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Endoscopic Sphenopalatine Artery Ligation in Recurrent Epistaxis with Hypertensio Aini Zhann; Dolly Irfandy; Bestari Jaka Budiman; Deka Viotra
Majalah Kedokteran Andalas Vol 46, No 4 (2023): Online Juli 2023
Publisher : Faculty of Medicine, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/mka.v46.i4.p736-744.2023

AbstractBackground: Epistaxis is the most common case in ORL-HNS emergencies. One of the risk factors of recurrent epistaxis is hypertension. Epistaxis in hypertension usually originates from the posterior vessels. This requires more invasive procedures such as sphenopalatine artery ligation. Case Report: A 58-year-old woman with complaints of recurrent epistaxis from the right nose. The results of the blood pressure examination showed the results of 190/120 mmHg. The patient underwent sphenopalatine artery ligation to prevent recurrence. Conclusion: One of the factors for recurrent epistaxis is hypertension. Initial management of epistaxis with recurrent hypertension can be done in a conservative way followed by surgery and keeping blood pressure stable. Endoscopic sphenopalatine artery ligation is the definitive treatment according to the epistaxis management algorithm. Endoscopic sphenopalatine artery ligation provides satisfactory results and minimal complications.Keywords: Recurrent epistaxis, hypertension, sphenopalatine artery ligation

Systemic Lupus Erythematosus with Lupus Nephritis, Community-Acquired Pneumonia, Bilateral Pleural Effusion, Pericardial Effusion, and Hypoalbuminemia in a 20-Year-Old Male Patient: A Case Report Pratama Yudha, Muhammad Agung; Deka Viotra; Najirman
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i8.1050

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation. Lupus nephritis is a serious complication of SLE that can cause kidney failure. Community acquired pneumonia (CAP), bilateral pleural effusion, pericardial effusion, and hypoalbuminemia are other complications that can occur in SLE patients. Case presentation: We report the case of a 20-year-old man with SLE who presented with lupus nephritis, CAP, bilateral pleural effusion, pericardial effusion, and hypoalbuminemia. Patients were diagnosed with SLE based on the American College of Rheumatology (ACR) classification criteria. The diagnosis of lupus nephritis is made based on the presence of proteinuria, hematuria, and casts on urinalysis, as well as findings on kidney biopsy. CAP is diagnosed based on the presence of fever, cough, cough with phlegm, and infiltrates on chest X-ray. Bilateral pleural effusion and pericardial effusion were diagnosed based on physical examination and findings on chest ultrasound. Hypoalbuminemia is diagnosed based on low serum albumin levels. Patients are treated with steroids, antimalarials, diuretics, and antibiotics. The patient's symptoms improved and complications resolved. Conclusion: SLE is a complex disease that can cause a variety of serious complications. Early diagnosis and treatment of these complications are essential to improve the patient's prognosis. This case shows that SLE can cause a variety of serious complications, including lupus nephritis, CAP, bilateral pleural effusion, pericardial effusion, and hypoalbuminemia. Early diagnosis and treatment of these complications are essential to improve the patient's prognosis.

Hyperhomocysteinemia in Chronic Kidney Disease: A Meta-Analysis Faurin, Muthia; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 12 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i12.1133

Background: Hyperhomocysteinemia, an elevated level of homocysteine in the blood, has been implicated in the progression of chronic kidney disease (CKD). This meta-analysis aims to comprehensively evaluate the association between hyperhomocysteinemia and CKD and its potential impact on clinical outcomes. Methods: This study systematically searched electronic databases (PubMed, Embase, Cochrane Library) for studies published between 2018 and 2024 investigating the relationship between hyperhomocysteinemia and CKD. Studies reporting data on the association between hyperhomocysteinemia and CKD progression, cardiovascular events, or mortality were included. We extracted relevant data and performed a meta-analysis using random-effects models. Results: The meta-analysis included 25 studies comprising 5,672 patients with CKD. Hyperhomocysteinemia was significantly associated with an increased risk of CKD progression (pooled odds ratio [OR] 1.85, 95% confidence interval [CI] 1.52-2.24), cardiovascular events (pooled OR 1.63, 95% CI 1.31-2.02), and all-cause mortality (pooled OR 1.48, 95% CI 1.17-1.87) in CKD patients. Subgroup analyses revealed a consistent association across different CKD stages and etiologies. Conclusion: Hyperhomocysteinemia is an independent risk factor for CKD progression, cardiovascular events, and mortality. Monitoring and managing hyperhomocysteinemia may represent a potential therapeutic target to improve outcomes in CKD patients.

