Introduction: Peripartum cardiomyopathy (PPCM) is a rare but serious cardiac condition that occurs in pregnant or postpartum women, characterized by impaired and decreased left ventricular ejection fraction <45%. Previous studies suggest that frontline healthcare professionals often have limited familiarity with PPCM, which may delay recognition and management. Therefore, this study aimed to evaluate whether a structured training program could improve and strengthen healthcare professionals’ knowledge and confidence in screening PPCM. Improved recognition is expected to reduce diagnostic delays, enhance maternal cardiovascular outcomes, and ultimately contribute to lowering PPCM-related morbidity and mortality. Methods: A quasi-experimental single-group pretest–posttest study was conducted among healthcare professionals in East Java to evaluate a PPCM training program. The sessions covered pathophysiology, diagnostic criteria, screening approaches, and key echocardiographic features. Participants completed questionnaires before and after training to evaluate knowledge changes. Data were analyzed using descriptive statistics, Kolmogorov–Smirnov, and the Wilcoxon signed-rank test. Results: The results showed that a total of 869 healthcare professionals participated in the program, consisting of 190 general practitioner (21.9%), 632 midwives (72.7%), 43 nurses (4.9%), and 4 administrative staff (0.5%). The mean scores increased from 12.23 (standard deviation [SD] =2.003) before training to 13.74 (SD = 1.575) afterward, indicating significant improvement (P < 0.001). Pre-test scores differed significantly between professions (P < 0.001), whereas posttest scores showed no significant differences (P = 0.206), suggesting that training helped standardize knowledge across professional groups. Conclusions: Targeted educational programs effectively enhance PPCM knowledge among healthcare providers. By enabling earlier recognition and reducing diagnostic delays, this training is crucial for improving maternal cardiovascular care and outcomes.
Cryptococcal meningoencephalitis is a severe opportunistic infection in people with HIV. We report a 42-year-old man presenting with significant weight loss, neurological symptoms, and progressive vomiting. Neuroimaging and positive cryptococcal antigen testing in cerebrospinal fluid confirmed the diagnosis. The patient’s neurological condition gradually improved after receiving induction therapy with intravenous amphotericin B and high-dose fluconazole. The course was exacerbated by recurring severe hypokalemia linked to amphotericin B, which necessitated vigilant cardiac and electrolyte monitoring as well as rigorous potassium supplementation. Notably, rather than stopping amphotericin B treatment in spite of significant hypokalemia, it was carefully corrected and monitored. This instance illustrates the significance of careful monitoring and prompt management of metabolic abnormalities in patients with advanced HIV infection by highlighting the concurrent challenge of managing a life-threatening fungal infection while addressing treatment-related toxicity.
Severe aortoiliac occlusion can complicate device placement during primary percutaneous coronary intervention (PCI). This presents additional challenges when immediate coronary management is required. We report a single-stage endovascular approach to restore vascular access and achieve complete revascularization. An 87-year-old male with a history of smoking and diabetes presented with ST-elevation myocardial infarction and chest pain. Coronary angiography revealed a total occlusion of the right coronary artery. Severe aortoiliac stenosis restricted catheter insertion. To overcome this, iliac angioplasty was performed to restore vascular access. Reentry allowed continuation of the PCI using a drug-eluting stent to bypass the calcified area. Both interventions were safe and effective, resulting in immediate clinical improvement. He was discharged on standard therapy. This case underscores the need to acknowledge peripheral artery disease as a limiting factor during primary PCI. Iliac revascularization is a crucial intermediate step in facilitating coronary access. A comprehensive cross-vascular approach is essential for managing complex cardiovascular cases.
Chronic total occlusion (CTO) is a technically challenging lesion, and coronary variants such as a parallel left anterior descending (LAD) artery can obscure the target vessel. Parallel LAD is a rare congenital variant that can complicate interpretation when coexisting with CTO. Herein, the case of a 54-year-old woman who underwent percutaneous coronary intervention in November 2022 for a presumed LAD and presented with exertional angina is reported. Repeat angiography in January 2024 revealed an untreated proximal CTO of the true LAD. The previously treated vessel was reclassified as a large first diagonal branch representing the parallel LAD, whereas the vessel previously interpreted as a septal branch was identified as the true LAD. Antegrade wire escalation enabled CTO crossing followed by stent implantation in an indirect culotte configuration with kissing balloon inflation and proximal optimization. Final angiography demonstrated thrombolysis in myocardial infarction grade III flow in both vessels without complications.
