Accreditation
SINTA 2Nationally Accredited Journal
Vol. 10 No. 9 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Articles
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When Bleeding Stops but Organs Fail: Fatal Multiple Organ Dysfunction Syndrome Following Massive Atonic Postpartum Haemorrhage in a Young Primipara — A Case Report
Views: 64Downloads: 28Background: Postpartum haemorrhage from uterine atony can precipitate profound haemorrhagic shock within minutes, and in resource-constrained referral systems the interval between the onset of bleeding and definitive source control is frequently the decisive determinant of survival.
Objective: To document, in granular day-by-day detail, the evolution of fatal multiple organ dysfunction syndrome following massive atonic postpartum haemorrhage in a young woman with no antecedent organ disease, and to translate that trajectory into transferable lessons for haemorrhage systems in resource-limited settings.
Case presentation: We describe a 28-year-old primipara referred four hours after a vacuum-assisted vaginal delivery of twins complicated by severe pre-eclampsia. On arrival she was stuporous, hypotensive (70/68 mmHg), tachycardic (142 beats/min) and oliguric, with active vaginal bleeding and a haemoglobin of 2.4 g/dL. Resuscitation and haemorrhage control proceeded in parallel: high-flow oxygen, dual large-bore access, crystalloid and colloid loading, tranexamic acid, balanced blood-component transfusion, bimanual compression, intubation and emergency laparotomy. A flaccid, bluish, atonic uterus and a fourth-degree perineal tear were identified; subtotal hysterectomy with sphincteroplasty and perineorrhaphy achieved haemostasis. Despite massive transfusion and intensive care, prolonged hypoperfusion evolved into ischaemic hepatitis, severe coagulopathy, stage III acute kidney injury requiring haemodialysis, hospital-acquired pneumonia with drug-resistant sepsis, acute pulmonary oedema and upper gastrointestinal bleeding. Progressive multiple organ dysfunction syndrome culminated in asystolic cardiac arrest on postoperative day 15.
Conclusion: This case illustrates a principle easily overlooked: definitive surgical haemostasis does not reverse organ injury already committed during the pre-operative shock interval. Objective cumulative blood-loss measurement, immediate haemorrhage-bundle and massive-transfusion protocol activation, explicitly documented uterotonic therapy, rapid balanced resuscitation and structured post-haemostasis organ surveillance are the interventions most likely to interrupt the lethal trajectory.
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Higher Ictal EEG Amplitude Predicts Greater PANSS Improvement in Schizophrenia Patients Undergoing Electroconvulsive Therapy: A Two-Group Analytical Study in Surakarta, Indonesia
Views: 62Downloads: 25Background: Schizophrenia frequently responds incompletely to antipsychotics, and electroconvulsive therapy (ECT) remains an important somatic augmentation for severe or treatment-resistant disease; however, the neurophysiological determinants of ECT response are shifting from seizure duration toward ictal electroencephalographic (EEG) quality, of which peak ictal amplitude is a putative but under-tested marker.
Objective: To determine whether peak ictal EEG amplitude predicts the magnitude of symptomatic improvement, measured by the Positive and Negative Syndrome Scale (PANSS), in schizophrenia patients undergoing electroconvulsive therapy.
Methods: This analytical two-group study at RSJD dr. Arif Zainuddin, a tertiary psychiatric hospital in Surakarta, Central Java, Indonesia, enrolled 36 consecutively sampled inpatients (18 per group) with DSM-5-TR/ICD-11-confirmed schizophrenia undergoing ECT, reported per STROBE. Peak ictal EEG amplitude was dichotomised at 1000 µV; the Positive and Negative Syndrome Scale (PANSS), applied by trained raters using the validated Indonesian adaptation, was measured before and after the ECT course. Analyses included paired and independent t-tests, correlation, receiver-operating-characteristic (ROC) analysis, and multivariable linear and penalised logistic regression.
Results: Both groups improved (both paired p<0.001), but the ≥1000 µV group achieved markedly greater total-PANSS reduction (34.7±9.2 vs 23.2±8.5 points; mean difference 11.5, 95% CI 5.5–17.5; t(34)=3.90; p=0.0004; Cohen d=1.30) and higher ≥30% response (72.2% vs 16.7%). Continuous amplitude correlated with PANSS reduction (r=0.73, p<0.001), the adjusted odds ratio for response was 4.85 (95% CI 1.56–15.06), and amplitude discriminated responders well (AUC 0.88; Youden cut-off ~1093 µV; sensitivity 81%, specificity 90%).
