Accreditation
SINTA 2Nationally Accredited Journal
Vol. 10 No. 10 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Articles
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Does Germline BRCA1/2 Status Modify the Effect of Neoadjuvant Pembrolizumab on Pathological Complete Response in Early-Stage Triple-Negative Breast Cancer? A Systematic Review and Meta-analysis of Treatment-Biomarker Interactions
Views: 77Downloads: 72Background: Germline BRCA1/2 pathogenic variants are associated with chemotherapy response, but higher response among pembrolizumab-treated carriers does not establish a treatment-predictive interaction.
Objective: To determine whether germline BRCA1/2 status modifies the effect of neoadjuvant pembrolizumab on pathological complete response in early-stage triple-negative breast cancer, estimated as a within-study treatment-by-biomarker interaction on the ratio-of-odds-ratios scale.
Methods: Accessible bibliographic, registry, and citation sources were searched from inception through the final accessible-source update for comparative cohorts of neoadjuvant pembrolizumab plus chemotherapy versus chemotherapy alone reporting pathological complete response (pCR) by germline BRCA1/2 status. One author approved screening, extraction, ROBINS-I, and ICEMAN judgements. Treatment-by-biomarker interactions were expressed as ratios of odds ratios (RORs) and pooled by restricted-maximum-likelihood random effects with Hartung-Knapp inference.
Results: Three retrospective cohorts (655 participants) were included; two (415 participants) provided complete interaction cells. Study RORs were 3.65 (95% CI 0.52-25.62) and 2.76 (0.39-19.39). The pooled ROR was 3.17 (0.54-18.51; p=0.076), with tau-squared=0 and I-squared=0%. The third cohort remained qualitative because noncarrier cells were irreconcilable. Risk of bias was serious, interaction credibility was low, and certainty was very low.
Conclusion: The direction of effect is compatible with greater relative pembrolizumab-associated pCR improvement among carriers, but the evidence does not establish a predictive interaction. Prospective adjusted interaction analyses are required.
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Segmental Open Mandibular Fracture with Type 2 Diabetes Mellitus Managed by Intraoral Open Reduction, Internal Fixation and 101 Days of Arch Bar Retention: A Case Report with a Structured Care-Gap Analysis
Views: 81Downloads: 99Background: Mandibular fracture is the maxillofacial injury most often treated operatively, and road traffic collision is its dominant cause. Published series report fixation technique and union; far fewer report the perioperative variables that govern outcome when a metabolic comorbidity is present.
Objective: To present the staged intraoral repair of a segmental open mandibular fracture in an adult with type 2 diabetes mellitus and, through a structured audit of the record, to identify the measurable perioperative determinants of outcome that were not documented during care.
Case presentation: A 51-year-old man was struck by a car while riding a motorcycle and sustained a multiple open mandibular fracture of the symphysis, right parasymphysis and a segmental right body, with an anterior open bite, an interincisal opening of 24 mm, right mandibular crepitus and an avulsed right mandibular canine. He had treated hypertension and type 2 diabetes mellitus. Computed tomography with three-dimensional reconstruction defined the pattern and excluded condylar and intracranial injury. On the eighth day after injury, intraoral open reduction with four plates was combined with Erich arch bar maxillomandibular fixation. Rigid intermaxillary fixation was released at 21 days and the mandibular arch bar retained for 101 days. At day 116 mouth opening was unrestricted and mastication pain-free, with no infection, dehiscence, malunion or plate exposure. Structured review of the record showed that four determinants of outcome were never documented: any glycaemic measurement, inferior alveolar nerve sensation, the disposition of the avulsed canine and the retained dental roots, and a closing interincisal measurement.
Conclusion: A staged intraoral repair restored occlusion and function in a diabetic adult with a segmental open mandibular fracture. The favourable result was achieved despite four recording gaps, each fixable at no cost, that would have converted a good outcome into a demonstrated one.