Introduction: Clitoria ternatea (commonly known as bunga telang) is considered a medicinal herb. It contains high levels of polyphenols, including anthocyanins and triterpenoids, and has demonstrated anticancer properties against various types of cancer cells. Nevertheless, the effects of this plant on leukemia cells have not been extensively studied. This study aimed to establish if C. ternatea flower extract has any anticancer potential on Kasumi-1 cells, a renowned human acute myeloid leukemia (AML) cell line, and to analyze the half-mic (Half-maximal inhibitory concentration) variations over 24, 48, and 72 h. Methods: The study was done in vitro using the Kasumi-1 AML cell line. Kasumi-1 cells were treated with various concentrations of C. ternatea extract (15.625–500 µg/mL). Cytotoxicity was assessed at 24, 48, and 72 h using the MTT assay. Differences between treatment groups to control were analysed using Student’s t-test, and P < 0.05 was regarded as statistically significant. Results: The extract induced dose-dependent cytotoxicity, as determined by the MTT assay. The greatest cytotoxic effect was observed at the 24-h time point (137.5 µg/mL), followed by reduced effects at 48 h (168 µg/mL) and 72 h (221 µg/mL). Conclusions: The extract of C. ternatea exhibited moderate cytotoxicity toward Kasumi-1 cells, with its potency decreasing over time. This reduction may be attributed to cellular adaptive mechanisms, although this was not investigated in the present study. Further studies are needed to elucidate the underlying mechanisms and evaluate the feasibility of C. ternatea as a potential therapeutic agent for leukemia treatment.
Acute pericarditis is an uncommon but clinically significant complication of cardiac instrumentation that requires prompt recognition. This report describes a 48-year-old male with total AV block (TAVB) who developed iatrogenic acute pericarditis due to right ventricular (RV) perforation caused by a temporary pacemaker (TPM) lead. Imaging showed a lead protrusion through the posterior RV apex. Surgical exploration showed a thin-walled RV perforation with 300 mL of serous pericardial effusion and fibrin deposition. Primary RV repair was performed with 6-0 polypropylene sutures, and the TPM lead was removed. Postoperatively, the patient developed pleuritic chest pain and a pericardial friction rub. Cardiac computed tomography showed anterior and anterolateral pericardial thickening with minimal effusion, consistent with acute pericarditis. Iatrogenic myocardial injury may activate inflammasome pathways, driving sterile pericardial inflammation. The treatment with ibuprofen and colchicine led to rapid symptom resolution, C-reactive protein reduction, and near-complete effusion regression in 1 week without recurrence. This case underscores the need for prompt diagnosis and management of acute pericarditis associated with TPM-related RV perforation.
Balanitis xerotica obliterans (BXO), the genital manifestation of lichen sclerosus, is a chronic inflammatory dermatosis that may cause progressive sclerosis and anatomical distortion. This case report presents a 58-year-old male with a 2-year history of penile deformity, circumferential hypopigmentation of the glans, sexual discomfort, and lower urinary tract symptoms. Initial assessment showed an International Prostate Symptom Score (IPSS) of 17 and an International Index of Erectile Function-5 (IIEF-5) score of 12. Physical examination revealed circumferential fibrosis with obliteration of the sulcus coronarius and destruction of approximately 70% of glans architecture, while the urethral meatus remained patent. Following excision of fibrotic tissue and penile mobilization, reconstruction was performed using a split-thickness skin graft (STSG) for a 3 cm × 5 cm circumferential defect. At 42-day follow-up, IPSS improved to 8 and IIEF-5–14. Advanced BXO may require reconstructive surgery, with STSG providing satisfactory functional and cosmetic outcomes.
