Accreditation
SINTA 2Nationally Accredited Journal
Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Articles
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The Silent Saboteur: Chronic Refractory Erythema Nodosum Leprosum Perpetuated by Neglected Odontogenic Foci in a Post-RFT Borderline Lepromatous Patient
Views: 271Downloads: 183Background: Erythema nodosum leprosum (ENL) is a severe, immune-complex mediated complication of lepromatous leprosy that can manifest before, during, or after multidrug therapy (MDT). While the primary etiology involves the release of Mycobacterium leprae antigens, the chronicity of ENL is frequently driven by secondary, often occult, triggers. Focal infections, particularly of odontogenic origin, are frequently overlooked in standard dermatological assessments, leading to refractory clinical courses.
Case presentation: We report the case of a 32-year-old male with a history of borderline lepromatous (BL) leprosy who had achieved release from treatment (RFT). The patient presented with severe, chronic, and recurrent ENL characterized by painful erythematous nodules, high-grade fever, and acute neuritis, occurring more than one year post-RFT. Laboratory evaluation revealed significant inflammatory markers, including a C-Reactive Protein level of 172.7 mg/L and leukocytosis. Crucially, intraoral examination identified neglected chronic dental caries (gangrene radix) and generalized periodontal inflammation. Despite medical advice, the patient refused dental intervention. The reactional state was managed with a combination of intravenous methylprednisolone and high-dose oral clofazimine. While cutaneous symptoms improved, the persistence of the focal infection poses a substantial risk for further recurrence.
Conclusion: This case highlights the critical and often underestimated role of odontogenic focal infections as perpetuating factors in chronic ENL. It underscores the necessity for a multidisciplinary approach integrating dentistry and dermatology. We propose that recalcitrant ENL in post-RFT patients should trigger mandatory screening for occult dental infections to disrupt the cycle of systemic inflammation.
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Sporadic Coexistence of Multiple Trichoepitheliomas and Solitary Neurofibroma: Mimicking Brooke–Spiegler Syndrome
Views: 253Downloads: 267Background: The simultaneous presentation of multiple adnexal tumors and neural sheath tumors on the face typically heralds a genodermatosis, most notably Brooke–Spiegler syndrome (BSS) or neurofibromatosis type 1 (NF1). The sporadic, non-syndromic coexistence of these entities in the same anatomical region is a diagnostic pitfall that challenges the principle of parsimony.
Case presentation: We report the case of a 24-year-old Asian female presenting with a 12-month history of 18 disseminated, skin-colored papules restricted to the centrofacial region, followed by the rapid development of a 3.0 cm solitary tumor on the right buccal region. Dermoscopic evaluation revealed a dichotomy in tumor morphology: the papules exhibited ivory-white backgrounds with multiple rosette signs and milia-like cysts, while the buccal tumor displayed a structureless pink pattern with absence of pigment networks. Detailed physical examination ruled out cutaneous stigmata of NF1. Histopathological analysis confirmed the diagnosis of multiple trichoepitheliomas and a solitary localized neurofibroma based on characteristic morphological features, including papillary mesenchymal bodies and mast cell presence. Immunohistochemistry was not utilized due to setting-specific resource limitations.
Conclusion: This case underscores the potential for sporadic benign tumors to mimic syndromic phenotypes (phenocopies). It highlights the critical importance of recognizing key hematoxylin and eosin morphological markers and clinical signs to establish accurate diagnoses in resource-limited settings where molecular genetics and immunohistochemical staining are unavailable.
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Biallelic versus Monoallelic TP53 Inactivation in Hematologic Malignancies: A Comparative Meta-Analysis of Lymphoid and Plasma Cell Disorders
Views: 217Downloads: 242Background: The tumor suppressor protein p53, encoded by the TP53 gene on chromosome 17p13.1, functions as the central guardian of genomic stability. In hematologic malignancies, including multiple myeloma (MM), chronic lymphocytic leukemia (CLL), and myelodysplastic syndromes (MDS), p53 dysfunction acts as a universal marker of chemoresistance and disease progression. Current clinical staging systems frequently conflate chromosomal deletion, or del(17p), with somatic mutation, thereby failing to distinguish between monoallelic (single-hit) and biallelic (double-hit) inactivation. This lack of granularity obscures the distinct biological consequences of these two states. This study aims to resolve the prognostic discordance between genomic subgroups in the context of modern therapeutic interventions.
Methods: We conducted a comparative meta-analysis of nine pivotal studies comprising 4,125 patients, selected through a stringent protocol requiring paired cytogenetic (FISH) and molecular sequencing data. Patients were stratified into three genomic subgroups: Wild type, monoallelic disruption (isolated deletion or isolated mutation), and biallelic disruption (deletion plus mutation). Data were synthesized using a random-effects model to calculate pooled hazard ratios (HR) for Overall Survival (OS), with specific subgroup analyses performed for Plasma Cell versus Lymphoid malignancies to account for lineage heterogeneity.
Results: The analysis revealed a profound prognostic dichotomy. In Multiple Myeloma, biallelic inactivation conferred a catastrophic prognosis with a pooled hazard ratio for death of 3.82 compared to Wild Type. Conversely, isolated del(17p) carried a significantly lower risk (HR 1.82), suggesting functional compensation by the residual allele. In CLL and Waldenström's Macroglobulinemia, TP53 mutations acted as independent drivers of poor survival (HR 2.80) even in the absence of deletion, consistent with a dominant-negative mechanism. The double hit phenotype was consistently associated with a median survival reduction exceeding fifty percent compared to monoallelic cases across all lineages.
Conclusion: The prognostic weight of TP53 abnormalities is defined by allelic dosage. Biallelic inactivation represents a distinct, high-risk biological entity requiring novel therapeutic approaches, whereas monoallelic alterations often exhibit intermediate outcomes. Clinical guidelines must mandate sequencing alongside FISH to prevent misstratification and overtreatment.
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Rapid Correction of Hypoalbuminemia and Promotion of Granulation Tissue in Pediatric Deep Partial-Thickness Burns via Targeted Immunonutrition: A Case Report
Views: 248Downloads: 143Background: Pediatric burns induce a profound hypermetabolic and hypercatabolic state, distinct from adults due to limited physiological reserves and high growth demands. The rapid onset of negative nitrogen balance and hypoalbuminemia significantly impairs wound healing and immune function.
