Accreditation
SINTA 2Nationally Accredited Journal
Vol. 8 No. 6 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Articles
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Analysis of Risk Factors for Increased Intraocular Pressure in Phacoemulsification Surgery: Single Center Study in Jakarta, Indonesia
Views: 593Downloads: 286Background: Phacoemulsification, a common cataract surgery technique, can increase intraocular pressure (IOP) postoperatively. This study aimed to identify risk factors contributing to increased IOP, focusing on patient age and duration of phacoemulsification.
Methods: A cross-sectional study was conducted at Harapan Jayakarta Hospital, Jakarta, for 4 months (May-September 2023) on 43 cataract patients ≥40 years old who underwent phacoemulsification. Inclusion criteria were preoperative IOP 10-21 mmHg, clear conjunctival and corneal structures. Data analysis was carried out univariate and bivariate using SPSS.
Results: Analysis showed a significant correlation between patient age and phacoemulsification duration (older patients = longer phacoemulsification time), with a mean age of 63.21 years. Phacoemulsification duration >270 seconds significantly increases the risk of postoperative IOP.
Conclusion: Prolonged exposure to ultrasonic waves during phacoemulsification can cause cellular injury to the internal structures of the eye, increasing IOP. Identifying modifiable risk factors, such as optimizing phacoemulsification timing, may reduce these complications and improve cataract surgery outcomes.
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Nephrotic Syndrome in a 24-Year-Old Female with Myelodysplastic Syndrome: A Case Report
Views: 546Downloads: 504Background: Nephrotic syndrome is rare in the normal population but is reported more frequently in patients with myelodysplastic syndrome (MDS). The pathogenesis is not clearly known, but it is thought to be related to immune dysregulation.
Case presentation: We report a case of nephrotic syndrome in a 24-year-old woman with MDS. Patients complain of swelling, foamy urination, paleness, weakness, bleeding gums, and reddish spots on the body. Physical examination revealed hypertension, anemia, petechiae, and edema. Laboratory examination showed anemia, thrombocytopenia, hypoalbuminemia, dyslipidemia, and proteinuria. Abdominal ultrasound showed chronic processes in the kidneys, ascites, and pleural effusion. A renal biopsy showed membranoproliferative glomerulonephritis.
Conclusion: Nephrotic syndrome in MDS patients is rarely reported, and its pathogenesis is still not clearly understood. Further research is needed to understand the pathogenesis and optimal therapeutic options.
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Polycystic Kidney Disease with Breast Nodules in a Male: A Case Report
Views: 715Downloads: 526Background: Polycystic kidney disease is a multisystem and progressive congenital kidney disorder characterized by kidney enlargement and the growth of cysts in the kidneys and other organs. Autosomal dominant polycystic kidney disease (ADPKD) is the most common type of inherited kidney disorder and is observed in 1/500 – 1/1000 people. The diagnosis is usually made by a positive family history , and the Ravine ultrasonographic criteria assess the age and number of cysts in both kidneys.
Case presentation: A 37-year-old male was reported with complaints of intermittent hematuria and a painless lump in the right breast for the last 6 years. Patients routinely drink herbal medicine when symptoms appear. Abdominal physical examination revealed renal ballottement. The lump in the right breast is palpable as a lump ± 1 cm from the nipple. No abnormalities in kidney or liver function were found on laboratory examination. Ultrasound was performed, and polycystic kidney disease was obtained in both kidneys and liver, as well as a hypervascular solid nodule in the right breast. The patient was given antibiotics and antifibrinolytics. Healthy lifestyle education is also provided to patients. The patient was then referred for a biopsy of the nodule.
Conclusion: Autosomal dominant polycystic kidney disease (ADPKD) is a common disease but only a few cases of ADPKD are accompanied by nodules in the breast, so a further approach is needed.
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Malignant Lesion on Intraoperative Frozen Section with Histopathology Feature Alveolar Soft Part Sarcoma: A Case Report
Views: 575Downloads: 524Background: Alveolar soft part sarcoma (ASPS) are slow-growing inert soft tissue masses, but fast-growing masses are also reported. Because the cancer tissue is rich in blood vessels, distant metastasis is easy to occur through the blood tract, and lung metastasis is the most common. The diagnosis of ASPS should be combined with histopathology examination because of its rarity and often misdiagnosed, especially in unusual sites.
