Bioscientia Medicina : Journal of Biomedicine and Translational Research

Awake Fiberoptic Intubation in a Patient with T4N2M1 Buccal Tumor and Pulmonary Metastasis: A Case Report and Anesthetic Challenges

Numbi Akhmadi Teguh, Jeffri Prasetyo Utomo, Taufiq Agus Siswagama — Thu, 19 Dec 2024 08:08:40 +0000

Background: Advanced buccal cancer with pulmonary metastasis presents significant challenges for airway management due to potential anatomical distortions and respiratory compromise. Awake fiberoptic intubation (AFOI) is often the preferred technique in these cases. This report describes the successful anesthetic management of a patient with a T4N2M1 buccal tumor and lung metastasis using AFOI.

Case presentation: A 64-year-old male with a T4N2M1 buccal tumor and pulmonary metastasis presented for an open biopsy and biopsy of the oral cavity. He had limited mouth opening (Mallampati 2), anemia, and hypoalbuminemia. AFOI was performed using dexmedetomidine and topical lidocaine. General anesthesia was induced with propofol and atracurium and maintained with sevoflurane. Postoperative pain was managed with paracetamol and ketorolac. The patient's recovery was uneventful.

Conclusion: This case highlights the importance of AFOI in securing the airway for patients with advanced buccal cancer and pulmonary metastasis. Meticulous preoperative planning, including optimization of comorbidities and vigilant perioperative monitoring, is essential for successful outcomes in these complex cases.

Clinical Presentation and Surgical Management of Invasive Ductal Carcinoma Grade III: A Case Report

Pande Putu Sucahaya Pradhana, Tasia Irma Endriani, Anak Agung Ngurah Pretangga — Fri, 20 Dec 2024 03:42:28 +0000

Background: Invasive ductal carcinoma (IDC) is the most common type of breast cancer, accounting for approximately 80% of all cases. This case report describes the clinical presentation, diagnosis, and surgical management of a 52-year-old female with IDC Grade III.

Case presentation: A 52-year-old female presented with a palpable lump in her left breast, associated with intermittent pain. She had undergone a left breast biopsy excision surgery three months prior. Physical examination revealed a tender mass in the left breast. Imaging studies and histopathological examination confirmed the diagnosis of IDC Grade III. The patient underwent a modified radical mastectomy (MRM).

Conclusion: This case highlights the importance of early detection and prompt surgical intervention in the management of IDC Grade III. MRM remains a cornerstone of treatment for locally advanced breast cancer, offering favorable outcomes and improved quality of life.

Intraoperative Frozen Section Diagnosis of Adenoid Cystic Carcinoma of the Minor Salivary Gland: A Case Report

Mustika Sari, Noza Hilbertina — Tue, 24 Dec 2024 05:38:20 +0000

Background: Adenoid cystic carcinoma (ACC) is a rare malignant tumor of the salivary glands known for its slow growth, invasive behavior, and propensity for perineural invasion. The diagnosis of ACC can be challenging, especially during intraoperative frozen section consultation. This case report highlights the crucial role of frozen section diagnosis in guiding surgical management and ensuring tumor-free margins, which are critical for patient prognosis.

Case presentation: A 44-year-old male presented with a slow-growing, occasionally painful nodule on his upper lip, without facial numbness or other systemic symptoms. A frozen section examination was performed intraoperatively to assess the lesion and determine the margin status. The frozen section revealed malignancy, characterized by tumor cell proliferation in tubular, cribriform, and solid patterns, all hallmarks of ACC, along with perineural invasion. A wide excision was performed, and subsequent frozen sections of the surgical margins confirmed they were free of tumor. The diagnosis of ACC was confirmed on histopathological examination of the paraffin block.

Conclusion: This case underscores the importance of frozen section diagnosis in the management of ACC of the minor salivary glands. The accurate assessment of the lesion and margin status during surgery allows for appropriate surgical decision-making, ensuring complete tumor removal and minimizing the risk of recurrence.

Predicting Mortality in Pulmonary Alveolar Proteinosis: A Meta-Analysis of Prognostic Factors

Mohd Syahbani Nugraha, Rohani Lasmaria, Dewi Wijaya — Tue, 24 Dec 2024 07:52:36 +0000

Background: Pulmonary alveolar proteinosis (PAP) is a rare lung disease with a variable clinical course. This meta-analysis aimed to synthesize the available evidence on prognostic factors associated with mortality in patients with PAP.

Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science databases for studies published from 2013 to 2024. Studies reporting prognostic factors associated with mortality in patients with PAP were included. Data on study characteristics, patient demographics, clinical variables, and outcomes were extracted. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for dichotomous outcomes, and hazard ratios (HRs) and 95% CIs were calculated for time-to-event outcomes. Random-effects meta-analysis was used to pool data, and heterogeneity was assessed using the I² statistic.

