Accreditation
SINTA 2Nationally Accredited Journal
Vol. 10 No. 8 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Articles
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Anesthetic Management of a Young Adult with Severe Rheumatic Mitral and Aortic Stenosis Undergoing Double Valve Replacement: A Case Report
Views: 100Downloads: 73Background. Rheumatic heart disease remains a leading cause of valvular pathology in young adults of low- and middle-income countries. The coexistence of severe mitral stenosis (MS) and severe aortic stenosis (AS) confronts the anesthesiologist with directly opposed hemodynamic imperatives and a markedly narrowed margin of safety, particularly during separation from cardiopulmonary bypass (CPB).
Case presentation. A 41-year-old man presented with a 14-year history of exertional syncope, progressive dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Transthoracic echocardiography demonstrated severe rheumatic MS (mitral valve area 0.8 cm²) and severe rheumatic AS (aortic valve area 0.8 cm², mean gradient 56 mmHg) with preserved left ventricular ejection fraction (67%), reduced right ventricular contractility (TAPSE 17 mm), and atrial fibrillation. He underwent double valve replacement under general anesthesia using an opioid-based, hemodynamically stable induction with full invasive monitoring. Separation from CPB was complicated by two episodes of ventricular tachycardia requiring synchronized cardioversion (30 J and 20 J) and was managed with a milrinone–dobutamine–norepinephrine strategy. The patient was transferred ventilated to intensive care on inotropic and antiarrhythmic support and stabilized.
Conclusion. Combined severe MS and AS demands an individualized plan reconciling contradictory goals: adequate preload and a controlled, unhurried heart rate for MS, against maintained afterload and coronary perfusion for AS. Meticulous invasive monitoring, a stable induction, anticipation of right ventricular dysfunction, and readiness for perioperative arrhythmia are decisive for a safe outcome.
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Optimal Timing of Tracheostomy in Critically Ill Adults Requiring Prolonged Mechanical Ventilation: An Updated Meta-Analysis of Randomized Controlled Trials
Views: 64Downloads: 50Background: Tracheostomy is among the most frequently performed procedures in the intensive care unit (ICU), yet the optimal timing relative to the onset of invasive mechanical ventilation remains contested. This study aimed to provide an updated quantitative synthesis of randomized controlled trials (RCTs) comparing early versus late tracheostomy in critically ill adults, incorporating the two most recent landmark trials.
Methods: PubMed was systematically searched, supplemented by reference-list screening, for RCTs comparing early with late tracheostomy in mechanically ventilated adults. Study selection and data extraction were performed independently and in duplicate. Risk of bias was appraised with the Cochrane RoB 2 tool and the certainty of evidence with the GRADE framework. Dichotomous outcomes (all-cause mortality, ventilator-associated pneumonia [VAP]) were pooled as risk ratios (RR); continuous outcomes (duration of mechanical ventilation, ventilator-free days) as standardized mean differences (SMD, Hedges’ g), using a DerSimonian–Laird random-effects model.
Results: Nine RCTs enrolling 2,500 critically ill adults were included. Early tracheostomy was not associated with reduced all-cause mortality (RR 0.88, 95% CI 0.70–1.09; p=0.24; I²=58.9%; prediction interval 0.48–1.59; seven trials; moderate certainty). A non-significant trend towards fewer VAP episodes was observed (RR 0.67, 95% CI 0.42–1.05; p=0.08; I²=71.0%; four trials; low certainty). Early tracheostomy showed non-significant tendencies towards a shorter duration of mechanical ventilation (SMD −1.38, 95% CI −3.44 to 0.68; I²=97.2%) and more ventilator-free days (SMD 0.20, 95% CI −0.07 to 0.47). Leave-one-out and Hartung–Knapp–Sidik–Jonkman analyses confirmed the robustness of the neutral mortality finding.
Conclusion: In critically ill adults requiring prolonged mechanical ventilation, early tracheostomy did not significantly reduce mortality and conferred, at most, modest and uncertain benefits on VAP and ventilation-related resource use. Timing should remain an individualized clinical decision rather than a uniform protocol.
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Risk of Amiodarone-Induced Pulmonary Toxicity Versus Placebo in Patients with Cardiac Arrhythmias and Heart Failure: A Meta-Analysis of Randomised Controlled Trials
Views: 44Downloads: 38Background: Amiodarone is the most effective antiarrhythmic agent for maintaining sinus rhythm, yet its long-term use is constrained by extracardiac toxicity, of which pulmonary toxicity is the most feared because it carries appreciable mortality and is frequently misdiagnosed. No contemporary meta-analysis has isolated amiodarone-induced pulmonary toxicity as the single primary endpoint across cardiac arrhythmia and heart-failure populations; this study quantified that risk.
