Cermin Dunia Kedokteran

Effects of Hypoxic Adipose-Derived Mesenchymal Stem Cells and Their Secretome on Type II Collagen Expression in a Rabbit Model of Disc Degeneration

2026-09-16T15:30:39+07:00

Introduction: Intervertebral disc (IVD) degeneration is a major cause of low back pain, and is characterized by the loss of extracellular matrix, particularly type II collagen. Regenerative therapies using mesenchymal stem cells (MSCs) and their secretome have shown promise, but their comparative effects on type II collagen expression require further investigation. This study aimed to evaluate and compare the effects of allogeneic hypoxic adipose-derived mesenchymal stem cells (Ad-MSCs) and their secretome on type II collagen expression in a rabbit model of IVD degeneration. Methods: A true experimental study was conducted on 18 New Zealand White rabbits. Degeneration was induced by needle puncture. Subjects were divided into three groups: control (fibrin glue), P1 (hypoxic Ad-MSC), and P2 (secretome). After 8 weeks, type II collagen expression was analyzed using immunohistochemistry. Results: Both P1 and P2 showed significantly higher type II collagen expression than the control (p = 0.001 and p < 0.001, respectively). The secretome group (P2) showed significantly higher expression than the Ad-MSC group (P1) (p = 0.039). These findings suggest that the secretome may provide a greater stimulatory effect on type II collagen expression than direct cell administration. Conclusion: The hypoxic Ad-MSC-derived secretome resulted in higher type II collagen expression than hypoxic Ad-MSCs administration in this rabbit model.

Point-of-Care Testing-Based Supplementary Parameters for the Early Identification of Reduced Kidney Function in Adults

2026-09-16T15:32:31+07:00

Introduction: Declining kidney function often goes undetected due to limited access to conventional laboratory testing. Pos Pembinaan Terpadu (Posbindu) provides simple point-of-care testing (POCT)–based laboratory examinations that can serve as screening parameters for early detection of kidney function impairment. This study aimed to assess the ability of POCT parameters used in Posbindu to predict decreased kidney function in adults. Methods: A cross-sectional study was conducted in five administrative regions of Jakarta from July 2024 to June 2025, involving participants who met the inclusion criteria. The variables included simple POCT parameters such as blood glucose, hemoglobin, hematocrit, uric acid, and lipid profile. Kidney function was determined using the estimated glomerular filtration rate (eGFR; CKD-EPI) with cutoffs of < 80 mL/min/1.73 m² and < 60 mL/min/1.73 m². Spearman correlation analysis was performed to evaluate initial associations, followed by receiver operating characteristic (ROC) analysis to assess discriminatory ability. Confidence intervals were calculated using the Fieller, Hartley, and Pearson methods. Results: Among the 235 respondents, 99 had an eGFR < 80 mL/min/1.73 m², and 18 had an eGFR < 60 mL/min/1.73 m². ROC analysis revealed variability in the predictive ability of the parameters for both kidney function categories: hemoglobin (area under the curve/AUC 0.494 vs. 0.524), fasting blood glucose (AUC 0.549 vs. 0.601), total cholesterol (AUC 0.562 vs. 0.503), HDL (AUC 0.512 vs. 0.457), and LDL (AUC 0.535 vs. 0.427), all of which were not significant (p > 0.05). The parameters with better predictive ability were uric acid (AUC 0.591, p = 0.017 at eGFR < 80; AUC 0.681, p = 0.011 at eGFR < 60 mL/min/1.73 m2, followed by triglycerides, which showed a significant association only at eGFR < 60 (AUC 0.663, p = 0.021) but not at eGFR < 80 (AUC 0.561, p = 0.109). Uric acid demonstrated the strongest and most consistent discriminatory ability, supported by biological plausibility involving oxidative stress, endothelial dysfunction, and afferent arteriolar changes that accelerate glomerular filtration decline. Triglycerides showed a complementary but more limited role, consistent with lipid-mediated kidney injury that typically becomes more apparent at more advanced stages of function decline. Given the cross-sectional design, we could not establish causal or temporal relationships, including the possibility of reverse causality. Conclusion: Uric acid demonstrated the most consistent discriminatory ability for declining kidney function at both the mild and moderate-to-severe decline thresholds, whereas triglycerides showed significant discriminatory ability only at the moderate-tosevere threshold, supporting the potential of both as substitute POCT-based parameters for the early screening of declining kidney function in the adult population.