Case presentation: We report the case of a 7-year-old male with pre-existing malnutrition (StrongKids Medium Risk) presenting with 23% total body surface area (TBSA) Grade IIB scald burns affecting the posterior humerus, lumbosacral, gluteus, and femoral regions. The patient exhibited acute hypoalbuminemia (2.3 g/dL) and anorexia due to pain. A specialized medical nutrition therapy (MNT) protocol was implemented using the Curreri Junior formula, targeting 2,500 kcal/day and 105 g protein/day. The intervention utilized a stepwise escalation of polymeric enteral nutrition enriched with immunonutrients (Glutamine, Zinc, and Vitamin C). Despite the severity of the injury, the patient demonstrated rapid nutritional rehabilitation. By day 5 of hospitalization, albumin levels normalized to 3.1 g/dL, and significant granulation tissue formation was observed. The patient achieved a weight gain of 0.4 kg during the acute phase, countering the expected catabolic weight loss.
Conclusion: Early, aggressive, and calculated nutritional support incorporating specific immunonutrients can reverse the catabolic effects of thermal injury in pediatric patients. This case highlights the efficacy of the Curreri Junior formula combined with Glutamine and Zinc in accelerating wound closure and correcting biochemical markers in resource-limited settings.
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Prevalence and Etiology of Ocular Morbidity in Maritime Environments: A Systematic Review and Meta-Analysis of Passenger and Crew Data
Views: 310Downloads: 154Background: The maritime environment constitutes a unique epidemiological enclosure characterized by isolation, specific occupational hazards, and distinct environmental stressors including hyper-salinity and high ultraviolet (UV) albedo. While gastrointestinal and respiratory outbreaks at sea are well-documented, the burden of ocular morbidity remains under-quantified. This study aims to determine the prevalence and etiology of ocular emergencies, stratifying risks between industrial seafarers (crew) and recreational travelers (passengers).
Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Data were extracted from eight observational studies (2014–2024) covering expedition cruises, commercial shipping, and leisure voyages. To address population heterogeneity, a stratified analysis was performed: Track A analyzed occupational trauma in crew, while track B analyzed environmental morbidity in passengers. A random-effects model was used to calculate pooled proportions with 95% Confidence Intervals (CI), accompanied by a leave-one-out sensitivity analysis.
Results: The dataset represented a combined population of over 5,000 maritime subjects. The pooled prevalence of ocular involvement in maritime trauma cases was 18.4% (95% CI: 12.1%–25.5%). Etiological analysis of crew injuries revealed a dominance of mechanical trauma, specifically metallic foreign bodies (40.5%), followed by chemical burns (26.2%). In contrast, passenger morbidity was driven by environmental factors (photokeratitis, dry eye) and infectious conjunctivitis.
Conclusion: Ocular emergencies represent a significant, preventable burden in maritime travel, with distinct risk profiles for crew and passengers. The high rate of occupational trauma suggests a failure in personal protective equipment (PPE) compliance, while the environmental burden reflects the dry ship phenomenon. Mandatory protective eyewear policies and the integration of anterior-segment tele-ophthalmology are critical interventions.
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Unmasking Organic Pathology in Pediatric Recurrent Abdominal Pain: Diagnostic Yield, Histopathological Discordance, and the Asian Enigma in a Tertiary Indonesian Setting
Views: 277Downloads: 177Background: Recurrent abdominal pain (RAP) in children presents a complex diagnostic dichotomy between functional disorders and organic pathology. In Southeast Asia, this challenge is compounded by the Asian Enigma of variable Helicobacter pylori prevalence. This study evaluated the diagnostic yield of Esophagogastroduodenoscopy (EGD) and the correlation between macroscopic and histopathological findings in an Indonesian tertiary pediatric cohort.
Methods: A retrospective, analytical cross-sectional study was conducted on 108 pediatric patients aged 1 to 18 years fulfilling Rome IV criteria for RAP between January 2022 and July 2025. EGD was performed, with biopsies taken based on macroscopic abnormalities or clinical suspicion (n=65). Diagnostic yield was calculated, and H. pylori prevalence was subjected to sensitivity analysis to account for non-biopsied patients. Multivariate logistic regression identified predictors of organic findings.
Results: The cohort was predominantly female (65.7%) and adolescent (48.1%). The overall diagnostic yield for macroscopic abnormalities was 77.8%, dominated by macroscopic gastritis (39.8%). H. pylori infection was confirmed in 26.9% of the total cohort, rising to 44.6% (95% Confidence Interval: 32.5%–57.3%) among biopsied patients. Sensitivity analysis estimated the true prevalence range between 26.9% and 48.0%. Notably, in a subset of patients with normal macroscopic mucosa (n=10), 30% exhibited microscopic inflammation, indicating endoscopic-histologic discordance. Independent predictors of organic pathology included age over 10 years (adjusted Odds Ratio 2.41) and vomiting (adjusted Odds Ratio 3.12).
Conclusion: EGD reveals a high burden of organic disease in Indonesian children with RAP, challenging the functional paradigm in this setting. The significant rate of H. pylori and potential microscopic inflammation in normal-appearing mucosa suggest that biopsy should be considered routine rather than targeted to avoid verification bias.
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Colchicine as a Strategic Therapeutic Alternative for Dengue-Associated Acute Pericarditis: Navigating the Hemorrhagic Risk
Views: 231Downloads: 259Background: Dengue infection remains a pervasive arboviral disease in tropical regions, manifesting with a spectrum of clinical severities ranging from undifferentiated fever to life-threatening shock and severe hemorrhage. While cardiac involvement such as myocarditis is documented, acute pericarditis is an underrecognized complication that poses a unique therapeutic dilemma. The standard first-line anti-inflammatory treatment for pericarditis, specifically non-steroidal anti-inflammatory drugs (NSAIDs), is relatively contraindicated in dengue due to the inherent coagulopathy and thrombocytopenia associated with the disease.
Case presentation: We report a case of a 53-year-old male presenting with high-grade fever, retro-orbital pain, and severe chest discomfort characteristic of pleuritis. Physical examination revealed a distinct pericardial friction rub and relative bradycardia (56 bpm). Laboratory analysis confirmed dengue infection with significant leukopenia (1.7 x 10³/µL), thrombocytopenia (49 x 10³/µL), and elevated liver transaminases. Electrocardiography (ECG) demonstrated diffuse ST-segment elevation, while echocardiography showed preserved ejection fraction (67.7%) without pericardial effusion. Diagnosed with dengue-associated acute pericarditis, the patient was ineligible for NSAIDs due to the high risk of gastrointestinal hemorrhage. He was successfully managed with low-dose Colchicine (0.5 mg daily) alongside standard supportive care. Rapid resolution of chest pain and normalization of ECG findings were observed within 48 hours without hemorrhagic complications.