Results: Six studies with a total of 1,375 PAP patients were included in the meta-analysis. The pooled analysis showed that several factors were significantly associated with increased mortality in PAP. These included older age (HR 1.45, 95% CI 1.02-1.9, p < 0.001), lower diffusing capacity for carbon monoxide (DLCO) % predicted (HR 0.87, 95% CI 0.65-0.98, p < 0.001), higher serum lactate dehydrogenase (LDH) levels (OR 2.50, 95% CI 1.80-3.47, p < 0.001), lower arterial oxygen tension (PaO₂) (HR 0.89, 95% CI 0.78-0.98, p=0.002), and a diagnosis of secondary PAP (OR 3.85; 95% CI 2.19-5.56, p <0.001). Heterogeneity was moderate to high for most analyses.

Conclusion: This meta-analysis identified several clinical and laboratory parameters associated with increased mortality in PAP. These factors could be used to identify high-risk patients who may benefit from closer monitoring and more aggressive treatment strategies. Further prospective studies are needed to validate these findings and to develop accurate predictive models for mortality in PAP.

Primary Malignant Peritoneal Mesothelioma Mimicking Ovarian Carcinoma: A Case Report Highlighting the Importance of Immunohistochemistry

Rio Hendra, Tofrizal, Hera Novianti, Yessy Setiawati — Fri, 27 Dec 2024 03:57:21 +0000

Background: Primary malignant peritoneal mesothelioma (PMPM) is an uncommon and aggressive malignancy arising from the mesothelial lining of the peritoneal cavity. The diagnosis of PMPM is often challenging due to its rarity, nonspecific clinical presentation, and histologic similarities to other malignancies, particularly adenocarcinomas. Immunohistochemistry plays a crucial role in differentiating PMPM from metastatic adenocarcinoma, which is essential for accurate diagnosis, appropriate treatment, and prognostication.

Case presentation: We present the case of a 43-year-old female who presented with abdominal distension, ascites, and weight loss, initially raising suspicion of ovarian carcinoma. However, histopathological examination of the omental tissue revealed a proliferation of epithelial cells with papillary and glandular-like growth patterns. Immunohistochemical staining demonstrated strong positivity for calretinin, a mesothelial marker, while staining for estrogen receptor (ER) and progesterone receptor (PR) was negative, effectively ruling out an ovarian or endometrial origin. The diagnosis of PMPM, epithelioid subtype, was confirmed.

Conclusion: This case underscores the challenges in diagnosing PMPM and highlights the critical role of immunohistochemistry in differentiating it from metastatic adenocarcinoma. Accurate diagnosis is essential for determining appropriate management strategies and providing prognostic information.

Pectoralis Major Flap: A Versatile Option for Head and Neck Reconstruction - A Case Report

Radot Oktora Tua Pasaribu, Affandi Wiramur, Joko Purnomo — Fri, 27 Dec 2024 08:28:31 +0000

Background: Skin flaps are an essential tool in reconstructive surgery, especially in the head and neck region where defects can result from tumor excision, trauma, or congenital anomalies. The pectoralis major flap is a well-established and versatile option for head and neck reconstruction due to its reliable vascularity, ease of harvest, and ability to cover a variety of defect sizes and locations.

Case presentation: This report describes the case of a 22-year-old male with a history of parotid cancer who presented with a large, bleeding mass on the right side of his neck. Following tumor excision, the resulting defect was successfully reconstructed using a pectoralis major flap.

Conclusion: The pectoralis major flap is a reliable and versatile reconstructive option for head and neck defects. It offers several advantages, including good vascularity, ease of harvest, and the ability to provide adequate tissue bulk for complex reconstructions.

A Multidisciplinary Approach to Managing Multiple Tuberous Xanthomas in a Pediatric Patient with Familial Hypercholesterolemia Type II: A Rare Case

Mon, 30 Dec 2024 04:18:43 +0000

Background: Familial hypercholesterolemia (FH) is a rare inherited disorder characterized by high cholesterol levels, primarily high levels of low-density lipoprotein cholesterol (LDL-C). This condition can lead to premature cardiovascular disease. A less recognized but significant manifestation of FH is the development of multiple tuberous xanthomas, which are exogenous masses or fatty deposits on the skin.

Case presentation: This report describes the case of a 4-year-old female child who presented to the Dermatology, Venereology, and Aesthetics Department of Dr. M. Djamil General Hospital Padang with multiple yellowish, painless, and non-itchy lumps on her body. These lumps were located on her knuckles, hands, elbows, buttocks, knees, back of knees, ankles, and feet. The lumps had been progressively increasing in size over the past month. Her medical history revealed that she first developed a yellowish lump on her right ankle two years prior, which gradually spread to other areas of her body. A dermoscopic examination showed a yellow-brown structureless area, and laboratory tests confirmed hypercholesterolemia with elevated LDL levels. Her triglycerides were normal, and both of her parents also had hypercholesterolemia. A histopathology examination confirmed the diagnosis of xanthoma. The patient was diagnosed with tuberous xanthomas and treated with simvastatin 1x10 mg, along with surgical excision of the xanthomas and flap reconstruction under general anesthesia.

Conclusion: This case highlights the importance of a multidisciplinary approach in managing multiple tuberous xanthomas in a child with FH. While surgical excision can effectively remove the lesions, ongoing lipid-lowering therapy is crucial to prevent recurrence and reduce cardiovascular risks associated with FH. Collaboration among dermatologists, pediatric cardiologists, and pediatric nutritionists is vital to ensure comprehensive care and enhance the patient's overall quality of life.

