Bioscientia Medicina : Journal of Biomedicine and Translational Research

Beyond the Obstruction: A Case of Lung Cancer with Coincidental COPD Diagnosis

Rosi Maulini — 2025-01-16

Background: Lung cancer frequently coexists with chronic obstructive pulmonary disease (COPD), particularly among smokers. The presence of both conditions can complicate diagnosis and lead to poorer outcomes. This case report presents a patient with lung cancer and concurrent COPD, highlighting the diagnostic and management challenges.

Case presentation: A 60-year-old male presented with a history of smoking, progressive dyspnea, and a recent diagnosis of right lung cancer (T4N3M1c, stage IV B). He also exhibited symptoms suggestive of COPD, such as chronic cough and expectoration. Spirometry confirmed moderate restriction and severe obstruction, consistent with COPD GOLD 3. The patient was managed with both lung cancer treatment and COPD therapy.

Conclusion: This case underscores the importance of considering COPD in patients with lung cancer, especially those with a history of smoking. Early diagnosis of both conditions is crucial for optimizing treatment strategies and improving patient outcomes.

Systemic Inflammatory Immune Index (SII) Predicts Disease Activity in Systemic Lupus Erythematosus (SLE) Patients: A Cross-Sectional Study

Edi Susanto — 2025-01-16

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by widespread inflammation and diverse clinical manifestations. The systemic inflammatory immune index (SII), calculated as platelet count * neutrophil count/lymphocyte count, has emerged as a potential marker of systemic inflammation in various conditions. This study aimed to investigate the relationship between SII and disease activity in SLE patients.

Methods: We conducted a cross-sectional study involving 60 SLE patients diagnosed according to the 2019 EULAR/ACR classification criteria. Demographic and clinical data were collected, and disease activity was assessed using the Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI). Blood samples were analyzed to determine SII values. Statistical analysis included Spearman's correlation to assess the relationship between SII and MEX-SLEDAI scores.

Results: The study population predominantly consisted of women (98.3%), with a median age of 29 years. A strong positive correlation was observed between SII and MEX-SLEDAI scores (r = 0.931, p < 0.001). Patients with higher SII values exhibited significantly greater disease activity.

Conclusion: Our findings suggest that SII is a promising predictor of disease activity in SLE patients. This readily available index may aid clinicians in assessing disease severity and tailoring treatment strategies. Further research is warranted to validate these findings and explore the utility of SII in monitoring disease progression and treatment response.

Successful Surgical Management of Grade IV Internal Hemorrhoids in a Pediatric Patient: A Case Report

Bayu Kusumo — 2025-01-20

Background: Anorectal malformations are congenital conditions with a range of clinical presentations. They can be associated with portal hypertension or anatomical anomalies that obstruct venous outflow. While anorectal issues are common in pediatrics, their etiology and management can differ significantly from those in adults. This report presents a successful case of pediatric hemorrhoids managed surgically with a satisfactory outcome.

Case presentation: A 4-year-old girl presented with a protruding anal lesion and intermittent constipation, first noticed at age 1. She was born aterm with no abnormalities. Physical examination revealed a 0.5 to 1 cm circular lesion obstructing the anal orifice, diagnosed as a grade-IV internal hemorrhoid. Laboratory results were within normal limits. Due to the severity of the lesion, a Whitehead hemorrhoidectomy was performed. Follow-up showed no complications, such as secondary wound healing, anal stricture, or mucosal ectropion.

Conclusion: Whitehead hemorrhoidectomy is an effective treatment for severe pediatric hemorrhoids, as demonstrated by this case with a complication-free recovery. Accurate surgical technique and vigilant follow-up are key to a successful outcome.

Clinical Spectrum of Orbital Cellulitis: Case Series From Subperiosteal Abscess to Life-Threatening Cavernous Sinus Thrombosis

Putri Amanda — 2025-01-20

Background: Orbital cellulitis encompasses a range of orbital infections with varying severity. This case series highlights the diverse clinical presentations, management strategies, and outcomes of orbital cellulitis, emphasizing the importance of prompt diagnosis and treatment.

Case presentation: We present two cases of orbital cellulitis with contrasting presentations. The first case involved a 16-year-old male with acute rhinosinusitis who developed severe orbital cellulitis complicated by cavernous sinus thrombosis (CST), requiring aggressive medical and surgical interventions. The second case involved a 2-month-old female with a subperiosteal abscess secondary to ethmoid and maxillary sinusitis, who responded well to medical management alone.

Conclusion: Orbital cellulitis presents a wide spectrum of clinical scenarios, ranging from localized infections to life-threatening intracranial involvement. Early recognition, appropriate imaging, and timely intervention are crucial for optimizing outcomes. While CST necessitates aggressive measures, subperiosteal abscesses can often be managed medically, particularly in young children.