Conclusion: This case underscores the utility of Colchicine as a safe, effective, and strategic alternative to NSAIDs for managing acute pericarditis in thrombocytopenic dengue patients. Early recognition of the pericarditis triad in dengue is crucial to prevent mismanagement, and Colchicine should be considered a cornerstone of therapy in this specific clinical context.
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Hydrostatic Pressure versus Passive Diffusion: A Split-Face Comparative Analysis of Intradermal Injection and Microneedling-Assisted Delivery of Botulinum Toxin Type A for Facial Pore Refinement
Views: 299Downloads: 320Background: Enlarged facial pores, medically termed dilated pilosebaceous follicles, represent a prevalent aesthetic concern driven by seborrhea, follicular hypertrophy, and loss of perifollicular elasticity. Microbotox, the intradermal administration of dilute OnabotulinumtoxinA (BoNT-A), targets these mechanisms through sebosuppression and arrector pili inhibition. However, the optimal delivery vehicle—active intradermal injection versus passive microneedling-assisted transport—remains debated regarding clinical delivery efficiency.
Case presentation: A 23-year-old female with Fitzpatrick Skin Type IV, severe pore enlargement (Kim’s Score 5), and seborrhea participated in a split-face comparative study. The right cheek received standard intradermal microdroplet injections of BoNT-A (20 U diluted in 1.0 mL saline). The left cheek underwent automated microneedling at a depth of 2.0 mm immediately followed by topical application of the same BoNT-A solution. Evaluation was performed at baseline, Day 7, and Day 14 using blinded clinical scoring and digital dermoscopic analysis. At Day 14, the intradermal injection side demonstrated superior pore reduction (Kim’s Score 5 to 3) compared to the microneedling side (Score 5 to 4). Digital quantification confirmed a 45% reduction in mean pore diameter on the injected side versus 18% on the microneedling side. While both modalities effectively reduced sebum scores to 1, the microneedling side exhibited delayed pore refinement, likely attributed to post-traumatic edema and the wash-out effect of blood flow antagonizing passive diffusion.
Conclusion: Direct intradermal injection provides superior clinical delivery efficiency for BoNT-A, resulting in more rapid and significant pore contraction. Microneedling-assisted delivery, particularly at depths inducing vascular injury, acts as a secondary adjunct for textural remodeling but is inferior for immediate pharmacological delivery of large-molecule toxins.
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Primary Furlow Palatoplasty for Delayed Repair of Veau Type I Cleft Palate in an Adolescent: Surgical Challenges and Bio-functional Outcomes
Views: 188Downloads: 192Background: Cleft palate is a pervasive congenital craniofacial anomaly characterized by the failure of palatal shelf fusion, resulting in a persistent communication between the oral and nasal cavities. While developed healthcare systems mandate repair between 9 and 12 months, delayed presentation in adolescence remains a distinct clinical entity in developing regions. These cases are surgically complex due to maxillary skeletal maturity, tissue fibrosis, and wider cleft gaps compared to infant cases. The primary surgical objective is to seal the defect and restore the velopharyngeal sphincter to prevent hypernasality. This study evaluates the efficacy and physiological advantages of the Furlow double opposing Z-plasty technique in a high-risk delayed primary repair scenario.
Case presentation: We report the management of a 14-year-old male presenting with an uncorrected non-syndromic incomplete cleft palate. Preoperative assessment revealed severe hypernasality and audible nasal air emission. Clinical examination confirmed a Veau Type I defect confined to the soft palate with a bifid uvula. Primary palatoplasty was executed using the Furlow technique. The procedure successfully recruited lateral tissue for palatal lengthening and achieved transverse muscle reorientation without the need for lateral relaxing incisions.
Conclusion: The intervention resulted in complete anatomical closure with no evidence of wound dehiscence, hemorrhage, or oronasal fistula formation. The Furlow technique proved to be a feasible and safe modality for Veau Type I defects in adolescents, effectively addressing the vertical pharyngeal gap and restoring the sphincter mechanism's anatomy.
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Intratympanic Corticosteroid Salvage for Pediatric Bilateral Sudden Sensorineural Hearing Loss Complicated by Methylprednisolone-Induced Hypertensive Urgency in an Obese Adolescent
Views: 277Downloads: 207Background: Bilateral sudden sensorineural hearing loss (SSNHL) is a rare otologic emergency, accounting for less than 5% of sudden deafness cases and occurring even less frequently in pediatric populations. Unlike unilateral cases, bilateral involvement strongly implicates systemic etiologies such as autoimmune inner ear disease (AIED). Systemic high-dose corticosteroids are the standard first-line therapy but pose significant risks of toxicity, including hypertensive crisis, particularly in adolescents with metabolic risk factors.
Case presentation: We report the case of a 17-year-old male (BMI 29.0 kg/m²) presenting with acute, simultaneous bilateral hearing loss (Pure Tone Average [PTA]: Right 82.5 dB, Left 81.25 dB) and severe tinnitus (Tinnitus Handicap Index [THI]: 78). Initial management with high-dose intravenous methylprednisolone (500 mg/day) was complicated on Day 7 by hypertensive urgency (Blood Pressure 150/95 mmHg) and neurological symptoms, necessitating immediate cessation of systemic therapy. Diagnostic investigation was limited by resource availability; however, elevated inflammatory markers supported a presumptive immune-mediated etiology. A salvage protocol was initiated using four weekly cycles of intratympanic Triamcinolone Acetonide. Following therapy, the patient demonstrated slight audiological recovery (PTA stabilized at 65 dB bilaterally) but achieved complete resolution of tinnitus (THI: 0).
Conclusion: This case highlights the critical role of intratympanic corticosteroids as a safe salvage modality when systemic therapy is contraindicated due to toxicity. The dissociation between modest audiometric gain and complete tinnitus resolution suggests successful mitigation of cochlear synaptopathy. The case underscores the necessity of cardiovascular monitoring and BMI-adjusted risk stratification in adolescents receiving high-dose steroids.