Methods: PubMed/MEDLINE, Scopus and Web of Science were searched for placebo- or usual-care-controlled randomised controlled trials (RCTs) of oral amiodarone in adults with cardiac arrhythmia or heart-failure indications reporting pulmonary toxicity. Two reviewers extracted 2×2 data and assessed risk of bias with Cochrane RoB 2.0. Because the outcome was dichotomous, the risk ratio (RR) was pooled using a DerSimonian–Laird random-effects model, with the odds ratio (OR) and Peto OR as corroborative measures.
Results: Nine RCTs comprising 6,209 patients (3,175 amiodarone; 3,034 control) were included. Pulmonary toxicity occurred in 77 of 3,175 amiodarone-treated patients (2.43%) versus 42 of 3,034 controls (1.38%). Amiodarone significantly increased pulmonary-toxicity risk (RR 1.70, 95% CI 1.17–2.45, p = 0.005), with no detectable heterogeneity (I² = 0%). The OR (1.74) and Peto OR (1.81) were concordant, and the estimate remained harmful under every single-study deletion (RR 1.46–2.64). Higher-dose strata showed a numerically larger effect (RR 2.50) than lower-dose strata (RR 1.69; subgroup p = 0.48).
Conclusion: Amiodarone was associated with an approximately 70% relative increase in pulmonary-toxicity risk versus placebo, a robust and homogeneous finding. The absolute excess was modest (about one additional case per 95 patients treated), supporting continued use with structured baseline and periodic pulmonary surveillance, particularly at higher maintenance doses and longer durations.
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Enzyme-Inducing Antiseizure Medications and Hypovitaminosis D in Children with Epilepsy: A Cross-Sectional Study in West Sumatera, Indonesia
Views: 53Downloads: 39Background. Long-term antiseizure-medication (ASM) therapy can accelerate vitamin D catabolism via hepatic cytochrome P450 induction, predisposing children with epilepsy to hypovitaminosis D and its skeletal consequences; Indonesian tertiary-centre data remain scarce.
Methods. This cross-sectional study examined the association between ASM class, number and duration and serum 25-hydroxyvitamin D [25(OH)D] in children aged 1–18 years at Dr. M. Djamil General Hospital, Padang, West Sumatera, between April and October 2025. Of 82 records screened, 77 were eligible; 25(OH)D was measured by enzyme-linked fluorescent assay, with hypovitaminosis D defined as <30 ng/mL. Associations were tested with Fisher–Freeman–Halton exact and chi-square tests, odds ratios, ANOVA, multivariable logistic regression and ROC analysis.
Results. Hypovitaminosis D affected 48 children (62.3%; 95% CI 51.2–72.3), with mean 25(OH)D of 18.3±6.7 versus 41.6±11.2 ng/mL in deficient versus replete children. ASM class was significantly associated with vitamin D status (exact p=0.037; Cramér's V=0.283): all nine enzyme-inducing users were deficient, versus 56.0% non-enzyme-inducing and 58.1% combination (ANOVA p=0.045, η²=0.080). Neither ASM number (p=0.642) nor duration (p=0.348) was associated. Enzyme-inducing exposure carried the largest adjusted odds (adjusted OR 5.66, 95% CI 0.62–52.06), and the model discriminated moderately (AUC 0.685).
Conclusion. Hypovitaminosis D is prevalent in Indonesian children with epilepsy and is most strongly linked to enzyme-inducing ASMs, supporting early routine 25(OH)D monitoring and supplementation from treatment initiation.
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Discordance Between Plasma and Intratumoral Estradiol in Treatment-Naïve Luminal Breast Cancer: A Cross-Sectional Study
Views: 38Downloads: 31Background: Estradiol drives luminal breast cancer, and plasma estradiol is widely used as a systemic marker; whether it reflects the intratumoral hormonal milieu is uncertain. This study evaluated the relationship between plasma and intratumoral estradiol and their demographic determinants in treatment-naive luminal breast cancer.
Methods: An observational analytical cross-sectional study was conducted at Dr. Moewardi Regional General Hospital and the Anatomical Pathology Laboratory, Universitas Sebelas Maret, Surakarta, Indonesia (2019-2024). Fifty-six treatment-naive patients with Luminal A or Luminal B breast cancer were enrolled by total sampling. Plasma estradiol was measured by enzyme-linked immunosorbent assay and intratumoral estradiol by immunohistochemistry; data were analysed with Spearman correlation, chi-square/Fisher tests, logistic regression and ROC analysis, with effect sizes and 95% confidence intervals.
