Bioscientia Medicina : Journal of Biomedicine and Translational Research

Clinical Characteristics, Outcomes, and Predictors of Severity in Acute Eosinophilic Pneumonia (AEP): A Meta-analysis

Zaki Arbi Ismani, Deddy Herman, Fenty Anggrainy — Wed, 16 Apr 2025 03:35:32 +0000

Background: Acute eosinophilic pneumonia (AEP) is a rare, potentially life-threatening respiratory illness characterized by rapid onset of symptoms, diffuse pulmonary infiltrates, and marked eosinophilia in bronchoalveolar lavage (BAL) fluid. This meta-analysis aimed to synthesize published data to provide robust estimates of clinical characteristics, outcomes, and predictors of severity in patients diagnosed with AEP.

Methods: A systematic literature search was conducted in PubMed, Embase, Scopus, and Web of Science databases for studies published between January 1^st, 2014, and December 31^st, 2024. Inclusion criteria specified observational studies reporting on clinical features, diagnostic findings, and clinical outcomes in patients meeting standard AEP diagnostic criteria. Data extraction and quality assessment (using the Newcastle-Ottawa Scale) were performed independently by two reviewers. Pooled proportions and means were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic. Potential predictors of MV requirement were evaluated by pooling odds ratios (ORs) where available.

Results: Six studies met the inclusion criteria, comprising a total of 315 patients diagnosed with AEP. The pooled mean age was 29.5 years (95% CI: 26.8-32.2), with a predominance of male patients (pooled proportion: 78%, 95% CI: 71%-84%, I²=45%). A strong association with recent smoking initiation or change was confirmed (pooled proportion: 85%, 95% CI: 78%-91%, I²=55%). Common presenting symptoms included dyspnea (95%), fever (92%), and cough (88%). While peripheral eosinophilia was variable at presentation (pooled mean: 650 cells/µL, 95% CI: 450-850), BAL eosinophilia was markedly elevated (pooled mean percentage: 42%, 95% CI: 37%-47%, I²=78%). The pooled proportion of patients requiring mechanical ventilation was substantial (38%, 95% CI: 30%-46%, I²=68%). Overall in-hospital mortality remained low (pooled proportion: 1.8%, 95% CI: 0.5%-3.5%, I²=0%). Significant heterogeneity was observed for most pooled estimates. Factors significantly associated with an increased likelihood of requiring mechanical ventilation included a shorter time from symptom onset to presentation (<3 days) (pooled OR: 3.1, 95% CI: 1.8-5.3, I²=35%) and higher initial C-reactive protein (CRP) levels (analyzed descriptively due to varied reporting).

Conclusion: This meta-analysis confirms that AEP typically affects young male smokers and presents acutely with severe respiratory symptoms. Despite variable peripheral eosinophilia, marked BAL eosinophilia is a diagnostic hallmark. A significant proportion requires mechanical ventilation, highlighting the potential severity. However, mortality is low with appropriate treatment, typically corticosteroids. Very acute onset and higher inflammatory markers may predict the need for ventilatory support, warranting close monitoring in these patients. Further research with standardized reporting is needed to refine predictors and optimize management strategies.

Predictive Accuracy of the Placenta Accreta Index (PAI) for Histopathological Severity in Placenta Accreta Spectrum Disorders: A Prospective Cohort Study

Nola Yolanda, Donel S — Wed, 16 Apr 2025 08:47:16 +0000

Background: Placenta accreta spectrum disorder (PASD) represents a range of conditions characterized by abnormal placental adherence and invasion into the uterine wall, posing significant risks of maternal morbidity and mortality, primarily due to severe hemorrhage. The incidence has risen, largely attributed to increasing rates of cesarean deliveries. Prenatal diagnosis is crucial for optimal management. The Placenta Accreta Index (PAI), an ultrasound-based scoring system, was developed to aid in prenatal risk assessment. This study aimed to evaluate the predictive accuracy and correlation of PAI scores with final histopathological findings in patients with suspected PASD at a tertiary hospital in Riau, Indonesia.

Methods: A descriptive-analytical study with prospective data collection was conducted over six months (July-December 2024) at Arifin Achmad Regional General Hospital Pekanbaru. The study included 29 pregnant women diagnosed with placenta previa totalis and suspected PASD based on clinical and initial ultrasound findings. Patients underwent transabdominal Doppler ultrasonography between 32-34 weeks of gestation to calculate the PAI score. Following delivery (primarily via cesarean hysterectomy), placental and uterine specimens underwent histopathological examination to determine the definitive PASD classification (accreta, increta, percreta). Correlation between PAI scores and pathological severity was assessed using the Spearman correlation test. Logistic regression was used to evaluate PAI as a predictor of pathological outcomes. Sensitivity and specificity were calculated using a PAI cut-off score of ≥6. Statistical significance was set at p < 0.05.

Results: Of the 29 participants, the mean age was 32.83 ± 2.82 years, the mean parity was 3.21 ± 1.05, and a mean number of prior cesarean sections was 1.72 ± 0.70. Histopathology confirmed PASD in all cases: 23 (79.3%) were placenta accreta, 5 (17.2%) were placenta increta, and 1 (3.5%) was placenta percreta. A statistically significant positive correlation was found between PAI score and histopathological severity (Spearman's R = 0.512, p = 0.012). Logistic regression confirmed PAI score as a significant predictor of pathological outcome (β = 3.64, 95% CI 1.301–5.982, p = 0.003). Using a cut-off score of ≥6, PAI demonstrated a sensitivity of 88.6% and specificity of 83.3% for predicting PASD based on the abstract data.

Conclusion: The Placenta Accreta Index (PAI) demonstrated a significant positive correlation with the histopathological severity of Placenta Accreta Spectrum Disorders. PAI serves as a valuable and accurate predictive tool for assessing the degree of placental invasion prenatally. Its use can significantly aid clinicians in risk stratification, surgical planning, and optimizing obstetric management to improve maternal outcomes in this high-risk population.

Determinants of Recurrence in Intracranial Meningioma: A Decade of Experience with Surgical and Pathological Correlations in Bandung, Indonesia

Sheila Sumargo, Guata Naibaho, Roland Sidabutar — Mon, 21 Apr 2025 00:00:00 +0000

Background: Intracranial meningiomas are common primary central nervous system tumors, mostly benign, yet recurrence remains a significant clinical challenge influencing patient prognosis. Understanding the characteristics and determinants of recurrence, particularly in specific populations, is crucial. Data on recurrent meningioma from developing countries like Indonesia are limited. This study aimed to describe the clinicopathological features and surgical management experience of recurrent intracranial meningiomas over a 10-year period at a tertiary referral hospital in Bandung, Indonesia.

Methods: A retrospective analysis was conducted on all adult patients (≥18 years) surgically treated for recurrent intracranial meningioma at the Department of Neurosurgery, Dr. Hasan Sadikin General Hospital, Bandung, between January 2012 and December 2022. Patients with incomplete records were excluded. Data collected included demographics, clinical presentation, radiological findings (tumor location, bone infiltration, tumor invasion), surgical history (number of resections, time to recurrence), and histopathological results. Descriptive statistics were used for analysis.