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Emergency Neuroanesthesia for Spontaneous Subdural Hematoma in a Pediatric Patient with Hemophilia A: A Protocol-Based Multidisciplinary Approach
Views: 221Downloads: 223Background: Spontaneous subdural hematoma (SDH) in pediatric patients with Hemophilia A is a rare, life-threatening emergency requiring a delicate balance between hemostatic correction and neuroprotective anesthesia. The mortality rate is high without immediate surgical decompression, yet the surgery itself poses catastrophic bleeding risks.
Case presentation: We report the case of an 11-year-old male (25 kg) with severe Hemophilia A (Factor VIII <1%) who presented with a three-day history of headache and vomiting, culminating in a sudden loss of consciousness (GCS E2V2M5). Neuroimaging revealed a massive left frontotemporoparietal SDH (8 mm thickness) with a 12 mm midline shift and non-communicating hydrocephalus. The patient had discontinued prophylaxis five months prior. Management involved a strict multidisciplinary protocol. Preoperatively, aggressive Factor VIII replacement was initiated to achieve 100% activity. Intraoperatively, a total intravenous anesthesia (TIVA) strategy utilizing propofol, fentanyl, and dexmedetomidine was employed to maintain cerebral perfusion pressure (CPP) while strictly controlling intracranial pressure (ICP). Tranexamic acid was used as an adjunct. The patient underwent successful craniotomy and hematoma evacuation with minimal blood loss. Postoperative care focused on serial factor VIII replacement and neurological monitoring, resulting in a favorable discharge outcome.
Conclusion: Successful management of spontaneous SDH in hemophilia requires a target-controlled approach to both hemostasis and hemodynamics. The integration of preoperative factor loading, neuroprotective anesthesia with dexmedetomidine, and postoperative vigilance is critical for survival.
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Intraoperative Vagal Excitation During Rigid Esophagoscopy for an Esophageal Earring in a 4-Month-Old Infant: A Case Report
Views: 217Downloads: 147Background: Esophageal foreign body ingestion is a prevalent otorhinolaryngologic emergency in the pediatric population but is epidemiologically rare in infants under six months of age. While rigid esophagoscopy remains the gold standard for extraction, it involves stimulating the highly innervated aerodigestive tract. This case highlights a life-threatening vagal reflex—an underreported complication in infants—during foreign body removal.
Case presentation: A 4-month-old female infant presented with a history of accidental earring ingestion three days prior, manifesting as hypersalivation and feeding refusal. Radiographic imaging confirmed a radiopaque foreign body at the T1 vertebral level or thoracic inlet. The patient underwent rigid esophagoscopy under general anesthesia. During the extraction phase, mechanical manipulation of the esophageal mucosa triggered profound vagal excitation, resulting in severe bradycardia and oxygen desaturation. The procedure was immediately paused, and the patient was successfully resuscitated using vagolytic agents and hyperoxygenation by the anesthesiology team. A second attempt was successful without recurrence of the reflex. Post-operative recovery was uneventful.
Conclusion: Foreign body ingestion in early infancy requires a high index of suspicion and meticulous perioperative planning. The manipulation of the esophageal inlet can trigger potent vagovagal reflexes, particularly in infants with high vagal tone. This case underscores the necessity of deep anesthetic planes, prophylactic vagolytic preparation, and seamless communication between the surgeon and anesthesiologist to manage hemodynamic instability.
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Comparative Analysis of Early Postoperative Cognitive Decline Following Isoflurane versus Sevoflurane Anesthesia in Geriatric Patients: A Prospective Observational Study
Views: 260Downloads: 130Background: As the global geriatric population expands, postoperative cognitive dysfunction (POCD) has emerged as a critical perioperative complication. While volatile anesthetics are standard for maintenance, conflicting evidence exists regarding the comparative neurotoxicity of Isoflurane and Sevoflurane, particularly in resource-limited settings where cost influences agent choice. This study aimed to evaluate and compare the magnitude of early cognitive decline associated with these two agents in an Indonesian geriatric cohort.
Methods: We conducted a prospective comparative observational study involving 40 geriatric patients (aged ≥60 years, ASA II-III) undergoing elective non-cardiac surgery at Arifin Achmad Regional General Hospital, Indonesia. Patients were recruited via consecutive sampling and allocated to receive maintenance anesthesia with either Sevoflurane (n=20) or Isoflurane (n=20) according to standard clinical protocols. Cognitive function was assessed preoperatively and at 72 hours postoperatively using the Montreal Cognitive Assessment-Indonesian Version (MoCA-INA). The primary outcome was the magnitude of cognitive change (Delta score) and the incidence of cognitive decline.
Results: Baseline characteristics were homogenous (p > 0.05). The Sevoflurane group exhibited a non-significant trend toward decline (Pre: 26.85 ± 1.09 vs. Post: 26.45 ± 1.28; p = 0.057) with a mean delta of 0.40. Conversely, the Isoflurane group demonstrated a statistically significant deterioration (Pre: 26.90 ± 1.07 vs. Post: 25.90 ± 1.55; p = 0.008) with a mean delta of 1.00. The magnitude of decline was significantly greater in the Isoflurane group (p = 0.026). The incidence of early cognitive decline was 25% for Isoflurane versus 10% for Sevoflurane.
Conclusion: Isoflurane anesthesia is associated with a greater magnitude of early postoperative cognitive decline compared to Sevoflurane in geriatric patients. While Sevoflurane is not devoid of cognitive impact, it appears to offer a superior safety profile for early neurocognitive recovery. These findings suggest Sevoflurane may be the preferable agent for geriatric anesthesia in settings where newer agents like Desflurane are unavailable.
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Syzygium aromaticum (L.) Merr. & L.M. Perry Extract Restores Immune Homeostasis and Accelerates Healing in MRSA-Infected Wounds: A Mechanistic In Vivo Study via Downregulation of TNF-α, CRP, and IL-10
Views: 215Downloads: 196Background: The rise of Methicillin-Resistant Staphylococcus aureus (MRSA) in surgical site infections necessitates the development of non-resistant therapeutic adjuvants. Syzygium aromaticum (Clove) possesses known antimicrobial properties, yet its specific immunomodulatory effects on the MRSA-induced cytokine storm and wound chronicity remain under-characterized. This study investigated the efficacy of a standardized ethanolic extract of S. aromaticum flower buds in modulating the inflammatory milieu and accelerating wound repair.