Association of Air Pollution Exposure and Face-Washing Behavior with Acne Vulgaris Among Medical Students

2026-09-16T15:46:45+07:00

Introduction: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous unit that is common among young adults. Air pollution exposure and face-washing behavior may be associated with AV. This study aimed to analyze the association of air pollution exposure and face-washing behavior with AV among medical students. Methods: This analytical cross-sectional study included 117 eligible students from the 2024 cohort of the Faculty of Medicine, Universitas Muhammadiyah Surakarta, using total sampling. Data were collected using questionnaires that underwent content and face validation, as well as clinical observation. We assessed the association between facewashing behavior and AV using the Chi-square test, and the association between air pollution exposure and AV using Fisher's exact test. Results: AV prevalence was 79.5%. Overall, 94.9% of respondents had heavy air pollution exposure, and 59.8% had positive face-washing behavior. Face-washing behavior was not significantly associated with AV (Chi-square = 1.521; p = 0.217; OR for negative vs positive behavior = 1.83; 95% CI 0.69–4.84). Air pollution exposure was also not significantly associated with AV (Fisher's exact p = 0.601; OR for heavy vs moderate exposure = 2.02; 95% CI 0.35–11.76). Conclusion: In this sample, neither air pollution exposure nor face-washing behavior was significantly associated with AV. Interpretation is limited by the highly imbalanced exposure distribution, the small moderate-exposure group, and the cross-sectional design.

Effect of Probiotic Supplementation on Glycemic Control in Patients with Type 2 Diabetes Mellitus: An Evidence-Based Case Report

2026-09-16T15:34:31+07:00

Introduction: Type 2 diabetes mellitus (T2DM) remains a global health challenge with rising prevalence and significant long-term complications. Emerging evidence highlights the role of gut microbiota in glucose metabolism, with probiotics proposed as a potential adjunctive therapy to improve glycemic control. Methods: Literature searches were performed in PubMed, Cochrane, and Scopus for randomized controlled trials (RCTs) and meta-analyses published within the last five years. Studies were critically appraised using the Oxford Center for Evidence-Based Medicine (OCEBM) tools and outcomes for fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and HOMA-IR were assessed. Results: Six studies met the inclusion criteria, including one network meta-analysis and five RCTs. Probiotic supplementation, particularly multi-strain formulations of Lactobacillus and Bifidobacterium, significantly improved FBG and HbA1c and enhanced β-cell function. However, heterogeneity in strains, dosage, and intervention duration limited definitive conclusions. Most studies reported that probiotic supplementation is well tolerated, with only mild and transient gastrointestinal side effects. Conclusion: Probiotic supplementation, especially a multi-strain combination of Lactobacillus and Bifidobacterium, may be a safe additional therapy to improve blood sugar control in people with type 2 diabetes. Larger clinical trials with stronger methodologies are still needed to determine the optimal dose, strain composition, and duration of supplementation.

Antimicrobial Resistance in Chronic Diarrhea: A Case Report of Cefazolin-Resistant Enteric Infection

2026-09-21T13:49:40+07:00

Introduction: Antimicrobial resistance is an emerging global health challenge that may lead to treatment failure and prolonged illness. Although cefazolin resistance is relatively uncommon, it can complicate infectious disease management, including chronic diarrhea. Case: A 7-month-old girl presented with fever and chronic mucoid diarrhea. Despite treatment with multiple antibiotics, including cefazolin, metronidazole, and vancomycin, her symptoms worsened, with diarrhea increasing to seven episodes daily, accompanied by severe anemia and malnutrition. Antibiotic susceptibility testing revealed isolated cefazolin resistance (MIC = 64 μg/mL). After susceptibility-guided treatment with intravenous ciprofloxacin and supportive care, the patient improved significantly and was discharged after 10 days. Discussion: This case highlights the importance of considering antimicrobial resistance in children with persistent diarrhea who fail to respond to empirical antibiotic therapy. Cefazolin resistance likely contributed to treatment failure and clinical deterioration. Early microbiological investigation and susceptibility-guided therapy were essential to achieve clinical recovery and prevent further complications. Conclusion: Clinicians should consider cefazolin-resistant enteric infection in cases of chronic diarrhea with poor response to empirical treatment. Prompt culture and antibiotic susceptibility testing are crucial to guide appropriate antimicrobial therapy and improve patient outcomes.

Sigmoid Volvulus Causing Prolonged Complete Mechanical Intestinal Obstruction Without Bowel Ischemia in a Geriatric Patient: A Case Report

