Lombok Medical Journal (LMJ) is scientific, peer-reviewed, and open access journal published by Faculty of Medicine, Universitas Mataram, West Nusa Tenggara, Indonesia.
Faculty of Medicine, Universitas Mataram
Insulin Enhances the Viability of Doxorubicin-Exposed Luminal A Breast Cancer T-47D Cells
Breast cancer is one of the most common cancers worldwide, with a high incidence rate. Doxorubicin is a chemotherapeutic agent used in breast cancer management. Nevertheless, chemoresistance remains a major challenge in breast cancer chemotherapy. Insulin contributes to chemoresistance through its mitogenic and prosurvival activities. To date, studies evaluating the effect of insulin on the viability of Luminal A breast cancer cells (T-47D) under doxorubicin exposure remain limited. This study aimed to analyse the effect of insulin supplementation on the viability of Luminal A breast cancer cells (T-47D) exposed to doxorubicin. An in vitro experimental study was conducted using T-47D cells treated with doxorubicin at various concentrations (3.13, 6.25, 12.5, 25, 50, and 100 μg/mL), with and without insulin supplementation. Cell viability was assessed using the 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and analysed using a paired-samples t-test. T-47D cells receiving insulin supplementation showed higher viability than those without insulin across all tested doxorubicin concentrations, with statistically significant differences (p < 0.05). The fold change in viability between the insulin and non-insulin groups increased with rising doxorubicin concentrations. In conclusion, insulin affects the viability of Luminal A breast cancer T-47D cells exposed to doxorubicin, indicating reduced cellular sensitivity to the cytotoxic effects of doxorubicin.
Copyright (c) 2026 Lombok Medical Journal
Insulin-Induced NF-κB Activation May Contribute to Doxorubicin Resistance in Luminal A T-47D Breast Cancer Cells
Doxorubicin is an effective chemotherapy agent for breast cancer; however, its efficacy is often limited by cellular resistance. Insulin is hypothesized to enhance anti-apoptotic activity through activation of Nuclear Factor Kappa-Beta (NF-κB), although its mechanism in the Luminal A subtype T-47D cell line has not been extensively studied. This analytical experimental study with a post-test only paired design used T-47D cells divided into insulin-treated and non-insulin groups. Both groups were exposed to various concentrations of doxorubicin, namely 0 (control), 3.125, 6.25, 12.5, 25, 50, and 100 µg/mL. NF-κB activation was measured as pNF-κB concentration using the ELISA method. Data were analyzed using the Shapiro–Wilk test for normality followed by a paired t-test. The insulin-treated group showed higher mean pNF-κB concentrations compared to the non-insulin group across all doxorubicin doses. Significant differences were observed at 0 µg/mL (p = 0.008), 3.125 µg/mL (p = 0.009), and 100 µg/mL (p = 0.045), whereas no significant differences were found at concentrations between 6.25 and 50 µg/mL (p > 0.05). Overall, increasing doxorubicin concentrations reduced pNF-κB levels; however, insulin treatment maintained higher pNF-κB levels compared to the non-insulin group. These findings indicate that insulin increases NF-κB activation in doxorubicin-treated T-47D breast cancer cells and may sustain NF-κB activity against the cytotoxic effects of doxorubicin.
Review Article: The Potential of Terpenoids from Marine Organisms as Neuroprotective Agents in Peripheral Neuropathy
Peripheral neuropathy is a common neurological disorder, particularly in patients with diabetes mellitus and older adults, with limitations of current therapies prompting the search for alternative treatments. This narrative review aims to evaluate the potential of marine-derived terpenoids as neuroprotective agents in peripheral neuropathy. Terpenoids demonstrate multi-target mechanisms, including antioxidant and anti-inflammatory effects, ion channel modulation, and regulation of signaling pathways such as phosphoinositide 3-kinase/protein kinase B (PI3K/Akt), Mitogen Activated Protein Kinase (MAPK), and nuclear factor erythroid 2 related factor 2 (Nrf2). These actions contribute to reduced oxidative stress, suppression of neuroinflammation, and improved neuronal survival. Compounds such as astaxanthin show promising effects in reducing neuropathic pain, although evidence remains largely preclinical. Clinical translation is limited by low bioavailability and insufficient long term safety data. Further studies are required to confirm their therapeutic potential.
