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Rachmat Hidayat
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INDONESIA
Bioscientia Medicina : Journal of Biomedicine and Translational Research
Published by Universitas Sriwijaya
ISSN : -     EISSN : 25980580     DOI : -
Core Subject : Health, Science,
BioScientia Medicina is an open access international scholarly journal in the field of biomedicine and translational research aimed to publish a high-quality scientific paper including original research papers, reviews, short communication, and technical notes. This journal welcomes the submission of articles that offering a sensible transfer of basic research to applied clinical medicine. BioScientia Medicina covers the latest developments in various fields of biomedicine with special attention to medical sciences, Traditional Herb, genetics, immunology, environmental health, toxicology, bioinformatics and biotechnology as well as multidisciplinary studies. The views of experts on current advances in nanotechnology and molecular/cell biology will be also considered for publication as long as they have a direct clinical impact on human health.
Arjuna Subject : Kedokteran - Anatomi
Articles 1,509 Documents
Prophylactic Statin Therapy for the Prevention of Anthracycline-Induced Cardiotoxicity in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies Nadia Karimah Amalia; Yenny Dian Andayani; Mediarty; Norman Djamaludin
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 7 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i7.1634

Abstract

Background. Anthracycline-based chemotherapy remains a cornerstone of curative-intent breast-cancer treatment but carries a dose-dependent risk of cancer therapy-related cardiac dysfunction (CTRCD). Statins exert pleiotropic anti-inflammatory, antioxidative, and endothelial-stabilizing effects that may attenuate myocardial injury; however, prior meta-analyses pooled breast-cancer and lymphoma populations, obscuring breast-cancer-specific signals. Methods. A systematic review and random-effects meta-analysis was conducted per PRISMA 2020. PubMed, Cochrane, Scopus, and Web of Science were searched for randomized controlled trials (RCTs) and propensity-matched cohort studies enrolling adult breast-cancer patients receiving anthracycline-based chemotherapy with or without trastuzumab. Co-primary outcomes were CTRCD incidence and standardized change in left-ventricular ejection fraction (LVEF, Hedges' g). Risk of bias was assessed using RoB 2.0 and ROBINS-I. Sensitivity analyses included leave-one-out exclusion and restriction to breast-cancer-only RCTs. Results. Ten studies (1,239 patients; six RCTs, four cohort studies) were included. The pooled risk ratio for CTRCD was 0.49 (95% CI 0.28–0.85; p = 0.011; I² = 0%). The pooled standardized mean difference for LVEF change was 0.38 (95% CI −0.06 to 0.81; I² = 81%), corresponding to approximately +2.1 LVEF percentage points. Sensitivity analyses restricted to breast-cancer-only RCTs strengthened the CTRCD effect (RR 0.36, 95% CI 0.16–0.82). HER2-positive subgroup analyses yielded a pooled RR of 0.28 (95% CI 0.10–0.80). Conclusion. Prophylactic statin therapy is associated with a clinically meaningful and statistically significant reduction in CTRCD in breast-cancer patients receiving anthracyclines. The protective effect is particularly pronounced in HER2-positive patients. A cautious, risk-stratified use of statins as a cardioprotective adjunct is supported pending adequately powered, breast-cancer-specific randomized trials.
Repeated Optical Biometry Failure as an Underrecognized Marker of Late In-the-Bag Intraocular Lens Decentration in Axial Myopia: A Case Report Angel Lim; Ni Made Dwipayani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 7 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i7.1636