Case presentation: A 22-year-old female came to the oncology surgery polyclinic at Dr. M. Djamil General Hospital Padang with a chief complaint of a lump in her left thigh since 1 year ago and has been getting enlarged in the last 6 months. The lump has been painful for the last 2 months. Upon an intraoperative frozen section examination, it was concluded that the lesion was malignant. Then, the tissue was prepared from formalin fixed paraffin embedded (FFPE), and the lesion was diagnosed as alveolar soft part sarcoma.
Conclusion: In the case of ASPS, surgical management has an important role. The goal of the intraoperative frozen section of this patient is to determine whether the lesion is benign or malignant. There is a need for histological examination, collaboration, and optimal communication between pathologists and surgeons to avoid limitations and pitfalls examination.
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Local Anesthetics with Vasoconstrictors in Hypertensive Patients Undergoing Dental Extraction Procedures: A Serial Case Report
Views: 1,955Downloads: 2,501Background: Systemic absorption of vasoconstrictors and adverse cardiac effects are reasons for not using vasoconstrictors in hypertensive patients. However, several recent studies reported that the use of local anesthetics with vasoconstrictors in hypertensive patients doesn’t cause a statistically significant increase in blood pressure and heart rate. The objective of the study is to evaluate the preoperative, intraoperative and postoperative blood pressure, heart rate and peripheral oxygen saturation in hypertensive patient who undergoing dental extraction procedures with local anesthetics with vasoconstrictors.
Case presentation: We reported three serial cases of male patients (40, 45, 47 years old) undergoing radixes lower posterior tooth extracted, with blood pressures 143/88mmHg, 140/86mmHg and 142/86 mmHg. The patient underwent extraction under infiltration local anesthetics with vasoconstrictors (epinephrine). All patient’s blood pressure increased 1-3 points intraoperative and decreased again postoperative. The patient's heart rate also increased 10-25 times per minute intraoperative. The decrease in oxygen saturation (2%) only occurred in one patient, intraoperative.
Conclusion: The slight hemodynamic changes in these three patients indicate that the use of local anesthetics with vasoconstrictors in hypertensive patients undergoing dental extraction procedures is relatively safe.
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The Role of rs6152 Allele and Non-Genetic Factors in Androgenetic Alopecia: A Pilot Study in the Indonesian Local Population
Views: 1,278Downloads: 1,052Background: Androgenetic alopecia (AGA) is a common form of hair loss which inflicts progressive hair loss leading to various patterns. The cause of this disease is believed to be multifactorial, which is majorly attributed to genetic and non-genetic factors. This pilot study aimed to investigate the association of rs6152 allele, a SNP on AR gene, with AGA, as well as explore other contributing factors in the Indonesian local population.
Methods: In this cross-sectional study, a total of 100 participants, which categorized into alopecia subjects and non-alopecia subjects, were enrolled for rs6152 SNPs detection. Anthropomorphic data such as height and weight, blood pressure and family history were obtained by measurement and questionnaire.
Results: The study showed low frequency of individuals with rs6152 non-risk alleles (2%) and further analysis showed no significant association between rs6152 allele and AGA. However, familial history analysis revealed a strong association between family history and AGA risks. Additionally, age, gender, hypertension status and BMI were identified as significant factors associated (p-value < 0.05) with AGA.
Conclusion: rs6152 was not a reliable genetic marker for AGA in the Indonesian local population. While familial history with AGA showed the inheritance pattern of autosomal dominant inheritance with sex limitation, non-genetic factors such as age, gender, hypertension status and BMI were strongly associated with AGA risk. This shows the complexity and multifactorial causes of AGA in the Indonesian local population.
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Effect of Diagnosis, Complications, and Nutrition for Using Nasogastric Tube to Body Weight of Child Patients with Feeding Difficulty at Dr. M. Djamil General Hospital, Padang, Indonesia
Views: 794Downloads: 419Background: Several conditions in children can cause nutritional intake via the oral route to be inadequate. Providing enteral nutrition via a nasogastric tube (NGT) is an alternative option. Research on the use of NGTs in Indonesia is still limited, so this research aims to determine the effect of NGT use on the weight of pediatric patients with feeding difficulties at Dr. M. Djamil General Hospital, Padang.
