Bioscientia Medicina : Journal of Biomedicine and Translational Research

Ki-67 and HER2-Negative Status as Predictive Factors for Recurrence and Progression in Breast Cancer: Implications for Treatment Strategies

Chemy Wiryawan Cahyono — 2025-02-18

Background: Breast cancer remains a significant health challenge, with HER2-negative subtypes representing a majority of cases. Ki-67, a marker of cell proliferation, has emerged as a potential prognostic factor in various cancers, including breast cancer. This study aimed to evaluate the association of Ki-67 expression and HER2-negative status with tumor characteristics, treatment response, and disease progression in breast cancer patients.

Methods: A retrospective cross-sectional study was conducted at Dr. Kariadi General Hospital, Semarang, Indonesia. Data from 94 patients diagnosed with breast cancer were collected, including immunohistochemical profiles, HER2 status, Ki-67 index, treatment regimens, and tumor size. Statistical analysis was performed using SPSS version 25.0 for Windows.

Results: The majority of patients (50%) presented with Luminal B-type breast cancer, and 77.7% had a Ki-67 index >20%. HER2-negative status was observed in 78.7% of patients. No significant correlation was found between HER2-negative status and the type of therapy given (p=0.131) or tumor size (p=0.467). Similarly, Ki-67 expression >20% did not correlate significantly with the type of therapy (p=0.070) or tumor size (p=0.156).

Conclusion: While Ki-67 and HER2-negative status are recognized as important prognostic factors in breast cancer, this study did not find a significant association with treatment modalities or tumor size in the studied population. Further research with a larger sample size and longer follow-up is needed to validate these findings and explore the complex interplay of Ki-67, HER2 status, and other clinical variables in breast cancer progression.

Beta vulgaris Extract as a Post-Cholecystectomy Dietary Intervention: A Systematic Review of its Effects on Gut Microbial Balance, Bile Acid Metabolism, and E. Coli/Lactobacillus Dynamics

Benedick Johanes Alvian — 2025-02-18

Background: Cholecystectomy, while a common surgical procedure, significantly alters bile acid dynamics and the gut microbiome, potentially leading to an imbalance favoring opportunistic pathogens like Escherichia coli over beneficial bacteria like Lactobacillus. This systematic review investigates the potential of beetroot (Beta vulgaris) extract, rich in betalains and prebiotic fibers, as a dietary intervention to mitigate these post-cholecystectomy microbial shifts.

Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted for studies published between 2013 and 2024. Keywords included "cholecystectomy," "gallbladder removal," "bile acids," "Escherichia coli," "Lactobacillus," "beetroot," "Beta vulgaris," "prebiotic," "gut microbiome," and related terms. Studies investigating the effects of Beta vulgaris (or its constituents) on gut microbial composition, bile acid metabolism, or relevant clinical outcomes in post-cholecystectomy contexts (human or animal models) were included. Quality assessment was performed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials (RCTs) and the ROBINS-I tool for non-randomized studies.

Results: Seven studies met the inclusion criteria: three human RCTs, two animal studies (rats), and two in vitro studies. The human studies were of moderate to high risk of bias. The animal studies had a lower risk of bias but limited direct applicability to humans. The in vitro studies provided mechanistic insights but lacked the complexity of the in vivo environment. Due to the heterogeneity of study designs and outcome measures, a meta-analysis was not feasible. Beetroot extract supplementation (standardized to betalain content) was associated with a significant increase in Lactobacillus abundance (mean increase of 15%, p < 0.05) and a decrease in E. coli abundance (mean decrease of 10%, p < 0.05) in the post-cholecystectomy gut. There was also a shift in bile acid profiles, with an increase in secondary bile acids known to be less inhibitory to Lactobacillus.

Conclusion: While existing evidence is limited, the theoretical basis and preliminary findings suggest that beetroot extract holds promise as a post-cholecystectomy dietary intervention to promote a healthier gut microbiome. Further high-quality, well-powered RCTs are warranted to confirm these potential benefits and elucidate the underlying mechanisms.

Clinical Characteristics and Progression of Osteogenesis Imperfecta Type III: A Case Series

Edbert Wielim — 2025-02-19

Background: Osteogenesis imperfecta (OI) is a rare genetic disorder primarily affecting bone formation, leading to increased bone fragility and fractures. OI Type III is characterized by severe clinical manifestations, including multiple fractures, skeletal deformities, and short stature. This case series describes the clinical characteristics and progression of three patients diagnosed with OI Type III, highlighting the impact of early intervention with zoledronic acid on their outcomes.

Case presentation: This study presents three cases of OI Type III in female patients. Two patients (Patient A and Patient R) were diagnosed at birth with multiple fractures and received zoledronic acid treatment starting at three months of age. The third patient (Patient D) presented with fractures later in infancy and began treatment at one year of age. All patients demonstrated hallmark features of OI Type III, including blue sclerae, short stature, and progressive skeletal deformities. However, the two patients who received earlier treatment with zoledronic acid showed better mobility and fewer fractures compared to the patients who started treatment later.

Conclusion: This case series emphasizes the importance of early diagnosis and intervention in OI Type III. Zoledronic acid appears to be effective in reducing fracture rates and improving mobility in these patients. Further studies with larger sample sizes are needed to confirm these findings and optimize treatment strategies for OI Type III.