Abstract

Background: Late in-the-bag intraocular lens (IOL) dislocation is a delayed complication of cataract surgery driven by progressive zonular weakness, with axial myopia recognized as an independent risk factor. Its role as a hidden cause of optical biometry failure, however, has received little emphasis in the literature. Case presentation: A 58-year-old woman with longstanding axial myopia presented seven years after uneventful right-eye phacoemulsification with progressively blurred vision, monocular diplopia, and ghost images. Best-corrected visual acuity (BCVA) was 6/38 in the right eye improving to 6/15 with pinhole; refractometry revealed a new −4.00 D cylinder at axis 90° with persistent visual distortion consistent with irregular astigmatism. Slit-lamp examination showed inferior decentration of an in-the-bag posterior chamber IOL with a visible inferior haptic. Posterior segment evaluation through the displaced optic was hazy. Repeated optical biometry of the affected eye failed to acquire a valid axial-length signal across three sessions, whereas the fellow eye yielded reliable measurements. The patient was referred to a tertiary vitreoretinal center for IOL repositioning or exchange with possible pars plana vitrectomy and scleral fixation. Conclusion: In a myopic pseudophakic eye presenting with new-onset monocular diplopia and an astigmatic shift, repeated failure of optical biometry should be recognized as a critical diagnostic clue to underlying IOL instability, prompting timely tertiary referral and individualized surgical planning.
Intraoperative Incisional Wound Irrigation with 0.05% Chlorhexidine versus 0.9% Saline to Prevent Surgical Site Infection after Laparotomy for Hollow-Viscus Perforation Peritonitis: A Double-Blind Randomized Controlled Trial Oktova Ardianto; Bambang Am Am Setya Sulthana; Rizki Diposarosa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 7 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i7.1637

Abstract

Background: Surgical site infection (SSI) is the most frequent complication of abdominal surgery and a major source of morbidity, prolonged hospitalization and cost, particularly in dirty (class IV) wounds created by gastrointestinal perforation; intraoperative incisional irrigation may lower wound bioburden, yet the optimal irrigant is undefined. Methods: We conducted a double-blind randomized controlled trial at a tertiary referral center in Bandung, Indonesia (November 2019–August 2020) comparing incisional irrigation with 0.05% chlorhexidine versus 0.9% saline in adults undergoing emergency laparotomy for hollow-viscus perforation peritonitis. After fascial closure, incisions were irrigated by allocation and patients were followed for 30 days, with superficial SSI (ASEPSIS score) as the primary outcome. Results: Of 141 patients screened, 96 were analyzed (49 chlorhexidine, 47 saline). Superficial SSI occurred in 5/49 (10.2%) chlorhexidine versus 14/47 (29.8%) saline patients (χ²=5.795, p=0.016; Fisher exact p=0.021; OR 0.268, 95% CI 0.088–0.818; relative risk 0.343; absolute risk reduction 19.6%; number-needed-to-treat 5.1). In multivariable logistic regression, chlorhexidine remained independently protective (adjusted OR 0.228, 95% CI 0.062–0.836, p=0.026), while intra-abdominal contamination (aOR 1.377 per 100 mL, p=0.008) and operative time (aOR 1.645 per 30 min, p=0.027) increased risk; the model discriminated well (AUC 0.835). No irrigation-related adverse events occurred. Conclusion: Incisional irrigation with 0.05% chlorhexidine markedly reduced superficial SSI after laparotomy for perforation peritonitis and offers a low-cost strategy for dirty abdominal wounds.
Efficacy and Safety of Adding Antiangiogenic Therapy to EGFR-Tyrosine Kinase Inhibitors versus EGFR-Tyrosine Kinase Inhibitor Monotherapy in EGFR-Mutant Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis of Randomised Controlled Trials Hermis Arsena; Sri Melati Munir
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 7 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i7.1638