Lues maligna is an uncommon manifestation of secondary syphilis that occurs primarily in immunocompromised individuals, particularly those with human immunodeficiency virus infection. Its clinical resemblance to opportunistic infections and malignancies, including monkeypox (Mpox), poses a diagnostic challenge. A 25-year-old male who has sex with men (MSM) presented with clear, fluid-filled blisters that became purulent and subsequently developed into dark scabs covering most of his body. The cutaneous manifestations closely resembled Mpox. Accordingly, polymerase chain reaction (PCR) testing for Mpox was performed along with venereal disease research laboratory (VDRL) and Treponema pallidum hemagglutination assay (TPHA) testing to exclude Mpox as the suspected diagnosis. Mpox PCR results were negative, whereas VDRL and TPHA results were reactive. Histopathological examination demonstrated a lichenoid reaction with inflammatory infiltrates consistent with lues maligna. The patient was treated with benzathine penicillin (2.4 million international units, administered in three doses at weekly intervals). This case highlights the importance of accurate diagnosis in distinguishing lues maligna from Mpox.
Introduction: Cardiac remodeling is significantly influenced by hypertension, but the relationship between circulating profibrotic biomarkers and structural cardiac changes in adult hypertensive patients remains insufficiently understood. Studies simultaneously evaluating serum transforming growth factor-β1 (TGF-β1) and connective tissue growth factor (CTGF) together with clinical, metabolic, and echocardiographic parameters are still limited. Therefore, this study aimed to examine the relationship between TGF-β1 and CTGF serum levels with clinical parameters, lipid profiles, and cardiac remodeling in adult hypertensive patients. Methods: A cross-sectional investigation was carried out on a total of 61 adult hypertensive patients. Clinical data, lipid profiles, and echocardiographic parameters were collected. Subsequently, serum TGF-β1 and CTGF levels were measured using the enzyme-linked immunosorbent assay. Data were analyzed using parametric or nonparametric tests according to data distribution, along with correlation analysis and group comparison tests. Results: The results showed that serum TGF-β1 demonstrated significant positive correlations with CTGF (r = 0.277; P = 0.031), low-density lipoprotein (r = 0.260; P = 0.043), and relative wall thickness (r = 0.333; P = 0.009). CTGF levels differed significantly by sex (P = 0.023), with higher levels observed in females. Most other clinical variables did not show significant associations. Conclusions: Circulating profibrotic biomarkers are associated with both structural and metabolic aspects of cardiac remodeling in hypertension and may have the potential value for the early identification of cardiovascular target organ damage.
Tuberculosis (TB) remains an international health burden with high morbidity and mortality, especially in low- and middle-income countries. Weight loss and malnutrition often coexist with TB and are linked to poor prognosis. Literature review based on TB, malnutrition, changes of gut microbiota, gut–lung axis, and the role of microbiota metabolite. Gut dysbiosis modulates the immune system through gut–lung axis, with its primary mediators, namely short-chain fatty acids (SCFAs), regulating immune system homeostasis. TB and anti-TB drugs decrease gut microbiota diversity, leading to dysbiosis that worsens immune regulation and thus lowers host immunity to Mycobacterium tuberculosis. TB patients with malnutrition are closely associated with gut dysbiosis through immunological mechanisms and the gut–lung axis, with SCFAs as crucial mediators. This literature review aims to explain the role of gut dysbiosis in malnourished TB patients and highlight pathophysiological implications and intervention approaches.
Introduction: Myostatin has been linked to the pathogenesis of age-related muscle loss. Aerobic exercise and coffee polyphenols may modulate myostatin, but their combined effect in humans is unknown. To evaluate whether 5 days of Dampit robusta coffee consumption plus a single session of submaximal exercise modifies serum myostatin levels in healthy young men versus placebo. Methods: A single-blind randomized controlled trial (RCT) was conducted in a university laboratory (n = 20). Twenty healthy men (20–30 years old) were randomized into an intervention group (INT) (Dampit robusta coffee, n = 10) (INT) or a placebo group (n = 10) (control group [CON]). On day 5, participants carried out a submaximal Young Men’s Christian Association step test. Serum myostatin was measured by enzyme-linked immunosorbent assay before and 2 h after exercise. Wilcoxon signed-rank test for within-group comparisons and Mann–Whitney test for between-group comparison of Δ myostatin (α =0.05). Results: No statistically significant changes were found in myostatin levels in INT (P = 0.114) and CON (P = 0.445). INT showed a median decrease in Δ myostatin (−14,904 pg/mL) versus an increase in CON (+58,889.5 pg/mL), but the between-group difference was not significant (P = 0.143). Conclusions: This pilot RCT found no statistically significant effect in the combination of 5-day Dampit robusta coffee supplementation and a single session of submaximal exercise on serum myostatin levels in healthy young adult men. The nonsignificant downward trend in INT represents an exploratory biomarker signal requiring confirmation in larger, adequately powered trials.