Results: Plasma estradiol did not correlate with intratumoral estradiol (Spearman rho = 0.136; 95% CI -0.13 to 0.39; p = 0.319) and discriminated tissue positivity at chance level (AUC = 0.42; 95% CI 0.25-0.59). Age >=50 years (OR 7.27; 95% CI 2.01-26.29; p = 0.001) and postmenopausal status (OR 11.61; 95% CI 2.85-47.38; p < 0.001) were associated with high plasma estradiol, and postmenopausal status remained independent after adjustment (adjusted OR 11.16; 95% CI 2.68-46.54). Neither variable was associated with intratumoral estradiol (p = 0.863 and p = 0.665).
Conclusion: Systemic estradiol does not represent the tumour hormonal state in luminal breast cancer; intratumoral estrogen appears governed by local intracrine mechanisms. Tumour-specific assessment may guide endocrine therapy more accurately than plasma measurement alone.
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Progressive Fahr's Syndrome with Severe Hypocalcemia in a Woman with Uncontrolled Type 2 Diabetes Mellitus and Coronary Artery Disease: A Case Report
Views: 44Downloads: 30Background: Fahr's syndrome denotes bilateral, symmetric calcification of the basal ganglia and other deep cerebral structures arising from an identifiable secondary cause, most commonly a disorder of calcium–phosphate metabolism. Its association with diabetes mellitus and systemic vascular calcification is increasingly recognized but seldom documented in a single patient.
Case presentation: A 58-year-old woman presented with one month of intermittent confusion, bilateral resting hand tremor, intermittent muscle cramps, and gait imbalance. Three months earlier she had a first-ever generalized tonic–clonic seizure coinciding with a new diagnosis of type 2 diabetes mellitus, after which she was non-adherent to insulin therapy. Examination revealed a fine resting tremor, a positive Trousseau sign, and impaired finger-to-nose testing. Investigations showed severe hypocalcemia (4.4 mg/dL), HbA1c 9.7%, and electrocardiographic anterior ischemia with cardiomegaly on chest radiography. Non-contrast cranial computed tomography demonstrated extensive bilateral symmetric calcification of the basal ganglia, cerebellum, thalami, and corona radiata–centrum semiovale. She was diagnosed with Fahr's syndrome with hypocalcemia, type 2 diabetes mellitus, and coronary artery disease, and managed with insulin, calcium lactate, vitamin D3, aspirin, simvastatin, and bisoprolol, with symptomatic improvement by the third hospital day.
Conclusion: Bilateral intracranial calcification warrants a structured search for secondary causes, particularly calcium–phosphate disturbance. The coexistence of uncontrolled diabetes, coronary artery disease, and progressive brain calcification supports a panvascular contribution and underscores the need for sustained metabolic control and longitudinal neurological follow-up, given that no curative therapy currently exists.
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Comparative Effectiveness of Channa micropeltes Albumin Extract Versus Human Albumin on Lactate and Central Venous Oxygen Saturation as Predictors of Mortality in Critically Ill Patients with Hypoalbuminemia: A Double-Blind Randomized Controlled Trial
Views: 40Downloads: 28Background: Hypoalbuminemia is highly prevalent in critically ill patients and is linked to impaired tissue perfusion and increased mortality. Human albumin is the gold-standard replacement but is costly and largely imported. Channa micropeltes (giant snakehead) albumin extract is a potential economical local alternative, yet comparative evidence on tissue-perfusion biomarkers—lactate and central venous oxygen saturation (ScvO2)—as predictors of mortality is scarce.
Methods: A double-blind randomized controlled trial in the intensive care unit of Dr. Moewardi Regional General Hospital, Surakarta, enrolled 32 adults with serum albumin <2.8 g/dL randomized to oral Channa micropeltes extract 5 g every 12 h (n=16) or intravenous 20% human albumin (n=16) for three days. Lactate and ScvO2 were sampled via central venous catheter on day 0 and day 3; mortality was followed to day 4. Analyses included repeated-measures ANOVA, Cohen's d, ROC curves and multivariable logistic regression.
Results: Lactate fell in both arms (Channa 5.29±1.32 to 3.52±1.00; human 5.31±0.94 to 3.63±1.09 mmol/L; both p<0.001; d≥1.5) and ScvO2 rose (Channa +10.53%; human +9.54%; both p<0.001), with no between-group difference (Δ lactate p=0.812; Δ ScvO2 p=0.620). Day-3 biomarker AUCs for mortality were 0.572 and 0.498. Albumin type was not associated with mortality (adjusted OR 0.354; 95% CI 0.067–1.862; p=0.220; NNT 16). No serious adverse events occurred.