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Excess Adiposity Predicts In-Hospital Mortality but Not SCORTEN in Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Three-Year Retrospective Cohort at Dr. Moewardi General Hospital, Surakarta
Views: 65Downloads: 45Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare drug-induced reactions in which in-hospital death occurs in 12–49% of cases, yet the reference prognostic instrument, SCORTEN, contains no anthropometric variable. Whether body mass index (BMI) carries independent prognostic information is unknown.
Objective: To determine whether body mass index carries independent prognostic information — for in-hospital mortality and for the SCORTEN severity score — in adults admitted with Stevens–Johnson syndrome and toxic epidermal necrolysis.
Methods: This retrospective observational analytic study used total sampling of the ICD-10 L51.1/L51.2 admission register at Dr. Moewardi General Hospital, Surakarta, from January 2022 to December 2024. Forty-three adults were classified by Asia-Pacific BMI thresholds and analysed against SCORTEN, diagnostic class and in-hospital mortality using exact, Firth-penalised and interval-valued methods, with STROBE reporting.
Results: Eight patients died (18.6%; 95% CI 9.7–32.6). BMI was not associated with SCORTEN (Spearman ρ = 0.163; 95% CI −0.14 to 0.44; p = 0.296), and all 3,280 exhaustively enumerated reconstructions of the incompletely reported score distribution reproduced a non-significant coefficient (ρ 0.061–0.287); the minimum detectable |ρ| was 0.42, so this null is uninformative rather than negative (BF01 = 3.10). Mortality rose across the ordered BMI strata from 0% to 36.4% (Cochran–Armitage z = 2.053; p = 0.040, exact permutation p = 0.056), and at the Asia-Pacific overweight threshold reached 35.3% versus 7.7% (odds ratio 6.55; 95% CI 1.14–37.75; Fisher exact p = 0.042; Firth-penalised odds ratio 5.54, 95% CI 1.20–34.09; number needed to harm 3.6; E-value 8.65; fragility index 1).
Conclusion: Excess adiposity is associated with in-hospital death in Indonesian patients with epidermal necrolysis through a channel SCORTEN does not capture. The estimate is imprecise and requires prospective multicentre confirmation.
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Visual Recovery to 6/6 After Plasma Exchange Begun 29 Days Into a Corticosteroid-Refractory Aquaporin-4-IgG-Positive Optic Neuritis Attack: A Case Report
Views: 89Downloads: 62Background: Optic neuritis in aquaporin-4 immunoglobulin G (AQP4-IgG)-positive neuromyelitis optica spectrum disorder (NMOSD) is severe and frequently corticosteroid-refractory. Plasma exchange is recommended within days of onset, and the evidence that later treatment still helps is thin. Whether an attack first treated a month after onset can still recover fully is unresolved.
Objective: To describe the visual and structural recovery that followed therapeutic plasma exchange begun 29 days after onset — far outside the recommended window — in a corticosteroid-refractory aquaporin-4-IgG-positive optic neuritis attack, and to audit the record against the quantified determinants of outcome.
Case presentation: A 34-year-old woman with systemic lupus erythematosus, antiphospholipid syndrome and AQP4-IgG seropositivity documented one month earlier presented 24 days after the onset of painful visual loss in the right eye. Best-corrected visual acuity was 3/60 and the Ishihara score 0 of 25. No relative afferent pupillary defect was demonstrable in the affected eye, because the fellow eye, atrophic since an attack 11 years earlier, showed the defect instead. A full Optic Neuritis Treatment Trial course of intravenous methylprednisolone, from day 24 to day 27, produced no measurable change. Plasma exchange was started on day 29; acuity reached 6/60 on day 33 and 6/6 on day 35, and the Ishihara score rose to 5 of 25 by day 40 without any procedure-related adverse event. At day 53 the peripapillary retinal nerve fibre layer measured 91 micrometres in the treated eye against 41 in the fellow eye.
Conclusion: Complete recovery of high-contrast acuity followed plasma exchange begun 29 days after onset, far outside the recommended window, while colour vision recovered only partially. A chronically damaged fellow eye can abolish the relative afferent pupillary defect in an acutely inflamed eye, and the attack occurred on azathioprine in a patient already known to be seropositive.