Methods: A true experimental study was conducted using 30 male Wistar rats with MRSA-infected dorsal excision wounds. Subjects were randomized into six groups (n=5): Normal Control (K1), Negative Control (MRSA+Vehicle, K2), Positive Control (MRSA+Vancomycin, K3), and treatment groups receiving 25 mg (P1), 50 mg (P2), and 100 mg/200g BW (P3) of extract orally for 10 days. The extract was characterized via HPLC. Serum TNF-α, CRP, and IL-10 were quantified by ELISA. Secondary outcomes included bacterial load reduction and macroscopic wound contraction rates.
Results: HPLC analysis confirmed eugenol (68.4%) and β-caryophyllene (12.1%) as major constituents. MRSA infection (K2) provoked a severe inflammatory state (TNF-α: 17.92 ± 0.42 pg/mL; IL-10: 110.21 ± 2.72 pg/mL). The 100 mg extract dose (P3) significantly suppressed TNF-α (7.40 ± 0.48 pg/mL, p<0.001) and normalized IL-10 (49.92 ± 2.56 pg/mL), demonstrating non-inferiority to Vancomycin (p=1.000). Bacterial load was reduced by 4 log units (1.2 × 10³ vs 5.8 × 10⁷ CFU/g).
Conclusion: Standardized S. aromaticum extract functions as a potent immunomodulator, resolving MRSA-induced inflammation by balancing pro- and anti-inflammatory cytokines, thereby facilitating the transition from the inflammatory to the proliferative phase of healing.
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The Price of Delay and the Uncoupling of Severity: A Penalized Multivariate Analysis of Treatment Adequacy Versus Timing as Determinants of Congenital Syphilis
Views: 197Downloads: 137Background: Despite global elimination targets, congenital syphilis (CS) remains a critical cause of preventable neonatal morbidity. While the importance of antenatal screening is established, the relative impact of treatment adequacy (dosage/adherence) versus timing on neonatal severity—specifically the uncoupling phenomenon where severe visceral damage occurs despite normal birth biometrics—remains under-characterized in resource-limited settings.
Methods: A retrospective cross-sectional study analyzed 101 syphilis-exposed mother-infant pairs at a tertiary referral center in Indonesia (2021–2025). We evaluated maternal serologic testing time, treatment timing, and treatment adequacy (defined strictly per CDC guidelines; inadequate defined as <30 days pre-delivery, non-penicillin, or missed doses). To address sparse data bias and quasi-complete separation in the dataset, Firth’s Penalized Likelihood Logistic Regression was utilized to calculate adjusted odds ratios (aOR) for severe clinical manifestations.
Results: The prevalence of proven/possible CS was 58.4%. High-fidelity analysis revealed that inadequate maternal treatment was the dominant predictor of adverse outcomes (aOR = 85.40; 95% CI: 14.2–512.5; p<0.001), significantly outpacing delayed serologic testing (aOR = 4.8; p=0.012). A distinct uncoupling profile was identified: neonates born to inadequately treated mothers had high odds of severe visceral manifestations (hepatosplenomegaly, hematological failure) (aOR = 11.05), yet traditional biometrics (low birth weight, prematurity) showed no significant association (p>0.05).
Conclusion: Treatment adequacy is the single most critical determinant of neonatal prognosis. The dissociation between normal birth weight and severe organ damage suggests that anthropometry is a poor triage tool for syphilis. A zero-tolerance policy for therapeutic deviations is imperative.
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Prognostic Significance of the Epithelial–Mesenchymal Transition Phenotype in Basal Cell Carcinoma: A Meta-Analysis of E-Cadherin Loss and Stromal Alpha-SMA Upregulation as Recurrence Predictors
Views: 182Downloads: 119Background: Basal cell carcinoma represents the most prevalent cutaneous malignancy worldwide. While metastasis is rare, local recurrence poses a substantial therapeutic challenge, particularly in the anatomically critical H-zone of the face. Conventional risk stratification relies on tumor size and histological subtype, but these markers frequently fail to capture the intrinsic biological aggressiveness of the tumor. The epithelial–mesenchymal transition phenotype, characterized by the loss of epithelial adhesion molecule E-cadherin and the activation of the tumor stroma via alpha-smooth muscle actin expression, has emerged as a potential driver of local invasion.
Methods: We conducted a systematic review and meta-analysis adhering to PRISMA 2020 guidelines to evaluate the prognostic value of these biomarkers. A comprehensive search identified ten pivotal studies comprising 648 cases. The primary endpoint was adverse outcome, defined as clinical recurrence or the presence of high-risk infiltrative histology. Data were synthesized using a random-effects model to calculate pooled Odds Ratios and Standardized Mean Differences, with rigorous sensitivity analyses to account for heterogeneity.
Results: The meta-analysis revealed a profound association between stromal activation and adverse outcomes. Alpha-SMA upregulation was the most robust predictor, with a pooled Odds Ratio of 6.82 (95% CI: 3.14–14.81; p < 0.0001). Loss of membranous E-cadherin also significantly predicted recurrence (Odds Ratio = 4.15; 95% CI: 1.89–9.10; p = 0.0004), although with higher heterogeneity, reflecting the focal nature of partial epithelial–mesenchymal transition at the invasive front. The combined phenotype of high alpha-SMA and low E-Cadherin represented the highest risk profile.
Conclusion: The epithelial–mesenchymal transition phenotype serves as a high-fidelity predictor of basal cell carcinoma recurrence. Stromal alpha-SMA marks a permissive soil for invasion and should be considered for integration into pathological reporting for ambiguous or high-risk tumors to guide surgical margin management.
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The Steel-Blue Peppering and Systemic Eosinophilia: Dermoscopic-Histopathological Correspondence of the Tyndall Effect in Generalized Fixed Drug Eruption
Views: 201Downloads: 275Background: Generalized fixed drug eruption (GFDE) represents a severe and distinctive variant of delayed-type hypersensitivity, characterized by widespread, recurrent pigmentary lesions involving at least three anatomical sites. Its clinical presentation often mimics extensive lichenoid dermatoses or infectious conditions such as Hansen’s disease, leading to significant diagnostic delays, particularly in geriatric populations with polypharmacy. While dermoscopy offers a non-invasive bridge to histopathology, specific correlative studies in generalized cases remain scarce.