Results: Twenty-eight patients met the inclusion criteria. The cohort was predominantly female (n=24, 85.7%) with a median age of 46 years (range 26-67). The most common presenting symptoms were protrusion (n=11, 39.3%) and headache (n=7, 25.0%). Tumors were most frequently located in the parietal (n=10, 35.7%) and sphenoorbital (n=9, 32.1%) regions. Significant bone infiltration was observed in 75.0% (n=21) of cases. Tumor invasion into adjacent structures occurred in 21.4% (n=6), most commonly involving the cavernous sinus (n=2, 7.1% of total / 33.3% of invaded). The median time to recurrence detection was 36 months (range 6-144). Most patients (n=22, 78.6%) underwent two tumor removal surgeries during the study period. Based on available histopathology (n=17), meningothelial (n=10, 35.7% of total / 58.8% of available) and transitional (n=3, 10.7% of total / 17.6% of available) subtypes were the most common WHO Grade 1 diagnoses. One case each of atypical (Grade 2) and malignant (Grade 3) meningioma were identified.

Conclusion: Recurrent intracranial meningiomas predominantly affected middle-aged females, often presenting with symptoms related to mass effect in parietal and sphenoorbital locations. High rates of bone infiltration and significant tumor invasion, particularly involving the cavernous sinus, were characteristic features. Recurrence was typically diagnosed within 3 years, with meningothelial and transitional subtypes being the most frequent histologies observed in this recurrent group. These findings underscore the complex nature of meningioma recurrence and highlight the need for tailored management strategies and long-term surveillance, particularly in cases with high-risk features like bone and sinus invasion.

Impact of Acupoint Specificity on Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

Hedi Suanto Tjong, Hendsun Hendsun, Guo Xinyu, Hitoshi Tanaka — Mon, 21 Apr 2025 06:49:31 +0000

Background: Acupuncture, a cornerstone of Traditional Chinese Medicine (TCM), is increasingly utilized for cardiovascular diseases (CVDs). A central tenet is acupoint specificity – the hypothesis that stimulating specific acupoints yields distinct therapeutic effects compared to non-specific points or sham interventions. However, the empirical evidence supporting acupoint specificity for cardiovascular outcomes remains debated. This systematic review aimed to evaluate the current evidence regarding the impact of acupoint specificity on clinically relevant cardiovascular outcomes.

Methods: A systematic search was conducted in major biomedical databases (PubMed, Embase, Cochrane Library, Scopus) for randomized controlled trials (RCTs) published between January 2014 and December 2024. Studies were included if they compared acupuncture at specific, predefined acupoints relevant to cardiovascular conditions against a control group involving sham acupuncture (non-penetrating, superficial needling at non-acupoints, or needling at irrelevant acupoints) or minimal acupuncture. The primary outcomes included changes in blood pressure (systolic and diastolic), heart rate variability (HRV) parameters, angina frequency/severity, and major adverse cardiovascular events (MACE). Study quality was assessed using the Cochrane Risk of Bias tool.

Results: Seven RCTs involving 850 participants met the inclusion criteria, addressing hypertension (n=3), stable angina (n=2), heart failure support (n=1), and HRV modulation in healthy subjects (n=1). Three studies (one hypertension, one angina, one HRV) suggested statistically significant benefits of specific acupoint stimulation (such as PC6, ST36, LR3) over sham controls for primary outcomes (such as greater reduction in systolic blood pressure, reduced angina frequency, specific HRV modulation). Heterogeneity was substantial across studies, even within the same condition, particularly concerning acupoint selection, stimulation parameters, and control group design.

Conclusion: The evidence supporting clinically significant acupoint specificity for cardiovascular outcomes remains inconclusive and inconsistent. While some studies suggest potential benefits of stimulating specific points like PC6 or ST36 compared to sham interventions, others fail to demonstrate superiority. High-quality, rigorously designed RCTs with standardized protocols, appropriate sham controls, and adequate sample sizes are imperative to clarify the role of acupoint specificity in acupuncture's cardiovascular effects.

Metoclopramide-Induced Extrapyramidal Syndrome in a Child: Diagnostic Challenges and Management

Ni Made Suartiningsih, Ni Made Ayu Agustini — Mon, 21 Apr 2025 08:29:11 +0000

Background: Metoclopramide, a dopamine D2 receptor antagonist, is used for its antiemetic and prokinetic properties. However, its use in pediatric populations is restricted due to a significant risk of neurological adverse effects, particularly acute extrapyramidal symptoms (EPS). These reactions, including acute dystonia, are more frequent in children compared to adults, posing diagnostic and management challenges.

Case presentation: We report the case of a 10-year-old girl who presented with acute torticollis and oculogyric crisis following the administration of metoclopramide syrup for fever and vomiting. The symptoms developed approximately one day after initiating the medication. Physical examination and basic laboratory results were otherwise largely unremarkable, apart from elevated white blood cells suggestive of an underlying infection. A diagnosis of metoclopramide-induced acute extrapyramidal syndrome was made.

Conclusion: The patient experienced rapid resolution of symptoms within 30 minutes following the administration of intravenous diphenhydramine. Metoclopramide was discontinued, and she was discharged without symptom recurrence. This case underscores the importance of recognizing metoclopramide-induced EPS in children, the diagnostic difficulties posed by its varied presentation potentially mimicking other serious neurological conditions, and the effectiveness of prompt management with anticholinergic agents like diphenhydramine. Clinicians must maintain a high index of suspicion, adhere to restrictive prescribing guidelines for metoclopramide in pediatrics, and consider safer antiemetic alternatives.

Six-Minute Walk Test Performance in Non-Dialysis Chronic Kidney Disease: An Observational Study from a Tertiary Hospital Setting

Irena Fathin Amelia, Harnavi Harun, Miftah Irramah, Selfi Renita Rusjdi — Tue, 22 Apr 2025 06:14:13 +0000

Background: Functional capacity dramatically declines in non-dialysis chronic kidney disease (CKD-ND), impacting patient prognosis and quality of life. Accurate, practical assessment is crucial for timely intervention. This study evaluated functional capacity using Six-Minute Walk Test (6MWT) and explored associated clinical factors in Indonesian CKD-ND patients.

Methods: We conducted a cross-sectional study at RSUP Dr. M. Djamil Padang, enrolling 44 patients with CKD stages 3-5 not on dialysis. Using purposive sampling, we collected 6MWT distance (6MWD) following ATS guidelines and extracted demographic/clinical data (age, gender, BMI, eGFR, etiology) from medical records. Functional capacity, expressed as Metabolic Equivalents (METs), was estimated from 6MWD and patient data using the Nury formula. Descriptive statistics summarized the findings.

Results: The cohort (54.5% male, mean age 56-65 years) predominantly had advanced CKD (43.2% Stage 5) and hypertension etiology (45.4%). Functional capacity was severely impaired: mean 6MWD was low (Men: 291m, Women: 255m), and a striking 70.5% of patients exhibited low functional capacity (<3.0 METs). No participants achieved high capacity (>6.0 METs). Lower mean 6MWD and a higher prevalence of low METs were distinctly observed in patients with lower eGFR and advanced age.