Abstract

Background. Resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) limits the durability of targeted therapy in EGFR-mutant non-small cell lung cancer (NSCLC). Inhibiting the vascular endothelial growth factor (VEGF) axis has been proposed to delay this resistance, but individual trials diverge and the antiangiogenic class has not been synthesised together across treatment settings. This study quantified the effect of adding antiangiogenic therapy to an EGFR-TKI on progression-free survival (PFS) and toxicity. Methods. Four databases were searched for randomised controlled trials (RCTs) comparing an EGFR-TKI plus an antiangiogenic agent (bevacizumab or ramucirumab) with the same EGFR-TKI alone in EGFR-mutant NSCLC. The pre-specified primary analysis was PFS in the first-line setting, expressed as the hazard ratio (HR) and pooled with an inverse-variance random-effects (DerSimonian-Laird) model; a restricted maximum-likelihood model confirmed it. Heterogeneity used I², τ² and a 95% prediction interval; risk of bias used Cochrane RoB 2.0. Results. Seven RCTs (eight reports; 1,512 patients; six first-line, one second-line) were included. In the six first-line trials the combination prolonged PFS (pooled HR 0.61, 95% CI 0.53-0.70; p<0.0001) with no heterogeneity (I²=0%; prediction interval 0.50-0.74); the restricted maximum-likelihood estimate was identical. The benefit was consistent for bevacizumab (HR 0.62, 0.52-0.73) and ramucirumab (HR 0.59, 0.46-0.76), a mean prolongation of median PFS of about 5.5 months. Adding the second-line osimertinib/T790M trial attenuated the effect (HR 0.66, 0.56-0.77; I²=32%), driven by absence of benefit in that setting (HR 0.96). Leave-one-out estimates were stable (0.59-0.63); the Egger test was non-significant. Grade ≥3 adverse events were increased (risk ratio 1.95, 1.47-2.57; absolute increase about 29 percentage points; number needed to harm about 4). Conclusion. Adding antiangiogenic therapy to a first-line EGFR-TKI consistently prolongs PFS in EGFR-mutant NSCLC as a VEGF-pathway class effect, at the cost of roughly doubled severe toxicity and without a demonstrated overall-survival gain. The benefit was not evident in the second-line osimertinib/T790M setting, suggesting the strategy delays rather than overcomes resistance.
Anesthetic Management of a Young Adult with Severe Rheumatic Mitral and Aortic Stenosis Undergoing Double Valve Replacement: A Case Report Fauzul Nurul Azmi; Pelinggo Jaya; Vera Muharrami
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 8 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i8.1639

Abstract

Background. Rheumatic heart disease remains a leading cause of valvular pathology in young adults of low- and middle-income countries. The coexistence of severe mitral stenosis (MS) and severe aortic stenosis (AS) confronts the anesthesiologist with directly opposed hemodynamic imperatives and a markedly narrowed margin of safety, particularly during separation from cardiopulmonary bypass (CPB). Case presentation. A 41-year-old man presented with a 14-year history of exertional syncope, progressive dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Transthoracic echocardiography demonstrated severe rheumatic MS (mitral valve area 0.8 cm²) and severe rheumatic AS (aortic valve area 0.8 cm², mean gradient 56 mmHg) with preserved left ventricular ejection fraction (67%), reduced right ventricular contractility (TAPSE 17 mm), and atrial fibrillation. He underwent double valve replacement under general anesthesia using an opioid-based, hemodynamically stable induction with full invasive monitoring. Separation from CPB was complicated by two episodes of ventricular tachycardia requiring synchronized cardioversion (30 J and 20 J) and was managed with a milrinone–dobutamine–norepinephrine strategy. The patient was transferred ventilated to intensive care on inotropic and antiarrhythmic support and stabilized. Conclusion. Combined severe MS and AS demands an individualized plan reconciling contradictory goals: adequate preload and a controlled, unhurried heart rate for MS, against maintained afterload and coronary perfusion for AS. Meticulous invasive monitoring, a stable induction, anticipation of right ventricular dysfunction, and readiness for perioperative arrhythmia are decisive for a safe outcome.
Optimal Timing of Tracheostomy in Critically Ill Adults Requiring Prolonged Mechanical Ventilation: An Updated Meta-Analysis of Randomized Controlled Trials Fauzul Nurul Azmi; Novita Anggraeni; Johannas; Wan Novriza Wijaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 8 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i8.1640