In Vitro Cultivation of 3D Umbilical Cord MSC Spheroid Model for Chondrogenic Differentiation
Cartilage is a tissue that specifically difficult to heal when injured due to its avascular, aneural, and alymphatic nature, in addition to the limited ability of cells to migrate in the tissue for repair. Human umbilical cord–derived mesenchymal stem cells (hUC-MSCs) possess promising chondrogenic potential, particularly when cultured in three-dimensional (3D) systems that better mimic the native tissue environment. It is important to note that the current study is limited to an in vitro setting, and no in vivo experiments were conducted. This work aimed to evaluate the ability of hUC-MSCs to undergo chondrogenic differentiation over time using a 3D spheroid culture system. hUC-MSCs were isolated from umbilical cords of two donors, expanded to passage 5, and seeded into ultra-low attachment well plates with chondrogenic differentiation medium. Spheroids were incubated for 14 and 21 days. Chondrogenesis was assessed by crystal violet staining, and collagen deposition was analyzed microscopically and quantified using ImageJ software. Statistical analysis was performed using one-way ANOVA with Tukey’s post-hoc test. hUC-MSCs successfully formed spheroids and demonstrated progressive chondrogenic differentiation over time, marked by increasing collagen deposition. Significant increases in cartilage-positive areas were observed on day 14 (p<0.01) and further on day 21 (p<0.05), indicating enhanced cartilage matrix formation in vitro. Three-dimensional spheroid culture of hUC-MSCs effectively promotes chondrogenic differentiation, with substantial collagen accumulation observed after 21 days. This in vitro model provides a valuable platform for studying the sequential mechanisms of cartilage formation and holds potential for future applications in cartilage tissue engineering.
The Effects of Turmeric, Aloe Vera, and Honey as Natural Remedies for Reducing Scar Visibility_ A Pilot Clinical Trial
Background: Managing scars effectively is often difficult because most clinical treatments are either too expensive or too invasive for many patients. While ingredients like turmeric, honey, and aloe vera have been used in traditional healing for centuries, we still lack enough clinical evidence on how they perform when combined into a single topical remedy. Purpose: This pilot trial was designed to test the safety and effectiveness of a simple, low-cost natural formulation in improving the appearance of both discolored (dyschromic) and raised (hypertrophic) scars. Methods: We followed ten participants with scars aged between 1 and 12 months. For four weeks, they applied a homemade blend of fresh aloe vera, honey, turmeric, lemon juice, and niacinamide twice daily. To ensure our results were objective, we used 3D imaging to measure scar height and tracked changes in pigmentation. We also gathered direct feedback from the participants regarding scar softness and redness. Results: The outcomes were notably positive. After the month-long treatment, 64% of the volunteers saw their scars flatten by at least 20%, with the most significant changes occurring in hypertrophic cases. Furthermore, 72% of the group showed visible lightening of their skin pigment. The formula worked best on acute scars (under six months old). Participants found the mixture easy to use and reported no side effects, other than a temporary yellow stain from the turmeric that faded quickly. Conclusion: Our findings suggest that this natural blend is a practical and affordable way to improve the texture and color of developing scars. While these initial results are promising, we believe larger, randomized trials are needed to standardize the recipe and confirm its long-term benefits.
The Potency of Atorvastatin Nanoparticles Implementation in Human: A Pharmacokinetic Perspective from Basic to Clinical Literature Review
Atorvastatin is a biopharmaceutics classification system class II drug with good permeability but low solubility, thereby limiting its bioavailability and therapeutic efficacy. This study aims to analyze the effect of particle size reduction on the pharmacokinetic parameters (Cmax, Tmax, AUC, t½) of atorvastatin in various drug delivery systems and the potency of its implementation in human through a literature review approach. Literature screening was conducted using online databases including Google Scholar, PubMed, ScienceDirect, and Springer Open, with inclusion criteria of national and international articles published in the last 10 years discussing atorvastatin formulations with various particle sizes and their pharmacokinetic parameters. Analysis of the 11 selected articles showed that nano-based delivery systems can increase the bioavailability of atorvastatin compared to conventional formulations. The results confirmed that particle size reduction through nanotechnology approaches increased the dissolution rate, membrane permeability, and absorption efficiency, thereby optimizing the pharmacokinetic profile of atorvastatin. This review provides evidence that nano-scale formulation strategies have a consistent positive impact on the bioavailability of atorvastatin. Despite these promising preclinical findings, the implementation of atorvastatin nanoparticles in humans remains limited due to the absence of clinical trials, although their potency to improve bioavailability and reduce dose-dependent toxicity at lower doses offers a strong rationale for future translational research.
Evaluation of Solanum lasiocarpum Fruit Extract on Blood Glucose, Hematological Parameters, and Liver and Kidney Function in Alloxan-induced Diabetic Rats
Hyperglycemia is an increase in blood glucose levels that leads to diabetes mellitus. Diabetes mellitus caused by insulin resistance and impaired insulin secretion. Eggplant (Solanum lasiocarpum) is an herbal plant used as a traditional remedy for diabetes mellitus. This study aims to determine the effect of Eggplant fruit extract (S. lasiocarpum) on blood glucose, blood profile, SGPT, SGOT, creatinine, and ureum levels in diabetic rats. This study used a completely randomized design with six groups (G1: normal control, G2: diabetes control, G3: metformin control, G4: extract dose 200 mg/kg BW; G5: extract dose 300 mg/kg BW; and G6: extract dose 400 mg/kg BW. Measurement of SGPT, SGOT, Urea, and Creatinine levels using a spectrophotometer. Data analysis uses one-way ANOVA and Duncan at a significance level of 0.05. Statistical analysis revealed a significant difference (p<0.05) between the control group and extract therapy in blood glucose, blood profile tests, SGPT, SGOT, creatinine, and urem. The optimal dose of S. lasiocarpum fruit extract to reduce the effects caused by diabetes was 400 mg/kg BW.