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Acute Changes in Cartilage Oligomeric Matrix Protein and CTX-II Following Endurance Running in Adults: A Systematic Review and Meta-analysis
Views: 70Downloads: 71Background: Acute running-related changes in cartilage oligomeric matrix protein (COMP) and the C-terminal cross-linked telopeptide of type II collagen (CTX-II) should not be interpreted automatically as structural cartilage injury. This review evaluated the magnitude and consistency of these biomarker responses after endurance running.
Objective: To quantify the magnitude and consistency of the immediate post-run change in serum cartilage oligomeric matrix protein (COMP), and to summarize the corresponding CTX-II responses, in adults following endurance running.
Methods: The protocol was registered in PROSPERO (CRD420261485170). PubMed/MEDLINE, CENTRAL, ClinicalTrials.gov, WHO ICTRP, OpenAlex, Crossref, and citation networks were searched for adult running studies reporting pre- and post-exercise COMP or CTX-II. The primary effect was the log ratio of immediate post-run to pre-run serum COMP. Random-effects models used restricted maximum likelihood with Hartung-Knapp inference.
Results: The search identified 221 unique reports; seven reports met the criteria for qualitative synthesis, and four compatible healthy-adult COMP estimates involving 57 participants entered the meta-analysis. The pooled post/pre ratio was 1.132 (95% CI 0.794–1.613), with τ²=0.0365, I²=89.0%, and a 95% prediction interval of 0.560–2.286 at ρ=0.50. Three estimates increased and one decreased after running. CTX-II and recovery findings were too heterogeneous for pooling. Certainty was very low.
Conclusion: Serum COMP may change acutely after endurance running, but the direction and magnitude are inconsistent. These short-term surrogate responses do not establish cartilage damage, protection, or long-term clinical harm.
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Sequential Inflammatory and Pupillary-Block Ocular Hypertension in Streptococcus suis Endogenous Endophthalmitis: An Observational Analytic Case Study
Views: 78Downloads: 56Background: Streptococcus suis, a zoonosis acquired from pigs and raw pork, is a rare cause of endogenous endophthalmitis, and no quantitative account of the pressure complications of such an eye has been published.
Objective: To characterize, in a single culture-proven case of Streptococcus suis endogenous endophthalmitis, the two mechanisms and the course of the raised intraocular pressure, and to derive the clinical implications for management.
Methods: a structured analysis of one culture-proven case managed at a tertiary hospital in Bali, Indonesia, over 48 days. Acuity was converted to logMAR on four published scales, all 19 pressure readings were analysed with a repeatability model, and corticosteroid causation was scored with the Naranjo instrument.
Results: a 46-year-old man who had eaten raw pork a week earlier presented with meningitis, reduced hearing and a left eye with light perception, hypopyon and vitritis. Cerebrospinal fluid and vitreous both grew S. suis. Pressure rose in two distinct episodes: an inflammatory one peaking at 29.0 mmHg on day 7, and a pupillary block from posterior synechiae with iris bombé peaking at 30.0 mmHg on day 16, which fell 11.0 mmHg after iridotomy with simultaneous reintroduction of timolol. Corticosteroid causation scored 3, a value largely fixed by the temporal sequence alone. Acuity improved by 0.70 logMAR overall, but the division of that gain across the vitrectomy reversed with the conversion scale: 0.40 before and 0.30 after by clinical convention against 0.10 and 0.60 with measured hand-movement values. The eye remained blind.
Conclusion: raised pressure in such eyes is not one entity, the pupil must be examined before pressure-lowering therapy is escalated, and a logMAR change at this level of vision is uninterpretable unless its scale is stated.