Diagnostic Roles of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Vertebral Fracture due to Tuberculosis and Malignancy

Iwan Vanca Saragih, Agus Priambodo — Mon, 30 Dec 2024 08:14:06 +0000

Background: Vertebral fracture is a serious complication that can occur due to various medical conditions, including bone tuberculosis and malignancy (eg, cancer metastasis to the vertebrae). This condition invariably causes an increase in the inflammatory process in the body, which can be identified through the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR). This study aims to investigate the differences in NLR and PLR values in patients with vertebral fractures due to TB or malignancy.

Methods: A retrospective observational study was conducted on vertebral fracture patients who underwent surgery in the Orthopedic Surgery Department of Dr. Kariadi Hospital Semarang between January 1^st, 2022, and December 31^st, 2023. Data on demographics and laboratory test results were extracted from medical records. Statistical analysis was performed using univariate analysis and presented as percentage and frequency. T-test or Mann-Whitney test was used to determine the difference based on their normality distribution. The diagnostic value of NLR and PLR was also analyzed using the receiver operating characteristic (ROC) curve and Youden index.

Results: The study included 54 vertebral fracture patients. The mean age of patients was 41.77 ± 16.00 years, and the majority were female patients (68.5%). The Neutrophil to Lymphocyte Ratio (NLR) value was significantly higher in vertebral fracture due to malignancy patients than TB (5.5 (IQR 3.92 – 13.39) vs 4.53 (IQR 2.91 – 6.96), p=0.020). In contrast, the Platelet to Lymphocyte Ratio (PLR) value was not significantly different (p>0.05). The area under the curve for the NLR (0.69, 95% confidence interval [CI], 0.54 – 0.839) was greater than that of PLR (0.408, 95% CI, 0.246 – 0.571).

Conclusion: NLR showed significantly different results in determining the cause of vertebral fractures, either tuberculosis or malignancy. NLR can be used as an important diagnostic marker to help differentiate between vertebral fractures caused by malignancy and those caused by infection.

The Importance of Dermoscopy for Early Recognition of Superficial Spreading Melanoma in Adolescents: A Case Report

Cherry Chalik, Ennesta Asri, Indah Indria Sari — Mon, 06 Jan 2025 03:44:43 +0000

Background: Malignant melanoma, a highly aggressive form of skin cancer, is rare in adolescents. Early diagnosis is crucial for the best possible treatment and prognosis. Dermoscopy, a non-invasive technique, has been shown to increase the sensitivity of melanoma diagnosis, leading to early identification and better treatment outcomes.

Case presentation: A 14-year-old female presented with a painful, bleeding black nevus on her right upper arm, increasing in size over four months. Dermoscopic examination, using a two-step algorithm and the ABCD rule, categorized the lesion as malignant melanoma. Histopathological examination confirmed the diagnosis of superficial spreading melanoma (Breslow 2, AJCC stage IIB). The patient underwent Mohs surgery for treatment.

Conclusion: This case highlights the importance of dermoscopy in the early recognition of melanoma in adolescents. Dermoscopy aids in differentiating between benign and malignant melanocytic lesions, enabling prompt diagnosis and treatment. Increased awareness and utilization of dermoscopy can significantly improve outcomes in this patient population.

Challenges in Managing Corneal Ulcer with Hypopyon in an Uncontrolled Diabetes Mellitus Patient: A Case Report

Nyoman Yuni Suryani Dharmaputri P., Luh Putu Eka Naryati — Mon, 06 Jan 2025 08:27:47 +0000

Background: Corneal ulcer is an ophthalmological emergency that can cause blindness. The risk of increasing this complication occurs mainly in patients with systemic diseases such as diabetes mellitus.

Case presentation: a 50-year-old male patient was treated with OS corneal ulcer cum hypopyon with a history of diabetes mellitus. On the first visit, the visual acuity examination was found to be 6/7.5 in both eyes, and the results of the corneal erosion examination were in the left eye. However, on further evaluation, the left eye's visual acuity worsened to 6/45. Anterior segment examination of the left eye showed infiltration and hypopyon formation on the next visit evaluation. The patient's condition did not improve with conventional therapy, so surgical intervention was performed in the form of amniotic membrane transplantation, hypopyon aspiration, and intracameral antibiotic injection. Corneal and hypopyon scraping culture results did not show bacterial and fungal growth. Corneal condition improved after blood sugar was controlled with insulin.

Conclusion: Corneal ulcers with hypopyon in patients with diabetes and diabetic keratopathy require a comprehensive approach to address infection, inflammation, and impaired healing. Multidisciplinary collaboration, especially blood sugar control, is important to improve long-term prognosis.

Early-Onset Urticaria Pigmentosa in a 7-Month-Old Infant: A Case Report

Nellia Fonna, Mutia Sari, Rina Gustia — Tue, 07 Jan 2025 01:45:48 +0000

Background: Urticaria pigmentosa (UP) is the most common form of cutaneous mastocytosis in children, accounting for 70-90% of cases. UP typically presents in infancy or early childhood with characteristic skin lesions that vary in appearance. The hallmark of UP is the presence of reddish-brown macules or papules that urticate or blister upon rubbing, a phenomenon known as Darier's sign. Histopathological examination of a skin biopsy is confirmatory, demonstrating an increased number of mast cells in the dermis.