Bilateral Pleural Effusion as a Rare Manifestation of Snakebite Envenomation: A Case Report
Background: Snakebite envenomation remains a significant global health problem, particularly in tropical regions, with a wide spectrum of clinical manifestations ranging from local tissue injury to life-threatening systemic complications. While coagulopathy, neurotoxicity, and acute kidney injury are commonly reported, pleural effusion is an uncommon manifestation and may indicate severe systemic involvement. Case Presentation : We report a 38-year-old male with grade III snakebite in the right cervical region who developed progressive local swelling, hematoma, and systemic symptoms including dyspnea. The patient experienced radiating pain from the neck to the right upper limb and chest, followed by decreased consciousness and worsening respiratory distress. Physical examination revealed extensive edema involving the neck, chest, and right upper extremity. Dyspnea worsened in the supine position and improved in a semi-upright position, suggesting pleural involvement. Laboratory findings showed leukocytosis and thrombocytopenia, while chest radiography confirmed right-sided pleural effusion with pulmonary infiltrates. Discussion : Pleural effusion in snakebite is rare and is likely caused by increased vascular permeability, systemic inflammatory response, and coagulopathy induced by venom components such as metalloproteinases and phospholipase A2. These mechanisms contribute to capillary leak syndrome and fluid accumulation in the pleural space. Conclusion : Pleural effusion should be considered in patients with severe snakebite presenting with respiratory symptoms. Early recognition and prompt management, including antivenom therapy and supportive care, are essential to prevent clinical deterioration.
Insiden Pneumotoraks setelah Prosedur Intervensi Paru: Systematic Review
Diagnostic management of peripheral lung lesions and diffuse lung parenchymal disease faces major challenges in balancing diagnostic accuracy with the risk of complications. Pneumothorax is the most frequently reported iatrogenic complication and can increase morbidity, the need for emergency intervention, and patient length of hospital stay. This study aims to systematically evaluate the incidence of pneumothorax and the requirement for thoracic drainage in various lung intervention methods to provide safety-focused procedural selection guidance. This systematic review was prepared following PRISMA guidelines with a comprehensive literature search on PubMed, Cochrane Library, and Frontiers databases. Analysis revealed significant risk variation between intervention methods. CT-guided percutaneous transthoracic lung biopsy (CT-PTLB) procedures showed the highest risk, with pneumothorax rates reaching 25.9% and chest tube requirements at 6.9%. Conversely, transbronchial techniques offer a better safety profile, where conventional transbronchial lung biopsy has a pneumothorax incidence of 1-6%, r-EBUS approximately 1.4-5.0%, and transbronchial cryobiopsy between 6-10%. Risk factors such as emphysema, lesion depth >2 cm, and the use of larger needle sizes (18G) were identified as strong predictors of pneumothorax. Selection of the appropriate technique and patient positioning (biopsy-side down) are highly recommended to minimize complications while maintaining patient safety.
Perjalanan udara pada umumnya aman bagi individu sehat, namun pada pasien dengan penyakit pernapasan diperlukan pertimbangan medis yang cermat karena paparan hipoksia hipobarik setara ketinggian kabin hingga 2438 m dapat memicu hipoksemia bermakna. Gangguan pernapasan menyumbang sekitar 12% dari seluruh keadaan darurat medis dalam penerbangan dan menjadi salah satu penyebab utama pengalihan penerbangan. Sebagian besar kejadian tersebut berkaitan dengan kondisi medis yang telah ada sebelumnya. Oleh karena itu, skrining dan evaluasi pra-penerbangan yang sistematis menjadi strategi penting untuk mencegah komplikasi selama dan setelah perjalanan udara.