Clinical and Demographic Profile of Chronic Kidney Disease Patients Undergoing Kidney Transplantation at a Tertiary Hospital in Indonesia

Khairil Faiz Amir — 2025-01-21

Background: Chronic kidney disease (CKD) is a global health problem, and kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). This study aimed to describe the clinical and demographic profile of CKD patients undergoing kidney transplantation at Dr. M. Djamil General Hospital, Padang, Indonesia.

Methods: A descriptive retrospective study was conducted using medical records of CKD patients who underwent kidney transplantation between 2015 and 2023. Data on age, gender, duration of hemodialysis, donor-recipient relationship, blood pressure, blood type, crossmatch results, serum urea and creatinine levels, and etiology of CKD were collected and analyzed.

Results: The study included 18 patients, all aged 19 to 59 years. The majority of patients were male (55.6%) and had undergone hemodialysis for less than 3 years (55.6%). Prehypertension and hypertension were the most prevalent blood pressure categories (44.4% each). Blood types A and O were most common (27.8% each), with consistent crossmatch results across groups. High levels of serum urea and creatinine were predominant, and hypertension was the most frequent etiology of CKD (66.7%).

Conclusion: This study provides valuable insights into the characteristics of CKD patients undergoing kidney transplantation in Indonesia. The findings highlight the importance of early detection and management of CKD, particularly hypertension, to reduce the burden of ESRD and the need for transplantation.

Immunomodulatory Effects of Mesenchymal Stem Cell Secretome in Systemic Lupus Erythematosus: A Meta-Analysis

Narisa Felinka Kusuma — 2025-01-21

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by immune system dysregulation and multi-organ damage. Mesenchymal stem cells (MSCs) have emerged as a promising therapeutic option due to their immunomodulatory properties, primarily mediated through their secretome (MSCS). This meta-analysis aimed to evaluate the efficacy and safety of MSCS in SLE patients.

Methods: A systematic search of PubMed, Embase, and Web of Science was conducted for studies published between 2013 and 2024 investigating the effects of MSCS in SLE. Randomized controlled trials (RCTs) comparing MSCS with placebo or standard care were included. The primary outcome was SLE disease activity, assessed using the SLE Disease Activity Index (SLEDAI). Secondary outcomes included immunological markers (e.g., anti-dsDNA antibodies, complement levels), quality of life, and adverse events. Data were pooled using a random-effects model.

Results: Nine RCTs (n=485 patients) met the inclusion criteria. MSCS therapy significantly reduced SLEDAI scores compared to controls (standardized mean difference [SMD] -0.78, 95% CI -1.25 to -0.31, p=0.001). Significant improvements were also observed in anti-dsDNA antibody levels (SMD -0.62, 95% CI -1.01 to -0.23, p=0.002) and complement C3 levels (SMD 0.55, 95% CI 0.21 to 0.89, p=0.002). MSCS was generally well-tolerated, with no serious adverse events reported.

Conclusion: This meta-analysis demonstrates that MSCS therapy has significant immunomodulatory effects in SLE, leading to improved disease activity and immunological profiles. Larger, well-designed RCTs with longer follow-up periods are needed to confirm these findings and assess the long-term efficacy and safety of MSCS in SLE.

Procalcitonin Levels in Pulmonary Tuberculosis and Bacterial Pneumonia: A Cross-Sectional Study at a Tertiary Hospital in Indonesia

Abdullah Fikri — 2025-01-22

Background: Pulmonary tuberculosis (TB) and bacterial pneumonia are respiratory infections with high morbidity and mortality rates. Despite having similar clinical symptoms and radiological findings, these conditions require different treatment approaches. Procalcitonin is a potential biomarker to differentiate these conditions, as its levels tend to increase in bacterial infections but not in TB. This study aims to compare procalcitonin levels in patients with pulmonary TB and bacterial pneumonia.

Methods: This research employed an observational analytic design with a cross-sectional approach conducted at Dr. Mohammad Hoesin General Hospital (RSMH), Palembang. The study subjects were patients with pulmonary TB and bacterial pneumonia who met the inclusion and exclusion criteria. Procalcitonin levels were measured using ELISA methods. Data were analyzed to determine differences in procalcitonin levels between the two groups.

Results: The study found that procalcitonin levels in bacterial pneumonia patients were significantly higher than those in pulmonary TB patients (p<0.05). These findings indicate that procalcitonin levels can serve as a diagnostic parameter to distinguish between the two conditions.

Conclusion: Procalcitonin levels can be a useful biomarker for differentiating pulmonary TB from bacterial pneumonia. This biomarker is expected to assist clinicians in making more accurate diagnoses and expediting clinical decision-making.

Anesthesia Management in a Neonate with Esophageal Atresia Undergoing Esophagotomy and Thoracotomy: A Case Report

Galih Puspitasari — 2025-01-23

Background: Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are congenital anomalies requiring surgical repair in the neonatal period. Anesthetic management for these cases is complex, involving careful planning and execution to ensure a safe perioperative course. This case report details the anesthetic challenges and management of a neonate with EA undergoing thoracotomy and esophagotomy.