Conclusion: Higher ictal EEG amplitude independently predicts greater symptomatic improvement in schizophrenia, supporting routine intra-procedural amplitude monitoring to optimise therapeutic seizure quality, particularly in resource-constrained psychiatric practice.
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Admission Systemic Immune-Inflammation Index and Its Association with High Thrombus Burden and No-Reflow in ST-Segment Elevation Myocardial Infarction: A Retrospective Cohort Study
Views: 55Downloads: 35Background: ST-segment elevation myocardial infarction (STEMI) is a thrombo-inflammatory emergency, and successful epicardial recanalisation during primary percutaneous coronary intervention (PCI) does not always restore myocardial perfusion. The Systemic Immune-Inflammation Index (SII), derived from routine platelet, neutrophil and lymphocyte counts, may reflect thrombo-inflammatory risk.
Objective: This study evaluated the association of admission SII with high thrombus burden and no-reflow in STEMI patients undergoing primary PCI.
Methods: This STROBE-compliant retrospective cohort study consecutively sampled 118 STEMI patients at Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar. High thrombus burden was defined as TIMI thrombus grade 4-5 and no-reflow as post-procedural TIMI flow grade =2. The optimal SII cut-off was derived by receiver operating characteristic analysis (Youden index); associations were assessed with chi-square/Fisher tests and modified Poisson regression with robust standard errors.
Results: High thrombus burden occurred in 99 patients (83.9%) and no-reflow in 16 (13.6%). High SII was associated with high thrombus burden (90.8% vs 75.5%; relative risk 1.203, 95% CI 1.013-1.428; p=0.025) and no-reflow (20.0% vs 5.7%; relative risk 3.53, 95% CI 1.062-11.753; p=0.024), persisting after adjustment (adjusted relative risk 1.194 and 3.226, respectively). Discrimination was weak-to-modest (AUC 0.597 and 0.674).
Conclusion: Admission SII was independently associated with high thrombus burden and no-reflow but had insufficient accuracy for standalone prediction, supporting its role as a simple adjunctive marker rather than a definitive predictor.
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Synergistic Reduction of TNF-α by Combined Ursodeoxycholic Acid and Multi-Strain Probiotics in a Rat Model of Cholestasis
Views: 62Downloads: 44Background: Cholestasis is a complex hepatobiliary disorder in which impaired bile flow provokes a sustained inflammatory response, with tumor necrosis factor-alpha (TNF-α) acting as a central pro-inflammatory mediator. Ursodeoxycholic acid (UDCA) is the first-line therapy, but a substantial subset of patients responds incompletely, motivating adjunctive strategies that target extrahepatic, gut-derived drivers of inflammation through the gut–liver axis.
Objective: To evaluate whether multi-strain probiotics potentiate the anti-inflammatory (TNF-α–lowering) effect of ursodeoxycholic acid (UDCA) in experimental cholestasis.
Methods: This randomised, post-test-only controlled experimental study was reported in accordance with ARRIVE 2.0 guidelines. Thirty-five male Sprague-Dawley rats were randomised into seven groups (n=5): healthy control (K1), disease control (K2), UDCA monotherapy (K3), probiotic monotherapy (K4), and three UDCA plus dose-escalating probiotic combinations (K5–K7). Cholestasis was induced by common bile duct ligation; interventions ran for 21 days. Serum TNF-α was quantified by ELISA and analysed with one-way ANOVA, Tukey HSD and Games-Howell post hoc tests, effect sizes, and dose-response regression.
Results: TNF-α differed markedly across groups (F(6,28)=783.5, p<0.001, η²=0.994). Ligation raised TNF-α from 5.69±0.25 pg/mL (K1) to 17.88±0.43 pg/mL (K2; p<0.001, Cohen's d=34.7). Both monotherapies reduced TNF-α (K3 14.91±0.49; K4 12.50±0.32; both p<0.001), but combination therapy achieved significantly greater suppression, lowest in K7 (7.91±0.18 pg/mL; 55.8% reduction; 81.8% normalisation toward healthy). A significant dose-dependent decline occurred across combination groups (slope=−0.113 pg/mL per mg, r=−0.94, R²=0.89, p<0.001).