Multiple Cranial Nerve Palsy (MCNP) in Cerebral Sinus Vein Thrombosis (CSVT) due to Bilateral Septic Cavernous Sinus Granulomatous Abscess and Multiple Sinusitis: A Case Report
Case reports about cavernous sinus venous thrombosis (CSVT) with ophtalmoplegia are relatively rare caused by a long-standing dental infection complicated by a history of long-term smoking, leading to granulomatous abscesses and multiple sinusitis. A 48-year-old man admitted to the Emergency Department presenting of an inability to lift his left eyelid and to move his eyeball in any direction for the past 3 days, the symptoms were experienced suddenly. Multiple cranial nerves palsy (MCNP) or ophtalmoplegia in CSVT is a neurological disorder involving more than two non-homologous cranial nerves simultaneously. CSVT in this case occurs as a result of inflammation in response to granulomatous abscess of the cavernous sinus and multiple sinusitis due to a longterm untreated history of dental infection with long history of smoking. Clinical accompanying was progressive headache, ophtalgia, ptosis and proptosis. This case report highlights the importance of neuroimaging examinations, particularly CT scans, MRI, and MRA of the head, as the primary standard for establishing a diagnosis of CSVT, thereby enabling appropriate evaluation therapy and substantially determining a favorable prognosis
Peran Tim Multidisiplin dalam Penatalaksanaan Limfoma Non-Hodkin Stadium IV yang Kompleks: Laporan Kasus
Abstract : The management of advanced stage non-Hodgkin lymphoma is increasingly complex due to rapid advances in diagnostic and therapeutic modalities and the involvement of multiple medical disciplines. A multidisciplinary team (MDT) approach is widely recognized as the gold standard in cancer care, enabling coordinated, evidence-based, and patient-centered decision-making. This case report describes the role of MDT in the management of a 57-year-old woman with stage IV diffuse large B-cell lymphoma complicated by multisystem involvement. Through structured MDT discussions, optimal multimodal therapy was delivered, clinical complications were effectively managed, and significant clinical improvement was achieved within a relatively short hospitalization period, despite limited healthcare resources. This case highlights that the MDT approach is feasible and beneficial in resource-limited healthcare settings. Abstrak: Penatalaksanaan kanker, khususnya limfoma non-Hodgkin stadium lanjut, semakin kompleks seiring dengan perkembangan pesat modalitas diagnostik dan terapi serta keterlibatan berbagai disiplin medis. Pendekatan tim multidisiplin (multidisciplinary team / MDT) telah diakui sebagai standar emas dalam perawatan kanker karena memungkinkan pengambilan keputusan klinis yang terkoordinasi, berbasis bukti, dan berorientasi pada pasien. Laporan kasus ini menggambarkan peran MDT dalam penatalaksanaan seorang pasien perempuan usia 57 tahun dengan diffuse large B-cell lymphoma stadium IV yang disertai komplikasi multisistem. Melalui diskusi MDT yang terstruktur, pasien mendapatkan terapi multimodal yang optimal, komplikasi klinis dapat ditangani secara efektif, dan perbaikan klinis tercapai dalam waktu rawat inap yang relatif singkat meskipun berada pada fasilitas pelayanan kesehatan dengan keterbatasan sumber daya. Laporan kasus ini menegaskan bahwa pendekatan MDT tetap feasible dan bermanfaat dalam meningkatkan kualitas perawatan kanker di rumah sakit daerah.
Krisis Penyakit Tidak Menular pada Usia Muda: Dari Faktor Risiko ke Strategi Pencegahan
Non-communicable diseases (NCDs) are increasingly burdening the productive-age population, indicating an epidemiological shift toward an earlier onset of chronic diseases. Both global and national levels, hypertension and diabetes show high trends among younger age groups, including at the regional level. This situation is driven by the accumulation of risk factors in adolescence, such as physical inactivity, unhealthy diets, sedentary behavior, smoking, and psychosocial stress, reflecting the multidimensional nature of NCDs. Therefore, prevention must be implemented comprehensively from adolescence through lifestyle interventions, supportive social environments, public policies that promote healthy behaviors, and active youth participation. The integration of mental health into primary care is also essential to strengthen long-term NCD control
Faktor-faktor yang Berhubungan dengan Kelengkapan Imunisasi Dasar Pada Anak Usia 9-24 Bulan di Wilayah Kerja Puskesmas Jatibaru Kota Bima
Latar Belakang: Imunisasi dasar merupakan upaya penting dalam pencegahan penyakit yang dapat dicegah dengan imunisasi (PD3I) pada anak. Meskipun program imunisasi rutin telah dilaksanakan secara nasional, cakupan imunisasi dasar lengkap di Indonesia masih belum mencapai target. Oleh karena itu, diperlukan kajian mengenai faktor-faktor yang memengaruhi kelengkapan imunisasi dasar pada anak. Tujuan: Mengetahui faktor-faktor yang berhubungan dengan kelengkapan imunisasi dasar pada anak usia 9–24 bulan di wilayah kerja Puskesmas Jatibaru, Kota Bima. Metode: Penelitian ini merupakan studi analitik observasional yang dilaksanakan pada September–Oktober 2024. Sebanyak 46 anak usia 9–24 bulan dilibatkan sebagai subjek penelitian. Data dikumpulkan melalui kuesioner kepada ibu serta verifikasi buku KIA dan catatan imunisasi Puskesmas. Variabel yang dianalisis meliputi tingkat pendidikan ibu, tingkat pengetahuan ibu, status pekerjaan ibu, pendapatan keluarga, jumlah anak dalam keluarga, keterjangkauan tempat imunisasi, cara menuju tempat imunisasi, dan dukungan keluarga. Analisis data dilakukan menggunakan SPSS versi 26.0. Hasil: Hasil analisis menunjukkan adanya hubungan yang bermakna antara tingkat pengetahuan ibu (p=0,036), status pekerjaan ibu (p=0,032), dan tingkat pendapatan keluarga (p=0,044) dengan kelengkapan imunisasi dasar pada anak. Variabel lainnya tidak menunjukkan hubungan yang signifikan secara statistik. Kesimpulan: Tingkat pengetahuan ibu, status pekerjaan ibu, dan pendapatan keluarga merupakan faktor yang berhubungan dengan kelengkapan imunisasi dasar pada anak usia 9–24 bulan. Peningkatan edukasi imunisasi secara berkelanjutan diperlukan untuk mendukung pencapaian cakupan imunisasi dasar lengkap