Case presentation: A five-day-old male infant presented with EA, pneumonia, and sepsis. After preoperative optimization, the neonate underwent thoracotomy and esophagotomy under general anesthesia with invasive monitoring. The perioperative course was complicated by the patient's comorbidities, requiring meticulous airway management, hemodynamic monitoring, and temperature regulation.

Conclusion: Successful anesthetic management of neonates with EA undergoing thoracotomy necessitates a multidisciplinary approach, addressing the unique challenges posed by the condition and associated comorbidities. This case highlights the importance of preoperative optimization, careful intraoperative management, and vigilant postoperative care in achieving a positive outcome.

A Rare Case of Systemic Lupus Erythematosus with Concomitant Inflammatory Bowel Disease: A Diagnostic and Therapeutic Challenge

Made Cantika Kumara Dipa — 2025-01-24

Background: Systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) are chronic conditions with complex pathophysiologies. While both diseases can affect the gastrointestinal tract, their co-occurrence is rare and presents unique diagnostic and therapeutic challenges. This case report describes a patient with SLE who developed IBD, highlighting the complexities of managing such cases.

Case presentation: A 27-year-old female with a history of SLE presented with hematochezia, abdominal pain, and weight loss. A colonoscopy revealed findings consistent with IBD. The patient's SLE was well-controlled on immunosuppressive therapy, but the addition of IBD required careful medication adjustments to manage both conditions effectively.

Conclusion: The coexistence of SLE and IBD is an uncommon but significant clinical scenario. This case underscores the importance of a thorough evaluation of IBD in SLE patients presenting with gastrointestinal symptoms. Furthermore, it emphasizes the need for a multidisciplinary approach to optimize treatment strategies and improve patient outcomes.

Magnesium and Osteoporosis: A Meta-Analysis of the Effects on Bone Turnover Markers, Fracture Incidence, and Quality of Life

Mia Indah Sari — 2025-01-24

Background: Osteoporosis, a prevalent bone disease characterized by reduced bone mineral density (BMD) and increased fracture risk, poses a significant public health challenge. Magnesium, an essential mineral involved in bone metabolism, has emerged as a potential therapeutic agent. This meta-analysis aimed to evaluate the effects of magnesium supplementation on bone turnover markers, fracture incidence, and quality of life in individuals with osteoporosis.

Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted from January 2013 to December 2024 to identify randomized controlled trials (RCTs) investigating the impact of magnesium supplementation on adults diagnosed with osteoporosis. The primary outcomes were changes in bone turnover markers (serum calcium, phosphorus, alkaline phosphatase, and osteocalcin), fracture incidence, and quality of life scores. Standardized mean differences (SMD) and risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models.

Results: Nine RCTs met the inclusion criteria, encompassing a total of 825 participants. Magnesium supplementation demonstrated a significant improvement in bone turnover markers, with a decrease in serum alkaline phosphatase (SMD = -0.35; 95% CI: -0.62, -0.08; p = 0.01) and osteocalcin (SMD = -0.29; 95% CI: -0.51, -0.07; p = 0.009). A trend towards reduced fracture incidence was observed in the magnesium group (RR = 0.72; 95% CI: 0.51, 1.02; p = 0.06). Furthermore, magnesium supplementation significantly improved quality of life scores, as measured by the Osteoporosis Quality of Life Questionnaire (OQLQ) (SMD = 0.41; 95% CI: 0.15, 0.67; p = 0.002).

Conclusion: This meta-analysis provides evidence that magnesium supplementation may have beneficial effects on bone turnover markers and quality of life in individuals with osteoporosis. Although a trend towards reduced fracture incidence was observed, further large-scale RCTs are warranted to confirm this finding.

Procalcitonin Outperforms NLR as a Sepsis Predictor in Pneumonia Patients: A Cross-Sectional Study from a Tertiary Hospital in Padang, Indonesia

Dina Fitri Fauziah — 2025-01-31

Background: Pneumonia remains a significant cause of morbidity and mortality worldwide, with sepsis being a severe complication. Early identification of sepsis is crucial for prompt treatment and improved outcomes. This study aimed to evaluate the performance of procalcitonin (PCT) and neutrophil-lymphocyte ratio (NLR) as predictors of sepsis in pneumonia patients at a tertiary hospital in Padang, Indonesia.

Methods: A cross-sectional study was conducted on 110 adult pneumonia patients admitted to Dr. M. Djamil General Hospital Padang between 2022 and 2023. Data on demographics, clinical characteristics, NLR, and PCT levels were collected from electronic medical records. Sepsis was defined according to established clinical criteria. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic accuracy of NLR and PCT in predicting sepsis.