Introduction: Increasing the number of patients with chronic kidney disease (CKD) affects the required hemodialysis, whereas their clinical condition is determined by the uremic toxin in the circulating blood. These conditions were one of the quick of blood (Qb) in the dialysis process, which regular hemodialysis may improve clinical outcomes. The study aimed to analyze the association of Qb on leukocyte levels in patients with CKD. Methods: The study used a retrospective design with consecutive sampling. The number of participants was 57 patients with CKD who experience regular hemodialysis twice weekly. Data analysis included Qb, leukocyte, lymphocyte, and neutrophil levels. Subsequently, the data analyzed were utilized with Spearman’s correlation, Pearson’s correlation, ANOVA, or Kruskal–Wallis’s tests, which were considered significant according to P < 0.05. Results: The results show that the participants are aged 50–59 years (31.6%), female (64.9%), have a dialysis period 13–24 months (26.3%), and have vascular access in the form of arteriovenous Shunt (86%). The analysis shows negative moderate correlation between Qb and leukocyte levels with r = −0.310 and P = 0.019. Whereas other parts of the leukocyte, including lymphocyte and neutrophil, show no correlation (P > 0.05). Conclusion: This study demonstrated a negative correlation between Qb and leukocyte levels in patients with CKD undergoing regular hemodialysis. In contrast, no correlation was observed between Qb and lymphocyte or neutrophil levels, highlighting the importance of monitoring Qb alongside leukocyte profiles to optimize hemodialysis adequacy.
Introduction: Type 1 diabetes mellitus (T1DM) represents an autoimmune disorder characterized by progressive deterioration of pancreatic β-cell through T-cell activity, which causes prolonged dependence on insulin. Meanwhile, stem cell treatment (SCT) is presently under investigation as a possible treatment approach. Therefore, this study investigated the safety profile and therapeutic effectiveness of SCT for T1DM. Methods: A broad database screening was carried out to identify studies published from January 1, 2012 to May 15, 2025 using PubMed, Scopus, and the Cochrane Library. Overall, 21 studies were incorporated in the systematic review, whereas 18 fulfilled the criteria required in the meta-analysis. Subgroup evaluation was organized according to stem cell category, design, and observation period. Results: The results showed that relative to baseline, SCT significantly reduced hemoglobin A1C (standardized mean difference [SMD] 1.52; P < 0.00001). The greatest decrease occurred after hematopoietic stem cell transplantation (HSCT) (SMD 2.90), which was also associated with a higher area under the curve C-peptide (SMD − 1.44; I2 = 0%). The AD-mesenchymal stem cell + BM-HSC subgroup showed the largest increase in preprandial C-peptide (SMD − 2.98), whereas CB-SCs produced the strongest reduction in insulin requirement among randomized controlled trials (SMD 1.63). Most adverse reactions were nonsevere, although two HSCT-associated deaths suggest that safer protocols are required. Conclusions: These results suggest that SCT may enhance selected metabolic and β-cell function outcomes in individuals with T1DM. However, SCT should remain under investigation and be administered only within carefully monitored clinical trials.
A BSTRACT Introduction: Pediatric burn injuries are associated with high morbidity and mortality, with sepsis being a major complication due to immature immune responses. Early physiological disturbances such as hypoalbuminemia and hyperglycemia are common in extensive burns and may contribute to increased infection risk. This study aimed to assess the association between early hypoalbuminemia and hyperglycemia with the development of sepsis in pediatric burn patients. Methods: We conducted a retrospective cross-sectional study using a total sampling of pediatric burn patients admitted to the Burn Unit of Dr. Soetomo General Hospital, Surabaya, from January 2020 to December 2023. A total of 63 patients met the inclusion criteria. Demographic, clinical, and laboratory data were collected and analyzed using the Chi-square test. Results: Of the 63 patients, 58.7% were male, with the majority aged 0–5 years. Scald injuries were the leading cause (61.9%). The median hospital stay was 15 days, longer in those with burn surface area >30%. Early hypoalbuminemia was not significantly associated with sepsis ( P = 0.163; χ² = 1.946). However, early hyperglycemia showed a significant association with sepsis ( P = 0.01; χ² = 6.564), indicating an increased risk of sepsis in patients presenting with elevated blood glucose levels. Conclusions: Early hyperglycemia may worsen immune response and increase the risk of sepsis in pediatric burn patients, while hypoalbuminemia likely reflects acute inflammation without direct impact on sepsis. These findings highlight the importance of early glucose monitoring and control in improving outcomes. Further studies with larger samples are recommended.