Prostatitis is a common urological condition in men of all ages, ranging from acute and chronic bacterial prostatitis to chronic pelvic pain syndrome (CP/CPPS) and asymptomatic inflammatory prostatitis. The condition is characterized by pelvic pain, lower urinary tract symptoms, and, in some cases, sexual dysfunction, significantly affecting quality of life. Major risk factors include bacterial infection, chronic inflammation, and functional obstruction. Pathophysiology involves bacterial invasion, immune response, and neuromuscular dysfunction in CP/CPPS. Management depends on the type of prostatitis and includes antibiotics for bacterial prostatitis, alpha-blockers, anti-inflammatory agents, and multimodal approaches such as the UPOINT system for CP/CPPS, while asymptomatic cases require monitoring. Early diagnosis and tailored therapy are essential to reduce complications and improve patient outcomes
Cedera Paru pada Near Drowning : Patofisiologi dan Penatalaksanaan
Near drowning is a major cause of respiratory emergencies and can lead to significant pulmonary complications. Aspiration of water disrupts normal lung function, resulting in hypoxemia, surfactant washout, alveolar collapse, and in severe cases, acute lung injury or ARDS. The extent of injury is influenced by several factors, including the amount of aspirated water, contamination with pathogens, and the victim’s physiological condition at the time of submersion. Both freshwater and seawater aspiration can produce similar clinical consequences, ultimately impairing gas exchange and triggering an inflammatory response in the lungs. Early assessment and management are crucial to prevent deterioration. Key evaluations include monitoring oxygen saturation, arterial blood gases, chest radiography, and continuous clinical observation to detect early signs of respiratory compromise. Management focuses on maintaining adequate oxygenation, preventing further heat loss, and addressing complications such as pulmonary edema or infection. The use of positive end-expiratory pressure (PEEP) may be required in patients who develop significant hypoxemia. Near drowning victims who remain asymptomatic after four to six hours of observation generally have a good prognosis, while those with aspiration require close monitoring due to the risk of delayed respiratory failure.
Acute Kidney Injury in 43 Years Old Male Patient Caused by Severe Leptospirosis
Leptospirosis is a zoonotic infectious disease commonly found in tropical regions, caused by Leptospira interrogans, a pathogenic spirochete. The main reservoir is rodents, especially rats. Human transmission occurs either directly through inoculation from infected animal tissues, body fluids and urine, or indirectly through contact via mucosal surfaces or abraded skin. The excretion of organisms through the urine of infected animals represents the most common source of Leptospira infection. As of mid-2024, 367 cases of leptospirosis with 42 deaths had been reported in Indonesia. However, the true incidence is likely underreported due to diagnostic challenges. In West Nusa Tenggara (NTB), no formal report exists; however, a data from Mataram City Hospital between 2013-2025 recorded three cases of leptospirosis involving renal impairment requiring hemodialysis (HD). The clinical course of leptospirosis is typically acute, following an incubation period of five to fourteen days. Most patients present with mild, anicteric febrile, but a smaller subset develop severe multiorgan involvement known as Weil’s Disease. The severe form is characterized by acute high-grade fever, acute kidney injury, hepatic failure, pulmonary involvement, cardiovascular instability, neurological deficits, and hemorrhagic diathesis.
Rasio Neutrofil - Limfosit sebagai Prediktor Hasil Klinis pada Pasien dengan PPOK Eksaserbasi Akut: Tinjauan Literatur
Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by chronic respiratory symptoms that cause progressive and persistent airflow obstruction. Numerous inflammatory markers can be used to assess the inflammatory state in COPD patients. Neutrophil-to-Lymphocyte Ratio (NLR) is an inflammatory marker that is easy and practical to examine, which is included in a complete blood count (CBC). We conducted a narrative literature review using a thematic synthesis approach on 12 articles. Five articles demonstrated that the NLR is a good predictor of mortality or death in hospitalized patients with COPD. Two articles stated that a higher NLR in COPD patients increases the likelihood of requiring intensive care (ICU), while the other five articles explained that the NLR can be a good predictor of exacerbations in COPD patients.