Phytochemical Screening and In Vitro Antibacterial Activity of Swietenia mahagoni Leaf Extract against Streptococcus mutans: A Promising Natural Approach for Caries Prevention

Firdha Muharraran — 2025-02-28

Background: Dental caries, primarily caused by Streptococcus mutans, is a prevalent oral health issue. The rise of antibiotic resistance and side effects of synthetic antimicrobials have fueled the search for plant-derived alternatives. Swietenia mahagoni (mahogany) leaves, traditionally used for medicinal purposes, exhibit potential antibacterial properties. This study investigated the phytochemical composition and in vitro antibacterial activity of S. mahagoni leaf extracts against S. mutans.

Methods: S. mahagoni leaves were collected, processed, and extracted using ethanol. Phytochemical screening identified alkaloids, tannins, flavonoids, and saponins. Antibacterial activity was assessed through the agar well diffusion method against S. mutans, using various extract concentrations (25%, 50%, 75%) and chlorhexidine as a positive control. Inhibition zone diameters were measured to determine antibacterial efficacy.

Results: Phytochemical analysis confirmed the presence of alkaloids, tannins, flavonoids, and saponins in the S. mahagoni leaf extract. The extract demonstrated significant antibacterial activity against S. mutans at all concentrations. The highest concentration (75%) showed the largest inhibition zone (18.07 ± 0.37 mm), significantly larger than those of lower concentrations and the positive control (chlorhexidine, 13.87 ± 0.21 mm).

Conclusion: S. mahagoni leaf extract exhibits substantial antibacterial activity against S. mutans, likely due to its diverse phytochemical content. These findings suggest its potential as a natural anti-caries agent. Further research is needed to explore its use in developing novel oral health products.

The Role of Channa striata in Attenuating Inflammatory Markers (PCT, TNF-α, CRP) Following Intestinal Anastomosis in Hyperglycemic Rats: A Systematic Review and Dose-Response Meta-Analysis

Anangga Haryanto — 2025-02-20

Background: Hyperglycemia impairs wound healing and exacerbates inflammation, increasing the risk of complications following intestinal anastomosis. Channa striata (snakehead fish) extract, traditionally used for wound healing, contains bioactive compounds with potential anti-inflammatory properties. This systematic review and meta-analysis aimed to evaluate the dose-dependent effects of C. striata extract on procalcitonin (PCT), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) levels in hyperglycemic rats undergoing end-to-end intestinal anastomosis.

Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library databases for studies published between 2013 and 2024. Inclusion criteria were: studies using hyperglycemic rat models, end-to-end intestinal anastomosis, C. striata extract administration (with varying doses), and measurement of PCT, TNF-α, and/or CRP. Data extraction included study characteristics, animal model details, C. striata extraction method and dosage, and inflammatory marker levels at various time points. Risk of bias was assessed using the SYRCLE's RoB tool. A random-effects meta-analysis was performed to estimate the standardized mean difference (SMD) in inflammatory marker levels between C. striata-treated and control groups. Dose-response relationships were explored using meta-regression.

Results: Seven studies met the inclusion criteria. C. striata extract was administered via various routes (oral, intraperitoneal) and at different doses (ranging from 100 mg/kg to 1000 mg/kg). Meta-analysis revealed a significant reduction in PCT levels (SMD = -1.25, 95% CI: -1.80, -0.70; p < 0.001), TNF-α levels (SMD = -1.55, 95% CI: -2.15, -0.95; p < 0.001), and CRP levels (SMD = -1.38, 95% CI: -1.98, -0.78; p < 0.001) in C. striata-treated groups compared to controls. Meta-regression indicated a significant dose-dependent relationship for TNF-α (p = 0.02) and CRP (p = 0.04), with higher doses showing greater reductions. Risk of bias assessment revealed some concerns in most studies, primarily related to blinding and random sequence generation.

Conclusion: This systematic review and meta-analysis provides evidence that C. striata extract significantly reduces inflammatory markers (PCT, TNF-α, CRP) following intestinal anastomosis in hyperglycemic rats. A dose-dependent effect was observed for TNF-α and CRP, suggesting that higher doses may be more effective. Further high-quality studies with standardized protocols are needed to confirm these findings and determine optimal dosing regimens for clinical translation.

Effectiveness of Mangifera indica L. Leaf Extract in Controlling Candida albicans Growth on Orthodontic Retainers: A Promising Approach to Improve Oral Hygiene

Yuni — 2025-03-06

Background: Orthodontic retainers, especially thermoplastic retainers, are prone to Candida albicans colonization, potentially leading to oral health issues. This study investigated the effectiveness of Mangifera indica L. leaf extract in controlling C. albicans growth on orthodontic retainers and also analyzed its phytochemical constituents.

Methods: M. indica leaf extract was prepared using maceration and digestion techniques. Thermoplastic retainers were contaminated with C. albicans and then immersed in different concentrations of M. indica leaf extract (25%, 50%, 75%, and 100%) for 15 minutes. Chlorhexidine digluconate 2% served as the positive control, and dimethyl sulfoxide (DMSO) was the negative control. The antifungal activity was evaluated by measuring the diameter of the inhibition zone. Phytochemical screening was conducted to identify the presence of various secondary metabolites in the extract.

Results: All concentrations of M. indica leaf extract demonstrated significant antifungal activity against C. albicans. The 75% extract showed the highest inhibition zone, comparable to chlorhexidine digluconate 2%. Phytochemical screening revealed the presence of alkaloids, flavonoids, tannins, and other bioactive compounds in the extract.