Results: The study population had a mean age of 57.72 ± 14.41 years, with 56.4% being male. Of the 110 patients, 73.6% had community-acquired pneumonia (CAP) and 26.4% had hospital-acquired pneumonia (HAP). Sepsis was present in 55.5% of the patients. The median NLR and PCT levels were significantly higher in the sepsis group compared to the non-sepsis group (NLR: 14 vs. 6.6, p=0.002; PCT: 2.17 vs. 0.24, p=0.000). ROC analysis showed that PCT had a higher area under the curve (AUC) compared to NLR (0.724 vs. 0.676), indicating better diagnostic accuracy. The optimal cut-off point for PCT was 0.455, with a sensitivity of 65.6% and specificity of 65.3%. For NLR, the cut-off point was 10.375, with a sensitivity of 63.9% and specificity of 63.3%.

Conclusion: PCT demonstrated superior diagnostic accuracy compared to NLR in predicting sepsis among pneumonia patients in this study. However, NLR remains a valuable tool, especially in resource-limited settings where PCT testing may not be readily available.

Guava Leaf Extract: A Promising Alternative to Chlorhexidine for Reducing Streptococcus mutans Colonization on Orthodontic Appliances

Davin — 2025-01-31

Background: Streptococcus mutans is a major contributor to the formation of dental plaque and the initiation of caries. Orthodontic appliances, particularly removable ones, can create favorable conditions for S. mutans colonization, increasing the risk of caries and other oral health issues. Chlorhexidine is a commonly used antimicrobial agent in dentistry, but it can have side effects like tooth staining and altered taste. Guava leaf extract has shown promising antibacterial properties due to its rich content of flavonoids, tannins, and other bioactive compounds. This study aimed to compare the effectiveness of guava leaf extract and chlorhexidine in reducing S. mutans colonization on acrylic-based removable orthodontic appliances.

Methods: This in vitro study used 25 acrylic plates, which were divided into five groups: guava leaf extract at concentrations of 75%, 80%, and 90%, chlorhexidine gluconate 0.2% (positive control), and aquades (negative control). The acrylic plates were first contaminated with S. mutans and then immersed in the respective solutions for 10 minutes. The number of S. mutans colonies was then counted using a colony counter.

Results: The mean number of S. mutans colonies was significantly lower in the chlorhexidine group (27.8 ± 6.6 CFU/ml) and the guava leaf extract groups (9.4 ± 3.3 CFU/ml for 90%, 42 ± 7.8 CFU/ml for 80%, and 381 ± 81.1 CFU/ml for 75%) compared to the aquades group (1461.2 ± 274.5 CFU/ml). There was no significant difference between the chlorhexidine group and the 90% and 80% guava leaf extract groups.

Conclusion: Guava leaf extract, particularly at concentrations of 90% and 80%, is as effective as chlorhexidine in reducing S. mutans colonization on orthodontic appliances. Guava leaf extract may be a promising natural alternative to chlorhexidine for maintaining oral hygiene in orthodontic patients, especially those with concerns about chlorhexidine's side effects.

Pomegranate Extracts as a Natural Denture Cleanser: A Promising Alternative to Sodium Bicarbonate for Inhibiting Candida albicans

Cindy Denhara Wijaya — 2025-02-03

Background: Denture stomatitis, caused primarily by Candida albicans overgrowth, is a common oral health issue among denture wearers. Maintaining denture hygiene is crucial for prevention. This study investigated the efficacy of red pomegranate (Punica granatum L.) peel and fruit extracts as natural denture cleansers compared to sodium bicarbonate, a standard denture cleansing agent.

Methods: Heat-cured acrylic resin plates were fabricated and contaminated with C. albicans. Samples were divided into four groups and soaked for 8 hours in: 75% pomegranate peel extract, 75% pomegranate fruit extract, 5% sodium bicarbonate solution (positive control), and aquadest (negative control). C. albicans colony counts were performed using the spread plate technique and colony counter. Data were analyzed using Kruskal-Wallis and Mann-Whitney tests.

Results: Both pomegranate peel and fruit extracts significantly reduced C. albicans growth compared to the negative control (p<0.05). The peel extract showed comparable efficacy to sodium bicarbonate (p>0.05), while the fruit extract demonstrated slightly lower but still substantial antifungal activity.

Conclusion: Red pomegranate peel and fruit extracts hold promise as natural denture cleansers for inhibiting C. albicans and potentially preventing denture stomatitis. Further research is warranted to evaluate their long-term effects on denture materials and clinical efficacy.

Diagnostic Accuracy of Pulmonary Function Tests in Identifying Shrinking Lung Syndrome: A Meta-Analysis

M Haikal — 2025-02-07

Background: Shrinking lung syndrome (SLS) is a rare but significant pleuropulmonary complication of systemic autoimmune diseases, primarily systemic lupus erythematosus (SLE). Early and accurate diagnosis is crucial for timely intervention, but often challenging due to the insidious onset and overlapping symptoms with other respiratory conditions. This meta-analysis aims to synthesize the existing evidence on the diagnostic performance of various PFT parameters in identifying SLS.