Conclusion: This study reveals profound functional limitations in Indonesian CKD-ND patients well before dialysis initiation. Lower eGFR and older age were strongly associated with poorer performance. The 6MWT effectively quantifies this impairment, highlighting its utility for routine screening and emphasizing the urgent need for functional assessment and rehabilitation strategies in CKD-ND management.

Nicotine Hypersensitivity in Inflammatory Dermatoses: A Systematic Review of Evidence for Nicotine as a Cutaneous Hapten

Bernard J.L. Sudan — Wed, 23 Apr 2025 01:39:19 +0000

Background: Inflammatory dermatoses, such as seborrheic dermatitis (SD) and atopic dermatitis (AD), affect a significant portion of the population, yet their precise etiology often remains debated. Nicotine, a ubiquitous alkaloid primarily associated with tobacco but also present in certain plants and therapeutic products, has been proposed as a potential hapten capable of triggering hypersensitivity reactions manifesting as inflammatory skin conditions. This systematic review aimed to evaluate the existing evidence supporting the role of nicotine as a cutaneous hapten involved in the pathophysiology of inflammatory dermatoses.

Methods: A systematic literature search was conducted using PubMed, Embase, and Google Scholar databases for studies published between January 2014 and December 2024. Keywords included "nicotine," "hapten," "allergy," "hypersensitivity," "contact dermatitis," "seborrheic dermatitis," "atopic dermatitis," "urticaria," and "skin reaction." Inclusion criteria encompassed original research (in vivo human studies, case reports/series, in vitro mechanistic studies) investigating nicotine's potential to elicit immune-mediated skin reactions consistent with a hapten mechanism. Data extraction focused on study design, population, nicotine source/exposure, diagnostic methods (patch test, prick test), and key findings related to hypersensitivity. Quality assessment was performed using appropriate tools (CARE guidelines for case reports, Joanna Briggs Institute checklists for other study types).

Results: Following title/abstract screening and full-text review, six studies met the inclusion criteria. These included one cross-sectional prick-test study, two case reports detailing reactions to electronic cigarettes, one patch-test study, and two in vitro studies investigating mast cell responses. The prick-test study (N=30) reported positive reactions to nicotine in 20% of non-smokers and 7% of smokers, including one patient with SD. Case reports described eczematous reactions (perioral, hand dermatitis) associated with e-cigarette use. The patch test study indicated positive reactions in a subset of individuals exposed to nicotine patches. In vitro studies demonstrated nicotine-induced mast cell degranulation and mediator release (histamine), potentially inhibited by mast cell stabilizers.

Conclusion: Consistent evidence from the included studies published between 2014-2024 suggests nicotine possesses the potential to act as a cutaneous hapten, capable of eliciting hypersensitivity reactions in susceptible individuals. Findings include positive diagnostic tests (prick/patch), clinical correlations (e-cigarette dermatitis), and plausible biological mechanisms involving mast cell activation. These reactions may contribute to or mimic inflammatory dermatoses like SD or contact dermatitis. Further robust clinical and mechanistic research is warranted to confirm these findings and clarify the prevalence and clinical significance of nicotine hypersensitivity in various dermatological conditions.

Navigating Spheno-Orbital Meningioma in Indonesia: Clinical Characteristics and Diagnostic Considerations from a Decade of Experience

Sheila Sumargo, Guata Naibaho — Fri, 25 Apr 2025 06:43:07 +0000

Background: Spheno-orbital meningiomas (SOM) represent a distinct subgroup of meningiomas originating from the sphenoid wing, characterized by orbital extension, significant bony invasion, and hyperostosis. These tumors present diagnostic and therapeutic challenges due to their complex anatomical location near critical neurovascular structures and a notable tendency for recurrence. Understanding the specific clinical profile of SOM patients is essential for timely diagnosis and effective management strategies. This study aimed to delineate these characteristics within an Indonesian population.

Methods: A retrospective, descriptive, cross-sectional study was performed using medical record data from patients diagnosed with SOM between January 2012 and December 2022 at the Department of Neurosurgery, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Data collected included patient demographics, case history (new vs. recurrent), presenting symptoms, neurological status (Glasgow Coma Scale), and radiological findings (lesion singularity/multiplicity). Total sampling was employed, and data were analyzed descriptively.

Results: The study included 252 subjects. A striking female predominance was observed (95.6%), with a mean patient age of 44.3 years (range 14-79). The vast majority were new cases (94.4%). Protrusion (proptosis) was the most frequent presenting symptom (79.0%), followed by headache (11.1%), blindness (5.2%), and blurred vision (4.0%). Most patients (97.2%) were fully conscious (GCS 15) upon admission. Radiological assessment revealed single lesions in 71.4% of cases.

Conclusion: In this large Indonesian cohort, SOM predominantly affected middle-aged females and typically presented with proptosis. Awareness of this distinct clinical signature is crucial for improving diagnostic accuracy and facilitating prompt, comprehensive management. The findings underscore the need for high clinical suspicion, particularly in female patients presenting with orbital symptoms.

Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective Study on Causative Agents and Patient Profiles in an Indonesian Hospital Setting

Nurrachmat Mulianto, Lifesia Natali Lidjaja — Mon, 28 Apr 2025 01:25:03 +0000

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) represent rare, severe mucocutaneous adverse drug reactions characterized by extensive epidermal necrosis and significant morbidity and mortality. Understanding the specific causative agents and patient profiles within local populations is crucial for early diagnosis and management. This study aimed to characterize SJS/TEN cases in a tertiary hospital setting in Indonesia.

Methods: A retrospective descriptive study was conducted using secondary data from medical records of patients diagnosed with SJS, SJS/TEN overlap, and TEN admitted to the inpatient installation of Dr. Moewardi General Hospital, Surakarta, Indonesia, between January 2022 and December 2024. Data collected included demographics (age, gender), comorbidities, diagnosis classification (SJS, SJS/TEN overlap, TEN), suspected causative drugs, length of hospital stay, SCORTEN score, and patient outcome (discharged alive or deceased). Total sampling was employed, excluding records with incomplete data. Data were compiled and analyzed descriptively.

Results: Fifty-one patients were included, with a slight female predominance (52.94%). The largest age group affected was 19-59 years (60.78%). The distribution of diagnoses was SJS (41.18%), SJS/TEN overlap (31.37%), and TEN (27.45%). The mean SCORTEN score for the cohort was 2. The most common suspected causative drug classes were antibiotics (25.71%), followed by analgesic-antipyretics (24.29%), and anticonvulsants (22.86%). Carbamazepine (11.43%) and amoxicillin (10%) were frequent individual culprits. Epilepsy (13.73%) and diabetes mellitus (11.76%) were common comorbidities, although a significant portion (33.33%) had no recorded comorbidity. The mean length of stay was 9 days. Overall mortality was 15.68%, with higher rates observed in TEN (28.57%) compared to SJS (9.52%) and SJS/TEN overlap (12.5%).

Conclusion: SJS/TEN affected predominantly adults, with antibiotics, analgesics, and anticonvulsants being the most implicated drug classes. While mortality was considerable, it appeared lower than some international reports, particularly for TEN. Recognizing common causative agents and patient risk factors, such as specific comorbidities like epilepsy and diabetes, can aid clinicians in early identification and prompt management of these life-threatening conditions.