Conclusion: Channa micropeltes albumin extract was non-inferior to human albumin for restoring tissue-perfusion biomarkers, supporting its potential as an economical, locally available alternative in critically ill patients with hypoalbuminemia.
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Early Individualized Medical Nutrition Therapy in Recurrent Luminal B Breast Cancer Complicated by Post-Chemotherapy Febrile Neutropenia and Pancytopenia with Moderate Malnutrition: A Case Report
Views: 41Downloads: 38Background: Breast cancer is the most common malignancy among women, and malnutrition affects approximately 30–50% of hospitalized patients with cancer, independently increasing treatment-related toxicity, prolonging hospitalization, and worsening survival. When cytotoxic chemotherapy precipitates febrile neutropenia and pancytopenia, reduced intake, systemic inflammation, and bone-marrow suppression converge, yet nutritional care is frequently deprioritized during the neutropenic nadir.
Case presentation: A 58-year-old woman with recurrent left breast cancer (luminal B subtype), previously treated with mastectomy and three chemotherapy cycles, presented with two weeks of anorexia, fever (40.6 °C), vomiting, diarrhea, and 3 kg weight loss. Anthropometry showed a body mass index of 17.6 kg/m2 and a mid-upper-arm circumference of 23 cm; laboratory testing confirmed febrile neutropenia (absolute neutrophil count 0.05 ×103/µL) with pancytopenia and hypoalbuminemia (2.7 g/dL). She met three phenotypic and two etiologic Global Leadership Initiative on Malnutrition (GLIM) criteria, establishing moderate malnutrition. Alongside supportive care and granulocyte colony-stimulating factor, individualized medical nutrition therapy targeting 2,100 kcal/day and 90 g protein/day was delivered as a soft oral diet with a peptide-based oral nutritional supplement and vitamin B12. Oral intake rose from 50% or less to 86% by day three and 93% by day four; over six days, weight, appetite, physical function, and all hematologic indices recovered, and she was discharged stable.
Conclusion: Early, individualized medical nutrition therapy initiated before severe malnutrition develops can support concurrent nutritional, immune, and hematologic recovery in breast cancer patients with post-chemotherapy hematologic toxicity. Routine nutritional screening and prompt, protein-focused intervention should be integrated into oncology care.
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Mycological Culture Profile and Clinical Predictors of Culture Positivity in Dermatophytosis: A Four-Year Retrospective Study at a Tertiary Referral Hospital in Bali, Indonesia
Views: 46Downloads: 33Background: Dermatophytosis is the commonest superficial mycosis, yet the aetiological spectrum in eastern Indonesia and the determinants of a positive fungal culture remain poorly characterised. We aimed to describe the mycological culture profile and identify predictors of culture positivity at a tertiary referral centre in Bali.
Methods: This STROBE-compliant retrospective cross-sectional study analysed 214 consecutively sampled patients with dermatophytosis at the Dermatology and Venereology clinic of Ngoerah Hospital, Denpasar, between January 2020 and December 2023. Potassium-hydroxide (KOH) microscopy and Sabouraud culture data were extracted from records. Proportions carried 95% Wilson confidence intervals (CI); associations were assessed by chi-square/Fisher tests with odds ratios and Cramér's V, followed by multivariable logistic regression (adjusted odds ratio [aOR], Nagelkerke R²) and receiver-operating-characteristic analysis.
Results: Mean age was 42.7 years and the male-to-female ratio 1.68:1; Fitzpatrick phototype IV predominated (51.9%). Culture was positive in 138 patients (64.5%; 95% CI 57.9–70.6). Trichophyton rubrum was the leading isolate (50.0%; 95% CI 41.8–58.2), followed by the T. mentagrophytes complex (15.9%) and Microsporum canis (10.1%); anthropophilic species comprised 81.2%. KOH positivity (aOR 5.20; 95% CI 2.27–11.87; p<0.001) independently predicted culture positivity, whereas prior antifungal use was protective (aOR 0.30; 95% CI 0.13–0.65; p=0.002); the model discriminated well (AUC 0.785; 95% CI 0.715–0.855).
Conclusion: Dermatophytosis in Bali is dominated by anthropophilic T. rubrum, and culture yield is governed chiefly by prior antifungal exposure and KOH status, supporting a stewardship-oriented diagnostic pathway in which culture is prioritised for KOH-positive, treatment-naive and recalcitrant presentations.