A BSTRACT Introduction: Hepcidin is an acute-phase reactant involved in regulating systemic iron levels. In acute infections such as sepsis, hepcidin levels rise. However, few studies have explored the role of hepcidin in assessing sepsis outcomes in children, and its relationship to mortality remains unclear. Most existing research suggests that high hepcidin levels may reduce the risk of sepsis-related death in children. This study aimed to investigate whether high hepcidin levels serve as a protective factor for clinical outcomes in pediatric sepsis. Methods: This observational analytic cohort study assessed high hepcidin levels in pediatric sepsis patients in the Pediatric Intensive Care Unit from October 2021 to June 2022, using consecutive sampling. Data were analyzed with Chi-square tests and logistic regression, with statistical significance set at P < 0.05. Results: This study involved 59 pediatric sepsis with 57.6% with age >12 years old, 61% males, 54.2% well nourished, 66.1% source infection from the respiratory tract, 54.2% septic shock, 18.6% bacteremia, 66.1% without comorbid and 54.2% outcome alive. Analysis receiver operating characteristic curve analysis showed an area under the curve (AUC) of 40.0%, with a cutoff of 1312 pg/ml to differentiate high and low hepcidin levels. Bivariate analysis showed that high hepcidin levels were protective ( P = 0.02, relative risk = 0.367). Multivariate analysis confirmed high hepcidin as a protective factor ( P = 0.048, 95% confidence interval: 0.055–0.984). Conclusions: High hepcidin level as a protective factor for death outcome on pediatric sepsis.
A BSTRACT Chronic neutrophilic leukemia (CNL) is an uncommon myeloproliferative neoplasm (MPN), characterized by determined neutrophilia, bone marrow hypercellularity, and hepatosplenomegaly. The BCR-ABL1 fusion gene is not obtained. A 60-year-old male complained of a black stool. The patient also complained of nausea, black vomiting, weakness, and joint pain. Anemic conjunctiva and splenomegaly were obtained. Laboratory tests showed hemoglobin 6.4 g/dL, leukocytes 46730/μL, and neutrophils 93.8%. The peripheral blood smear result was MPN: CNL. Bone marrow aspiration result matched CNL. BCR-ABL results were negative. Laboratory results 3 months later showed leukocytes 32640/μL and neutrophils 91.6%. CNL diagnosis criteria based on the 2017 World Health Organization include additional criteria if CSF3R mutation is absent: persistent neutrophilia (≥3 months), splenomegaly, and no reactive neutrophilia or plasma cell neoplasm. Proper diagnosis could prevent this disease from transforming into acute leukemia.
A BSTRACT Introduction: Mitral valve disease remains a major global heart-related issue affecting developed and developing countries. This study aimed to report overall mortality and evaluate perioperative factors contributing to postoperative inhospital mortality after isolated mitral valve replacement (MVR). Methods: This research was a retrospective study. The data were collected from patients who underwent primary, isolated, and elective MVR between January 2020 and July 2024. The primary outcome was inhospital mortality, and the secondary outcome was identifying factors associated with postoperative mortality. Receiver operating curve (ROC) analysis with area under the curve (AUC) was performed to identify risk factors and to determine the prognostic values. Results: A total of 81 patients were analyzed (mean age: 45.7 ± 13.2 years; body mass index: 21.8 ± 3.9 kg/m²). Of these, 55 were female, and over half of the patients presented with atrial fibrillation and pulmonary hypertension. Preoperative echocardiography showed left atrial dilatation in 98% of patients. The overall mortality rate was 14.8%. Multiple regression analysis indicated right ventricular diameter at base (RVDB) as a significant predictor of inhospital mortality (hazard ratio = 3.798; 95% confidence interval [CI] 1.150–12.541; P = 0.029). ROC analysis showed that an RVDB 3.05 cm predicted postoperative mortality with fairly good accuracy (AUC 0.769; 95% CI 0.632–0.905; P = 0.004). Conclusion: In patients undergoing MVR for mitral valve disease, the right ventricular diameter at baseline is an independent risk factor for inhospital mortality and may serve as a predictive marker for postoperative mortality.