Impact of Glycemic Control on Amsler Grid Findings in Patients with Diabetic Retinopathy in Palembang, Indonesia

Ramzi Amin, Ayu Aliyah — Mon, 28 Apr 2025 08:18:38 +0000

Background: Diabetic retinopathy (DR) remains a principal cause of vision impairment globally, frequently affecting the macula and central vision. This study aimed to investigate the association between glycemic control status and the presence of Amsler grid abnormalities in patients diagnosed with diabetic retinopathy in Palembang.

Methods: This cross-sectional study was conducted at the outpatient ophthalmology and internal medicine clinics of a tertiary referral hospital in Palembang between January 2023 and December 2024. Patients aged 18 years or older with a confirmed diagnosis of type 1 or type 2 diabetes mellitus and any stage of diabetic retinopathy, capable of performing Amsler grid testing, were included after providing informed consent. Patients with other significant ocular pathologies affecting the macula or media opacities precluding fundus examination were excluded. Data collected included demographics, diabetes history, comprehensive ophthalmic examination findings, standardized Amsler grid testing results, and recent HbA1c levels. Glycemic control was categorized as good (<7.0%), fair (7.0-9.0%), and poor (>9.0%). Statistical analysis involved descriptive statistics, chi-square tests, t-tests/Mann-Whitney U tests, and multivariable logistic regression to assess the association between HbA1c levels and abnormal Amsler grid findings, adjusting for potential confounders.

Results: A total of 385 patients with DR (mean age 58.2 ± 9.5 years; 53.8% female) were included. The mean duration of diabetes was 12.4 ± 6.8 years, and the mean HbA1c was 8.9% ± 2.1%. Abnormal Amsler grid findings were reported by 161 participants (41.8%). Patients with abnormal Amsler grid findings had significantly higher mean HbA1c levels compared to those with normal findings (9.8% ± 1.9% vs. 8.3% ± 1.8%, p < 0.001). In the multivariable logistic regression analysis, after adjusting for age, diabetes duration, DR severity, and hypertension, poor glycemic control (HbA1c >9.0%) was independently associated with significantly higher odds of having abnormal Amsler grid findings compared to good glycemic control (HbA1c <7.0%) (Adjusted Odds Ratio [aOR] = 3.45, 95% CI: 1.98-6.01, p < 0.001). Fair glycemic control (HbA1c 7.0-9.0%) also showed increased odds, although to a lesser extent (aOR = 1.82, 95% CI: 1.05-3.15, p = 0.032). Each 1% increase in HbA1c was associated with a 35% increased odds of abnormal Amsler findings.

Conclusion: This study demonstrated a significant association between poorer glycemic control, as indicated by higher HbA1c levels, and the presence of abnormal Amsler grid findings among diabetic retinopathy patients in Palembang. These findings underscore the critical role of meticulous glycemic management in preserving not only retinal structure but also central visual function detectable through simple psychophysical tests. The Amsler grid serves as a valuable, accessible tool for functional monitoring in this patient population.

Advances in Urinary Tract Infection Screening Among Pregnant Women: A 5-Year Systematic Review

Qonita Prasta Agustia, Rahajeng — Tue, 29 Apr 2025 01:32:39 +0000

Background: Urinary tract infections (UTIs), including asymptomatic bacteriuria (ASB), represent a significant clinical challenge during pregnancy, posing risks to both mother and fetus. Physiological changes increase susceptibility. Urine culture remains the diagnostic gold standard. This review assessed recent evidence on UTI clinical manifestations and diagnostic approaches in pregnant women.

Methods: A systematic literature search of PubMed and Google Scholar was conducted for experimental studies published in the last 5 years (2019-2023) focusing on UTI diagnosis in pregnancy. Search terms included "urinary tract infection," "pregnant women," "diagnosis," and "experimental study". Studies were selected using PRISMA guidelines and PICOS criteria. Data extraction and risk of bias assessment were performed.

Results: Fifteen experimental studies involving 4,377 pregnant participants were included. Common clinical manifestations included urgency, lower abdominal/pelvic pain, dysuria, fever, and hematuria. Urine culture was the primary diagnostic tool used. Escherichia coli was the most prevalent Gram-negative isolate, followed by Klebsiella spp. and Pseudomonas spp. Streptococcus aureus, Enterococcus faecalis, and Staphylococcus aureus were common Gram-positive isolates. Urine pH varied, with Gram-positive infections associated with more alkaline urine.

Conclusion: Clinical presentations of UTI in pregnancy were consistent across recent studies. Gram-negative bacteria, particularly E. coli, predominated. Urine culture remains the cornerstone of diagnosis, with urine pH potentially offering adjunctive diagnostic information.

Navigating Diagnosis and Treatment of Perianal Condyloma Acuminata in a Bisexual Man: Clinical and Histopathological Insights

Rose Widanti Sugiyanto, Erna Kristiyani, Ketut Kwartantaya — Tue, 29 Apr 2025 08:38:46 +0000

Background: Condyloma acuminata (CA), caused by Human Papillomavirus (HPV), commonly affects the anogenital region, particularly in young, sexually active individuals. Perianal presentation is less common but significant, often linked to specific sexual practices. Bisexual men represent a unique demographic concerning STI risk factors and require careful assessment. This report details the diagnosis and management of perianal CA in a young bisexual male, emphasizing the diagnostic utility of clinical assessment, sexual history, and histopathology.

Case presentation: A 24-year-old Indonesian bisexual male presented with a three-month history of progressively enlarging, asymptomatic perianal nodules. He reported unprotected receptive anal intercourse with a male partner five months prior. Examination revealed multiple skin-colored, verrucous papules in the perianal region. HIV and syphilis screenings were negative. Histopathological examination of a biopsy specimen confirmed CA, showing parakeratosis, papillomatosis, acanthosis, and koilocytosis.

Conclusion: Treatment with 90% trichloroacetic acid (TCA) combined with cauterization resulted in significant clinical improvement at one-week follow-up. This case highlights the importance of obtaining a thorough, non-judgmental sexual history, recognizing characteristic lesion morphology, and utilizing histopathology for definitive diagnosis in managing perianal CA, particularly in populations with diverse sexual practices.

Novel Enhalus acoroides Phytosomes: Formulation, Characterization, and Bioavailability Enhancement

Siti Mardiyanti, Effionora Anwar, Yesi Desmiaty, Siti Sadiah — Wed, 30 Apr 2025 01:45:07 +0000

Background: Enhalus acoroides (seagrass) possesses valuable bioactive compounds, including quercetin, with potential therapeutic applications, notably antidiabetic effects. However, the poor solubility and low bioavailability of compounds like quercetin limit their clinical efficacy. Phytosomes, phospholipid-based nanocarriers, represent a promising strategy to overcome these limitations. This study aimed to develop and characterize E. acoroides extract-loaded phytosomes to enhance its potential bioavailability.

Methods: E. acoroides was collected, processed, and extracted using ultrasound-assisted extraction (UAE). Total phenolic (TPC) and flavonoid content (TFC) were determined. Phytosomes were prepared using the thin-layer hydration method with varying extract-to-soya lecithin ratios (F1=1:1, F2=1:2, F3=1:3). Characterization involved particle size analysis, zeta potential measurement, Fourier Transform Infrared Spectroscopy (FTIR), Transmission Electron Microscopy (TEM), entrapment efficiency (EE%) determination via HPLC, and in vitro dissolution studies.