Conclusion: M. indica leaf extract, particularly at 75% concentration, effectively inhibits C. albicans growth on orthodontic retainers, suggesting its potential as a natural alternative for maintaining oral hygiene during orthodontic treatment. The presence of various bioactive compounds in the extract contributes to its antifungal activity.

Massive Hemoptysis: A Meta-Analysis of Urgent Interventional Approaches

Bambang Rojullun Taufik — 2025-02-20

Background: Massive hemoptysis is a life-threatening medical emergency requiring immediate intervention. This meta-analysis evaluated the efficacy and safety of urgent interventional approaches for managing massive hemoptysis.

Methods: A systematic search of electronic databases (PubMed, Embase, Scopus) was conducted from January 2013 to February 2024. Studies comparing different urgent interventional approaches (bronchial artery embolization [BAE], bronchoscopic interventions, surgery) in adults with massive hemoptysis were included. The primary outcome was treatment success (cessation of bleeding). Secondary outcomes included mortality, complications, and length of hospital stay.

Results: Nine studies (n=1145 patients) were included. BAE was the most common intervention (7 studies), followed by bronchoscopic interventions (4 studies) and surgery (3 studies). Pooled analysis showed that BAE had a higher success rate compared to bronchoscopic interventions (OR 2.15, 95% CI 1.32-3.51, p=0.002) and surgery (OR 1.88, 95% CI 1.15-3.08, p=0.01). BAE was associated with a lower mortality rate compared to surgery (OR 0.43, 95% CI 0.21-0.88, p=0.02) but not bronchoscopic interventions (OR 0.78, 95% CI 0.45-1.35, p=0.37). Complication rates were similar across all interventions.

Conclusion: BAE appears to be the most effective urgent interventional approach for massive hemoptysis, with a higher success rate and lower mortality compared to surgery. Bronchoscopic interventions may be considered in selected cases. Further research is needed to compare different BAE techniques and optimize patient selection.

Thermally Oxidized Cooking Palm Oil-Induced Histopathological Alterations in Brain, Heart, Liver, and Kidney: A Systematic Review of Lipid Peroxidation and Inflammatory Mechanisms

Nimas Ayu Nirwanti — 2025-02-21

Background: Repeated heating of cooking palm oils at high temperatures generates various toxic compounds, including lipid peroxidation products. These compounds are implicated in various diseases through oxidative stress and inflammation. This systematic review aims to evaluate the histopathological effects of thermally oxidized cooking oil (TOCO) consumption on the brain, heart, liver, and kidney, focusing on the roles of lipid peroxidation and inflammation.

Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science databases using predefined keywords and inclusion/exclusion criteria. Studies published between 2013 and 2024 investigating the histopathological effects of TOCO on the specified organs were included. Data on histopathological changes, markers of lipid peroxidation (malondialdehyde [MDA], 4-hydroxynonenal [4-HNE]), and inflammatory markers (TNF-α, IL-1β, IL-6) were extracted.

Results: Seven studies met the inclusion criteria. The data revealed consistent histopathological changes across all four organs. In the brain, neuronal degeneration, astrogliosis, and microglial activation were observed. The heart exhibited cardiomyocyte hypertrophy, fibrosis, and inflammatory cell infiltration. The liver showed hepatocyte necrosis, steatosis, and inflammation. The kidneys presented with tubular necrosis, glomerular damage, and interstitial fibrosis. Elevated levels of MDA and 4-HNE were consistently reported in all affected tissues, along with increased expression of TNF-α, IL-1β, and IL-6.

Conclusion: Consumption of TOCO induces significant histopathological damage in the brain, heart, liver, and kidney. The observed damage is strongly associated with increased lipid peroxidation and inflammatory responses. These findings highlight the potential health risks associated with consuming repeatedly heated cooking oils and underscore the need for public health awareness and strategies to mitigate these risks.

Continuous Positive Airway Pressure (CPAP) versus Non-Invasive Ventilation (NIV) in Obesity Hypoventilation Syndrome: A Meta-Analysis

Meliza Wahyuni — 2025-02-21

Background: Obesity hypoventilation syndrome (OHS) is a serious respiratory condition characterized by obesity, sleep-disordered breathing, and daytime hypercapnia. Both continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) are commonly used to treat OHS, but their comparative effectiveness remains unclear. This meta-analysis aimed to compare the efficacy of CPAP versus NIV in improving gas exchange, sleep quality, and quality of life in patients with OHS.

Methods: A systematic search of electronic databases (PubMed, Scopus, Web of Science) was conducted from 2013 to 2024 to identify randomized controlled trials (RCTs) comparing CPAP and NIV in adults with OHS. The primary outcomes were changes in daytime arterial carbon dioxide (PaCO₂) and apnea-hypopnea index (AHI). Secondary outcomes included changes in daytime arterial oxygen (PaO₂), sleep efficiency, and quality of life measures. Data were pooled using a random-effects model, and the standardized mean difference (SMD) with 95% confidence intervals (CI) was calculated.

Results: Seven RCTs with a total of 584 participants were included in the meta-analysis. Compared to CPAP, NIV was associated with a significantly greater reduction in PaCO₂ (SMD -0.45; 95% CI -0.88 to -0.02; p=0.04) and AHI (SMD -0.61; 95% CI -1.17 to -0.05; p=0.03). NIV also showed a trend towards greater improvement in PaO₂, although this was not statistically significant (SMD 0.32; 95% CI -0.06 to 0.70; p=0.10). No significant differences were observed between CPAP and NIV in sleep efficiency or quality of life measures.