Case presentation: We report the case of a 69-year-old male presenting with diffuse, well-demarcated, violaceous plaques affecting the face, trunk, extremities, and genitalia. The eruption demonstrated a pathognomonic acute latency, recurring at identical anatomical sites within six hours of re-exposure to an unprescribed analgesic cocktail. High-definition non-contact polarized dermoscopy identified two distinct morphological patterns: a brown starburst pattern with central clearing on the extremities and diffuse steel-blue peppering on femoral lesions. Notably, the patient exhibited a mixed immunophenotype characterized by marked eosinophilia (2,080 cells per microliter) and elevated total immunoglobulin E (2,295 IU per milliliter). Parasitic infection was rigorously excluded via negative stool examination and serology, and a Naranjo probability score of 10 confirmed a definite adverse drug reaction. Histopathological examination confirmed interface dermatitis with necrotic keratinocytes and marked pigment incontinence.
Conclusion: This study illustrates that steel-blue peppering is a reliable dermoscopic surrogate for deep dermal pigment incontinence via the Tyndall effect. The discrepancy between high systemic eosinophilia and low tissue eosinophilia suggests a complex, potentially mixed-hypersensitivity phenotype in generalized cases, distinct from classic localized fixed drug eruption.
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Pediatric Steroid High-Responder: Irreversible Visual Loss and Secondary Glaucoma Following Chronic Cutaneous-Ocular Dexamethasone Misuse
Views: 315Downloads: 153Background: Chronic misuse of potent topical corticosteroids can lead to irreversible visual loss, particularly in the pediatric population which exhibits a more aggressive trabecular meshwork remodeling response than adults. This case aims to delineate the silent progression of steroid-induced ocular hypertension in the absence of red-eye symptoms and emphasizes the critical pharmacokinetic risks of cutaneous-ocular absorption in children.
Case presentation: We report a catastrophic case of a 7-year-old male presenting with irreversible vision loss following six years of unsupervised, intermittent use of a combined Neomycin-Polymyxin B-Dexamethasone ointment for recurrent hordeolum. The cumulative exposure exceeded 125 mg of Dexamethasone. Examination revealed bilateral dense posterior subcapsular cataracts (PSC) and advanced glaucomatous optic neuropathy in left eye. Following sequential phacoaspiration, the left eye showed persistently elevated IOP (IOP elevated up to 59 mmHg) attributed to decompensated outflow facility. Management required Trabeculectomy with intraoperative 5-Fluorouracil (5 mg/0.1 mL). The high- responder phenotype in children involves rapid formation of Cross-Linked Actin Networks (CLANs) and MYOC gene upregulation. We discuss the double-hit mechanism where cataract extraction washes out hyposecretory factors, unmasking total trabecular blockage. The choice of 5-Fluorouracil over Mitomycin C is defended based on the safety profile regarding hypotony maculopathy in pediatric myopic eyes.
Conclusion: Dexamethasone carries a high risk of transcutaneous-ocular absorption in pediatric eye and eyelids. Regulatory reform reclassifying antibiotic-steroid combinations as non-repeatable prescriptions is imperative to prevent such preventable blindness.
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Outcomes of Surgical Resection versus Medical Management in Chronic Pulmonary Aspergillosis: A Systematic Review and Meta-Analysis of Comparative Cohorts
Views: 260Downloads: 197Background: Chronic pulmonary aspergillosis (CPA) is a progressive and debilitating fungal infection that complicates structural lung diseases, particularly in patients with a history of treated tuberculosis. The therapeutic strategy remains a subject of intense debate, polarized between surgical resection, which offers a potential definitive cure but carries significant operative risks, and long-term azole therapy, which is suppressive but prone to drug resistance and high relapse rates. This study aimed to systematically evaluate survival outcomes and recurrence risks between these two modalities, specifically addressing the clinical heterogeneity between simple aspergilloma (SA) and chronic cavitary pulmonary aspergillosis (CCPA).
Methods: We conducted a systematic review and meta-analysis of six pivotal retrospective cohort studies published between 2013 and 2022, representing the modern era of thoracic surgery. Databases including PubMed, Scopus, and Embase were searched for comparative studies reporting overall survival (OS) and recurrence rates. Data were pooled using a random-effects model to account for clinical heterogeneity. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), with specific adjustments for allocation bias and confounding factors.
Results: The meta-analysis integrated data from 268 patients. Surgical resection was associated with a significant reduction in all-cause mortality compared to medical therapy (Pooled Hazard Ratio [HR] 0.12; 95% CI 0.04–0.35). In stratified analysis, recurrence rates were 2.7% for simple aspergilloma versus 10.3% for CCPA in surgical arms, contrasting sharply with relapse rates of 36–50% in medical arms upon drug cessation. An analysis of adjuvant antifungal therapy in a subset of patients showed no statistical benefit in completely resected simple aspergilloma. Postoperative complications occurred in 24.5% of surgical cases, primarily consisting of prolonged air leaks.
Conclusion: Surgical resection offers superior recurrence-free survival in selected candidates with localized disease compared to medical therapy. While effectively curative for simple aspergilloma, surgery in CCPA acts as a cytoreductive measure with a persisting recurrence risk, necessitating a multimodal approach. Medical therapy remains the mainstay for patients with bilateral disease or poor pulmonary reserve, but requires indefinite duration to prevent relapse.
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Functional Restoration of the Superior Auriculocephalic Sulcus in Cryptotia: A Case Report Validating the Twin Compression Theory via an Extended Sub-Galeal Advancement Flap
Views: 193Downloads: 168Background: Cryptotia, characterized by the invagination of the superior helix beneath the temporal skin, presents significant functional challenges regarding the retention of eyewear and protective masks. While prevalent in East Asian populations, data from the Indonesian archipelago is scarce. This study aims to document the functional and aesthetic outcomes of a modified surgical technique in a monozygotic twin, addressing the twin compression etiological hypothesis.
Case presentation: A 7-year-old male monozygotic twin presented with Type I Cryptotia of the right ear, with a superior helix-to-mastoid distance of 0 mm. The co-twin exhibited normal auricular morphology. The patient underwent a partial otoplasty combined with a modified posterior auricular advancement flap. The specific modification involved extended sub-galeal undermining to recruit maximum tissue elasticity. Cartilage reshaping was performed using non-absorbable horizontal mattress sutures. Postoperative evaluation at 3 months revealed a superior helix-mastoid distance increase to 12 mm and an auriculocephalic angle restoration to 30 degrees. Patient-Reported Outcome Measures via a validated Visual Analog Scale showed an improvement from 2 to 9 out of 10. No immediate recurrence or hypertrophic scarring was observed.
Conclusion: The extended sub-galeal advancement flap offers a promising solution for sulcus restoration, prioritizing vascularity and tissue recruitment over skin grafting. This case supports the intrauterine mechanical compression theory as a viable etiology for sporadic cryptotia. Short-term results are robust, though long-term surveillance is required to monitor cartilage memory.