Abstract

Background: Tracheostomy is among the most frequently performed procedures in the intensive care unit (ICU), yet the optimal timing relative to the onset of invasive mechanical ventilation remains contested. This study aimed to provide an updated quantitative synthesis of randomized controlled trials (RCTs) comparing early versus late tracheostomy in critically ill adults, incorporating the two most recent landmark trials. Methods: PubMed was systematically searched, supplemented by reference-list screening, for RCTs comparing early with late tracheostomy in mechanically ventilated adults. Study selection and data extraction were performed independently and in duplicate. Risk of bias was appraised with the Cochrane RoB 2 tool and the certainty of evidence with the GRADE framework. Dichotomous outcomes (all-cause mortality, ventilator-associated pneumonia [VAP]) were pooled as risk ratios (RR); continuous outcomes (duration of mechanical ventilation, ventilator-free days) as standardized mean differences (SMD, Hedges’ g), using a DerSimonian–Laird random-effects model. Results: Nine RCTs enrolling 2,500 critically ill adults were included. Early tracheostomy was not associated with reduced all-cause mortality (RR 0.88, 95% CI 0.70–1.09; p=0.24; I²=58.9%; prediction interval 0.48–1.59; seven trials; moderate certainty). A non-significant trend towards fewer VAP episodes was observed (RR 0.67, 95% CI 0.42–1.05; p=0.08; I²=71.0%; four trials; low certainty). Early tracheostomy showed non-significant tendencies towards a shorter duration of mechanical ventilation (SMD −1.38, 95% CI −3.44 to 0.68; I²=97.2%) and more ventilator-free days (SMD 0.20, 95% CI −0.07 to 0.47). Leave-one-out and Hartung–Knapp–Sidik–Jonkman analyses confirmed the robustness of the neutral mortality finding. Conclusion: In critically ill adults requiring prolonged mechanical ventilation, early tracheostomy did not significantly reduce mortality and conferred, at most, modest and uncertain benefits on VAP and ventilation-related resource use. Timing should remain an individualized clinical decision rather than a uniform protocol.
Risk of Amiodarone-Induced Pulmonary Toxicity Versus Placebo in Patients with Cardiac Arrhythmias and Heart Failure: A Meta-Analysis of Randomised Controlled Trials Dzaki Murtadho; Dewi Wahyu Fitrina; Deddy Herman
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 8 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i8.1641

Abstract

Background: Amiodarone is the most effective antiarrhythmic agent for maintaining sinus rhythm, yet its long-term use is constrained by extracardiac toxicity, of which pulmonary toxicity is the most feared because it carries appreciable mortality and is frequently misdiagnosed. No contemporary meta-analysis has isolated amiodarone-induced pulmonary toxicity as the single primary endpoint across cardiac arrhythmia and heart-failure populations; this study quantified that risk. Methods: PubMed/MEDLINE, Scopus and Web of Science were searched for placebo- or usual-care-controlled randomised controlled trials (RCTs) of oral amiodarone in adults with cardiac arrhythmia or heart-failure indications reporting pulmonary toxicity. Two reviewers extracted 2×2 data and assessed risk of bias with Cochrane RoB 2.0. Because the outcome was dichotomous, the risk ratio (RR) was pooled using a DerSimonian–Laird random-effects model, with the odds ratio (OR) and Peto OR as corroborative measures. Results: Nine RCTs comprising 6,209 patients (3,175 amiodarone; 3,034 control) were included. Pulmonary toxicity occurred in 77 of 3,175 amiodarone-treated patients (2.43%) versus 42 of 3,034 controls (1.38%). Amiodarone significantly increased pulmonary-toxicity risk (RR 1.70, 95% CI 1.17–2.45, p = 0.005), with no detectable heterogeneity (I² = 0%). The OR (1.74) and Peto OR (1.81) were concordant, and the estimate remained harmful under every single-study deletion (RR 1.46–2.64). Higher-dose strata showed a numerically larger effect (RR 2.50) than lower-dose strata (RR 1.69; subgroup p = 0.48). Conclusion: Amiodarone was associated with an approximately 70% relative increase in pulmonary-toxicity risk versus placebo, a robust and homogeneous finding. The absolute excess was modest (about one additional case per 95 patients treated), supporting continued use with structured baseline and periodic pulmonary surveillance, particularly at higher maintenance doses and longer durations.
Enzyme-Inducing Antiseizure Medications and Hypovitaminosis D in Children with Epilepsy: A Cross-Sectional Study in West Sumatera, Indonesia Trisna Yunita; Rahmi Lestari; Nice Rachmawati Masnadi; Eva Chundrayetti; Amirah Zatil Izzah; Indra Ihsan; Rinang Mariko
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 8 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i8.1642