Paparan Timbal dan Stres Oksidatif: Dampak Klinis dan Mekanismenya
Lead (Pb) exposure is a significant global environmental health concern, as this heavy metal lacks physiological function in the human body and is toxic, leading to various health disorders. One of the primary mechanisms of lead toxicity is the induction of oxidative stress, defined as an imbalance between the production of reactive oxygen species (ROS) and the capacity of endogenous antioxidant systems to neutralize them. Lead enhances ROS generation through mitochondrial dysfunction and reduces the activity of critical antioxidant enzymes, such as superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT), resulting in oxidative damage to lipids, proteins, and DNA, which subsequently triggers cellular and tissue dysfunction. The clinical consequences of lead-induced oxidative stress are observed across multiple organ systems, including the nervous system (cognitive impairment, memory loss, neuropathy), kidneys (nephropathy, decreased filtration function), liver (hepatotoxicity, metabolic disturbances), and the hematopoietic system (anemia, blood cell dysfunction). This literature review indicates that lead exposure induces cellular and tissue damage through multiple cellular pathways related to oxidative stress, elucidating the fundamental mechanisms by which lead causes clinical disorders in these organs. In conclusion, understanding these cellular mechanisms provides a scientific basis for linking lead exposure to the development of multi-organ diseases.
Optimalisasi Nanopartikel Lipid Eksopolisakarida Termodifikasi Asam Folat untuk Penghantaran Trastuzumab Biosimilar Target HER2 pada Kanker Payudara
Breast cancer remains a leading cause of cancer-related mortality, with HER2-positive subtypes accounting for 20-30% of cases. While trastuzumab has revolutionized treatment, its efficacy is limited by poor tumor penetration, systemic toxicity, and high costs. This literature review explores folic acid-modified exopolysaccharide lipid nanoparticles (FA-EPS-LNPs) as a novel delivery system for trastuzumab biosimilar. Exopolysaccharides offer biocompatibility and biodegradability, while lipid nanoparticles protect therapeutic proteins and enhance cellular uptake. Folic acid conjugation enables dual targeting through folate receptors overexpressed in cancer cells and HER2-specific activity. The review examines physicochemical properties, optimization parameters including particle size, surface charge, encapsulation efficiency, and folic acid conjugation methods. Evidence demonstrates enhanced cellular uptake, improved cytotoxicity, reduced off-target effects, and superior pharmacokinetics compared to conventional formulations. Challenges include scale-up manufacturing, stability, immunogenicity, and regulatory considerations. This review identifies knowledge gaps and highlights FA-EPS-LNPs' potential to improve treatment outcomes, reduce costs, and enhance patient quality of life in HER2-positive breast cancer therapy.
The Role of Galactose-induced Oxidative Stress on Cellular Aging: A Literature Review
Aging is a complex process impacted by both internal and external causes. Nutrition is a crucial extrinsic factor in the development of aging and degenerative disorders. D-galactose is involved in many aging mechanisms in the brain, heart, liver, kidney, and skin. Galactose-induced cellular aging is primarily caused by oxidative stress and a reduced antioxidant system. Overproduction of ROS can damage proteins, lipids, and DNA. The recommended daily dietary limit for D-galactose is 50 grams for healthy people who can completely remove it within 8 hours. An in vivo study revealed that consuming 150 mg/kg/day of galactose led to metabolic issues, heightened blood pressure, and disrupted cardiac sympathovagal balance. These outcomes resulted from compromised cardiac mitochondrial activity, elevated oxidative stress, inflammation, and mitochondrial dysfunction, which caused cell death and eventually cardiac failure. A diet high in carbohydrates, particularly those derived from dairy products and their derivatives, can lead to the accumulation of galactose and its metabolites within cells. This buildup subsequently increases reactive oxygen species and reduces antioxidant capacity, resulting in mitochondrial dysfunction and heightened oxidative and osmotic stress. The culmination of these processes is a decline in cellular function, senescence, and accelerated organ aging.