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Intracrine Dynamics of Luminal Breast Cancer: Correlating Intratumoral Estradiol with Estrogen Receptor Alpha Overexpression in an Advanced-Stage Cohort
Views: 207Downloads: 145Background: In postmenopausal breast cancer, systemic serum estradiol levels often fail to reflect the biologically active concentrations within the tumor microenvironment, a phenomenon known as intracrineology. While the roles of estrogen receptor alpha (ERα) and beta (ERβ) are well-characterized, the specific relationship between local ligand concentration and receptor expression in advanced-stage malignancies remains under-investigated. This study investigates the correlation between intratumoral estradiol (E2) concentration and the expression of ER isoforms in Luminal A and Luminal B subtypes.
Methods: A retrospective cross-sectional study was conducted on 56 tissue samples (38 Luminal A, 18 Luminal B) from patients at Dr. Moewardi Regional General Hospital, Indonesia. Pre-analytical variables were strictly controlled, ensuring cold ischemia time was less than one hour. Expressions of E2, ERα, and ERβ were quantified using immunohistochemistry and assessed via H-Scores. Due to non-normal data distribution, associations were analyzed using Spearman’s Rho and Generalized Linear Models (GLM) with a Gamma distribution and log-link function, coupled with bootstrapping to generate robust confidence intervals.
Results: The cohort was characterized by advanced disease, with 85.7% of patients presenting with Stage III or IV breast cancer. Luminal A tumors exhibited significantly higher mean intratumoral E2 (91.58 versus 56.67; p = 0.038) and ERα expression (122.23 versus 109.72; p = 0.045) compared to Luminal B. A significant positive correlation was observed between tissue E2 and ERα (Rho = 0.347; p = 0.009). GLM analysis confirmed E2 as a significant predictor of ERα expression (p = 0.015), independent of age and stage. No significant correlation was found between E2 and ERβ (p = 0.113).
Conclusion: Intratumoral estradiol is a significant positive correlate of ERα expression in luminal breast cancer, supporting the existence of a ligand-driven autocrine maintenance loop even in advanced stages. The lack of correlation with ERβ suggests divergent regulatory mechanisms. These findings reinforce the rationale for therapies targeting local aromatase activity.
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Maternal Hyperthyroidism and Delayed Diagnosis of Bilateral Choanal Atresia in a 4-Month-Old Infant: A Case Report on Stentless Endoscopic Reconstruction
Views: 195Downloads: 131Background: Bilateral choanal atresia (BCA) is a life-threatening congenital anomaly typically presenting as a neonatal respiratory emergency. Survival beyond the neonatal period without surgical intervention is exceptionally rare. While the etiology is multifactorial, emerging evidence implicates maternal thyroid dysregulation in craniofacial malformations. This study reports a rare case of BCA diagnosed in a 4-month-old infant and evaluates the efficacy of stentless endoscopic repair using laterally-based mucoperiosteal flaps.
Case presentation: A 4-month-old female infant presented with failure to thrive (weight 5.2 kg, less than the 3rd percentile) and cyclical respiratory distress. Perinatal history revealed the mother had Graves' disease and discontinued methimazole at 6 weeks gestation. Retrospective analysis of maternal serum indicated uncontrolled thyrotoxicosis during the critical organogenesis window (TSH less than 0.01 mIU/L; fT4 2.8 ng/dL at 7 weeks). Diagnostic imaging confirmed mixed bony-membranous atresia. The patient underwent transnasal endoscopic choanoplasty using a laterally-based mucosal preservation technique. A 10-Fr silicone feeding tube was placed transnasally but did not function as a structural stent.
Conclusion: The intervention resulted in immediate airway patency. Quantitative outcomes showed an increase in oxygen saturation from 96% to 99% on room air and significant weight gain from 5.2 kg to 6.7 kg over two months. Follow-up at six months showed no restenosis. This case suggests a potential dual-hit teratogenic mechanism involving early methimazole exposure and subsequent uncontrolled maternal hyperthyroidism. Furthermore, it supports the efficacy of stentless repair in minimizing granulation tissue formation.
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Comparative Efficacy, Safety, and Patient Preference of One-Month (1HP) versus Three-Month (3HP) Rifapentine-Based Regimens for Latent Tuberculosis: A Network Meta-Analysis of HIV, Silicosis, and General Risk Populations
Views: 335Downloads: 223Background: The programmatic management of latent tuberculosis infection (LTBI) is undergoing a paradigm shift from long-course isoniazid monotherapy to short-course rifamycin-based regimens. While the 3-month weekly rifapentine/isoniazid (3HP) regimen is well-established, the ultra-short 1-month daily rifapentine/isoniazid (1HP) regimen offers a potential advancement in adherence. However, concerns regarding systemic hypersensitivity reactions, hepatotoxicity mechanisms, and efficacy in non-HIV populations like silicosis remain.
Methods: We conducted a systematic review and network meta-analysis (NMA) utilizing a random-effects frequentist model. We executed a comprehensive search of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials to identify randomized controlled trials comparing rifapentine-based regimens. We analyzed data comprising over 10,000 participants to evaluate the efficacy (prevention of active TB), safety (hepatotoxicity and hypersensitivity), and completion rates of 1HP, 3HP, 4-month rifampin (4R), and 9-month isoniazid (9H). We specifically integrated novel data on silicosis patients and patient preference metrics.
Results: The network analysis demonstrated that 1HP was non-inferior to 9H in preventing active tuberculosis (Incidence Rate Difference: -0.02 per 100 person-years). 1HP achieved the highest treatment completion rate (97%), significantly superior to 3HP (82%) and 9H (69%). Safety analysis revealed a distinct divergence: 3HP was associated with a higher incidence of systemic flu-like drug reactions (3.5%) compared to 9H (0.4%), whereas 1HP demonstrated a safety profile that minimized both the hepatotoxicity of isoniazid and the hypersensitivity of intermittent rifapentine. In silicosis patients, modified 1-month regimens proved safe. However, preference analysis indicated that 81% of patients preferred the weekly dosing of 3HP over the daily burden of 1HP.
Conclusion: 1HP represents the most effective strategy for maximizing treatment completion without compromising bactericidal activity. The daily dosing of 1HP appears to induce immune tolerance, mitigating the hypersensitivity reactions observed in weekly 3HP dosing. While 3HP remains a viable option for those preferring less frequent dosing, 1HP is the superior clinical recommendation for rapid sterilization of latent reservoirs.