Case presentation: We report a case of early-onset UP in a 7-month-old infant boy who presented with multiple hyperpigmented macules all over his body. The lesions were pruritic and had progressively increased in size and number over the past two weeks. Dermatological examination revealed multiple erythematous macules on the face, hyperpigmented macules on the chest, abdomen, and extremities, hyperpigmented plaques on the legs, and a nodule on the back. The lesions exhibited a positive Darier's sign, characterized by swelling and redness upon rubbing. Systemic examination was unremarkable, with no evidence of hepatomegaly, splenomegaly, or lymphadenopathy. Dermoscopy of the lesions revealed a central pigment network and a light brownish peripheral structure, suggestive of UP. Histopathological examination of a skin biopsy confirmed the diagnosis of UP, demonstrating an increased number of mast cells in the dermis. The patient was treated with oral antihistamines (cetirizine) and topical corticosteroids (hydrocortisone) for four weeks, resulting in significant regression of the lesions.

Conclusion: This case highlights the importance of recognizing the clinical features of UP in infants. Early diagnosis and appropriate management can help alleviate symptoms and improve the quality of life for affected children.

β2-Microglobulin: A Powerful Biomarker for Chronic Kidney Disease Progression

Yanuar Surya Saputra Poedjijo, Drajad Priyono, Deka Viotra, Harnavi Harun — Tue, 07 Jan 2025 03:01:16 +0000

Background: Chronic kidney disease (CKD) is a global health concern with increasing prevalence. Early detection and accurate prognosis are crucial for effective management. β2-microglobulin (β2M) has emerged as a promising biomarker in CKD, but its prognostic value requires further evaluation. This meta-analysis aimed to comprehensively assess the association between β2M and CKD progression.

Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between 2013 and 2024 investigating the relationship between β2M and CKD progression. Studies were included if they reported hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between β2M levels and renal endpoints (e.g., end-stage renal disease [ESRD], doubling of serum creatinine, or a decline in estimated glomerular filtration rate [eGFR]). A random-effects model was used to pool the HRs.

Results: Six eligible studies involving 5,420 participants were included. The pooled analysis demonstrated a significant association between elevated β2M levels and increased risk of CKD progression (HR = 2.15; 95% CI: 1.78-2.59; p < 0.001). Subgroup analyses revealed that this association remained consistent across different CKD stages and underlying etiologies.

Conclusion: Elevated β2M is a strong and independent predictor of CKD progression. Its incorporation into clinical practice may improve risk stratification and guide therapeutic interventions in CKD patients.

A Rare Presentation of Type 2 Lepra Reaction: Necrotizing Erythema Nodosum Leprosum with Extensive Ulceration

Tutty Ariani, Clarissa Maharani Putri — Wed, 08 Jan 2025 08:59:21 +0000

Background: Leprosy, primarily caused by Mycobacterium leprae, is a chronic infectious disease that mainly affects the skin and peripheral nerves. Type 2 leprosy reaction (ENL) is an immune complex-mediated complication characterized by inflammation of the skin, nerves, and other organs. A less common manifestation of ENL is necrotizing ENL, which presents with extensive skin necrosis and ulceration. This case report describes a rare presentation of necrotizing ENL with extensive ulceration in a young woman with borderline lepromatous leprosy.

Case presentation: A 20-year-old female presented with multiple, progressively enlarging, painless ulcers on her right leg and painful reddish nodules on her left arm and left leg. She had a history of borderline lepromatous leprosy. Dermatological examination revealed madarosis, infiltration, nodules, hyperpigmentation macules, ulcers, and blackish crusts. Sensory testing showed hypoesthesia in the abdomen and back, and anesthesia in both lower arms and legs. Histopathological examination confirmed the diagnosis of necrotizing ENL.

Conclusion: Necrotizing ENL is a rare and severe complication of leprosy. This case highlights the importance of early diagnosis and appropriate management with multi-drug therapy and corticosteroids to prevent significant morbidity and disability.

FOLFOX vs. FOLFIRI in Colorectal Adenocarcinoma: A Retrospective Study of Treatment Patterns, Side Effects, and Treatment Response

Thu, 09 Jan 2025 01:55:25 +0000

Background: Colorectal adenocarcinoma (CRC) is a prevalent malignancy with a high recurrence rate, necessitating multimodal treatment strategies. Chemotherapy regimens like FOLFOX (folinic acid, fluorouracil, oxaliplatin) and FOLFIRI (folinic acid, fluorouracil, irinotecan) are crucial components of this approach. This study aimed to analyze treatment patterns, side effects, and treatment response of FOLFOX and FOLFIRI in a real-world cohort of CRC patients.

Methods: A retrospective observational study was conducted on CRC patients who received FOLFOX or FOLFIRI between January 2020 and December 2023. Data on demographics, disease stage, chemotherapy regimen, side effects, comorbidities, and treatment response were collected from electronic medical records.