Results: The UAE extract yielded TPC of 0.318 ± 0.036 mg GAE/g and TFC of 1.023 ± 0.022 mg QE/g. Phytosome formulation F1 (1:1 ratio) exhibited optimal characteristics: particle size of 276.4 nm, PDI of 0.591, zeta potential of -18.0 mV, EE% of 80.47 ± 2.62%, and a spherical morphology. FTIR confirmed complexation. F1 phytosomes demonstrated significantly enhanced dissolution, releasing 87.13% of the entrapped compound over 12 hours compared to the crude extract.

Conclusion: E. acoroides extract was successfully encapsulated into phytosomes using a thin-layer method. The F1 formulation (1:1 extract:phospholipid ratio) demonstrated favorable physicochemical properties (nanoparticle size, moderate stability, high EE%) and markedly improved in vitro dissolution, suggesting enhanced bioavailability potential for E. acoroides phytoconstituents.

Evaluating Progesterone Level Fluctuations as a Response Indicator to Chemotherapy in Triple Negative Breast Cancer

Handito Sarwwotatwadhiko, Widyanti Soewoto, Ida Bagus Budhi Surya — Wed, 30 Apr 2025 07:52:06 +0000

Background: Triple negative breast cancer (TNBC) represents an aggressive subtype with limited targeted therapies and often poorer prognosis. Chemotherapy remains a cornerstone of treatment, yet its systemic effects, including hormonal alterations, are not fully elucidated. The role of progesterone in TNBC progression and its modulation by chemotherapy is particularly complex and warrants investigation. This study aimed to evaluate changes in serum progesterone levels following chemotherapy in TNBC patients.

Methods: A prospective cohort study was conducted at Dr. Moewardi General Hospital, Surakarta, involving 30 patients diagnosed with TNBC undergoing chemotherapy. Serum progesterone levels were quantified using the ELISA method before the first chemotherapy cycle and after the sixth cycle. Statistical analysis, primarily the Wilcoxon test, was used to compare pre- and post-chemotherapy levels.

Results: The cohort had a mean age of 49.13 ± 8.98 years. Prior to chemotherapy, progesterone levels varied: 53.3% were below normal (<0.5 ng/mL), 23.3% were normal (0.5-5 ng/mL), and 23.3% were above normal (>5 ng/mL). Following six cycles of chemotherapy, a significant decrease in progesterone levels was observed (p=0.020). The proportion of patients with below-normal levels increased to 63.3%. Overall, 10 patients showed decreased levels, 18 remained stable, and 2 showed increased levels. No significant correlation was found between progesterone level changes and baseline patient characteristics like age, menarche, or menopausal status.

Conclusion: Systemic chemotherapy significantly impacts progesterone levels in TNBC patients, leading to an overall decrease. Monitoring progesterone fluctuations during treatment may hold potential value for assessing therapeutic response or prognosis, warranting further investigation.

Impact of Exercise Modalities on Blood Pressure, Cardiorespiratory Fitness, and Resting Heart Rate in Hypertension: A Meta-Analysis

Kagami Gari Lindo, Muhammad Iqbal Andreas — Fri, 02 May 2025 08:24:57 +0000

Background: Hypertension represents a critical global health challenge and a leading modifiable risk factor for cardiovascular morbidity and mortality. Sedentary behavior is a significant contributor to its prevalence. While exercise is a cornerstone of hypertension management, the comparative efficacy of different exercise modalities—aerobic training (AT), resistance training (RT), and combination training (CT)—on key cardiovascular parameters requires continued synthesis. This meta-analysis aimed to quantitatively evaluate the impact of AT, RT, and CT on systolic blood pressure (SBP), diastolic blood pressure (DBP), cardiorespiratory fitness (CRF) assessed via maximal oxygen consumption (VO₂max), and resting heart rate (RHR) in adults with hypertension.

Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Cochrane Library, and ScienceDirect databases for randomized controlled trials (RCTs) published between January 1^st, 2014, and January 1^st, 2025. Inclusion criteria encompassed RCTs involving adults diagnosed with hypertension undergoing AT, RT, or CT interventions for at least 8 weeks, reporting changes in SBP, DBP, VO₂max, or RHR. Two independent reviewers performed study selection, data extraction, and quality assessment using the Cochrane Risk of Bias tool. Standardized mean differences (SMD) with 95% confidence intervals (CI) were pooled using random-effects models due to anticipated heterogeneity. Heterogeneity was assessed using the I² statistic.

Results: Seven RCTs, encompassing 410 participants with hypertension, met the inclusion criteria. The included studies were predominantly parallel-group RCTs, with durations ranging from 8 to 16 weeks. Meta-analysis indicated that AT resulted in a statistically significant overall reduction in blood pressure compared to RT (Overall BP SMD: -2.55; 95% CI: -4.97, -0.13; p = 0.04). Furthermore, AT demonstrated significantly greater improvements in VO₂max (SMD: -4.84; 95% CI: -7.00, -2.68; p < 0.0001) and RHR (SMD: -3.08; 95% CI: -4.75, -1.42; p = 0.0003) compared to RT. The overall pooled effect for VO₂max and RHR combined significantly favored AT (Overall SMD: -3.74; 95% CI: -5.06, -2.42; p < 0.00001). Limited data (two studies) suggested that combination training might offer superior blood pressure reduction compared to RT and potentially AT, but these findings require cautious interpretation due to the small number of studies. Significant heterogeneity was observed in the blood pressure analyses (I² > 88%), whereas heterogeneity was low to moderate for VO₂max and RHR analyses.

Conclusion: This meta-analysis indicated that aerobic training provided superior benefits in reducing overall blood pressure, improving cardiorespiratory fitness (VO₂max), and lowering resting heart rate compared to resistance training alone in adults with hypertension. Combination training showed potential, particularly for blood pressure control, warranting further high-quality research with larger sample sizes. These findings underscore the importance of incorporating structured exercise, particularly aerobic training, into comprehensive hypertension management strategies.

Nebulized Heparin for Inhalation Injury in Burn Patients: An Updated Systematic Review and Meta-Analysis of Efficacy and Safety Outcomes

Haikal Basyar, Russilawati, Masrul Basyar — Mon, 05 May 2025 08:21:18 +0000

Background: Inhalation injury significantly increases morbidity and mortality in burn patients, primarily through airway obstruction, inflammation, and impaired gas exchange. Nebulized heparin has been investigated as a potential therapy to counteract local pulmonary coagulopathy and fibrin cast formation. However, evidence regarding its clinical efficacy and safety remains conflicting. This systematic review and meta-analysis aimed to synthesize updated evidence on the efficacy and safety outcomes of nebulized heparin in burn patients with inhalation injury.