Conclusion: Combined UDCA and probiotics produce a synergistic, dose-dependent reduction of TNF-α in experimental cholestasis, supporting probiotics as a rational adjunct targeting the gut–liver axis and warranting translational evaluation in cholestatic patients.
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Laser Haemorrhoidoplasty versus Stapled Haemorrhoidopexy for Grade II–III Haemorrhoidal Disease: A Systematic Review and Meta-Analysis of Postoperative Pain and Perioperative Outcomes
Views: 53Downloads: 34Background: Postoperative pain and delayed recovery are the principal drawbacks of excisional haemorrhoid surgery, and two minimally invasive alternatives — laser haemorrhoidoplasty (LH) and stapled haemorrhoidopexy (SH) — are increasingly used to overcome them. Although each has repeatedly been compared with conventional haemorrhoidectomy, the direct head-to-head evidence comparing LH with SH has never been pooled quantitatively.
Objective: This systematic review and meta-analysis compared the perioperative, early postoperative pain and safety outcomes of LH and SH in adults with symptomatic haemorrhoidal disease.
Methods: PubMed, Scopus-indexed journals, Crossref and Google Scholar were searched systematically for randomised and comparative studies directly comparing LH with SH. Ten studies were included and seven contributed poolable data. Random-effects models (DerSimonian–Laird, with Hartung–Knapp–Sidik–Jonkman intervals for inference on continuous outcomes) generated risk ratios (RR) for dichotomous outcomes and standardised mean differences (SMD, Hedges g) for continuous outcomes; raw mean differences were reported for interpretability. Risk of bias was appraised with RoB 2 and ROBINS-I, and the certainty of evidence was rated for each outcome.
Results: Laser haemorrhoidoplasty was associated with a significantly shorter operative time (SMD −1.65, 95% CI −2.47 to −0.84; p<0.001; approximately 8 minutes shorter on average), a shorter hospital stay (SMD −3.07, 95% CI −5.58 to −0.55; p=0.017) and a non-significant trend toward less intraoperative blood loss (SMD −2.30, 95% CI −4.74 to 0.13; p=0.064). Early postoperative pain (≤24 h) did not differ significantly on pooling (SMD −0.66, 95% CI −1.95 to 0.63; p=0.32; I² 98%); this reflected a time-dependent crossover in which LH was less painful in the first hours but SH became less painful from 24 hours onward. Overall complications favoured LH numerically but not significantly (RR 0.58, 95% CI 0.25 to 1.30; p=0.18), an advantage confined to short-follow-up studies and reversed in the single 24-month trial. Recurrence, bleeding, anal stenosis and urinary retention were comparable. The certainty of evidence was low to very low for all outcomes.
Conclusion: Laser haemorrhoidoplasty offered consistent intraoperative advantages over stapled haemorrhoidopexy, whereas early pain and safety were comparable and duration of follow-up was the dominant effect-modifier. Both are reasonable minimally invasive options; technique selection should be individualised pending adequately powered long-term trials.
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Surgical Outcomes and Recurrence in Adult Abdominal Cocoon (Sclerosing Encapsulating Peritonitis): A Systematic Review and Meta-Analysis of Pooled Proportions
Views: 56Downloads: 43Background: Abdominal cocoon, also termed sclerosing encapsulating peritonitis (SEP) or encapsulating peritoneal sclerosis (EPS), is a rare cause of intestinal obstruction in which the small bowel is encased within a fibrocollagenous membrane, producing the prototypical frozen abdomen. Its surgical outcomes had never been pooled quantitatively.
Objective: To quantitatively pool the surgical outcomes of adult abdominal cocoon — peri-operative mortality, morbidity, recurrence and pre-operative diagnostic yield — in patients undergoing operative management.
Methods: PubMed, Scopus, the Cochrane Library and Google Scholar were searched for observational studies reporting the operative management and outcomes of adult abdominal cocoon. Ten case series (179 operated patients) were included. As all studies were single-arm, proportions were pooled with the Freeman–Tukey transformation under a DerSimonian–Laird random-effects model; robustness was tested with a logit-normal model, leave-one-out analysis and the Egger test, and quality with the Joanna Briggs Institute checklist.