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Vision-Related Quality of Life in Moderate-to-High Myopia Corrected with Rigid Gas Permeable Contact Lenses: A West Sumatran Cross-Sectional Study
Views: 44Downloads: 44Background: Rigid gas permeable (RGP) contact lenses correct highly ametropic eyes better than spectacles can, but whether that optical advantage reaches the patient, and what predicts it, is unstudied in Indonesia.
Objective: To characterize vision-related quality of life, and to test whether clinical variables predict it, in adults with moderate-to-high myopia corrected with rigid gas permeable contact lenses in West Sumatra, Indonesia.
Methods: In an analytical cross-sectional study, 26 adults with a spherical equivalent of at least −3.00 dioptres who had worn RGP lenses for at least one month were recruited at the Refraction, Contact Lens and Low Vision Subdivision of Dr. M. Djamil Central General Hospital, Padang, West Sumatra, between July and August 2025. Acuity was recorded in logMAR before fitting and with the lens, and quality of life with the Indonesian National Eye Institute Visual Function Questionnaire-25; predictors were related to the composite and 12 subscales by Spearman and Mann–Whitney tests, with Benjamini–Hochberg control across all 104 tests.
Results: The median composite score was 93.21 (62.95–97.16) and 20 of 26 (76.9%, 95% CI 56.4–91.0) scored at or above the visually-normal normative mean of 85.48. Every participant gained at least 0.304 logMAR, 3.0 times the 0.10 logMAR minimum clinically important difference, the median gain being identified to 1.374–1.470 logMAR. Three tests reached p < 0.05 against 4.9 expected under the global null and none survived correction (smallest q = 0.989); with a minimum detectable |ρ| of 0.557, six subscales at their ceiling and a corrected-acuity range below one such difference, the predictor analysis is uninformative rather than negative.
Conclusion: RGP correction restored near-normal function and patient-reported vision; a future Indonesian study needs about 89 participants.
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Bacteriological Profile and In-Vitro Biofilm Formation on Tracheostomy Cannulae at Four Weeks: A Cross-Sectional Study in Padang, Indonesia
Views: 44Downloads: 37Background: A tracheostomy tube bypasses the mucociliary escalator and is colonised rather than kept sterile, yet we identified no published study from Sumatra characterising what grows on it, and none anywhere sampling at a device age fixed by protocol.
Objective: To characterize the cannula bacteriology and to quantify in-vitro biofilm production on tracheostomy tubes at a protocol-fixed device age of four weeks in Padang, Indonesia.
Methods: This cross-sectional study enrolled 33 consecutive adults at a protocol-fixed device age of four weeks at Dr. M. Djamil General Hospital, Universitas Andalas, Padang, West Sumatra, between January and July 2024. The inner aspect of the distal outer cannula was swabbed, cultured on blood agar and identified by MALDI-TOF mass spectrometry; biofilm production was quantified by the tissue-culture-plate assay at 570 nm in triplicate against the plate-specific negative control.
Results: Every specimen yielded growth (33/33; 100%, 95% CI 89.6–100). Gram-negative bacilli accounted for 93.9% (95% CI 80.4–98.3) of isolates and non-fermenters for 60.6% (43.7–75.3); Pseudomonas aeruginosa was commonest at 51.5% (35.2–67.5). Moderate or strong biofilm production was found in 69.7% of isolates (52.7–82.6) and any biofilm production in 75.8% (59.0–87.2), median biofilm index 3.01 (IQR 1.71–4.55); all Klebsiella pneumoniae and Proteus mirabilis isolates produced biofilm, whereas P. aeruginosa did so in 70.6%. No patient or care factor predicted biofilm production after Holm adjustment, including inner-cannula cleaning frequency (odds ratio 5.26, 95% CI 0.54–270.0; adjusted p = 0.619).
Conclusion: A predominantly non-fermenting Gram-negative flora with a high biofilm phenotype is established by week four, supporting scheduled tube exchange at that interval and adding local device-microbiology evidence where none existed. Antimicrobial susceptibility testing was not performed and is the priority for the next study.