Methods: A systematic literature search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science for studies published between January 2014 and December 2024. We included randomized controlled trials (RCTs) and comparative cohort studies evaluating nebulized heparin versus placebo or standard care in adult and pediatric burn patients with inhalation injury. Primary efficacy outcomes included mortality and ventilator-free days (VFDs) at 28 days. Secondary outcomes included duration of mechanical ventilation (DoMV), hospital length of stay (LOS), changes in PaO₂/FiO₂ ratio, incidence of pneumonia, and safety outcomes (bleeding events). Data were synthesized, and a random-effects meta-analysis was planned to estimate pooled effect sizes (Risk Ratios [RR] or Standardized Mean Differences [SMD]). Study quality was assessed using appropriate tools.

Results: The search strategy yielded seven studies (3 RCTs, 4 cohort studies) meeting the inclusion criteria, encompassing a total of 950 patients. Study quality varied. The meta-analysis suggested a potential reduction in mortality associated with nebulized heparin compared to control groups (Risk Ratio [RR]: 0.79; 95% CI: 0.64-0.97, P=0.02; I²=45%). A trend towards increased VFDs (Standardized Mean Difference [SMD]: 0.35; 95% CI: -0.05 to 0.75, P=0.08; I²=60%) and reduced DoMV (SMD: -0.50; 95% CI: -0.85 to -0.15, P=0.005; I²=55%) was observed. Effects on hospital LOS and PaO₂/FiO₂ ratio were less consistent across studies. There was no significant difference in the incidence of pneumonia (RR: 0.95; 95% CI: 0.80-1.13, P=0.55; I²=20%). Safety analysis indicated no significant increase in major bleeding events (RR: 1.15; 95% CI: 0.88-1.50, P=0.30; I²=10%), although minor bleeding, like blood-stained sputum, was noted in some studies. Substantial heterogeneity was present for some outcomes.

Conclusion: Based on this updated systematic review and meta-analysis, nebulized heparin may be associated with reduced mortality and duration of mechanical ventilation in burn patients with inhalation injury, without a significantly increased risk of major bleeding. However, considerable uncertainty remains due to study heterogeneity and methodological limitations in the available literature. Its effect on pneumonia incidence appears negligible. Large-scale, high-quality RCTs are still needed to confirm these findings and establish optimal treatment protocols.

Hyperthyroidism-Induced Myocardial Ischemia: Quantification and Correlation with fT4 via 99mTc-Sestamibi Scintigraphy

Wed, 07 May 2025 05:32:35 +0000

Background: Hyperthyroidism exerts significant detrimental effects on the cardiovascular system, increasing the risk of major adverse cardiac events (MACE). While associations with atrial fibrillation and cardiomyopathy are well-documented, the incidence and characteristics of myocardial ischemia, particularly assessed by functional imaging, remain less explored. This study aimed to investigate the incidence of myocardial ischemia in hyperthyroid patients using Technetium-99m Sestamibi (⁹⁹ᵐTc-Sestamibi) myocardial perfusion scintigraphy (MPS) and correlate findings with thyroid hormone levels.

Methods: This prospective preliminary study enrolled fifteen consecutive patients with confirmed hyperthyroidism and no prior history of ischemic heart disease between January and April 2024. All subjects underwent thyroid function tests (TSH, fT4, T3) and a one-day rest/adenosine-stress ⁹⁹ᵐTc-Sestamibi MPS protocol. Myocardial ischemia presence, reversibility, severity (Summed Stress Score, SSS), and extent (total ischemic segments) were assessed using the AHA 17-segment model. Spearman correlation was used to analyze the relationship between hormone levels and MPS parameters.

Results: Fifteen subjects (93.3% female, mean age 34 ± 11 years) were included. Myocardial ischemia was detected in 14/15 subjects (93.3%). Among those with ischemia, 12 (80% of total subjects, 85.7% of ischemic subjects) exhibited reversible defects. Free thyroxine (fT4) levels showed a strong positive correlation with SSS (rs = 0.64, p = 0.01) and the total number of ischemic segments (rs = 0.65, p = 0.01).

Conclusion: This preliminary study revealed a high incidence of myocardial ischemia, predominantly reversible, in patients with hyperthyroidism detected by ⁹⁹ᵐTc-Sestamibi MPS. The severity and extent of ischemia demonstrated a significant positive correlation with fT4 levels. These findings underscore the potential utility of MPS in cardiovascular risk assessment and suggest the need for comprehensive cardiac evaluation in hyperthyroid patients, particularly those with higher fT4 levels.

Differential Roles of CD117 and Ki67 in Gastrointestinal Stromal Tumors: Diagnostic Utility Versus Prognostic Power

Thu, 08 May 2025 05:23:43 +0000

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the digestive tract, primarily driven by mutations in KIT or PDGFRA genes. CD117 (c-KIT) expression is a key diagnostic marker, while the Ki67 labeling index reflects cellular proliferation. Risk stratification, often using modified NIH criteria based on tumor size, mitotic rate, and location, guides prognosis and treatment. This study investigated the distinct roles of CD117 and Ki67 expression in relation to risk stratification in GIST patients.

Methods: This cross-sectional analytical study examined 27 GIST cases diagnosed between January 2021 and December 2024 from three Indonesian hospitals. Formalin-fixed paraffin-embedded tissues were analyzed using immunohistochemistry for CD117 (clone YR145) and Ki67 (clone K2). CD117 positivity was defined as ≥5% tumor cell staining, and high Ki67 expression as >10% nuclear staining. Risk stratification utilized the modified NIH criteria. The Chi-square test assessed correlations (p<0.05 significance).

Results: The cohort predominantly comprised patients >50 years (66.7%), males (59.3%), with gastric tumors (51.9%), large tumor size (>5cm in 96.3%), spindle cell morphology (77.8%), and high mitotic rates (74.1%). Most cases (85.2%) were classified as high-risk. CD117 was positive in 81.5% (22/27) of cases but showed no significant correlation with risk stratification (p=0.561). High Ki67 expression was found in 74.1% (20/27) of cases and demonstrated a significant positive correlation with high-risk stratification (p=0.002). The combination of CD117 and Ki67 status also showed a significant association with risk stratification (p=0.001).

Conclusion: While CD117 expression remains a cornerstone for GIST diagnosis and targeted therapy selection, it did not correlate significantly with risk stratification in this cohort. Conversely, a high Ki67 labeling index was significantly associated with high-risk GIST, underscoring its potential as a valuable prognostic marker alongside established risk stratification parameters.

Investigating the Landscape of Programmed Death-Ligand 1 (PD-L1) in Thymic Tumors: Implications for Histopathological Classification and Staging

Rio Hendra, Noza Hilbertina, Henny Mulyani, Tofrizal, Afriani, Husna Yetti — Thu, 08 May 2025 07:52:39 +0000

Background: Thymic epithelial tumors (TETs) are uncommon malignancies originating in the mediastinum, characterized by considerable histopathological diversity and variable clinical trajectories. Programmed Death-Ligand 1 (PD-L1), an immune checkpoint protein, is implicated in mechanisms of tumor immune evasion. This study aimed to investigate the correlation between PD-L1 immunoexpression and distinct histopathological types, as well as the Masaoka-Koga stage, in TETs.