2026-09-16T15:35:38+07:00

Introduction: Sigmoid volvulus is a major cause of large bowel obstruction in older adults and can progress to bowel ischemia, necrosis, and perforation. Although prolonged complete obstruction raises concern for bowel compromise, symptom duration alone does not necessarily indicate bowel nonviability. This case highlights the importance of intraoperative assessment of bowel viability in determining surgical management. Case: A 76-year-old male with chronic constipation and recently reduced mobility presented with progressive abdominal distension, abdominal pain, and complete absence of defecation and flatus for one week. He had no fever, nausea, or vomiting. Laboratory investigations showed hyponatremia, hypokalemia, and impaired renal function. Contrast-enhanced computed tomography demonstrated marked bowel dilatation, a redundant sigmoid colon, and twisting consistent with complete mechanical obstruction due to sigmoid volvulus. After fluid resuscitation, electrolyte correction, and gastrointestinal decompression, exploratory laparotomy was performed. A 360° rectosigmoid volvulus was identified without ischemia or perforation. Detorsion and manual decompression were followed by three-point sigmoidopexy. The patient recovered uneventfully and was discharged on postoperative day 5. Discussion: This case is clinically significant because it demonstrates preserved bowel viability despite prolonged complete obstruction. Intraoperative assessment, rather than symptom duration alone, guided surgical management and allowed a non-resectional approach. Conclusion: Prolonged complete mechanical intestinal obstruction due to sigmoid volvulus may occur without bowel necrosis. Timely stabilization, diagnosis, surgical exploration, and assessment of bowel viability are essential for individualized management.

Spastic Paraplegia Secondary to Spinal Metastasis in a Patient with Advanced-Stage Breast Cancer: A Case Report

2026-09-16T15:37:06+07:00

Introduction: Spinal metastasis in breast cancer patients can lead to severe pain, neurological deficits, and significant morbidity, impacting quality of life and chances of survival in breast cancer patients. Case: A 48-year-old woman was referred to a neurologist because of lower extremity weakness. Due to spinal cord compression, she had paraplegia with chronic progressive mixed-type lower back pain, with radiating to the pelvis, accompanied by numbness, tingling, and burning from both feet to the subumbilical region, and impairment of defecation and urination. She had a history of breast cancer with chemotherapy and radiotherapy. Her numeric rating scale score was 7, ID pain score was 4, Karnofsky score was 40; neurological examination revealed spastic paraplegia, segmental hypoesthesia at and below the 11^th spinal cord level, and urinary and bowel retention. Radiologic examination showed kyphosis with osteolytic and osteosclerotic thoracic vertebrae. Bone survey showed bone metastases in thoracic vertebral bodies 5–12, the right ilium, and the right proximal femur. Discussion: The patient was diagnosed with spinal metastasis based on physical examination and supporting investigations, but further follow-up was limited. Early recognition of the clinical condition is expected to help prevent further deterioration of neurological deficits. Conclusion: The patient was diagnosed with spinal metastasis from breast cancer and received analgesic and corticosteroid therapy. The prognosis was poor.

Aplasia Cutis Congenita Associated with Duodenal Atresia: A Marker of Underlying Congenital Abnormalities: A Case Report

2026-09-16T15:40:07+07:00

Introduction: Aplasia cutis congenita (ACC) is an uncommon congenital skin defect characterized by the absence of skin, commonly in the scalp. ACC has been found to be accompanied by certain embryological malformations, so it may indicate underlying dysplasia. This case report emphasizes that ACC is not only a superficial finding but also serves as an indicator of underlying abnormalities. Case: A premature female neonate was born via spontaneous delivery with respiratory distress. There was an absence of the epidermis in the region of colli, bilateral antebrachia to dorsum manus, and bilateral distal femoral to dorsum pedis with firm borders, visible blood vessels, underlying muscles, and agenesis of the ears and nose. On the third day, the patient vomited blood, and the babygram examination showed a double bubble appearance. The patient was diagnosed with ACC and duodenal atresia. The patient was treated with D10% infusion, cefotaxime injection, parenteral amino acid, oral sucralfate, and gentamicin ointment. While preparing for referral, the patient's condition deteriorated, and the patient died on the 7th day of treatment. Discussion: ACC is characterized by the absence of skin and underlying tissues, and its classification is not always clearly defined. Developmental anomalies of the skin and subcutaneous tissue, such as ACC, can indicate serious underlying conditions. Prognosis depends on the severity of other genetic disorders. In this case, definitive surgical management of the duodenal atresia was not performed because the patient’s clinical condition deteriorated before the intervention could be undertaken. Conclusion: This unusual combination highlights the multisystem nature of ACC and the challenges of applying Frieden’s classification. Extensive or atypical ACC warrants thorough evaluation for associated congenital abnormalities to guide management and prognosis.