Results: Pooled peri-operative mortality was 4.5% (95% CI 0.2–12.1%; k=7); because zero-event studies influence the double-arcsine transformation, a logit-normal model gave 13.1% and the crude proportion 7.9%, so mortality is best summarised as low-to-moderate. Pooled morbidity was 19.5% (95% CI 5.9–36.9%; k=5), recurrence 3.3% (95% CI 0.0–21.8%; k=3) and pre-operative diagnostic yield 19.1% (95% CI 6.0–36.0%; k=4). Leave-one-out kept mortality between 3.0% and 8.5%.
Conclusion: Surgery for adult abdominal cocoon achieved low-to-moderate mortality and acceptable morbidity with infrequent recurrence, supporting membrane excision and adhesiolysis in selected patients, while the low pre-operative diagnostic rate signals a need for greater awareness.
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Global and Site-Specific Osteoarthritis Burden, 1990–2021, and Rehabilitation Capacity Modeling for Indonesia: A Spatiotemporal Analysis
Views: 33Downloads: 27Background: Osteoarthritis is a major and growing cause of disability, but prevalence does not directly measure clinically assessed rehabilitation need, demand, utilization, or unmet need.
Objective: We quantified global, regional, national, and joint-site burden and linked rehabilitation-amenable prevalence to transparent capacity scenarios for Indonesia.
Methods: We integrated annual WHO/IHME rehabilitation-amenable osteoarthritis estimates for 195 countries (1990–2021), published GBD 2019 site-specific prevalence, published GBD 2021 incidence and years lived with disability, and WHO rehabilitation specifications. EAPC was calculated from annual posterior-mean age-standardized rates using log-linear regression; published joinpoint AAPC retained its original name. Deterministic scenarios converted Indonesia’s 2021 prevalence into direct-contact hours and multidisciplinary FTE-year equivalents.
Results: In 2021, 371.6 million people globally and 9.08 million in Indonesia had osteoarthritis-related functioning problems for which rehabilitation could be beneficial. From 1990 to 2021, prevalence increased by 137.7% globally and 199.8% in Indonesia. Prevalence EAPC was 0.34% annually globally and 0.55% in Indonesia. Knee osteoarthritis had the highest site-specific rate, whereas hand incidence and YLDs had the fastest published AAPCs in several middle-SDI settings. Indonesia’s foundational, scale-up, and comprehensive scenarios produced 5,673, 29,223, and 93,914 direct-contact FTE-year equivalents.
Conclusion: Rehabilitation-amenable osteoarthritis burden increased faster in Indonesia than globally and varied by joint site and development level. Scenario outputs are model-based decision quantities, not national staffing requirements or workforce gaps, and require stakeholder validation with local severity, capacity, delivery, referral, adherence, and workforce data.
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Dietary Pattern and Psychological Stress Are Not Associated with Gastro-oesophageal Reflux Symptoms in Female Preclinical Medical Students: A Precision-Focused Cross-Sectional Study
Views: 68Downloads: 58Background: Gastro-oesophageal reflux disease is among the most prevalent chronic gastrointestinal disorders worldwide and its absolute burden continues to rise, yet studies of behavioural determinants in young adults report statistical significance without magnitude and almost never state the effect size their design could detect.
Objective: To estimate the association of dietary pattern and psychological stress with symptom-defined gastro-oesophageal reflux, and the precision with which those associations could be detected, in a restriction-based sample of female preclinical medical students.
Methods: This STROBE-compliant cross-sectional study used a restriction-based design to isolate behavioural exposures from adiposity and the other dominant reflux risk factors. Of 120 randomly selected female preclinical medical students at the Faculty of Medicine, Universitas Pembangunan Nasional "Veteran" Jakarta, 104 responded (86.7%) and 87 met eligibility criteria fixing female sex, body mass index 18.5-24.9 kg/m2, never-smoking, no alcohol intake and no gastro-active medication. Dietary pattern, stress and reflux symptoms were measured with validated Indonesian instruments and analysed with exact tests, Firth penalised logistic regression, Bayesian estimation, quantitative bias analysis and formal precision analysis.
Results: GERD-Q positivity was 12.6% (95% CI 7.2-21.2); 8.0% had a poor dietary pattern and 43.7% reported stress. Adjusted odds ratios were 3.35 (95% CI 0.55-16.12; p = 0.208) for poor dietary pattern and 1.10 (95% CI 0.31-3.78; p = 0.339) for stress; Bayes factors favouring the null ranged from 0.99 to 2.05 and from 1.78 to 4.90 across four priors. Minimum detectable odds ratios were 12.23 and 4.32. Correcting for outcome misclassification raised the dietary odds ratio to 6.61.