Methods: We conducted a systematic search of PubMed, Embase, Scopus, and Web of Science databases from January 2013 to May 2024. We included studies that reported the diagnostic accuracy of PFTs (specifically, total lung capacity [TLC], forced vital capacity [FVC], diffusing capacity for carbon monoxide [DLCO], and maximal inspiratory pressure [MIP]) in differentiating SLS from other respiratory conditions or healthy controls in patients with systemic autoimmune diseases. Heterogeneity was assessed using the I² statistic.

Results: Nine studies, comprising a total of 685 patients with systemic autoimmune diseases (215 with SLS and 470 without SLS), were included. The pooled sensitivity and specificity of TLC ≤ 80% predicted for diagnosing SLS were 0.85 (95% CI, 0.78-0.90) and 0.72 (95% CI, 0.63-0.80), respectively. For FVC ≤ 80% predicted, the pooled sensitivity and specificity were 0.78 (95% CI, 0.69-0.85) and 0.65 (95% CI, 0.55-0.74), respectively. DLCO showed lower sensitivity (0.68; 95% CI, 0.57-0.77) but higher specificity (0.80; 95% CI, 0.71-0.87). MIP demonstrated a sensitivity of 0.75 (95% CI: 0.61, 0.85) and a specificity of 0.60 (95% CI: 0.44, 0.74). Significant heterogeneity was observed across studies (I² > 50% for most analyses).

Conclusion: PFTs, particularly TLC, are valuable tools in the diagnostic workup of SLS. While TLC demonstrates good sensitivity, its moderate specificity necessitates a comprehensive evaluation, integrating clinical findings, imaging, and potentially other biomarkers.

High-Frequency Chest Wall Oscillation versus Conventional Airway Clearance Techniques in Non-Cystic Fibrosis Bronchiectasis: A Meta-Analysis

Dzaki Murtadho — 2025-02-10

Background: Non-cystic fibrosis bronchiectasis (NCFB) is a chronic lung disease characterized by irreversible airway dilation and impaired mucociliary clearance, leading to chronic cough, sputum production, and recurrent infections. This meta-analysis aims to compare the efficacy of high-frequency chest wall oscillation (HFCWO) with conventional airway clearance techniques (CACT) in adults with NCFB.

Methods: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted from January 2013 to March 2024. Randomized controlled trials (RCTs) comparing HFCWO with CACT (postural drainage, percussion, active cycle of breathing technique, positive expiratory pressure therapy) in adults with NCFB were included. The primary outcomes were a change in forced expiratory volume in one second (FEV1) and sputum weight. Secondary outcomes included quality of life, exacerbation frequency, and adverse events. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic.

Results: Nine RCTs involving a total of 485 participants were included. The meta-analysis showed no statistically significant difference in FEV1 change between HFCWO and CACT (mean difference [MD] 0.05 L, 95% confidence interval [CI] -0.02 to 0.12; I² = 45%). HFCWO was associated with a statistically significant increase in sputum weight compared to CACT. SGRQ total score showed a statistically significant improvement in the HFCWO group compared to CACT (MD -4.21, 95% CI -7.88 to -0.54; I² = 58%).

Conclusion: HFCWO may provide a modest benefit in terms of increased sputum clearance and improved quality of life compared to CACT in adults with NCFB. However, there was no significant difference in lung function (FEV1) or exacerbation frequency. The moderate to high heterogeneity in some outcomes suggests that further research is needed to confirm these findings and identify patient subgroups who may benefit most from HFCWO.

A Rare Case of Adult-Onset Still's Disease Presenting with Hypercoagulability and Ocular Vasculitis

Hadi Nugraha Mustofa — 2025-02-10

Background: Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder characterized by fever, arthritis, rash, and hyperferritinemia. While AOSD commonly presents with systemic and articular manifestations, it can rarely involve other organ systems, including the eye and the coagulation system.

Case presentation: We present a case of an 18-year-old male with AOSD who developed hypercoagulability and ocular vasculitis. The patient presented with high-grade fever, polyarthritis, and the characteristic salmon-pink rash. Laboratory investigations revealed leukocytosis, elevated inflammatory markers, and a significant elevation of serum ferritin. Imaging studies ruled out other diagnoses. During the course of his illness, the patient developed hematomas and was found to have elevated fibrinogen and D-dimer levels, suggestive of hypercoagulability. He also experienced ocular symptoms and was diagnosed with ocular vasculitis. The patient was treated with systemic corticosteroids, methotrexate, and anticoagulation therapy, which led to the resolution of his symptoms.

Conclusion: This case highlights the rare and serious complications of AOSD, including hypercoagulability and ocular vasculitis. Early recognition and prompt treatment are crucial to prevent morbidity and mortality associated with these complications.

A Case of Concurrent COPD Exacerbation, Osteoporosis, and Fracture: Unveiling the Interplay

Fadhilla Annisa Efendi — 2025-02-11

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory condition with systemic effects, including an increased risk of osteoporosis and fractures. This case report presents a patient with acute COPD exacerbation, osteoporosis, and vertebral fractures, highlighting the complex interplay between these conditions.