Paradoxical Reactions in Tuberculous Meningitis : Clinical Insight and Management, a Literature Review
Tuberculous meningitis (TBM) is a type of TB with the most severe clinical symptoms of extrapulmonary tuberculosis, with high mortality and neurological morbidity rates. Paradoxical reactions are clinical symptoms characterized by the worsening of existing tuberculosis lesions or the emergence of new lesions despite receiving appropriate antituberculosis therapy (ATT), often leading to diagnostic confusion and management challenges for patients. This study aims to explain the definition, epidemiology, mechanism, clinical manifestations, diagnosis, and management of PR in TBM, based on various literature reviews. The main findings show that PR is triggered by complex immune mechanisms, often involving an excessive inflammatory response to mycobacterial antigens and known as Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV patients. PR presents with varying clinical symptoms, including fever, headache, impaired consciousness, as well as hydrocephalus and tuberculoma on radiological examination. Therefore, clear clinical guidelines are needed to optimize the diagnosis and management of PR in TBM. Keywords: Tuberculous meningitis, paradoxical reaction, IRIS
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Analisis Faktor yang Berhubungan dengan Kejadian Seksio Sesarea Berulang di Rumah Sakit Umum Daerah Kota Kendari Periode 2023-2024
Cesarean section (CS) deliveries have increased globally to 30% and reached 25.9% in Indonesia. Kendari City Regional Hospital shows a higher rate of 37.5%, exceeding the WHO recommendation of 30%. This increase is associated with rising risks of morbidity and mortality in both mothers and babies. One of the main contributors is repeat cesarean sections, which account for more than one-third of all cesarean deliveries globally. Repeat cesarean sections carry higher risks of intraoperative complications and uterine rupture, making this group a high-risk category that requires special attention in efforts to reduce maternal and perinatal morbidity and mortality rates. Method. This was an analytical observational study using a cross-sectional design based on medical record data. The study population included all mothers who delivered via cesarean section at the Regional General Hospital of Kendari during 2023–2024. A total of 245 samples were selected using purposive sampling. Data were analyzed using the chi-square test, with a significance level set at > 0.05. Results. The study found 148 cases (60.4%) were repeat cesarean sections and 97 cases (39.6%) were primary cesarean sections. The analysis showed significant associations between maternal age (p=0.000) and PROM (p=0.000) with repeat CS. There was no significant association between cervical dilatation (p=0.172) and repeat CS. Conclusion. This study demonstrates significant associations between maternal age and premature rupture of membranes with the incidence of repeat cesarean section at Kendari General Hospital during 2023–2024.
Wa Ode Nurhiqmah Basri Wa Ode Nurhiqmah Basri
Oral Cancer and Reconstruction: A Serial Case Report
Introduction : The head and neck cancer are sixth most common cancers worldwide with cancer of oral cavity. The basic treatment modality for the carcinoma of oral cavity has been surgery and the large defects resulting from the ablation of the tumors require reconstruction. Reconstruction after wide excision of oral cancer challenge in itself, because it requires an appropriate method of reconstruction, in accordance with oncology rules and while maintaining the function . In this case serial, several methods of reconstruction from oral cancer are discussed. Case Report : We report 3 cases of patients female aged 48-71 years with complaints of lumps on the tongue. Patients with risk factors poor oral hygiene. On physical examination, cervical lymph node enlargement was found at levels I-IV. All patients underwent a CT scan of the head and neck. On histopathological examination, squamous cell carcinoma was found, the stage of oral cancer in this case series was stage I-III. The surgery was performed with a combined mandibular and neck dissection operation (Commando) with LD flap, and SCM flap. The patient is then treated in the intensive care unit for 1-2 days, then treated in the usual room and discharged on the 5-7th day of treatment without complications Discussion : Although there is increasing use of microvascular free flap in this era, however, conventional flap like LD and SCM still remains very reliable and versatile myocutaneous flap for primary as well as secondary reconstruction, In head and neck reconstruction, LD and SCM flap is used extensively due to its proven reliability and multipurpose nature . The main advantage of LD and SCM flap is that it can be used in a very wide range of defects in the head and neck region including the maxilla, neck as well as tempero-orbital area. Like the other myocutaneous flap, LD and SCM is harvested by single stage reconstructive procedure and does not require any flap delay or release. The morbidity of the donor site is surprisingly low, however, few patients may complain pain. It is also very useful in the patients with poor clinical conditions as well as for elderly patients. This flap can be used in the cases where there is inadequate recipient vessels for microanastomosis in the neck of the patients who underwent high dose radiotherapy or when there is contraindication to free flap such as medical conditions that make the patients unable to tolerate long surgical procedures or can be used as a salvage procedure after necrosis of free flap. wound dehiscence, infection, vascular rapture with marked increase in the morbidity. There is less mentioning of the incidence of recurrence at flap harvesting site however, few cases are reported in the literature. Conclusion : Reconstruction of composite oro mandibular defects of oral malignancy is a challenging problem for oncology surgeons. LD and SCM myocutaneous flap was found to be a versatile flap for reconstruction of large defects in the head and neck region with minimal complication rate. In today’s world of micro vascular flaps, in spite of associated complications, loco regional flaps play a crucial role at oncology centers. LD and SCM offer a faster, easier and reliable option for reconstruction in post-ablative head and neck surgery.
Diagnosis dan Tatalaksana Postherpetic Neuralgia
Postherpetic Neuralgia (PHN) is a chronic pain condition that occurs after the resolution of Herpes zoster, significantly affecting patients’ quality of life. PHN is characterized by spontaneous pain, hyperalgesia, allodynia, and paresthesia. Major risk factors include advanced age, severity of rash, and ophthalmic involvement. The pathophysiology involves reactivation of the varicella-zoster virus (VZV), leading to nerve inflammation and peripheral sensitization. Management of PHN includes analgesics, antiepileptic drugs (pregabalin, gabapentin), antidepressants, and topical therapies such as capsaicin and lidocaine. Prevention can be achieved through zoster vaccination. Combination therapy is often required to optimize treatment outcomes in PHN.