Methods: This cross-sectional investigation analyzed 29 archival cases of TETs diagnosed between January 2019 and December 2024 at the Anatomical Pathology Laboratory of Dr. M. Djamil General Hospital Padang. Samples were procured via consecutive sampling from formalin-fixed paraffin-embedded (FFPE) tumor tissues. Histopathological classification was reassessed according to the WHO 2021 criteria. PD-L1 expression was evaluated immunohistochemically and quantified using the Tumor Proportion Score (TPS). Masaoka-Koga staging was determined from clinical records. Statistical analysis of correlations was performed using the Chi-square test.

Results: PD-L1 immunoexpression was detected in the preponderance of cases. Low positive PD-L1 expression (TPS 1-49%) was observed in 82.8% of TETs, while high positive expression (TPS ≥50%) was noted in 10.3%. Thymic carcinoma constituted the most prevalent histopathological category (51.7%), and the majority of patients (91.7%) presented at an advanced Masaoka-Koga stage. Statistical analysis did not demonstrate a significant correlation between PD-L1 expression levels and histopathological type (p=0.195). Furthermore, no significant association was identified between PD-L1 expression and Masaoka-Koga stage (p=0.800).

Conclusion: This study indicated that while PD-L1 is frequently expressed in TETs within this cohort, its expression level did not exhibit a significant correlation with specific histopathological subtypes or the Masaoka-Koga clinical stage. Further investigations incorporating larger sample sizes are warranted to delineate the precise role of PD-L1 within the complex biological spectrum of thymic neoplasms.

Harnessing the Power of Nature: Ananas comosus Extract Gel as an Alternative Topical Treatment for Grade 2 Burn Wounds

Kharmi Juni Yanti, Diah Adriani Malik, Novi Kusumaningrum — Fri, 09 May 2025 02:31:03 +0000

Background: Burn injuries remain a significant global health challenge, often leading to complications such as infection and delayed healing. Conventional treatments can be costly and may have side effects, prompting exploration into natural therapeutic alternatives. Ananas comosus (pineapple), rich in the enzyme bromelain, has demonstrated anti-inflammatory and wound-healing properties, suggesting its potential as a topical agent for burn wounds. This study aimed to evaluate the efficacy of a topical gel formulated from Ananas comosus extract in promoting the healing of grade 2 burn wounds in a Wistar rat model by assessing its impact on wound diameter and the levels of pro-inflammatory cytokines Interleukin-1 beta (IL-1β) and Interleukin-6 (IL-6).

Methods: A true experimental study with a post-test only control group design was conducted using 30 male Wistar rats. Grade 2 burn wounds were induced on the dorsum of the rats. The rats were randomly assigned to six groups (n=5 per group): a normal control (KN, no treatment), negative control (K-), a positive control (K+, silver plus alginate hydrogel), and three treatment groups receiving topical Ananas comosus extract gel at concentrations of 15% (P1), 20% (P2), and 25% (P3) twice daily for 14 days. Wound diameter was measured on days 1, 3, 6, 9, 12, and 14 using the ImageJ application. On day 15, tissue samples were collected for IL-1β and IL-6 quantification via ELISA. Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests for wound diameter, and One-Way ANOVA with LSD post-hoc test for cytokine levels, with p<0.05 considered significant.

Results: Significant differences in burn wound diameter and levels of IL-1β and IL-6 were observed among the groups (p<0.05). The P2 group (20% pineapple extract gel) exhibited the most significant reduction in wound diameter compared to the negative control and was comparable to the positive control group. This group also showed a marked decrease in IL-1β and IL-6 levels, with IL-1β levels similar to the positive control and IL-6 levels significantly lower than the untreated group and approaching those of the positive control.

Conclusion: Topical application of 20% Ananas comosus extract gel effectively accelerated the healing of grade 2 burn wounds and reduced the levels of pro-inflammatory cytokines IL-1β and IL-6 in Wistar rats. These findings support the potential use of pineapple extract as an alternative herbal topical therapy for burn injuries. Further research is warranted to explore optimal formulations and clinical applications in humans.

Unraveling the Angiogenic Landscape in Endometrioid Endometrial Carcinoma: VEGF Expression, Histopathological Differentiation, and Lymphovascular Invasion as Key Players

Fri, 09 May 2025 06:11:39 +0000

Background: Endometrioid endometrial carcinoma (EEC) is a prevalent gynecological malignancy whose prognosis is influenced by factors including histopathological grade and lymphovascular invasion (LVI). Angiogenesis, crucial for tumor growth and metastasis, is significantly mediated by vascular endothelial growth factor (VEGF). This study aimed to investigate the expression of VEGF in EEC and its correlation with histopathological differentiation and LVI.

Methods: This observational analytical study employed a cross-sectional design using 36 archival paraffin block samples of EEC diagnosed between January 2022 and December 2024 at the Anatomical Pathology Laboratory of Dr. M. Djamil General Hospital Padang. Cases were selected via simple random sampling from a population of 59. Histopathological grade (Grade 1, 2, or 3 based on FIGO architectural and nuclear criteria) and LVI (negative, focal, or substantial) were re-evaluated from Hematoxylin-Eosin (H&E) stained slides. VEGF expression was assessed by immunohistochemistry, scored semiquantitatively based on the percentage of positive tumor cells and staining intensity, and categorized as low or high. Data were analyzed using Chi-square tests, with p<0.05 considered statistically significant.

Results: The mean age of patients was 54.36 years, with the highest prevalence in the 51-60 age group (41.7%). Grade 3 tumors were most common (38.9%), followed by Grade 2 (33.3%) and Grade 1 (27.8%). LVI was present in 47.2% of cases, predominantly focal (38.9%). High VEGF expression was observed in 58.3% of EEC cases. A statistically significant association was found between high VEGF expression and higher histopathological grade (p=0.000), with 66.7% of Grade 3 tumors showing high VEGF expression. No significant association was found between VEGF expression and LVI (p=0.080).

Conclusion: High VEGF expression significantly correlated with higher histopathological grades in EEC, suggesting its role in tumor aggressiveness and dedifferentiation. However, a significant association with LVI was not established in this cohort. VEGF expression warrants further investigation as a potential prognostic biomarker and therapeutic target in EEC.

Beyond the Scar: A Case Report on the Clinical Presentation, Diagnostic Nuances, and Surgical Management of Type I Cesarean Scar Pregnancy

Mon, 12 May 2025 03:57:06 +0000

Background: Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy where the gestational sac implants within the fibrous tissue of a previous cesarean section scar. Its incidence is rising in parallel with increasing cesarean delivery rates, posing significant risks of maternal morbidity, including uterine rupture and severe hemorrhage. Type I CSP, or endogenic CSP, involves implantation on a healed scar with growth primarily towards the uterine cavity. Early and accurate diagnosis, relying heavily on ultrasonographic nuances, is crucial for appropriate management and fertility preservation.

Case presentation: We present the case of a 36-year-old woman, G7P3033, with a history of two prior cesarean sections, who presented at 6-7 weeks of gestation with vaginal discharge. Transabdominal ultrasonography revealed a gestational sac implanted on the anterior uterine wall within the cesarean scar area, with a thin myometrium between the sac and the bladder, consistent with a Type I (endogenic, COS-1, Grade II) Cesarean Scar Pregnancy. The patient also had Stage II hypertension. After thorough evaluation and counseling, the patient underwent a laparotomy with wedge resection of the CSP and scar revision, along with bilateral fimbriectomy as per her request for sterilization.