Conclusion: This meta-analysis suggests that NIV is more effective than CPAP in improving gas exchange and reducing apnea-hypopnea events in patients with OHS. While both treatments appear to be well-tolerated, NIV may be the preferred initial treatment option for OHS, especially in patients with significant hypercapnia.

Pregnancy-Triggered Severe Lupus Nephritis with Pleural Effusion: A Case Report

Zaki Mahmudi Dasril — 2025-02-24

Background: Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE), characterized by kidney inflammation. Pregnancy can trigger or exacerbate LN due to hormonal shifts and altered immune responses. This case highlights the challenges in diagnosing and managing pregnancy-associated LN.

Case presentation: A 27-year-old woman presented with anasarca, malar rash, shortness of breath, and foamy urine during her first pregnancy. She had a history of SLE with previous symptoms limited to skin and joint involvement. Investigations revealed nephrotic-range proteinuria, hematuria, elevated creatinine, and positive anti-nuclear antibodies (ANA). Renal biopsy confirmed Class IV lupus nephritis. She was diagnosed with pregnancy-triggered severe LN with nephrotic syndrome, pleural effusion, and a hypercoagulable state. Treatment included high-dose corticosteroids and mycophenolate mofetil, with close monitoring of both maternal and fetal health.

Conclusion: This case underscores the importance of recognizing and promptly managing LN in pregnancy. Early diagnosis, multidisciplinary care, and individualized treatment are crucial to optimize maternal and fetal outcomes.

Chondroprotective Potential of Oleocanthal and Hydroxytyrosol from Extra Virgin Olive Oil: A Meta-Analysis

Muhammad Addien Prima Nanda — 2025-02-24

Background: Osteoarthritis (OA) is a prevalent degenerative joint disease characterized by cartilage degradation, inflammation, and pain. Oleocanthal and hydroxytyrosol, two potent anti-inflammatory and antioxidant polyphenols found in extra virgin olive oil (EVOO), have shown promising chondroprotective effects in preclinical studies. This meta-analysis aimed to evaluate the efficacy of oleocanthal and hydroxytyrosol in preventing cartilage degradation and ameliorating OA symptoms.

Methods: A systematic search of electronic databases (PubMed, Scopus, and Web of Science) was conducted to identify relevant studies published between 2013 and 2024. Randomized controlled trials (RCTs) and preclinical studies investigating the effects of oleocanthal or hydroxytyrosol on OA were included. The primary outcome was cartilage degradation, assessed by imaging or histological scores. Secondary outcomes included pain and inflammation.

Results: Nine studies (4 RCTs and 5 preclinical studies) met the inclusion criteria. The RCTs included a total of 315 participants with knee OA. The interventions consisted of oral administration of oleocanthal or hydroxytyrosol at various doses and durations. The preclinical studies used different in vivo animal models. Pooled analysis of the RCTs showed that oleocanthal or hydroxytyrosol significantly reduced cartilage degradation compared to control (SMD = -0.85, 95%CI -1.20 to -0.50, p < 0.001). In the preclinical studies, oleocanthal and hydroxytyrosol also significantly reduced cartilage degradation scores (SMD = -1.10, 95%CI -1.50 to -0.70, p < 0.001). Pooled analysis of pain outcomes showed a significant reduction with oleocanthal or hydroxytyrosol compared to control (Preclinical: SMD = -0.60, 95%CI -0.90 to -0.30, p < 0.001; RCTs: SMD=-1.20, 95%CI-1.60 to -0.80, p < 0.001). Oleocanthal and hydroxytyrosol significantly reduced inflammatory markers (Preclinical: SMD = -0.85, 95%CI-1.15 to -0.55, p < 0.001; RCTs: SMD= -1.50, 95%CI-1.90 to -1.10, p < 0.001).

Conclusion: This meta-analysis provides evidence for the chondroprotective potential of oleocanthal and hydroxytyrosol from EVOO. These polyphenols may offer a promising therapeutic strategy for preventing cartilage degradation, reducing pain, and improving OA symptoms. Further large-scale RCTs are warranted to confirm these findings and establish optimal dosage and treatment duration.

The Efficacy of Antimalarial Therapy in the Treatment of Pulmonary Malaria: A Meta-Analysis

Nalia Maharani AP — 2025-02-24

Background: Pulmonary malaria, a severe form of malaria that affects the lungs, is associated with high mortality rates. Antimalarial therapy is the cornerstone of treatment, but the optimal regimen remains a subject of debate. This meta-analysis aimed to evaluate the efficacy of different antimalarial therapies in the treatment of pulmonary malaria.

Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) was conducted to identify randomized controlled trials (RCTs) comparing different antimalarial therapies for pulmonary malaria. The primary outcome was mortality. Secondary outcomes included parasite clearance time, respiratory distress resolution, and length of hospital stay. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Results: Seven RCTs met the inclusion criteria, enrolling a total of 1,245 patients with pulmonary malaria. The studies compared various antimalarial regimens, including artemisinin-based combination therapy (ACT), quinine, and artesunate. The meta-analysis showed that ACT was associated with a significantly lower risk of mortality compared to quinine (RR 0.67, 95% CI 0.52-0.86, p = 0.002). There was no significant difference in mortality between ACT and artesunate (RR 0.92, 95% CI 0.75-1.13, p = 0.43). ACT was also associated with a faster parasite clearance time and quicker resolution of respiratory distress compared to quinine.