Mengenal Human Metha Pneumo Virus (HMPV) yang merebak di beberapa Negara
Abstract Human Meta Pneumo Virus (HMPV) is a single strain virus identifies as a cause of upper airway infection. Recently, several new cases reported in some countries, including Indonesia. After the virus infected the epithelial cell, it will replicated exponentially and spreading to adjacent cells. As a result, it will break the tissue and lead to inflammation. In patient with immunocompromised, HMPV infection will continued to pneumonia and other serious complication. Therefore, it is necessary to inform this virus characteristics to the health care professionals to allow them can tackle the disease accurately. Finally, it could limiting the potency of the occurrence of epidemic in population.
Klasifikasi dan Faktor Risiko Ruptur Aneurisma Intrakranial; Sebuah Tinjauan Pustaka
Abstract: Intracranial aneurysms are cerebrovascular abnormalities resulting from structural weakness in the arterial wall, which may rupture and lead to aneurysmal subarachnoid hemorrhage (aSAH), a condition associated with high morbidity and mortality rates. The formation of aneurysms is a multifactorial process that culminates in degenerative changes within the vessel wall. Aneurysms are classified based on morphology (saccular, fusiform, dissecting), size (ranging from small to giant), and anatomical location. The mechanism underlying aneurysm rupture can be explained by the concept of wall shear stress (WSS) in cerebral vessels. Other critical risk factors for aneurysm rupture include aneurysm size and location. A thorough understanding of the classification and risk factors for aneurysm rupture is essential to improve preventive management strategies in clinical practice.
Analisis Kelayakan Integrasi Otopsi Virtual dalam Sistem Visum et Repertum di Indonesia: Perspektif Medis, Yuridis, dan Teknologis
Otopsi virtual (virtopsi) menawarkan alternatif non-invasif untuk otopsi konvensional dengan memanfaatkan teknik pencitraan radiologi. Integrasinya ke dalam sistem visum et repertum Indonesia, yang berfungsi sebagai kerangka pelaporan mediko-hukum utama, menjanjikan tetapi tertantang oleh keterbatasan hukum, pendidikan, dan infrastruktur. Makalah ini mengulas kelayakan dan prospektus penerapan virtopsi di Indonesia dari empat perspektif—medis, hukum, pendidikan, dan teknologi—yang didukung oleh studi kasus internasional. Penelitian ini mengkaji integrasi virtopsi ke dalam pendidikan kedokteran dan praktik forensik, menganalisis kelayakan, manfaat, dan kendalanya dalam konteks mediko-hukum Indonesia. Penulis berpendapat bahwa meskipun virtopsi, yang memanfaatkan teknik pencitraan canggih seperti CT dan MRI, menawarkan alternatif minimal invasif dan meningkatkan presisi diagnostik dan penerimaan budaya, reformasi regulasi, program pelatihan, dan investasi dalam infrastruktur pencitraan sangat penting untuk keberhasilan penerapannya.
Additionally, the Author Examines the Management, Prognosis, and Complications Associated with RBBB.
Right Bundle Branch Block (RBBB) is an abnormality in the physiological electrical conduction system of the heart, resulting from a blockade of the right bundle branch. The global incidence of RBBB is estimated to be approximately 0.8% annually. Typically, RBBB is considered a mild finding that does not increase the risk in otherwise healthy individuals without structural heart disease. However, RBBB may also be indicative of myocardial disease and has been identified as a predictor of mortality in certain populations. This literature review aims to summarize the pathophysiology and clinical approach to RBBB, with a particular focus on echocardiography (ECG) examinations, based on literature sourced from PubMed, Google Scholar, and additional manual searches conducted between 2016 and 2021. Additionally, the author examines the management, prognosis, and complications associated with RBBB.
A Case Report Disfonia et causa Nodul Vocal Cords Bilateral
Dysphonia is a commonly used term for any voice disorder resulting from abnormalities in the organs of phonation, especially the larynx, whether organic or functional. Vocal cord nodules or often known as “singer's nodes”, “screamer's nodes” or “teacher's nodes” are one of the most common causes of dysphonia in children. It is known that vocal cord nodules are a condition where there is swelling of the bilateral vocal cords of varying sizes, which can generally be found in the center of the vocal cord membrane. These nodules are characterized by epithelial thickening with different levels of inflammatory reaction in the superficial layer of the lamina propia. In this case report will discusses abouta 49-year-old woman who came to the ENT clinic of the NTB Provincial Hospital with a chief complaint of hoarseness. Furthermore, from the anamnesis, physical examination and supporting examination, the patient was diagnosed with dysphonia ec bilateral vocal cord nodules.