Methods: Experimental research with a pre and post-test-only design was conducted on 96 children aged 1 month - 18 years in the children's inpatient room at Dr. M. Djamil General Hospital, Padang. Body weight measurements were carried out before and after using NGT for 4 weeks (January 2022 – January 2023) at the pediatric nutrition and metabolic diseases polyclinic. Data were analyzed using paired t-test and ANOVA.
Results: Most subjects (40.9%) were in the 1-12 month age group. The most common type of nutrition was ONS (oral nutritional supplements) (84.4%), the most common diagnosis was pulmonology (33.3%), and the majority were without complications (72.9%). There is an influence on the child's weight before and after using NGT (p-value <0.01). Significant differences were also found in changes in children's weight with diagnosis and complications (p<0.01).
Conclusion: The use of NGT can increase the weight of pediatric patients who have feeding difficulties at Dr. M. Djamil General Hospital, Padang. Significant differences were found in changes in children's weight by diagnosis and complications.
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Perineural Injection of Mecobalamin Versus Dextrose 5% Against Clinical Changes and Electrophysiological Features of Carpal Tunnel Syndrome Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
Views: 983Downloads: 1,687Background: Carpal tunnel syndrome (CTS) is a common compression neuropathy with symptoms of pain, tingling, and numbness in the hands. Perineural injections of steroids and mecobalamin have been shown to be effective in relieving CTS symptoms. This study aims to compare the effectiveness of the perineural injection of mecobalamin and 5% dextrose on clinical changes and electrophysiological features in CTS sufferers.
Methods: This research is a pilot study open-label randomized controlled trial conducted at Dr. Mohammad Hoesin General Hospital Palembang. A total of 24 CTS patients were randomly divided into two groups: the mecobalamin group (n=12) and the 5% dextrose group (n=12). Patients in both groups received a single perineural injection.
Results: In the mecobalamin group, there were significant improvements in pain scores (NPRS), Boston carpal tunnel questionnaire (BCTQ) - symptom severity scale (SSS), and functional status scale (FSS) after 2 weeks. In the 5% dextrose group, there were also significant improvements in pain scores and BCTQ-SSS and BCTQ-FSS scores. However, the electrophysiological picture did not change significantly after 2 weeks of perineural injection. Comparison between groups showed significant differences in NPRS, BCTQ-FSS, and sensory amplitude.
Conclusion: Perineural injection of mecobalamin and 5% dextrose is effective in improving clinical symptoms of CTS. Mecobalamin showed better effects on improving NPRS, BCTQ-SSS, and sensory conduction amplitude than 5% dextrose.
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The Role of Branched-Chain Amino Acid (BCAA) Supplementation in Sarcopenia among the Elderly
Views: 1,798Downloads: 681Background: Sarcopenia is a syndrome characterized by loss of skeletal muscle mass, strength, and skeletal muscle function that occurs as a result of aging. To maintain muscle mass, a dynamic balance is needed between muscle protein synthesis (MPS) and its breakdown. BCAAs, including leucine (Leu), isoleucine (Ile), and valine (Val), have been found to have important mediating effects in protein synthesis, glucose homeostasis.
Methods: This literature review aims to explain further the role of BCAAs in sarcopenia.
Results: Numerous studies have demonstrated the advantages of BCAAs for maintaining or improving skeletal muscle mass and performance in both healthy elderly people and those with other comorbidities. It was also shown that resistance training and vitamin D supplementation enhanced the benefits of BCAAs.
Conclusion: There are still study results that contradict the role of BCAAs in sarcopenia, hence more research with homogeneity in supplementation dosage and outcome measurement methods is required in order to obtain stronger evidence to support its claims.
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Ketogenic Keys to Body Composition: Nutritional Insights and Comparative Dietary Effects
Views: 965Downloads: 686Background: The ketogenic diet, characterized by high fat, low carbohydrate intake, has garnered significant interest for its impact on body composition. Despite its popularity, the mechanisms and long-term effects of the diet remain subjects of ongoing research and debate within the medical and nutritional science communities.