Conclusion: ACT is an effective treatment for pulmonary malaria, associated with reduced mortality and improved clinical outcomes compared to quinine. There was no significant difference in efficacy between ACT and artesunate. These findings support the use of ACT as the preferred antimalarial regimen for patients with pulmonary malaria.

Platelet-to-Lymphocyte Ratio in Pediatric Dengue Patients: A Key Indicator of Disease Severity

Silma Farraha — 2025-02-27

Background: Dengue infection remains a significant health concern in Indonesia, with a high mortality rate. Early identification and prediction of severe dengue are crucial for effective management and mortality reduction. The platelet-to-lymphocyte ratio (PLR) has emerged as a potential biomarker for assessing dengue severity due to its association with inflammatory responses.

Methods: This descriptive study included 48 pediatric patients diagnosed with dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) at Dr. M. Djamil General Hospital Padang between March and August 2024. Patients were included if they were aged 0-18 years, had a confirmed diagnosis of DHF or DSS, and underwent complete blood count and serological testing for dengue. Patients with chronic diseases or other comorbidities were excluded. Complete blood counts were performed using flow cytometry, and PLR was calculated by dividing the platelet count by the absolute lymphocyte count. Clinical data were obtained from medical records.

Results: The majority of patients were aged 6-18 years (68.8%), with 20 (41.7%) presenting with DHF and 28 (58.3%) with DSS. The median platelet count was lower in DSS patients (26,000/mm³) compared to DHF patients (35,500/mm³). The median PLR was also significantly lower in DSS patients (8.95) compared to DHF patients (15.61). A PLR value <20 was more frequently observed in DSS patients (89.3%) than in DHF patients (75%).

Conclusion: A lower PLR value was associated with more severe clinical manifestations of dengue infection, particularly DSS. PLR can serve as a valuable biomarker for assessing dengue severity, utilizing readily available and cost-effective complete blood count results.

Monocyte-to-HDL Cholesterol Ratio Predicts 30-Day Mortality in ST-Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention

Kurniawan — 2025-02-27

Background: ST-elevation myocardial infarction (STEMI) is a leading cause of mortality worldwide. Despite advancements in treatment, especially with primary percutaneous coronary intervention (pPCI), 30-day mortality rates remain significant. The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has emerged as a potential predictor of mortality in STEMI patients, reflecting the balance between inflammation and anti-atherosclerotic processes in atherosclerotic plaques. This study aimed to evaluate the association between MHR and 30-day mortality in STEMI patients undergoing pPCI.

Methods: This prospective observational study included 55 STEMI patients treated with pPCI at Dr. M. Djamil General Hospital in Padang, Indonesia, between January and July 2024. Patients were included if they were ≥18 years old, undergoing their first pPCI, and had blood tests done within 24 hours of admission. Patients with prior revascularization, acute/chronic infections, malignancies, autoimmune diseases, or on lipid-lowering therapy were excluded. Blood samples were collected within 24 hours of admission. Monocyte counts were measured using flow cytometry, and HDL cholesterol levels were determined using a homogeneous enzymatic colorimetric method. The MHR was calculated by dividing the monocyte count by the HDL cholesterol level. The primary outcome was 30-day mortality, assessed through hospital records and telephone follow-up. Statistical analysis included chi square, t-tests, and Mann-Whitney U tests.

Results: The mean age of the study participants was 59.5 (±11.4) years, with 81.8% being male. The mean monocyte count and MHR were 968 (±212)/mm³ and 28.3 (±6.06), respectively. The median HDL cholesterol level was 33.4 (27-49) mg/dL. Both monocyte count and MHR were significantly higher in patients who died within 30 days compared to those who survived (p<0.001).

Conclusion: The MHR is an independent predictor of 30-day mortality in STEMI patients undergoing pPCI. This readily available and cost-effective biomarker may aid in risk stratification and guide treatment strategies for this high-risk population.

Mean Platelet Volume and Immature Platelet Fraction as Biomarkers in Differentiating Early-Onset and Late-Onset Neonatal Sepsis

Rahmi Dina Indra — 2025-02-28

Background: Neonatal sepsis is a significant contributor to infant mortality, with millions of cases occurring globally each year. It is classified into early-onset neonatal sepsis (EONS), occurring within the first 72 hours of life, and late-onset neonatal sepsis (LONS), occurring after 72 hours. Thrombocytopenia is a common finding in neonatal sepsis, and the degree of thrombocytopenia has been associated with the severity of the disease. Mean platelet volume (MPV) and immature platelet fraction (IPF) are markers of platelet size and immaturity, respectively, and may provide insights into the pathophysiology of sepsis and aid in its diagnosis.

Methods: This cross-sectional analytical study was conducted at Dr. M. Djamil General Hospital in Padang, Indonesia, from June to September 2024. The study included 41 neonates diagnosed with sepsis. Complete blood counts were performed using an automated hematology analyzer to determine MPV, IPF, and platelet count. Neonatal sepsis was classified as EONS (within the first 7 days of life) or LONS (from day 8 to 28). Data were analyzed using descriptive statistics and the unpaired t-test.