Results: A total of 146 patients were included. The majority were male (57.5%) with a mean of age 58.4 years. Most tumors were located in the rectum and sigmoid (75.3%), with over 50% of patients presenting with stage IV disease. FOLFIRI was the most common regimen (45.9%), followed by FOLFOX (36.3%). Common side effects included nausea, vomiting, decreased appetite, and hair loss. Hypertension was the most prevalent comorbidity. A total of 79.5% of patients were alive after chemotherapy.

Conclusion: This study provides insights into the real-world treatment patterns and outcomes of FOLFOX and FOLFIRI in CRC patients. The choice of regimen appears to be influenced by factors such as disease stage and patient characteristics. Further research is needed to compare the efficacy and safety of these regimens and identify optimal treatment strategies for specific patient subgroups.

Successful Anesthetic Management of Pheochromocytoma in a Patient with Preoperative Hypertension: A Case Report

Faisal Irwanda, Novita Anggraeni — Thu, 09 Jan 2025 04:28:38 +0000

Background: Pheochromocytoma, a rare tumor arising from chromaffin cells in the adrenal medulla, poses significant anesthetic challenges due to its propensity to release catecholamines, potentially leading to life-threatening hypertensive crises. This case report describes the successful anesthetic management of a patient with pheochromocytoma presenting with preoperative hypertension.

Case presentation: A 37-year-old female with a 12x5 cm right adrenal tumor diagnosed as pheochromocytoma was scheduled for adrenalectomy. She presented with a history of uncontrolled hypertension, episodic headaches, diaphoresis, and palpitations. Preoperative management focuses on blood pressure control using alpha and beta-adrenergic blockers. Anesthesia was induced with propofol, fentanyl, and atracurium, while nitroglycerin and sevoflurane were used to maintain hemodynamic stability. The patient's blood pressure was closely monitored throughout the procedure, with interventions made to manage fluctuations during tumor manipulation.

Conclusion: Successful anesthetic management of pheochromocytoma requires meticulous preoperative preparation, vigilant intraoperative monitoring, and prompt pharmacological interventions. This case highlights the importance of a multidisciplinary approach, including endocrinologists, anesthesiologists, and surgeons, to optimize patient outcomes.

Atypical Pneumonia in the Elderly: A Meta-Analysis of Risk Factors, Treatment Outcomes, and Mortality

Veghasanah Tanlie, Zarfiardy Aksa Fauzi — Mon, 13 Jan 2025 04:19:08 +0000

Background: Atypical pneumonia poses a significant threat to elderly individuals, often leading to severe complications and increased mortality. This meta-analysis aimed to evaluate risk factors, treatment outcomes, and mortality associated with atypical pneumonia in elderly patients.

Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted from January 2013 to December 2024. Studies reporting on atypical pneumonia in patients aged 65 years or older were included. Data on risk factors, treatment outcomes (clinical cure rate, radiological improvement, length of hospital stay), and mortality were extracted and pooled using random-effects models.

Results: Six studies involving 1,875 elderly patients with atypical pneumonia were included. Advanced age (≥80 years), comorbidities (chronic obstructive pulmonary disease, heart failure, diabetes mellitus), and delayed initiation of antibiotic therapy were identified as significant risk factors for severe disease and mortality. Treatment with macrolides was associated with a higher clinical cure rate (OR 2.15, 95% CI 1.52-3.04, p<0.001) and shorter hospital stay (mean difference -2.8 days, 95% CI -4.1 to -1.5, p<0.001) compared to fluoroquinolones. The pooled mortality rate was 12.8% (95% CI 9.5-16.1%).

Conclusion: Atypical pneumonia in the elderly is associated with significant morbidity and mortality. Early recognition of risk factors and prompt initiation of appropriate antibiotic therapy, particularly with macrolides, are crucial for improving outcomes in this vulnerable population.

Modified Hughes Tarsoconjunctival Flap Procedure for Lower Eyelid Defect: A Case Series

Aulia, Hendriati — Mon, 13 Jan 2025 05:53:49 +0000

Background: The Hughes procedure, or tarsoconjunctival flap, is a technique used in reconstructing full-thickness lower eyelid defects involving >50% of the eyelid margin to restore anatomical integrity, function, and cosmesis of the eyelid. The modified Hughes procedure spares the marginal upper lid tarsus and removes the levator muscle aponeurosis from the tarsoconjunctival flap. This study reports a case series of patients who underwent a modified Hughes procedure after basal cell carcinoma excision.

Case presentation: Two patients underwent lower eyelid reconstruction using the modified Hughes procedure. After a wide excision of the tumor, a tarsoconjunctival flap was created to reconstruct the posterior lamella of the eyelid. Subsequently, the anterior lamella of the eyelid was reconstructed using a full-thickness skin graft and an advancement flap, respectively. Both patients underwent a second surgery, tarsus flap release, 6-8 weeks after the first surgery. Postoperatively, tarsal flap apposition, skin flap/graft, and stitches were intact. After the tarsus flap release, wound healing was good. A tumor biopsy showed basal cell carcinoma.

Conclusion: The modified Hughes procedure is a treatment of choice in reconstructing full-thickness lower eyelid defects involving >50% of the eyelid margin. Full-thickness skin graft and advancement flap to reconstruct the anterior lamella of the eyelid are chosen after considering skin color, texture similarity, and the laxity of the eyelid and cheek.