Methods: This review systematically examines peer-reviewed clinical trials, observational studies, and comparative analyses conducted from 2004 to 2024. Studies were selected based on their relevance to the ketogenic diet's effects on body composition, adherence to rigorous methodological standards, and the provision of clear outcome measures related to fat mass, lean muscle mass, and overall weight changes.
Results: The review synthesizes findings to elucidate the diet's mechanisms, effects, and comparative performance against other dietary interventions. The ketogenic diet induces metabolic adaptations conducive to fat loss while potentially preserving lean muscle mass, mediated through ketosis and associated hormonal shifts. Comparative analyses suggest that the ketogenic diet may offer distinct advantages in fat reduction compared to low-fat and Mediterranean diets, attributed to its profound effects on metabolic pathways and satiety regulation. However, individual responses vary significantly, influenced by factors such as exercise, diet duration, macronutrient composition, and genetic predispositions.
Conclusion: The ketogenic diet emerges as a potent intervention for altering body composition, particularly effective in reducing fat mass. Its unique metabolic and hormonal effects distinguish it from other dietary approaches. Nevertheless, considerations regarding the diet's long-term sustainability, potential risks, and individual variability underscore the need for personalized dietary planning and further research.
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IgA Nephropathy and Lupus Nephritis in a 17-Year-Old Female: A Case Report
Views: 767Downloads: 654Background: Acute nephritic syndrome is classically presented with proteinuria, haematuria, azotemia, red blood casts, oliguria, and hypertension (PHARAOH) occurring acutely. Extensive inflammation of the glomeruli causes a decrease in the glomerular filtration rate so that it will produce uremic symptoms such as water and salt retention which will give a clinical picture of edema and hypertension, positive protein in the urine, the presence of erythrocytes or the appearance of dysmorphic erythrocytes in the urine.
Case presentation: A 17 year old female with nephritic syndrome is reported to have nephritic lupus and IgA nephropathy. He has been treated with corticosteroids, immunosuppressants, antihypertensives, and also diuretics followed by progress of clinical and laboratory conditions. Biopsy has been performed to provide a definitive diagnosis in the patient and determine the type of nephritic syndrome experienced. The biopsy showed features of IgA nephropathy (IgAN) and lupus nephritis.
Conclusion: Nephritic syndrome has been suspected due to the presence of haematuria, proteinuria, eyelid swelling, and hypertension. The management given to patients is supportive and symptomatic. Long-term administration of corticosteroids is needed in the treatment of nephritic syndrome as a maintenance therapy. Observation during treatment is needed to assess improvement or worsening of the disease experienced.
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The Profile of Sinonasal Tumors with Orbital Involvement in Dr. M. Djamil General Hospital, Padang, Indonesia: A 10-Year Overview
Views: 519Downloads: 597Background: Sinonasal tumors are rare tumors, either malignant or benign, that vary greatly based on the origin and primary tumor location in the sinonasal tract. The close anatomical relationship between the sinonasal tract and the orbital cavity makes orbital involvement very common (50%-80%) in sinonasal tumors, and this indicates a negative prognostic factor in sinonasal malignancy. The purpose of this study is to demonstrate the profile of sinonasal tumors with orbital involvement in our center.
Methods: Retrospective study from oncology subdivision files and medical records from January 2011 – December 2020. Collected data including age, gender, the clinical manifestations of orbital involvement, primary location, histopathology, and management of sinonasal tumors.
Results: There were 35 patients examined by the oncology subdivision either directly came or consulted from the ENT department, consisting of 18 (51.4%) males and 17 (48.6%) females. The age of patients ranged from 11 to 83 years old. with the most common age groups being 41-50 and 51-60 (25.7% in each age group). The majority of the patients (77.1%) had presented with proptosis. Maxillary sinus was the most common (45.7%) primary site of tumors, and squamous cell carcinoma was the most common (51.4%) histopathology found. Most of the patients (37.1%) were treated with a combination of chemotherapy and radiotherapy.
Conclusion: Orbital involvement commonly occurs in malignant sinonasal tumors with proptosis as a major clinical presentation. A combination of chemotherapy and radiotherapy was the most common practice management because the tumors were unresectable at the time of presentation.