β2-Microglobulin: A Powerful Biomarker for Chronic Kidney Disease Progression Yanuar Surya Saputra Poedjijo; Drajad Priyono; Deka Viotra; Harun, Harnavi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1219

Background: Chronic kidney disease (CKD) is a global health concern with increasing prevalence. Early detection and accurate prognosis are crucial for effective management. β2-microglobulin (β2M) has emerged as a promising biomarker in CKD, but its prognostic value requires further evaluation. This meta-analysis aimed to comprehensively assess the association between β2M and CKD progression. Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between 2013 and 2024 investigating the relationship between β2M and CKD progression. Studies were included if they reported hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between β2M levels and renal endpoints (e.g., end-stage renal disease [ESRD], doubling of serum creatinine, or a decline in estimated glomerular filtration rate [eGFR]). A random-effects model was used to pool the HRs. Results: Six eligible studies involving 5,420 participants were included. The pooled analysis demonstrated a significant association between elevated β2M levels and increased risk of CKD progression (HR = 2.15; 95% CI: 1.78-2.59; p < 0.001). Subgroup analyses revealed that this association remained consistent across different CKD stages and underlying etiologies. Conclusion: Elevated β2M is a strong and independent predictor of CKD progression. Its incorporation into clinical practice may improve risk stratification and guide therapeutic interventions in CKD patients.

Pregnancy-Triggered Severe Lupus Nephritis with Pleural Effusion: A Case Report Zaki Mahmudi Dasril; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 5 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i5.1275

Background: Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE), characterized by kidney inflammation. Pregnancy can trigger or exacerbate LN due to hormonal shifts and altered immune responses. This case highlights the challenges in diagnosing and managing pregnancy-associated LN. Case presentation: A 27-year-old woman presented with anasarca, malar rash, shortness of breath, and foamy urine during her first pregnancy. She had a history of SLE with previous symptoms limited to skin and joint involvement. Investigations revealed nephrotic-range proteinuria, hematuria, elevated creatinine, and positive anti-nuclear antibodies (ANA). Renal biopsy confirmed Class IV lupus nephritis. She was diagnosed with pregnancy-triggered severe LN with nephrotic syndrome, pleural effusion, and a hypercoagulable state. Treatment included high-dose corticosteroids and mycophenolate mofetil, with close monitoring of both maternal and fetal health. Conclusion: This case underscores the importance of recognizing and promptly managing LN in pregnancy. Early diagnosis, multidisciplinary care, and individualized treatment are crucial to optimize maternal and fetal outcomes.

Elevated Fibroblast Growth Factor-23 as an Independent Predictor of All-Cause Mortality, Cardiovascular Events, and Progression to ESRD in Pre-Dialysis CKD: A Systematic Review and Meta-Analysis Sri Puji Rahayuningsih; Drajad Priyono; Harnavi Harun; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1364

Background: Fibroblast growth factor-23 (FGF23) is a central hormone in mineral metabolism, with levels rising early in chronic kidney disease (CKD). While its role in the pathophysiology of CKD–Mineral and Bone Disorder (CKD-MBD) is established, its independent prognostic value for adverse outcomes in the pre-dialysis population remains a subject of intense investigation. We aimed to systematically quantify the association between elevated FGF23 levels and the risks of all-cause mortality, cardiovascular (CV) events, and progression to End-Stage Renal Disease (ESRD) in patients with pre-dialysis CKD. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. A comprehensive search of PubMed, EMBASE, and the Cochrane Library was performed for prospective cohort studies published between January 2014 and December 2024 that evaluated the prognostic value of FGF23 in adult, pre-dialysis CKD patients. The primary outcomes were all-cause mortality, a composite of major cardiovascular events, and progression to ESRD. Hazard Ratios (HRs) were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated with funnel plots and Egger's test. Results: Seven prospective cohort studies involving 14,882 patients were included. The analysis revealed that elevated FGF23 was a significant independent predictor for all three outcomes. The pooled HR for all-cause mortality was 1.42 (95% CI: 1.28–1.58; I²=72%), for cardiovascular events was 1.39 (95% CI: 1.21–1.59; I²=78%), and for progression to ESRD was 1.55 (95% CI: 1.35–1.78; I²=65%). The associations remained significant after adjustment for traditional CKD-MBD markers and renal function in the primary studies. Sensitivity analyses confirmed the robustness of these findings. Conclusion: This meta-analysis provides strong evidence that elevated FGF23 is a potent and independent predictor of all-cause mortality, cardiovascular events, and progression to ESRD in the pre-dialysis CKD population. These findings underscore the potential utility of FGF23 as a key biomarker for risk stratification and suggest it may be a critical therapeutic target to improve outcomes in this vulnerable population.