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Visual Acuity, Perimetric and Optic Disc Findings at Presentation in Pituitary Macroadenoma: A Retrospective Indonesian Series
Views: 32Downloads: 24Background: Pituitary macroadenoma compresses the optic chiasm, and the resulting visual loss becomes irreversible once retinal ganglion cells die. No Indonesian series describes their visual status at first specialist contact.
Methods: Retrospective review of consecutive pituitary macroadenoma patients at a West Sumatran referral hospital, July 2022 to October 2025, reported per STROBE. Proportions carry 95% Wilson intervals, tested against published benchmarks with Holm adjustment. Because the records give marginal rather than patient-level data, unidentified associations were bounded by enumerating every contingency table consistent with the observed margins.
Results: Seventeen of 18 patients were eligible (34 eyes); 11 (64.7%) were female and 11 (64.7%) aged 21–40 years, neither differing detectably from an even split (p = 0.332). Under every admissible eye pairing at least 13 of 17 (76.5%) had an eye below 6/18 versus a 25% benchmark (p < 0.001, h = +1.082). All 17 had an abnormal field versus a 70% benchmark (p = 0.003, h = +1.159): bitemporal hemianopia in 10 (58.8%), generalised depression in 7 (41.2%). Optic atrophy affected 9 (52.9%), papilloedema none. All seven with generalised depression had optic atrophy, versus 2 of 10 with bitemporal hemianopia (risk difference +80.0 pp, 95% CI +32.9 to +94.3; p = 0.002). Four of 17 tests survived Holm adjustment; others were unidentified, their odds ratio bounds spanning the null.
Conclusion: This cohort presented with markedly advanced visual compromise, optic atrophy being established in over half, without detectable demographic difference from international series. Unexplained visual complaints warrant early perimetry and fundoscopy.
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Association of Pre-Chemotherapy Serum Alkaline Phosphatase Levels and p53 Protein Expression with Huvos Tumor Necrosis Grading in High-Grade Osteosarcoma: An Indonesian Tertiary Referral Center Experience
Views: 33Downloads: 17Background: High-grade osteosarcoma shows unpredictable chemosensitivity. Whether pre-chemotherapy serum alkaline phosphatase (ALP) and immunohistochemical p53 expression forecast post-neoadjuvant histopathological tumor necrosis remains contested in resource-constrained settings.
Methods: In a hospital-based nested cohort, 14 consecutive patients with primary high-grade extremity osteosarcoma (Palembang, 2023–2025) received three cycles of standardized neoadjuvant chemotherapy before wide resection. Pre-chemotherapy serum ALP and immunohistochemical nuclear p53 were related to Huvos response, dichotomized as poor (<90% necrosis; grades I–II) or good (≥90%; grades III–IV), using Fisher’s exact test, risk and odds ratios, and ROC analysis.
Results: The cohort comprised 9 males (64.3%) and 5 females (35.7%), mean age 22.0 ± 10.7 years. Poor histological response occurred in 11 patients (78.6%) and good response in 3 (21.4%). Elevated baseline ALP (>104 U/L) occurred in 92.9%, and p53 immunoreactivity was positive in 78.6%. Baseline serum ALP was not significantly associated with Huvos response (76.9% poor in elevated vs. 100.0% in normal; Fisher’s exact p = 1.000; RR = 0.769, 95% CI: 0.571–1.036), nor was p53 (81.8% poor in p53-positive vs. 66.7% in p53-negative; p = 1.000; OR = 2.250, 95% CI: 0.130–38.811; RR = 1.227, 95% CI: 0.526–2.864). ROC analysis for serum ALP yielded an AUC of 0.515 (95% CI: 0.205–0.825, p = 0.938), equivalent to random classification. An empirical cutoff of 176.5 U/L showed 100.0% specificity but only 36.4% sensitivity.
Conclusion: Pre-chemotherapy serum ALP and immunohistochemical p53 expression fail to predict post-neoadjuvant histopathological tumor necrosis in osteosarcoma, and cannot substitute for microscopic Huvos grading in guiding adjuvant treatment.