Results: The mean age of the neonates was 11.6 days. There were 19 neonates with EONS and 22 with LONS. The mean MPV was significantly higher in the LONS group (11.7 fL) compared to the EONS group (10.2 fL) (p=0.001). Similarly, the mean IPF was significantly higher in the LONS group (10.9%) compared to the EONS group (7.7%) (p=0.001). There was no significant difference in platelet count between the two groups.

Conclusion: MPV and IPF were significantly higher in neonates with LONS compared to those with EONS, suggesting that these parameters may be useful biomarkers for differentiating between the two conditions. Further research with a larger sample size and longitudinal follow-up is needed to confirm these findings and to assess the potential clinical utility of MPV and IPF in the management of neonatal sepsis.

The Triglyceride-Glucose Index: A Potential Simple Screening Tool for Insulin Resistance in Young Adults

Kenny — 2025-02-28

Background: Insulin resistance is a key factor in the development of metabolic diseases, which are increasingly prevalent in young adults. Early detection is crucial for timely intervention. The triglyceride-glucose (TyG) index, calculated from fasting triglyceride and glucose levels, has emerged as a potential alternative to the more complex homeostasis model assessment of insulin resistance (HOMA-IR). This study aimed to evaluate the agreement between the TyG index and HOMA-IR in detecting insulin resistance in young adults.

Methods: A cross-sectional study was conducted on 102 non-diabetic young adults (aged 18-22 years). Fasting blood samples were collected to measure triglyceride, glucose, and insulin levels. The agreement between the TyG index and HOMA-IR was assessed using the Kappa coefficient.

Results: The median age of the participants was 20 years, with 65.7% being female. The prevalence of insulin resistance was 79.4% based on the TyG index (cut-off value of 4.25) and 43.1% based on HOMA-IR (cut-off value of 2.2). The agreement between the two indices was slight (Kappa = 0.155, p = 0.001).

Conclusion: The TyG index showed a higher prevalence of insulin resistance compared to HOMA-IR in this population. However, the agreement between the two indices was low. Further research is needed to validate the TyG index as a screening tool for insulin resistance in young adults.

Impact of Donation Frequency on Iron Stores and Hemoglobin Levels in Regular Blood Donors

Lili Novri Yanti — 2025-02-28

Background: Regular blood donation, while crucial for healthcare systems, can lead to iron deficiency and anemia in donors. This study investigated the impact of donation frequency on iron stores and hemoglobin levels in regular blood donors.

Methods: A cross-sectional study was conducted on 82 regular blood donors at the blood transfusion unit of Dr. M. Djamil General Hospital from February to April 2024. Participants underwent pre-transfusion screening, including a questionnaire on donation frequency and iron supplement use. Blood samples were collected during donation, and serum ferritin, hemoglobin, and erythrocyte indices (MCV, MCH, MCHC) were measured if the C-reactive protein (CRP) test was negative. Data were analyzed using the Kruskal-Wallis test.

Results: The mean age of the donors was 31 years, with the majority being female (56.1%). The most common donation frequency was 6-10 times (34.15%). None of the donors reported using iron supplements. Serum ferritin levels showed significant differences among female donors based on donation frequency (p=0.004) but not among male donors (p=0.114). Hemoglobin levels also differed significantly among female donors (p=0.002), but not among male donors (p=0.213). Significant differences were observed in MCV and MCH values in both male and female donors (p<0.001 and p=0.001, respectively), but not in MCHC values (p=0.135).

Conclusion: Donation frequency significantly impacts iron stores and hemoglobin levels in female blood donors but not in male donors. Regular monitoring of iron stores, particularly in female donors, is crucial to prevent iron deficiency and anemia.

Impact of Tocolytic Therapy on Cardiovascular Outcomes in Preterm Labor: A Systematic Review and Meta-Analysis

Ni Putu Ika Regiana Maharani — 2025-03-03

Background: Preterm labor is a significant cause of neonatal morbidity and mortality, and tocolytic therapy is often used to delay delivery and improve neonatal outcomes. However, tocolytic drugs can have adverse cardiovascular effects, including an increased risk of atrial fibrillation (AF). This meta-analysis aims to evaluate the impact of tocolytic therapy on cardiovascular outcomes in preterm labor, focusing on the risk of AF.

Methods: A systematic literature review was conducted following PRISMA guidelines. Relevant studies published between 2013 and 2024 were identified through PubMed, Scopus, ScienceDirect, and Cochrane Library. Studies evaluating the cardiovascular effects of tocolytic therapy in preterm labor were included. The primary outcome was the incidence of AF. Secondary outcomes included other cardiovascular adverse events.

Results: Ten studies met the inclusion criteria, comprising 550 pregnant women receiving tocolytic therapy. Tocolytic therapy was associated with a significantly increased risk of AF compared to no tocolytic therapy (mean difference 0.2, 95% CI 0.10-0.30). Nifedipine and ritodrine had a higher risk of AF compared to atosiban. The risk of AF was also higher in patients with pre-existing cardiovascular diseases.

Conclusion: Tocolytic therapy, particularly with nifedipine and ritodrine, increases the risk of AF in preterm labor. Atosiban appears to be a safer option for patients with cardiovascular risk factors. Careful consideration of the potential cardiovascular risks and benefits is crucial when making tocolytic therapy decisions.

Successful Management of Acute Respiratory Failure Following Drowning in a Child: A Case Report

Diki Septian — 2025-03-04

Background: Drowning is a significant global public health issue, leading to a substantial number of deaths annually, particularly among children. Acute respiratory failure (ARF) is a common and life-threatening complication of drowning, necessitating prompt and effective management. This case report describes the successful management of ARF in a 6-year-old child following a drowning incident.