Case presentation: A 68-year-old male patient presented with acute exacerbation of COPD. He had a history of smoking, hypertension, and a previous diagnosis of pulmonary tuberculosis. Clinical examination revealed signs of respiratory distress, and imaging confirmed emphysema, pneumonia, osteoporosis, and vertebral fractures. The patient received treatment for COPD exacerbation and osteoporosis, showing improvement in respiratory symptoms and pain.

Conclusion: This case underscores the importance of recognizing the association between COPD, osteoporosis, and fractures. Early diagnosis and appropriate management of these co-morbidities are crucial for improving patient outcomes and quality of life.

Unveiling the Hidden Patterns: A Dermoscopic Analysis of Vitiligo Lesions at a Tertiary Care Center in Surakarta, Indonesia

Sesia Pradestine — 2025-02-13

Background: Vitiligo, a common depigmenting disorder, presents with a variety of clinical manifestations. Dermoscopy, a non-invasive skin imaging technique, has emerged as a valuable tool for evaluating pigmentary disorders. This study aimed to analyze the dermoscopic patterns of vitiligo lesions in a cohort of patients at a tertiary care center in Surakarta, Indonesia, and to correlate these patterns with disease stability.

Methods: This cross-sectional study included 20 adult patients diagnosed with vitiligo at the Dermatology and Venereology Outpatient Clinic of Dr. Moewardi Regional General Hospital Surakarta in July 2023. A dermoscopic examination was performed on all patients using a polarized light dermoscope. Dermoscopic features were analyzed and categorized based on the BPLeFoSK criteria (Border, Pigment Network, Lesions, Follicular, Koebner). Disease stability was assessed based on clinical and dermoscopic findings.

Results: The majority of patients were female (75%) and between 21-40 years old (65%). All patients exhibited the characteristic "white glow" under dermoscopy. Other common findings included reduced or absent pigment network (40% each), perifollicular hyperpigmentation (30%), and perilesional hyperpigment (30%). Satellite lesions and micro-Koebner phenomenon, indicative of disease activity, were observed in 10% of patients each. Based on these findings, 80% of patients were classified as having stable vitiligo, while 20% had unstable vitiligo.

Conclusion: Dermoscopy revealed a spectrum of patterns in vitiligo lesions, with the "white glow" being a universal finding. The majority of patients in this cohort had stable vitiligo. Dermoscopy can aid in assessing disease activity and guiding treatment decisions in vitiligo patients.

Profound Alpha-Fetoprotein Elevation in Hepatocellular Carcinoma with Concomitant Cirrhosis: A Case Report

Fadhilaturrizqie Siregar — 2025-02-13

Background: Hepatocellular carcinoma (HCC) is a primary liver cancer that often arises in the setting of chronic liver disease, most commonly cirrhosis. Alpha-fetoprotein (AFP) is a tumor marker frequently elevated in HCC, but its diagnostic performance varies. We present a case of HCC with concomitant cirrhosis and a significant elevation of AFP.

Case presentation: A 30-year-old male presented with hematemesis, abdominal distension, and jaundice. He had a history of heavy alcohol consumption. Physical examination revealed anemia, icterus, hepatomegaly, and palmar erythema. Laboratory investigations showed elevated AFP (>400 IU/mL), reactive hepatitis B surface antigen (HBsAg), anemia, coagulopathy, and liver dysfunction. Imaging studies confirmed HCC and cirrhosis. This case highlights the diagnostic value of AFP in HCC, particularly when combined with clinical and imaging findings. The patient's history of alcohol abuse and HBsAg positivity are well-established risk factors for both cirrhosis and HCC. The marked elevation of AFP, along with the characteristic imaging features, strongly supported the diagnosis of HCC.

Conclusion: AFP remains a valuable tool in the diagnosis and monitoring of HCC, especially in patients with cirrhosis. However, it is essential to interpret AFP levels in conjunction with other clinical and laboratory data to ensure accurate diagnosis and timely management.

Garcinia mangostana L. Nanoextract Improves Early Inflammatory Phase Bone Fracture Healing in Diabetes Mellitus by Targeting IL-1β and TNF-α: A Comprehensive Meta-Analysis

Gregorius Gathot Garudanto — 2025-02-14

Background: Diabetic fracture healing is often impaired due to prolonged and exaggerated inflammation, characterized by elevated levels of pro-inflammatory cytokines like IL-1β and TNF-α. Garcinia mangostana L. (mangosteen) has demonstrated anti-inflammatory properties, and nanoformulations may enhance its bioavailability and efficacy. This meta-analysis aimed to evaluate the effect of Garcinia mangostana L. nanoextract on IL-1β and TNF-α levels during the early inflammatory phase of fracture healing in diabetic models.

Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library databases for studies published between 2013 and 2024. Studies investigating the effects of Garcinia mangostana L. nanoextracts on IL-1β and TNF-α levels in in vivo or in vitro models of diabetic fracture healing were included. Data on cytokine levels, fracture healing parameters (where available), and study characteristics were extracted. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic.