Profound Immunosuppression with Reversed CD4:CD8 Ratio in a Tuberculosis Patient with Acquired Immunodeficiency Syndrome: A Case Report

Doan Atrya, Efrida — Mon, 13 Jan 2025 08:53:51 +0000

Background: The co-occurrence of tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS) presents a formidable clinical challenge due to the synergistic impact on the immune system. This case report describes a patient with TB/AIDS co-infection exhibiting profound immunosuppression characterized by a severely diminished CD4 count and an unusual reversal of the CD4:CD8 ratio.

Case presentation: A 39-year-old male presented with symptoms indicative of both TB and advanced HIV infection, including shortness of breath, weight loss, and oral thrush. Physical examination revealed bilateral lung crackles. Laboratory investigations confirmed pulmonary TB and revealed a critically low CD4 count (6 cells/µL), and a CD8 count of 71 cells/µL, resulting in a reversed CD4:CD8 ratio of 0.08. The patient's HIV viral load was markedly elevated at 598,403 copies/mL. This case underscores the complex interplay between TB and HIV, highlighting the profound impact of co-infection on immune system function. The patient's severely depleted CD4 count and the atypical CD4:CD8 ratio reflect the advanced stage of HIV infection and the superimposed TB. The findings emphasize the need for close monitoring and aggressive management of co-infected patients to mitigate the risk of opportunistic infections and disease progression.

Conclusion: This case report documents a rare and severe presentation of TB/AIDS co-infection with profound immunosuppression and a reversed CD4:CD8 ratio. It serves as a reminder of the significant morbidity and mortality associated with advanced HIV and TB co-infection, particularly in cases of delayed diagnosis or suboptimal treatment adherence.

Novel Insights into the Pathophysiology of Coronary Slow Flow Phenomenon: The Role of Triglycerides-Glucose Index and Electrocardiogram Risk Score in Subclinical Atherosclerosis

Singgih Kusuma, Erwin Sukandi, Taufik Indrajaya, Ferry Usnizar, Irfannuddin — Tue, 14 Jan 2025 01:29:05 +0000

Background: Coronary slow flow phenomenon (CSFP) is characterized by delayed distal coronary vessel opacification without significant epicardial coronary stenosis. The underlying mechanisms of CSFP remain unclear, but subclinical atherosclerosis is a likely contributor. This study investigated the relationship between the Triglycerides-Glucose Index (TyG), Electrocardiogram Risk Score (ERS), and carotid intima-media thickness (CIMT) in CSFP patients.

Methods: This cross-sectional study involved 31 patients diagnosed with CSFP at Dr. Mohammad Hoesin General Hospital Palembang. CSFP was determined based on coronary blood flow slowdown on angiography. Data collection included anamnesis, physical examination, laboratory tests, echocardiography, and CIMT measurement. Statistical analysis was performed using SPSS 27.

Results: The majority of CSFP patients were male (51.6%) with a mean age of 50.87 ± 13.94 years. Dyslipidemia was the most prevalent risk factor (77.4%), followed by hypertension (35.5%), smoking (22.6%), and diabetes mellitus (6.5%). Statistical analysis revealed significant positive correlations between TyG index and CIMT (r = 0.445, p = 0.012), and between ERS and CIMT (r = 0.476, p = 0.007).

Conclusion: TyG and ERS indices are positively correlated with CIMT in CSFP patients. These indices may be useful tools for cardiovascular risk evaluation and early identification of high-risk patients for subclinical atherosclerosis and potential CSFP.

Epidural Hematoma Volume and Glasgow Coma Scale Score: A Cross-Sectional Analysis of Head Injury Patient

Stefanus Satria Adi Dharma, Erie Bambang Prijono Setyabudi Andar — Tue, 14 Jan 2025 03:24:09 +0000

Background: Epidural hematoma (EDH) is a common neurosurgical emergency with potentially life-threatening consequences. The Glasgow Coma Scale (GCS) is a widely used tool for assessing the severity of head injuries, but its correlation with EDH volume remains unclear. This study aimed to investigate the relationship between EDH volume and GCS score in head injury patients.

Methods: A retrospective cross-sectional analysis was conducted on 63 patients with head injuries and EDH admitted to a tertiary care hospital between 2021 and 2023. EDH volume was measured using computed tomography (CT) scans, and GCS scores were recorded upon admission. Statistical analysis was performed to assess the correlation between EDH volume and GCS score.

Results: The mean EDH volume was 30.5 ml (SD = 22.5), and the mean GCS score was 11.2 (SD = 3.8). A significant negative correlation was found between EDH volume and GCS score (r = -0.437, p < 0.001), indicating that larger EDH volumes were associated with lower GCS scores.

Conclusion: EDH volume is significantly correlated with GCS score in head injury patients. This finding underscores the importance of prompt diagnosis and surgical intervention for EDH, especially in patients with large hematomas and low GCS scores.