Conclusion: This case highlights the importance of high clinical suspicion for CSP in pregnant women with previous cesarean sections presenting with early pregnancy symptoms. Detailed ultrasonography is paramount for accurate diagnosis, classification, and guiding management. Surgical management, specifically laparotomy with wedge resection and scar repair, proved to be an effective treatment for this Type I CSP, allowing for removal of the ectopic pregnancy and reinforcement of the uterine wall, while addressing the patient's desire for permanent contraception. Timely intervention is key to preventing life-threatening complications and preserving future reproductive options if desired.

Management Strategies and Outcomes for Bilateral Pulmonary Hydatid Cysts: A Systematic Review and Meta-Analysis

Berliana Islamiyarti Hydra, Irvan Medison, Fenty Anggrainy — Wed, 14 May 2025 05:55:58 +0000

Background: Bilateral pulmonary hydatid disease presents a complex therapeutic challenge, necessitating careful consideration of surgical timing, approach, and adjuvant medical therapy to optimize patient outcomes while minimizing morbidity. This systematic review and meta-analysis aimed to evaluate the different management strategies and their associated outcomes in patients with bilateral pulmonary hydatid cysts.

Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science databases was conducted for studies published between January 2014 and December 2024, reporting on management strategies (one-stage bilateral surgery, two-stage bilateral surgery, medical therapy) and outcomes (postoperative complications, recurrence, mortality, length of hospital stay) in patients with bilateral pulmonary hydatid cysts. Studies were selected based on predefined inclusion and exclusion criteria. Data were extracted by two independent reviewers, and quality assessment was performed using a modified Newcastle-Ottawa Scale. Pooled proportions for outcomes were calculated using random-effects models. Heterogeneity was assessed using the I² statistic.

Results: Seven studies, encompassing a total of 305 patients with bilateral pulmonary hydatid cysts, met the inclusion criteria. The studies varied in design, including retrospective cohorts and prospective case series. Management predominantly involved surgical intervention, with 148 patients (48.5%) undergoing one-stage bilateral surgery and 127 patients (41.6%) undergoing two-stage procedures. Perioperative albendazole was administered to 245 patients (80.3%). The pooled overall postoperative complication rate was 28.7% (95% CI: 21.5%-36.8%; I²=78%). Major complications occurred in 12.1% (95% CI: 8.0%-17.9%; I²=65%). The pooled recurrence rate at a mean follow-up of 38.5 months was 8.5% (95% CI: 5.1%-13.8%; I²=55%). Overall mortality was 2.1% (95% CI: 0.9%-4.5%; I²=0%). Patients undergoing one-stage surgery exhibited a trend towards higher overall complication rates (33.1% vs. 25.2% for two-stage) but shorter total hospital stays. Adjuvant albendazole therapy was associated with a trend towards lower recurrence rates.

Conclusion: Surgical management, whether one-stage or two-stage, remains the cornerstone of treatment for bilateral pulmonary hydatid disease, achieving acceptable morbidity and mortality with good long-term control in most patients. Postoperative complications are relatively common, highlighting the complexity of these cases. While one-stage surgery may shorten overall hospital stay, it might be associated with a higher risk of immediate complications. Adjuvant albendazole appears beneficial in reducing recurrence. The choice of surgical strategy should be individualized based on patient status, cyst characteristics, and surgical expertise. Further prospective, comparative studies are needed to delineate optimal management pathways.

Thoracic Epidural Anesthesia Facilitating Upper Abdominal Surgery in the Presence of Malignant Pleural Effusion and Hepatic Metastases: A Case Report

Faisal Irwanda, Andre Azhar, Dino Irawan — Thu, 15 May 2025 05:42:29 +0000

Background: Upper abdominal surgery in patients with advanced metastatic cancer, particularly with significant pulmonary and hepatic involvement, presents substantial perioperative challenges. Malignant pleural effusion (MPE) and hepatic metastases compromise cardiorespiratory reserve, increasing the risks associated with general anesthesia and surgical stress. Thoracic epidural anesthesia (TEA) offers potential benefits by providing effective analgesia, reducing pulmonary complications, and attenuating the surgical stress response.

Case presentation: We report the case of a 65-year-old male patient with metastatic breast cancer involving the lungs, liver, and spine, complicated by recurrent malignant pleural effusion. He presented with dyspnea and abdominal pain, requiring a laparotomy for liver biopsy to guide further oncological management. Given his ASA III status, significant pulmonary compromise (pre-operative SpO₂ 93-94% on room air, effusion requiring drainage), and the nature of the surgery, TEA was chosen as the primary anesthetic technique. An epidural catheter was successfully placed at the T9-T10 interspace, achieving a T4 sensory block using ropivacaine 0.5%. The laparotomy and liver biopsy proceeded with stable intraoperative hemodynamics and adequate surgical conditions.

Conclusion: TEA provided effective anesthesia and analgesia for upper abdominal surgery in this high-risk patient with extensive metastatic disease and compromised pulmonary function. This approach facilitated the procedure while maintaining hemodynamic stability and avoiding the potential respiratory complications associated with general anesthesia and tracheal intubation. TEA should be considered a viable anesthetic option in carefully selected high-risk patients undergoing abdominal oncological surgery.

Fatal Feline Rabies: A Case Report of Encephalitis Following a Cat Scratch in an Endemic Indonesian Region

Gede Tamblang Baswara Putra, I Made Mahardika Yasa — Mon, 19 May 2025 07:14:01 +0000

Background: Rabies, a viral zoonosis caused by Lyssavirus, remains a significant public health threat, particularly in Asia and Africa, with an almost invariably fatal outcome once clinical symptoms manifest. While dogs are the primary vector, transmission via cats, especially through scratches, is an under-recognized risk in endemic areas like Indonesia. Delayed post-exposure prophylaxis (PEP) and gaps in surveillance contribute to ongoing fatalities.

Case presentation: We report the case of a 45-year-old Indonesian male from a rural, rabies-endemic area in Jembrana Regency, Bali, who developed fatal encephalitis. Approximately one month prior to symptom onset, he sustained a superficial scratch on his right hand from a free-roaming domestic cat. He did not seek immediate medical attention or PEP. His illness commenced with prodromal symptoms of fever and headache, rapidly progressing to agitation, dysphagia, severe hydrophobia, and aerophobia. Neurological examination revealed fluctuating consciousness, hyperactive reflexes, and marked autonomic dysfunction. Despite intensive supportive care in an isolation unit, his condition deteriorated, leading to death two days after admission. A clinical diagnosis of rabies encephalitis was made based on the characteristic symptoms, a clear history of exposure to a potential vector, and the epidemiological context.

Conclusion: This case underscores the critical importance of recognizing cats as significant vectors for rabies transmission, even via non-bite exposures like scratches, particularly in endemic settings. It highlights the urgent need for increased public awareness regarding prompt wound management and PEP for all potential rabies exposures, including those from felines. Furthermore, comprehensive rabies control strategies must incorporate feline vaccination and improved surveillance to effectively mitigate this fatal disease in regions like Indonesia.