Results: Nine studies met the inclusion criteria. Meta-analysis revealed that Garcinia mangostana L. nanoextract significantly reduced IL-1β levels (SMD = -2.85, 95% CI: -3.97 to -1.73, p < 0.00001; I² = 88%) and TNF-α levels (SMD = -2.14, 95% CI: -3.08 to -1.20, p < 0.00001; I² = 82%) compared to control groups in diabetic fracture healing models. Subgroup analyses indicated significant reductions in both in vivo and in vitro studies.

Conclusion: This meta-analysis provides evidence that Garcinia mangostana L. nanoextract significantly reduces IL-1β and TNF-α levels during the early inflammatory phase of fracture healing in diabetic models. These findings suggest that Garcinia mangostana L. nanoextract holds therapeutic potential for improving fracture healing outcomes in individuals with diabetes mellitus.

Mangosteen Nanoextract and Bone Regeneration in Diabetes: A Meta-Analysis of ALP and Osteocalcin Modulation during Fracture Callus Formation

Chrisantus Ronald Bria Seran — 2025-02-14

Background: Diabetic fracture healing is often impaired, leading to prolonged recovery and increased risk of non-union. Garcinia mangostana L. (mangosteen) possesses anti-inflammatory, antioxidant, and potentially osteogenic properties. This meta-analysis investigates the effect of mangosteen nanoextract on bone regeneration in diabetic fracture models, focusing on the modulation of alkaline phosphatase (ALP) and osteocalcin (OCN) levels during callus formation.

Methods: A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library databases, covering publications from January 2013 to May 2024. Studies evaluating the effects of mangosteen nanoextract on ALP and OCN levels in in vivo diabetic fracture models were included. Data on ALP and OCN levels at various time points during callus formation were extracted. A random-effects model was used to calculate the standardized mean difference (SMD) and 95% confidence intervals (CIs) for ALP and OCN levels between mangosteen nanoextract-treated and control groups. Heterogeneity was assessed using the I² statistic.

Results: Five studies met the inclusion criteria, encompassing a total of 150 diabetic animal models (rats or mice) with induced fractures. Mangosteen nanoextract treatment was associated with a significant increase in ALP levels during the early phase of callus formation (SMD = 1.25; 95% CI: 0.80, 1.70; p < 0.001; I² = 65%). Similarly, OCN levels were significantly higher in the nanoextract-treated group during the later stages of callus formation (SMD = 0.98; 95% CI: 0.55, 1.41; p < 0.001; I² = 58%).

Conclusion: This meta-analysis suggests that mangosteen nanoextract may enhance bone regeneration in diabetic fracture models by modulating ALP and OCN levels, key biomarkers of osteoblast activity and bone formation. Further research, including well-designed clinical trials, is warranted to confirm these findings and translate them into clinical practice.

Beetroot (Beta vulgaris) Extract: A Potential Therapeutic Agent for Modulating Post-Cholecystectomy Colonic Inflammation? An In Vivo Evidence Review

Mahmudin Ardian Ashadi — 2025-02-17

Background: Cholecystectomy, while a common and effective treatment for symptomatic gallstones, can induce alterations in bile flow and gut microbiota composition, potentially leading to colonic inflammation. Beetroot (Beta vulgaris) extract, rich in betalains, nitrates, and other bioactive compounds, has demonstrated anti-inflammatory and antioxidant properties in various models. This systematic review evaluates the in vivo evidence for the efficacy of beetroot extract in modulating colonic inflammation following cholecystectomy.

Methods: A systematic search of PubMed, Scopus, Web of Science, and Embase databases was conducted from January 2013 to May 2024, using keywords related to "beetroot," "Beta vulgaris," "cholecystectomy," "colon," "inflammation," and "in vivo." Studies investigating the effects of beetroot extract on colonic inflammation in animal models post-cholecystectomy were included. Data on inflammatory markers, histological changes, oxidative stress markers, and gut microbiota alterations were extracted.

Results: Seven in vivo studies met the inclusion criteria. Beetroot extract administration was associated with significant reductions in colonic levels of pro-inflammatory cytokines (TNF-α, IL-6, IL-1β) in five studies. Data showed an average reduction of TNF-α by 35% (p < 0.01), IL-6 by 28% (p < 0.05), and IL-1β by 42% (p < 0.001) across these five studies. Four studies reported improvements in histological scores of colonic inflammation, indicating reduced tissue damage. Three studies demonstrated a decrease in MPO activity, a marker of neutrophil infiltration, with data showing an average reduction of 25% (p < 0.05).

Conclusion: The available in vivo evidence, albeit limited, suggests that beetroot extract possesses significant potential for mitigating colonic inflammation following cholecystectomy. The observed anti-inflammatory effects are likely mediated by a combination of betalain-induced antioxidant and anti-inflammatory actions, nitrate-derived nitric oxide signaling, and modulation of the gut microbiota.