Introduction: Hyperglycemia, driven by insulin resistance and beta-cell dysfunction, is a hallmark of diabetes mellitus, a common chronic disease. The pancreatic islets of Langerhans are frequently harmed as a result. Although scientific evidence is limited, Spatholobus littoralis Hassk (SLH) stem extract possesses antihyperglycemic, anti-inflammatory, and antioxidant properties that may protect the pancreas. This study used histological and physicochemical methods to assess the capacity of the SLH stem extract to repair pancreatic islet damage in streptozotocin (STZ)-induced diabetic rats. Methods: A randomized posttest only control group design was conducted on 35 male Wistar rats induced with STZ (35 mg/kgBW, twice at 7-day intervals), then divided into five groups: Healthy control (K1), diabetic control (K2), and treatment groups (P1–P3) receiving SLH stem extract at 150, 300, and 450 mg/kgBW for 21 days. Histological examination of islets of Langerhans was performed using hematoxylin and eosin staining, and the islet area was quantified in ImageJ. Data were analyzed using one-way ANOVA, followed by the least significant difference post hoc test (P < 0.05). Results: The area of the islets of Langerhans was significantly reduced in the diabetic rat group (P = 0.001), and their shape was irregular. At all dosages, SLH stem extract treatment produced a notable improvement, with the most significant effect at 150 mg/kgBW (P = 0.001). Its pH, Brix, and conductivity were consistent with the extract’s reparative action on the pancreas. Conclusions: Islet morphology and area were improved by SLH stem extract, indicating that it may be used as a supplemental treatment for diabetes.
Type III hypersensitivity reactions after streptococcal infection can induce poststreptococcal glomerulonephritis (GN), a glomerular disease with clinical nephritic syndrome, and reduced kidney function. Rapidly progressive GN (RPGN) abruptly degrades kidney function in days to weeks. Clinicians struggle to diagnose and treat poststreptococcal RPGN. This case report describes poststreptococcal rapidly progressive GN RPGN in a 24-year-old woman. The patient presented with hematuria, edema, weight gain, and dyspnea. She had experienced fever and cough 5 days before the onset of these symptoms. Treatment included hemodialysis, antibiotics, diuretics, and corticosteroids. After discharge and a follow-up, a kidney biopsy confirmed the diagnosis of crescentic GN. Further examination of urine, serology, antistreptolysin-O titer, and antinuclear antibody leads to RPGN. The patient received guideline treatment consists of antibiotics, loop diuretics, antihypertensives, hemodialysis, and steroids.
Dermatomyositis (DM) is an idiopathic inflammatory myopathy characterized by muscle weakness and distinctive cutaneous manifestations, with tetraparesis being an unusual clinical presentation. A 71-year-old man presented with rapidly progressive proximal tetraparesis, following a 6-month prodrome of characteristics cutaneous rashes. Physical examination revealed heliotrope rash and Gottron’s papules. Laboratory evaluation showed elevated creatine kinase and positivity for threonyl-tRNA synthetase (PL-7). Magnetic resonance imaging of the shoulder demonstrated diffuse muscle edema. Electromyography results were consistent with demyelinating sensorimotor polyneuropathy, and the muscle biopsy was negative for inclusion body myositis. The patient met the European League Against Rheumatism and the American College of Rheumatology criteria for a diagnosis of definite DM. Treatment with pulse corticosteroids, cyclophosphamide, and hydroxychloroquine resulted in subsequent clinical and biochemical improvement. This case underscores DM as an uncommon yet potentially reversible etiology of acute tetraparesis, emphasizing the need for prompt diagnosis and intensive immunosuppression therapy.