Pregnancy-Triggered Severe Lupus Nephritis with Pleural Effusion: A Case Report Zaki Mahmudi Dasril; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 5 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i5.1275

Background: Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE), characterized by kidney inflammation. Pregnancy can trigger or exacerbate LN due to hormonal shifts and altered immune responses. This case highlights the challenges in diagnosing and managing pregnancy-associated LN. Case presentation: A 27-year-old woman presented with anasarca, malar rash, shortness of breath, and foamy urine during her first pregnancy. She had a history of SLE with previous symptoms limited to skin and joint involvement. Investigations revealed nephrotic-range proteinuria, hematuria, elevated creatinine, and positive anti-nuclear antibodies (ANA). Renal biopsy confirmed Class IV lupus nephritis. She was diagnosed with pregnancy-triggered severe LN with nephrotic syndrome, pleural effusion, and a hypercoagulable state. Treatment included high-dose corticosteroids and mycophenolate mofetil, with close monitoring of both maternal and fetal health. Conclusion: This case underscores the importance of recognizing and promptly managing LN in pregnancy. Early diagnosis, multidisciplinary care, and individualized treatment are crucial to optimize maternal and fetal outcomes.

Elevated Fibroblast Growth Factor-23 as an Independent Predictor of All-Cause Mortality, Cardiovascular Events, and Progression to ESRD in Pre-Dialysis CKD: A Systematic Review and Meta-Analysis Sri Puji Rahayuningsih; Drajad Priyono; Harnavi Harun; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1364

Background: Fibroblast growth factor-23 (FGF23) is a central hormone in mineral metabolism, with levels rising early in chronic kidney disease (CKD). While its role in the pathophysiology of CKD–Mineral and Bone Disorder (CKD-MBD) is established, its independent prognostic value for adverse outcomes in the pre-dialysis population remains a subject of intense investigation. We aimed to systematically quantify the association between elevated FGF23 levels and the risks of all-cause mortality, cardiovascular (CV) events, and progression to End-Stage Renal Disease (ESRD) in patients with pre-dialysis CKD. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. A comprehensive search of PubMed, EMBASE, and the Cochrane Library was performed for prospective cohort studies published between January 2014 and December 2024 that evaluated the prognostic value of FGF23 in adult, pre-dialysis CKD patients. The primary outcomes were all-cause mortality, a composite of major cardiovascular events, and progression to ESRD. Hazard Ratios (HRs) were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated with funnel plots and Egger's test. Results: Seven prospective cohort studies involving 14,882 patients were included. The analysis revealed that elevated FGF23 was a significant independent predictor for all three outcomes. The pooled HR for all-cause mortality was 1.42 (95% CI: 1.28–1.58; I²=72%), for cardiovascular events was 1.39 (95% CI: 1.21–1.59; I²=78%), and for progression to ESRD was 1.55 (95% CI: 1.35–1.78; I²=65%). The associations remained significant after adjustment for traditional CKD-MBD markers and renal function in the primary studies. Sensitivity analyses confirmed the robustness of these findings. Conclusion: This meta-analysis provides strong evidence that elevated FGF23 is a potent and independent predictor of all-cause mortality, cardiovascular events, and progression to ESRD in the pre-dialysis CKD population. These findings underscore the potential utility of FGF23 as a key biomarker for risk stratification and suggest it may be a critical therapeutic target to improve outcomes in this vulnerable population.