Conclusion: Neither exposure was associated with reflux symptoms; the study excludes only large effects, and about 459 participants would be needed to detect the observed dietary effect.
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Calcium Channel Blockers in Kidney Transplant Recipients: Cyclosporine-Era Kidney-Function Effects and Tacrolimus Pharmacokinetic Implications: A Meta-Analysis
Views: 52Downloads: 25Background: Post-transplant hypertension and calcineurin-inhibitor nephrotoxicity threaten cardiovascular and graft outcomes after kidney transplantation. Calcium channel blockers offer haemodynamic benefit and alter calcineurin-inhibitor exposure, but cyclosporine and tacrolimus studies assessed different evidence domains.
Objective: To pool the comparative effect of calcium channel blockers on kidney-function outcomes in adult kidney transplant recipients, and to distinguish the cyclosporine-era kidney-function evidence from the tacrolimus-era pharmacokinetic implications.
Methods: Comparative randomised trials and cohorts in adult kidney transplant recipients were identified through PubMed, the Cochrane Library, citation pathways, and reference checking. Kidney-function outcomes were directionally harmonised. Compatible standardised mean differences were pooled using a restricted maximum-likelihood random-effects model with Hartung–Knapp inference. Prediction intervals, subgroup analyses, influence diagnostics, sensitivity analyses, and Cochrane RoB 2 assessments were completed.
Results: At least 22 reports represented at least 21 independent datasets; seven cyclosporine-treated trials with 639 participants supplied compatible kidney-function data. Calcium channel blockers were favoured (Hedges g 0.38, 95% CI 0.11 to 0.66; I²=45.2%; τ²=0.042), although the 95% prediction interval ranged from −0.19 to 0.96. Leave-one-out estimates ranged from 0.26 to 0.45. DerSimonian–Laird and critical-risk sensitivities yielded g 0.38 and 0.37. A tacrolimus clinical subgroup and primary Egger test were not estimable.
Conclusion: Calcium channel blockers were associated with modestly better kidney-function measurements during cyclosporine treatment, but very-low-certainty evidence precluded a uniform benefit claim. Tacrolimus evidence instead concerned CYP3A5-dependent exposure and dose sparing; the two evidence streams remain clinically linked but quantitatively non-equivalent.
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Neglected Total Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy Coexisting with Bilateral Grade IV Hypertensive Retinopathy in Severe Pre-eclampsia: A Case Report from an Indonesian Archipelagic Province
Views: 32Downloads: 12Background: Pre-eclampsia injures the eye through the same endothelial mechanism that injures the kidney and brain, and its retinal signs track systemic severity. Rhegmatogenous retinal detachment arises by an entirely different mechanism, yet where vitreoretinal care is distant the two may present together in one patient, a coexistence not previously described.
Objective: To describe a previously unreported coexistence of chronic rhegmatogenous retinal detachment and grade IV hypertensive retinopathy of severe pre-eclampsia in one patient, and to set out the structural features that distinguish the two mechanisms at the bedside — the distinction that determines whether treatment is medical or surgical.
Case presentation: A 36-year-old woman was examined three weeks after a term vaginal delivery, four months after sudden visual loss in the left eye that began in the fifth month of a pregnancy complicated by pre-eclampsia. She also reported 19 years of unassessed visual loss in the right eye. Blood pressure was 154/114 mmHg. Acuity was hand movement right and 0.1 decimal left. The right eye showed total retinal detachment with a break at 9 o'clock, fixed folds, pigment clumping, grade C posterior proliferative vitreoretinopathy, posterior subcapsular cataract and a 7-degree sensory exotropia; the left eye showed optic disc swelling, peripapillary haemorrhage and a macular star. Both eyes met Scheie grade IV. Left macular tomography gave a central subfield of 182 micrometres and a minimum foveal thickness of 98, with five of nine sectors below the first percentile. No relative afferent pupillary defect was detectable.
Conclusion: Chronic rhegmatogenous and hypertensive retinal disease can coexist in one patient and must be separated structurally, because only one responds to blood pressure control. Sub-percentile macular thinning tempers the expectation of full recovery, and bilateral disease can abolish the relative afferent pupillary defect that would otherwise flag a blind eye.