Case presentation: A 6-year-old male child was brought to the emergency department (ED) after being rescued from a river. He was unconscious, cyanotic, and in respiratory distress. Initial assessment revealed a Glasgow Coma Scale (GCS) score of 9, oxygen saturation of 45% on room air, and crackles on lung auscultation. He was immediately intubated and placed on mechanical ventilation. A chest X-ray showed evidence of pneumonia and pulmonary edema. Arterial blood gas analysis confirmed acute hypoxemic respiratory failure. The patient was transferred to the intensive care unit (ICU) and managed with mechanical ventilation, antibiotics, and corticosteroids. He demonstrated gradual improvement in respiratory status and neurological function, leading to successful extubation and eventual discharge with a full recovery.

Conclusion: This case highlights the critical role of prompt recognition and aggressive management of ARF in drowning victims. Early intubation and mechanical ventilation, along with supportive care, can lead to successful outcomes even in severe cases. This report emphasizes the importance of raising awareness about drowning prevention and the need for readily available emergency medical services to improve outcomes in such incidents.

Clinical Characteristics and Management of Steroid-Induced Glaucoma

Pattih Primasakti — 2025-03-05

Background: Steroid-induced glaucoma (SIG) is a secondary glaucoma characterized by elevated intraocular pressure (IOP) due to steroid use. This study aimed to analyze the clinical characteristics and management of SIG patients at Dr. M. Djamil General Hospital Padang, Indonesia, from January 2019 to August 2023.

Methods: A retrospective descriptive study was conducted using medical records of patients diagnosed with SIG. Data collected included age, gender, steroid type, route of administration, duration of use, IOP at diagnosis, underlying diseases, glaucoma stage, and treatment.

Results: Seventeen patients were diagnosed with SIG. The majority were female (70.58%) and aged 4-39 years (58.83%). The most common underlying diseases were systemic lupus erythematosus (SLE) and allergic conjunctivitis (47%). Oral steroid administration was most frequent (76.4%), with a usage duration of 2-12 months in most cases (70.6%). IOP at diagnosis ranged from 22 to 31 mmHg in most patients (82.3% right eye, 64.7% left eye). Most patients presented with mild glaucoma (70.5%). Topical anti-glaucoma medications were the primary treatment (76.4%), with trabeculectomy performed in some cases (23.6%).

Conclusion: SIG is a preventable condition. Early detection and appropriate management are crucial to prevent vision loss. The clinical characteristics identified in this study contribute to a better understanding of SIG in our population. Further research on the interplay of risk factors, genetics, and histopathology is needed to enhance our comprehension of SIG.

Dietary BCAAs (Branched Chain Amino Acids) and Cognitive Function: Implications for Nutritional Interventions in Elderly Populations

Willya Eka Putri — 2025-03-06

Background: The aging process is often accompanied by a decline in cognitive function, impacting memory, attention, and decision-making. Malnutrition, including protein deficiency, is recognized as a contributing factor to cognitive decline in elderly populations. Branched-chain amino acids (BCAAs), essential amino acids obtained solely from dietary sources, play a pivotal role in various physiological processes, including neurotransmitter synthesis and protein synthesis in the brain. This study aims to investigate the relationship between serum BCAA levels and cognitive function in elderly individuals.

Methods: A cross-sectional study was conducted on 25 elderly subjects (age > 60 years) in Padang, Indonesia. Serum BCAA levels were measured using High-Performance Liquid Chromatography (HPLC), and cognitive function was assessed using the Montreal Cognitive Assessment - Indonesian version (MoCA-Ina). Statistical analysis was performed to determine the correlation between BCAA levels and MoCA-Ina scores.

Results: The mean serum levels of total BCAAs, leucine, isoleucine, and valine in the elderly subjects were 0.40 ± 0.15 mM, 0.09 ± 0.06 mM, 0.05 ± 0.02 mM, and 0.26 ± 0.10 mM, respectively. The median MoCA-Ina score was 23 (range: 8-27), indicating a significant proportion of participants with cognitive impairment. Statistical analysis revealed no significant correlation between total BCAA levels and MoCA-Ina scores (r = 0.071, p = 0.735). However, a moderate positive correlation was observed between isoleucine levels and MoCA-Ina scores (r = 0.344, p = 0.092), although not statistically significant.

Conclusion: This study suggests that serum BCAA levels, particularly isoleucine, may have implications for cognitive function in elderly populations. Further research with a larger sample size and longitudinal design is warranted to elucidate the complex relationship between dietary BCAAs, serum BCAA levels, and cognitive health in aging individuals.

Unfractionated Heparin versus Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Acutely Ill Medical Patients: A Meta-analysis

Rendi Dwi Prasetyo — 2025-03-06

Background: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in acutely ill medical patients. Both unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are effective for VTE prophylaxis, but their relative efficacy and safety remain unclear.

Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing UFH and LMWH for VTE prophylaxis in acutely ill medical patients. We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 2013 to 2024. The primary outcome was the incidence of VTE. Secondary outcomes included major bleeding and mortality.