Successful Anesthetic Management of a Cesarean Section in a Patient with Cardiomyopathy and Cardiogenic Shock: A Case Report

Alta Ikhsan Nur, Nopian Hidayat, Novita Anggraeni, Sony — Tue, 14 Jan 2025 05:40:10 +0000

Background: Cardiomyopathy in pregnancy is a rare but serious condition that can lead to significant maternal and fetal morbidity and mortality. Anesthetic management of these patients is challenging due to the complex interplay of physiological changes and the potential for hemodynamic instability. This case report describes the successful anesthetic management of a cesarean section in a patient with cardiomyopathy and cardiogenic shock.

Case presentation: A 29-year-old woman with cardiomyopathy and cardiogenic shock presented for emergency cesarean section at 36-37 weeks gestation. She had a history of global hypokinetic, left ventricular and atrial dilatation, and an ejection fraction (EF) of 32%. She was also in atrial fibrillation. Epidural anesthesia was selected due to its lower risk of complications compared to general anesthesia. The patient was carefully monitored throughout the procedure, and her hemodynamics were maintained with a combination of fluids and inotropes. The surgery was successful, and the patient delivered a healthy baby boy.

Conclusion: This case report demonstrates that successful anesthetic management of cesarean section is possible in patients with cardiomyopathy and cardiogenic shock. Careful planning, close monitoring, and a multidisciplinary approach are essential for a positive outcome.

Propolis from Mount Lawu: Dose-Dependent Antioxidant and Anti-Inflammatory Effects in a Rat Model of Wound Healing

Proginova Dian Yudatama, Amru Sungkar, Ida Bagus Budhi Surya Adnyana — Wed, 15 Jan 2025 00:00:00 +0000

Background: Chronic wounds present a significant healthcare challenge, necessitating the exploration of effective adjuvant therapies. Propolis, a natural product derived from beehives, has demonstrated antioxidant and anti-inflammatory properties. This study investigated the dose-dependent effects of Mount Lawu propolis extract on oxidative stress and inflammation in a rat model of wound healing.

Methods: A completely randomized experimental design was employed using male rats (Rattus norvegicus). Granulation tissue wounds were induced, and the rats were treated with varying doses of ethanol extract of Mount Lawu propolis. Immunohistochemical analysis was performed to assess the expression of Malondialdehyde (MDA) and Interleukin-6 (IL-6) in the wound tissue.

Results: The results demonstrated a significant dose-dependent decrease in MDA and IL-6 expression in the propolis-treated groups compared to the control group. The high-dose propolis group exhibited the most substantial reduction in both MDA and IL-6 levels.

Conclusion: Mount Lawu propolis extract exhibits potent antioxidant and anti-inflammatory effects in a dose-dependent manner, suggesting its potential as an adjuvant therapy for chronic wound management.

Do Ventilator Bundles Reduce Ventilator-Associated Pneumonia? A Meta-Analysis of Randomized Controlled Trials

Reski Anugrah Zuandra, Irvan Medison, Russilawati — Wed, 15 Jan 2025 04:03:25 +0000

Background: Ventilator-associated pneumonia (VAP) is a serious complication in mechanically ventilated patients, leading to increased morbidity, mortality, and healthcare costs. Ventilator bundles are evidence-based practices aimed at preventing VAP. This meta-analysis evaluated the effectiveness of ventilator bundles in reducing VAP incidence in critically ill adults.

Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted from January 2013 to December 2024. Randomized controlled trials (RCTs) comparing ventilator bundles to standard care in adult patients receiving mechanical ventilation were included. The primary outcome was the incidence of VAP. Secondary outcomes included mortality, length of intensive care unit (ICU) stay, and duration of mechanical ventilation. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.

Results: Nine RCTs involving 2,850 patients met the inclusion criteria. The implementation of ventilator bundles was associated with a significant reduction in VAP incidence (RR 0.68, 95% CI 0.55-0.84, p=0.0002). Mortality (RR 0.89, 95% CI 0.75-1.05, p=0.16) and duration of mechanical ventilation (mean difference -1.2 days, 95% CI -2.8 to 0.4, p=0.13) did not significantly differ between groups. However, a significant reduction in ICU length of stay was observed in the ventilator bundle group (mean difference -2.1 days, 95% CI -3.5 to -0.7, p=0.004).

Conclusion: This meta-analysis demonstrates that ventilator bundles are effective in reducing VAP incidence in critically ill adults. While no significant impact on mortality was observed, ventilator bundles were associated with a shorter ICU length of stay. These findings reinforce the importance of implementing ventilator bundles as a standard of care in ICUs to improve patient outcomes.

The Role of Superoxide Dismutase in Kidney Aging: A Meta-Analysis of Oxidative Stress, Inflammation, and Renal Function

Hannie Qalbina Syaiful, Harnavi Harun — Wed, 15 Jan 2025 07:57:45 +0000

Background: Kidney aging is an inevitable physiological process characterized by a progressive decline in renal function, increased oxidative stress, and chronic low-grade inflammation. Superoxide dismutase (SOD), a key antioxidant enzyme, plays a crucial role in mitigating oxidative damage. This meta-analysis aimed to comprehensively evaluate the association between SOD levels/activity and markers of oxidative stress, inflammation, and renal function in the context of kidney aging.

