus, Web of Science) was conducted to identify studies published between 2010 and 2023 that evaluated the impact of infection prevention bundles on neurosurgical outcomes and healthcare costs. The search strategy included keywords such as "neurosurgery," "infection prevention," "surgical site infection," "bundle," "outcomes," and "healthcare costs." Studies were included if they reported on at least one clinical outcome (e.g., surgical site infection rates, mortality, length of stay) and/or healthcare costs. Data extraction and quality assessment were performed independently by two reviewers.

Results: The search yielded 45 studies that met the inclusion criteria. The studies encompassed a variety of neurosurgical procedures, including craniotomies, spinal surgeries, and deep brain stimulation. The infection prevention bundles implemented varied across studies but commonly included preoperative antibiotic prophylaxis, skin antisepsis, and intraoperative measures. The pooled analysis demonstrated a significant reduction in surgical site infection rates and length of stay associated with the use of infection prevention bundles. Moreover, several studies reported cost savings, primarily attributed to reduced complications and shorter hospital stays.

Conclusion: The evidence suggests that infection prevention bundles are effective in improving neurosurgical outcomes and reducing healthcare costs. The implementation of these bundles should be considered a standard of care in neurosurgery to enhance patient safety and optimize resource utilization. Keywords: Neurosurgery, infection prevention, surgical site infection, healthcare costs, systematic review.