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Vitamin D Supplementation Efficacy in Severe Vitamin D-Deficient versus Insufficient COPD Patients: A Stratified Meta-Analysis of Exacerbation Risk
Views: 391Downloads: 135Background: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airway inflammation and recurrent exacerbations that accelerate disease progression. Vitamin D deficiency is highly prevalent in this population and correlates with impaired macrophage function. However, randomized controlled trials regarding supplementation have yielded conflicting results. We hypothesized that efficacy is limited by a ceiling effect, where benefits are strictly restricted to patients with profound baseline deficiency.
Methods: We conducted a systematic review and stratified meta-analysis of randomized controlled trials comparing Vitamin D supplementation to placebo in COPD. To ensure methodological homogeneity and avoid data duplication, we strictly included only primary RCTs and excluded aggregate IPD meta-analyses. Studies investigating acute treatment of active exacerbations were also excluded. Data were stratified by baseline serum 25-hydroxyvitamin D [25(OH)D] levels into Severe Deficiency (<10 ng/mL) versus Insufficiency/Sufficiency (≥10 ng/mL). The primary outcome was the risk of moderate-to-severe exacerbations, analyzed using pooled Odds Ratios (OR) with a random-effects model.
Results: Five pivotal prevention trials (Lehouck, PRECOVID, ViDA, Hornikx, and Rafiq Pilot) comprising approximately 1,212 participants were included in the quantitative synthesis. In the unstratified analysis, Vitamin D showed no significant benefit (OR 0.78; 95% CI 0.55–1.10). However, stratification revealed a distinct therapeutic window. Patients with severe deficiency (<10 ng/mL) experienced a statistically significant reduction in exacerbation risk (Pooled OR 0.51; 95% CI 0.32–0.87; p=0.012). This effect was driven primarily by trials utilizing high-dose bolus supplementation. Conversely, patients with baseline levels ≥10 ng/mL showed no benefit (OR 0.98; p=0.72), confirming the biological ceiling effect.
Conclusion: Vitamin D supplementation confers a significant protective benefit against COPD exacerbations exclusively in patients with severe baseline deficiency (<10 ng/mL). The results support a precision medicine approach—screen, stratify, and target—while cautioning that efficacy appears dependent on correcting profound deficiency, potentially utilizing high-dose intermittent regimens.
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Thresholds of Cytoprotection: Ethanolic Propolis Extract Mitigates Ischemia-Reperfusion Injury via the MDA/IL-6 Axis in a Graded Rat Skin Flap Model
Views: 218Downloads: 134Background: Distal necrosis in reconstructive skin flaps results from ischemia-reperfusion (I/R) injury, driven by reactive oxygen species (ROS) and pro-inflammatory cytokines. While Propolis exhibits antioxidant properties, its efficacy limit relative to the severity of ischemic challenge remains undefined.
Methods: A randomized, controlled experimental study was conducted using 36 male Wistar rats. A graded ischemia model was engineered using modified McFarlane flaps with increasing length-to-width ratios: Mild (2:1), moderate (3:1), and severe (4:1). Subjects were stratified into vehicle (Control) and treatment (Propolis 800 mg/kg/day, oral) groups across all dimensions. The primary endpoint was the percentage of viable flap area on Day 7. Secondary endpoints included serum Malondialdehyde (MDA), Interleukin-6 (IL-6), and histological scoring of inflammation.
Results: All animals survived the procedure. Propolis significantly increased viable tissue area in the moderate ischemia group (76.4 ± 4.2%) compared to Vehicle (52.1 ± 5.8%; p < 0.001). In Mild ischemia, survival was near-maximal in both groups (>92%). However, in Severe ischemia, Propolis failed to prevent significant necrosis (34.2 ± 6.1% survival vs. 28.5 ± 5.4% in Vehicle; p = 0.092), indicating a therapeutic ceiling. Biochemically, Propolis suppressed MDA (11.92 ± 0.45 nmol/mL) and IL-6 (121.0 ± 4.71 pg/mL) significantly in moderate challenges but was overwhelmed by the oxidative surge in severe ischemia (MDA > 12.0 nmol/mL).
Conclusion: Propolis confers significant protection against I/R injury by dampening lipid peroxidation and systemic inflammation, but this effect exhibits a distinct threshold. It is highly effective in moderate ischemic challenges but insufficient for severe vascular compromise.
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Feasibility, Visual Outcomes and Severity-Stratified Response to Pre-operative Intravitreal Bevacizumab Before Vitrectomy in Proliferative Diabetic Retinopathy
Views: 6Downloads: 2Background: Proliferative diabetic retinopathy is a leading cause of vision loss in working-age Indonesians, and pre-operative anti-vascular endothelial growth factor therapy has been proposed to make vitrectomy safer, yet Southeast Asian trial evidence is almost absent.
Objective: To assess the feasibility, visual outcomes, and severity-stratified response to pre-operative intravitreal bevacizumab before 23-gauge pars plana vitrectomy in patients with proliferative diabetic retinopathy.
Methods: In a single-centre, single-blind pilot randomised controlled trial at the Department of Ophthalmology, Faculty of Medicine, Universitas Sriwijaya/ Dr. Mohammad Hoesin Central General Hospital, Palembang (July–November 2025), 21 adults with proliferative diabetic retinopathy and non-clearing vitreous haemorrhage were allocated 1:1, stratified by haemorrhage severity, to intravitreal bevacizumab 1.25 mg/0.05 mL given 3–7 days before 23-gauge pars plana vitrectomy (n = 11) or to vitrectomy alone (n = 10). Progression criteria were pre-specified; the clinical outcome was best-corrected visual acuity change in LogMAR at one week.
Results: All progression criteria fell in the green zone (recruitment 95.5%, 95% CI 78.2–99.2; retention and adherence 100%). Bevacizumab-treated eyes gained more vision, but imprecisely (Hodges–Lehmann shift 0.35 LogMAR, envelope 0.10 to 0.50; Hedges' g 0.65), the trial retaining only 14.8% power for the observed difference. Baseline vitreous haemorrhage severity dominated visual gain (adjusted B -0.397 LogMAR per grade, 95% CI -0.639 to -0.155; Cochran–Armitage trend p = 0.015).
Conclusion: Pre-operative bevacizumab is feasible in an Indonesian tertiary centre and warrants a severity-stratified multicentre trial.