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Management of Thrombocytopenia with Partial Splenic Embolization in Liver Cirrhosis
Views: 765Downloads: 723Thrombocytopenia is a frequent complication in patients with cirrhosis. Thrombocytopenia is generally divided into mild, moderate, and severe thrombocytopenia. Thrombocytopenia in liver cirrhosis not only increases the risk of bleeding during surgery but can also have an impact on patient management, such as liver biopsy, administration of antiviral therapy, and postponement of elective surgery. The pathophysiology of thrombocytopenia in chronic liver disease can be caused by decreased platelet production, sequestration in the spleen, and increased platelet destruction. Partial splenic embolization (PSE) is one option for treating thrombocytopenia in chronic liver disease. PSE is an effective procedure in treating complications associated with hypersplenism and portal hypertension, such as esophageal varices, pancytopenia, portal hypertensive gastropathy and ascites.
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Primary Breast Angiosarcoma: Serial Cases
Views: 477Downloads: 396Background: Breast angiosarcoma is a rare malignancy arising from endothelial cell lining, approximately 0.04–0.05% of all breast malignancies and less than 1% of all sarcomas. Consisting of primary breast angiosarcoma (PAS) and secondary breast angiosarcoma (SAS). Diagnosis is often delayed because the case is rare and asymptomatic, the lump is painless, grows quickly, progressive disease can develop distant metastasize, and the prognosis is reportedly poor.
Case presentation: This case series presents two cases of primary breast angiosarcoma; the first patient is a patient who needs to obtain a diagnosis through physical examination, imaging, surgery, histopathology, and immunohistochemistry. The second patient is how to reconstruct the surgical defect using the Latissimus dorsi flap, and interestingly, with thirteen years of survival without recurrence, Surgery is the main treatment with high local recurrence. Wide excision in the form of a simple mastectomy is recommended if a tumor-free margin of 2-3 cm cannot be achieved. Tumor excision, or cosmesis, is not achieved, which is related to the proportion of breast and tumor size. The use of radiation therapy and neoadjuvant or adjuvant chemotherapy is still controversial.
Conclusion: Establishing a diagnosis with a thorough examination starts with anamnesis, physical examination, radiological examination, and histopathology, including immunohistochemistry, which is an important examination in confirming the diagnosis.
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Characteristics of Triple Negative Subtype Breast Cancer in Dr. Hasan Sadikin General Hospital for 5 Years (2019-2023): An Observational Study
Views: 525Downloads: 377Background: Triple-negative breast cancer has a percentage of 15% to 20% in breast cancer patients at the time of first diagnosis. Guidelines from St. Gallen guidelines, the American Society of Clinical Oncology, and the American College of Pathology state that triple-negative breast cancer is breast cancer with ER and PR expression <1%. As an aggressive subtype, outcomes are poor when compared with hormone receptor-positive.
Methods: This research is an observational study. The research subjects in this study were triple-negative breast cancer patients in Dr. Hasan Sadikin General Hospital, Surgical Oncology division, West Java, Indonesia, from October 2018 - November 2023. There were 702 research subjects who would be studied. Characteristics of triple-negative breast cancer were taken from medical records.
Results: The results showed that the average age of the subjects was 47 years. Based on histology, the most common was Invasive Carcinoma of no special type (86.75%), followed by Invasive lobular carcinoma (7.26%), medullary carcinoma (1.7%), micropapillary carcinoma (0.99%), metaplastic carcinoma (2.36%) and the least amount is Pleomorphic invasive lobular carcinoma (0.71%). The side of the breast affected is not significant, and the highest grade is 3. The involvement of lymph node metastases is due to aggressive tumor subtypes and lymphovascular invasion. Lymphovascular invasion is known to be a negative prognostic factor. It is a late stage for metastasis and local recurrence.
Conclusion: Triple-negative breast cancer is breast cancer that has histopathological heterogeneity; most of the tumors are grade 3 and have significant metastases in regional lymph nodes. There is no significant relationship between grading and regional lymph node metastases. there is a significant relationship between lymphovascular invasion and regional lymph nodes metastases.