Methods: A systematic search of PubMed, Scopus, and Web of Science databases was conducted for relevant studies published between 2013 and 2024. Studies investigating the relationship between SOD (SOD1, SOD2, SOD3) and kidney aging in humans were included. Data on SOD levels/activity, oxidative stress markers, inflammatory markers, and renal function parameters were extracted. Random-effects models were used to pool the standardized mean differences (SMD) and 95% confidence intervals (CI).

Results: Nine studies with a total of 1,245 participants were included in the meta-analysis. Pooled analysis revealed a significant negative association between SOD activity and markers of oxidative stress (SMD = -0.85, 95% CI: -1.20 to -0.50, p < 0.001). Similarly, SOD activity was inversely associated with inflammatory markers (SMD = -0.62, 95% CI: -0.95 to -0.29, p < 0.001). Furthermore, a significant positive association was observed between SOD activity and eGFR (SMD = 0.78, 95% CI: 0.41 to 1.15, p < 0.001).

Conclusion: This meta-analysis provides compelling evidence that SOD plays a critical role in mitigating oxidative stress and inflammation in kidney aging, contributing to the preservation of renal function. These findings highlight the potential of SOD as a therapeutic target for age-related kidney diseases.

Pharmacological and Interventional Approaches to Ascites Management in Cirrhosis: A Meta-Analysis

Annisa Ul Husni, Saptino Miro — Wed, 15 Jan 2025 08:16:42 +0000

Background: Ascites, a common complication of cirrhosis, significantly impacts patient morbidity and mortality. This meta-analysis evaluated the efficacy and safety of various pharmacological and interventional approaches for ascites management in patients with cirrhosis.

Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted from January 2013 to December 2024, identifying randomized controlled trials (RCTs) comparing different pharmacological agents (diuretics, albumin, vasopressin receptor antagonists) and interventional procedures (large-volume paracentesis, transjugular intrahepatic portosystemic shunt [TIPS]) in cirrhotic patients with ascites. The primary outcome was complete ascites resolution. Secondary outcomes included time to ascites recurrence, adverse events, and mortality. A random-effects model was used to pool data, and heterogeneity was assessed using the I² statistic.

Results: Twelve RCTs (n=2848 patients) met the inclusion criteria. Diuretics plus albumin was superior to diuretics alone in achieving complete ascites resolution (OR 2.18, 95% CI 1.65-2.88, p<0.001; I²=38%). Vasopressin receptor antagonists were comparable to diuretics plus albumin in terms of ascites resolution (OR 1.09, 95% CI 0.88-1.35, p=0.42; I²=12%) but associated with a lower incidence of hyponatremia (OR 0.52, 95% CI 0.35-0.78, p=0.002; I²=23%). Large-volume paracentesis was more effective than repeated small-volume paracentesis for ascites control (OR 1.75, 95% CI 1.31-2.34, p<0.001; I²=41%). TIPS was associated with a higher rate of complete ascites resolution compared to large-volume paracentesis (OR 2.45, 95% CI 1.78-3.38, p<0001; I²=35%) but a higher risk of hepatic encephalopathy (OR 2.21, 95% CI 1.48-3.30, p<0.001; I²=15%). Albumin reduced mortality in patients undergoing large-volume paracentesis (OR 0.68, 95% CI 0.49-0.94, p=0.02; I²=0%).

Conclusion: This meta-analysis supports the use of diuretics plus albumin, vasopressin receptor antagonists, large-volume paracentesis, and TIPS for ascites management in cirrhosis, with the choice of therapy individualized based on patient characteristics, ascites severity, and the risk of complications.

Neutrophil-Lymphocyte Ratio as a Novel Biomarker for Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study

Rahnowi Pradesta, Novadian, Yulianto Kusnadi, Nova Kurniati, Syarif Husin — Thu, 16 Jan 2025 02:53:05 +0000

Background: Early detection of diabetic nephropathy (DN) is crucial to prevent progression to end-stage renal disease. The gold standard for diagnosing DN involves urine microalbumin testing and renal biopsy. However, the availability of these diagnostic tools is limited in many healthcare facilities across Indonesia. Consequently, there is a pressing need for an alternative examination that is readily accessible and can effectively monitor the progression of DN.

Methods: This cross-sectional study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, from February 2024 to May 2024. The study aimed to investigate the correlation between neutrophil-lymphocyte ratio (NLR) and urinary albumin levels in type 2 diabetes mellitus (DM) patients. NLR, calculated from complete blood counts, has emerged as a potential inflammatory marker for various conditions. A total of 65 participants diagnosed with type 2 DM were enrolled in the study. Data analysis involved Spearman's correlation test to assess the relationship between NLR and urinary albumin levels.

Results: The majority of the 65 subjects were female (58.5%). The study found that 44 subjects had normoalbuminuria, 18 had microalbuminuria, and 3 had macroalbuminuria. A significant positive correlation was observed between NLR and albuminuria levels in type 2 DM patients (r = 0.795; p < 0.01).

Conclusion: The study's findings suggest that NLR is a potential cost-effective biomarker for the early detection of DN in type 2 DM patients, especially in resource-limited settings. Further large-scale studies are recommended to validate these findings and establish specific NLR thresholds for predicting DN progression.