Neonatal Conjunctivitis with Gram-Negative Diplococci Suggestive of Neisseria gonorrhoeae: A Case Report

2026-09-16T15:42:15+07:00

Introduction: Gonococcal conjunctivitis in a neonate is a conjunctival infection caused by Neisseria gonorrhoeae. Transmission commonly occurs during vaginal delivery from an infected mother. This serious infection can threaten vision if not promptly and properly treated. Case: A 14-day-old female infant was brought to the ophthalmology clinic by her parents with a complaint of bilateral eye discharge that had been present since she was 2 days old. The discharge was yellow, thick, and sticky. Ocular examination revealed edema and erythema of the upper eyelids with profuse purulent discharge. The tarsal conjunctiva was hyperemic with positive conjunctival vessel injection (CVI) and membrane formation. Mild corneal edema was observed. The direct pupillary light reflex was present. Gram staining of conjunctival swab specimens obtained from both eyes demonstrated Gram-negative diplococci. The patient was presumptively diagnosed with gonococcal conjunctivitis based on the clinical findings and Gram staining demonstrating Gram-negative diplococci. Treatment included eye toilet with sterile cotton buds, a single intravenous dose of ceftriaxone 25 mg/kg body weight, 0.3% ofloxacin eye drops administered six times daily to both eyes, and artificial tears administered six times daily to both eyes. Discussion: The clinical findings and Gram-stain results support a presumptive diagnosis of gonococcal conjunctivitis, an infection characterized by rapid progression and a high risk of corneal complications. Management with a single dose of ceftriaxone plus topical therapy led to rapid clinical improvement. Conclusion: Prompt diagnosis and treatment of neonatal gonococcal conjunctivitis with systemic and intensive topical antibiotic therapy resulted in a favorable clinical outcome and helped prevent serious ocular complications.

What Does School-Based Nutritious Meals Program Reveal about Nutritional Status and Micronutrient Biomarkers in School-Aged Children? Implications for Indonesia’s MBG Program

2026-09-16T15:43:42+07:00

Nutritional problems among school-aged children in Indonesia continue to reflect a double burden of malnutrition, marked by the coexistence of undernutrition, overweight, and micronutrient deficiencies. In response, the Free Nutritious Meals (Makan Bergizi Gratis/MBG) Program was introduced as a cross-sectoral initiative that provides daily balanced meals designed to meet children’s energy, protein, and essential micronutrient requirements. Existing studies consistently suggest that school feeding interventions are associated with improvements in anthropometric indicators, including weight-for-age, height-for-age, and body mass index-for-age, as well as favorable changes in micronutrient biomarkers such as hemoglobin, ferritin, and serum vitamin A. These outcomes are supported by physiological mechanisms related to adequate intake of animal-based protein, iron, zinc, and vitamin C, which are essential for growth, cognitive function, and immune competence. Nevertheless, implementation quality influences program effectiveness, including food safety, menu diversity, consistency of meal provision, and intersectoral coordination. Limited local biomarker data remain a key challenge, underscoring the need for longitudinal evaluations to assess MBG's biological impact. Overall, the MBG Program has the potential to contribute to improving the nutritional status of school-aged children and supporting Indonesia’s long-term human capital development.

Clinical Diagnosis and Management of Oculogyric Crisis: A Narrative Review

2026-09-16T15:38:16+07:00

Oculogyric crisis (OGC) is an acute dystonic reaction characterized by sustained, involuntary upward deviation of the eyes caused by repetitive spasms of the extraocular muscles. Episodes may last from several seconds to several hours. OGC is often misdiagnosed, particularly outside neurology and psychiatry, partly because of its variable presentation and its resemblance to other neurological or psychogenic movement disorders. Its pathophysiological mechanisms are not yet fully understood, although disruption of dopaminergic neurotransmission is a consistent finding. OGC is most frequently associated with the use of medications that affect dopaminergic pathways, including antipsychotics and certain antiemetics; it may also co-occur with underlying neurological or psychiatric conditions. Effective management typically involves withdrawing the causative agent and administering anticholinergic medications. This narrative review summarizes the etiology, pathophysiology, clinical manifestations, differential diagnosis, and management of OGC, providing a practical clinical overview for general practitioners and relevant specialists. Greater awareness of OGC may facilitate timely recognition and appropriate management while reducing diagnostic delays and unnecessary investigations.

Safety and Efficacy of Lutein and Zeaxanthin in the AREDS2 Formulation for Age-Related Macular Degeneration

2026-09-16T15:45:00+07:00

Age-related macular degeneration (AMD) is a progressive degenerative disease of the central retina and is a leading cause of vision loss among older adults worldwide. The original Age-Related Eye Disease Study (AREDS) supplement formula reduced the risk of progression to advanced AMD. However, the beta-carotene in this formula was associated with a higher risk of lung cancer in current and former smokers. AREDS2 evaluated lutein and zeaxanthin as safer substitutes for beta-carotene. These macular carotenoids have antioxidant effects and a better safety profile. Studies show that lutein and zeaxanthin help slow AMD progression through antioxidant effects and retinoprotective mechanisms. Researchers have also studied genetic factors, including complement factor H (CFH) and age-related maculopathy susceptibility 2 (ARMS2). However, current evidence is not strong enough to support individualized treatment based on these factors. Overall, lutein and zeaxanthin appear to provide a favorable balance of efficacy and safety as replacements for beta-carotene in the AREDS2 formulation.