Nanostructured Garcinia mangostana Extract Modulates RANKL Signaling and Calcium Homeostasis to Enhance Fracture Healing in Diabetic Bone: A Systematic Review of In Vivo Evidence

Adhimas Wicaksono — 2025-02-17

Background: Diabetic fracture healing is often impaired due to chronic hyperglycemia, oxidative stress, and inflammation, leading to dysregulation of bone remodeling. Receptor activator of nuclear factor kappa-Β ligand (RANKL) and calcium homeostasis are critical regulators of this process. Garcinia mangostana (mangosteen) extract, particularly in nanostructured form, has shown promise in modulating these pathways. This systematic review evaluates the in vivo evidence for the effects of nanostructured G. mangostana extract on RANKL signaling, calcium levels, and bone healing outcomes in diabetic fracture models.

Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase databases from January 2013 to May 2024. Studies were included if they utilized in vivo diabetic animal models with induced fractures, administered nanostructured G. mangostana extract, and assessed outcomes related to RANKL expression, calcium levels (serum or bone), and/or bone healing parameters (histology). Risk of bias was assessed using the SYRCLE's tool. Data were extracted and synthesized narratively.

Results: Seven studies met the inclusion criteria. All studies used rodent models (rats or mice) with induced type 1 or type 2 diabetes. Nanostructured G. mangostana extract, primarily containing xanthones, was administered via various routes (oral gavage, intraperitoneal injection). The majority of studies (6 out of 7) reported a significant decrease in RANKL expression and/or an increase in the osteoprotegerin (OPG)/RANKL ratio in the fracture callus of treated animals compared to diabetic controls. Serum calcium levels were generally normalized (5 out of 7 studies) in treated groups. Furthermore, treated animals exhibited improved histological evidence of enhanced callus formation and remodeling (all 7 studies). Risk of bias varied across studies, with some limitations in blinding and allocation concealment.

Conclusion: Nanostructured G. mangostana extract shows significant potential for improving fracture healing in diabetic bone by modulating RANKL signaling and calcium homeostasis. Further high-quality, pre-clinical studies are warranted to optimize dosage, delivery methods, and to fully elucidate the underlying mechanisms before clinical translation.

Modulation of Inflammatory and Regenerative Pathways by Channa striata Extract in End-to-End Anastomotic Wound Repair: A Systematic Review

Faizurrahman Andi Kusuma — 2025-02-17

Background: Intestinal anastomotic healing is a complex process, often complicated by inflammation and impaired regeneration, leading to leakage and stricture. Channa striata (snakehead fish) extract, traditionally used for wound healing, possesses bioactive compounds with potential anti-inflammatory and regenerative properties. This systematic review aimed to critically appraise the in vivo evidence for the effects of Channa striata extract on inflammatory and regenerative pathways in end-to-end anastomotic wound repair.

Methods: A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library databases was conducted for studies published between 2013 and 2024. Inclusion criteria comprised in vivo studies using animal models with end-to-end intestinal anastomosis, evaluating Channa striata extract versus a control, and reporting on relevant inflammatory and regenerative markers. Data extraction and risk of bias assessment (using SYRCLE's tool) were performed.

Results: Seven studies met the inclusion criteria. These studies, primarily using rat models, demonstrated that Channa striata extract significantly modulated key inflammatory and regenerative pathways. Specifically, the extract reduced pro-inflammatory cytokines, increased anti-inflammatory cytokines, enhanced growth factor expression, and promoted collagen deposition at the anastomotic site. These effects were associated with improved anastomotic bursting pressure and reduced leakage rates. Risk of bias varied across studies, with some limitations in blinding and allocation concealment.

Conclusion: Channa striata extract shows promise as a therapeutic agent for promoting anastomotic healing by modulating key inflammatory and regenerative pathways. However, further high-quality, standardized studies are needed to confirm these findings, elucidate precise mechanisms, and optimize extract formulation and dosage before clinical translation.

Challenges in Intensive Care Management of a Patient with Retropharyngeal Abscess and Mediastinal Extension: A Case Report

Liliriawati Ananta Kahar — 2025-02-18

Background: Retropharyngeal abscess (RPA) is a serious infection of the deep neck space that can extend to the mediastinum, leading to life-threatening complications. This case report highlights the challenges in managing a patient with RPA and mediastinal extension in the intensive care unit (ICU).

Case presentation: A 44-year-old male with a history of diabetes mellitus presented with pain, difficulty opening the mouth, and fever. Imaging revealed a retropharyngeal abscess extending to the mediastinum. The patient underwent surgical drainage and was admitted to the ICU for postoperative management. Challenges encountered included airway management, hemodynamic instability, sepsis, and ventilator weaning. The patient required a multidisciplinary approach involving anesthesiologists, intensivists, infectious disease specialists, and surgeons.

Conclusion: RPA with mediastinal extension is a challenging condition requiring prompt diagnosis, aggressive treatment, and meticulous intensive care management. A multidisciplinary approach is crucial for successful outcomes.