Efficacy, Safety, and Metabolic Effects of Low-Molecular-Weight Heparin versus Unfractionated Heparin in Chronic Hemodialysis: A Systematic Review and Meta-Analysis of Clinical Studies Evelin Veronike; Harnavi Harun; Drajad Priyono; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1494

Background: The optimal anticoagulation for chronic hemodialysis (HD) remains debated. Unfractionated heparin (UFH) is the historical standard but carries risks of metabolic complications and requires intensive monitoring. Low-Molecular-Weight Heparin (LMWH) offers pharmacological advantages, but concerns over bleeding risk in end-stage renal disease (ESRD) have limited its use. This study aimed to provide a holistic comparison by synthesizing recent evidence on the efficacy, safety, and, uniquely, the key metabolic consequences of LMWH versus UFH. Methods: This systematic review followed PRISMA 2020 guidelines. We searched PubMed, EMBASE, and CENTRAL from January 2014 to March 2025 for clinical studies comparing LMWH and UFH in chronic HD patients. We included 6 studies (3 prospective trials, 3 retrospective cohorts) totaling 7,890 patients. The primary efficacy outcome was circuit thrombosis; the primary safety outcome was major bleeding. Secondary outcomes focused on key metabolic markers (pre-dialysis potassium, lipid profile). Data from prospective trials and observational studies were analyzed separately using subgroup analysis and tested for interaction. Metabolic data were pooled using a random-effects model. Results: The analysis of key metabolic outcomes, derived from homogenous prospective trials (I2=0%), was the most robust finding. LMWH use was associated with a clinically significant reduction in pre-dialysis serum potassium (Mean Difference [MD]: -0.30 mEq/L; 95% CI: -0.50 to -0.10) and a superior atherogenic profile, including lower triglycerides (MD: -20.10 mg/dL) and higher HDL (MD: +4.50 mg/dL). For safety, no difference in major bleeding was found, a finding that was consistent across prospective trials (OR: 0.78; 95% CI: 0.33-1.85) and large retrospective cohorts (OR: 0.87; 95% CI: 0.69-1.09), with no subgroup interaction (p=0.75). Efficacy for preventing circuit thrombosis was also similar. Conclusion: This meta-analysis provides strong, high-quality evidence that LMWH confers significant and clinically relevant metabolic advantages over UFH, particularly in mitigating hyperkalemia and atherogenic dyslipidemia. Furthermore, our stratified analysis provides high confidence from real-world data that LMWH, when dosed appropriately, is as safe and effective as UFH.

Systemic Lupus Erythematosus with Lupus Nephritis, Community-Acquired Pneumonia, Bilateral Pleural Effusion, Pericardial Effusion, and Hypoalbuminemia in a 20-Year-Old Male Patient: A Case Report Pratama Yudha, Muhammad Agung; Deka Viotra; Najirman
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i8.1050

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation. Lupus nephritis is a serious complication of SLE that can cause kidney failure. Community acquired pneumonia (CAP), bilateral pleural effusion, pericardial effusion, and hypoalbuminemia are other complications that can occur in SLE patients. Case presentation: We report the case of a 20-year-old man with SLE who presented with lupus nephritis, CAP, bilateral pleural effusion, pericardial effusion, and hypoalbuminemia. Patients were diagnosed with SLE based on the American College of Rheumatology (ACR) classification criteria. The diagnosis of lupus nephritis is made based on the presence of proteinuria, hematuria, and casts on urinalysis, as well as findings on kidney biopsy. CAP is diagnosed based on the presence of fever, cough, cough with phlegm, and infiltrates on chest X-ray. Bilateral pleural effusion and pericardial effusion were diagnosed based on physical examination and findings on chest ultrasound. Hypoalbuminemia is diagnosed based on low serum albumin levels. Patients are treated with steroids, antimalarials, diuretics, and antibiotics. The patient's symptoms improved and complications resolved. Conclusion: SLE is a complex disease that can cause a variety of serious complications. Early diagnosis and treatment of these complications are essential to improve the patient's prognosis. This case shows that SLE can cause a variety of serious complications, including lupus nephritis, CAP, bilateral pleural effusion, pericardial effusion, and hypoalbuminemia. Early diagnosis and treatment of these complications are essential to improve the patient's prognosis.

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