Results: Seven RCTs with a total of 5,412 patients were included. LMWH was associated with a significantly lower risk of VTE compared to UFH (relative risk [RR] 0.68; 95% confidence interval [CI] 0.52-0.88; p = 0.004). There was no significant difference in major bleeding (RR 0.91; 95% CI 0.65-1.27; p = 0.58) or mortality (RR 0.93; 95% CI 0.78-1.11; p = 0.43) between the two groups.

Conclusion: LMWH is more effective than UFH for VTE prophylaxis in acutely ill medical patients without increasing the risk of major bleeding or mortality. LMWH should be considered the preferred agent for VTE prophylaxis in this population.

The Clinical Significance of DAT Positivity: A Comparative Analysis of IgG, C3d, and IgG/C3d-Positive Patients

Khaulah Karimah — 2025-03-07

Background: The direct antiglobulin test (DAT) is a crucial diagnostic tool in immunohematology, used to detect the presence of antibodies and/or complement components on the surface of red blood cells. DAT positivity is frequently associated with autoimmune hemolytic anemia (AIHA) and other immune-mediated hemolytic conditions. This study aimed to investigate the clinical significance of DAT positivity by comparing the characteristics of patients with IgG, C3d, and IgG/C3d-positive results.

Methods: A retrospective study was conducted on 55 patients with DAT-positive results, identified from the Blood Transfusion Unit of Dr. M. Djamil General Hospital Padang between June 2023 and August 2023. DAT-positive samples were further analyzed using monospecific anti-human globulin (AHG) reagents to determine the presence of IgG, C3d, or both on the red blood cells. Patient demographics, clinical diagnoses, blood groups, transfusion history, and hematological parameters were collected and analyzed.

Results: Out of the 55 DAT-positive patients, 51 (92.7%) were positive for IgG alone, 3 (5.5%) were positive for both IgG and C3d, and only 1 (1.8%) was positive for C3d alone. The majority of patients were adults (>18 years old) and female. A history of blood transfusion (>3 times) was common, particularly in the IgG-positive group. Hematological parameters indicative of hemolysis (hemoglobin ≤9 g/dL, reticulocyte count >2%, and total bilirubin >2 mg/dL) were observed in a significant proportion of patients, especially those with IgG and/or C3d positivity.

Conclusion: IgG positivity was the most common finding in DAT-positive patients, highlighting the prevalence of warm AIHA. The presence of C3d, alone or with IgG, suggests the involvement of complement activation and may indicate a different underlying pathology. This study emphasizes the importance of using monospecific AHG reagents to characterize DAT-positive results, as this information can aid in the diagnosis, management, and prediction of clinical outcomes.

Immunophenotyping vs. Bone Marrow Aspiration in Pediatric Acute Leukemia: A Comparative Analysis

Satria Utomo — 2025-03-07

Background: Acute leukemia is a significant global health concern, with increasing prevalence worldwide and in Indonesia. Accurate diagnosis and classification of acute leukemia subtypes, primarily acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML), are crucial for effective treatment. Immunophenotyping and bone marrow aspiration (BMA) are commonly used diagnostic methods, each with its strengths and limitations. This study aimed to analyze the concordance between immunophenotyping and BMA in diagnosing and classifying acute leukemia in children.

Methods: A retrospective cross-sectional study was conducted on 46 children diagnosed with acute leukemia at Dr. M. Djamil General Hospital Padang from January 2022 to July 2023. Data were collected from medical records, including patient demographics, immunophenotyping results, and BMA findings. Concordance between the two diagnostic methods was analyzed using Fisher's exact test.

Results: The study population consisted of 30 (65.2%) males and 16 (34.8%) females, with a median age of 4 years. Immunophenotyping identified 24 (52.2%) cases as ALL and 22 (47.8%) as AML. BMA classified 26 (56.5%) cases as ALL and 20 (43.5%) as AML. There was a high concordance between the two methods, with only 2 (4.3%) cases showing discordant results. These two cases were classified as AML by immunophenotyping but as ALL by BMA.

Conclusion: Immunophenotyping and BMA demonstrate a high level of concordance in diagnosing and classifying acute leukemia in children. The few discordant cases highlight the importance of considering both methods, especially in challenging cases, to ensure accurate diagnosis and appropriate treatment.

Pre- and Perioperative Optimization of a Geriatric Patient on Antithrombotic Therapy Undergoing Dermatologic Electrosurgery: A Case Report

Laila Kurnia Fitri — 2025-03-10

Background: Electrosurgery is a common and effective technique for removing skin lesions and achieving hemostasis in dermatologic surgery. However, managing patients on antithrombotic therapy, especially geriatric patients with comorbidities, presents a significant challenge. This case report highlights the importance of meticulous pre- and perioperative optimization in such patients to ensure safe and successful outcomes.

Case presentation: A 69-year-old male patient with a history of congestive heart failure (CHF), Non-ST elevation myocardial infarction (NSTEMI), type 2 diabetes mellitus, and hypertension presented with a nevus exhibiting cornu cutaneous. The patient had been on long-term aspirin therapy. The case discusses the complexities involved in deciding whether to discontinue aspirin, weighing the risks of bleeding against the potential for thrombotic events. After a three-week delay and consultation with an internist to address elevated coagulation parameters, the electrocauterization excision was performed successfully.

Conclusion: This case underscores the critical role of multidisciplinary collaboration and evidence-based decision-making in the perioperative management of geriatric patients on antithrombotic therapy undergoing dermatologic procedures. It emphasizes the need for individualized risk assessment and optimization strategies to balance the competing risks of bleeding and thrombosis.