Abstract

Background. Long-term antiseizure-medication (ASM) therapy can accelerate vitamin D catabolism via hepatic cytochrome P450 induction, predisposing children with epilepsy to hypovitaminosis D and its skeletal consequences; Indonesian tertiary-centre data remain scarce. Methods. This cross-sectional study examined the association between ASM class, number and duration and serum 25-hydroxyvitamin D [25(OH)D] in children aged 1–18 years at Dr. M. Djamil General Hospital, Padang, West Sumatera, between April and October 2025. Of 82 records screened, 77 were eligible; 25(OH)D was measured by enzyme-linked fluorescent assay, with hypovitaminosis D defined as <30 ng/mL. Associations were tested with Fisher–Freeman–Halton exact and chi-square tests, odds ratios, ANOVA, multivariable logistic regression and ROC analysis. Results. Hypovitaminosis D affected 48 children (62.3%; 95% CI 51.2–72.3), with mean 25(OH)D of 18.3±6.7 versus 41.6±11.2 ng/mL in deficient versus replete children. ASM class was significantly associated with vitamin D status (exact p=0.037; Cramér's V=0.283): all nine enzyme-inducing users were deficient, versus 56.0% non-enzyme-inducing and 58.1% combination (ANOVA p=0.045, η²=0.080). Neither ASM number (p=0.642) nor duration (p=0.348) was associated. Enzyme-inducing exposure carried the largest adjusted odds (adjusted OR 5.66, 95% CI 0.62–52.06), and the model discriminated moderately (AUC 0.685). Conclusion. Hypovitaminosis D is prevalent in Indonesian children with epilepsy and is most strongly linked to enzyme-inducing ASMs, supporting early routine 25(OH)D monitoring and supplementation from treatment initiation.
Discordance Between Plasma and Intratumoral Estradiol in Treatment-Naïve Luminal Breast Cancer: A Cross-Sectional Study Arga Scorpianus Renardi; Widyanti Soewoto; Brian Wasita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 8 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i8.1643

Abstract

Background: Estradiol drives luminal breast cancer, and plasma estradiol is widely used as a systemic marker; whether it reflects the intratumoral hormonal milieu is uncertain. This study evaluated the relationship between plasma and intratumoral estradiol and their demographic determinants in treatment-naive luminal breast cancer. Methods: An observational analytical cross-sectional study was conducted at Dr. Moewardi Regional General Hospital and the Anatomical Pathology Laboratory, Universitas Sebelas Maret, Surakarta, Indonesia (2019-2024). Fifty-six treatment-naive patients with Luminal A or Luminal B breast cancer were enrolled by total sampling. Plasma estradiol was measured by enzyme-linked immunosorbent assay and intratumoral estradiol by immunohistochemistry; data were analysed with Spearman correlation, chi-square/Fisher tests, logistic regression and ROC analysis, with effect sizes and 95% confidence intervals. Results: Plasma estradiol did not correlate with intratumoral estradiol (Spearman rho = 0.136; 95% CI -0.13 to 0.39; p = 0.319) and discriminated tissue positivity at chance level (AUC = 0.42; 95% CI 0.25-0.59). Age >=50 years (OR 7.27; 95% CI 2.01-26.29; p = 0.001) and postmenopausal status (OR 11.61; 95% CI 2.85-47.38; p < 0.001) were associated with high plasma estradiol, and postmenopausal status remained independent after adjustment (adjusted OR 11.16; 95% CI 2.68-46.54). Neither variable was associated with intratumoral estradiol (p = 0.863 and p = 0.665). Conclusion: Systemic estradiol does not represent the tumour hormonal state in luminal breast cancer; intratumoral estrogen appears governed by local intracrine mechanisms. Tumour-specific assessment may guide endocrine therapy more accurately than plasma measurement alone.
Progressive Fahr's Syndrome with Severe Hypocalcemia in a Woman with Uncontrolled Type 2 Diabetes Mellitus and Coronary Artery Disease: A Case Report Luh Wayan Puspa Ningsih; Ida Bagus Kade Satyagraha
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 8 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i8.1644

Abstract

Background: Fahr's syndrome denotes bilateral, symmetric calcification of the basal ganglia and other deep cerebral structures arising from an identifiable secondary cause, most commonly a disorder of calcium–phosphate metabolism. Its association with diabetes mellitus and systemic vascular calcification is increasingly recognized but seldom documented in a single patient. Case presentation: A 58-year-old woman presented with one month of intermittent confusion, bilateral resting hand tremor, intermittent muscle cramps, and gait imbalance. Three months earlier she had a first-ever generalized tonic–clonic seizure coinciding with a new diagnosis of type 2 diabetes mellitus, after which she was non-adherent to insulin therapy. Examination revealed a fine resting tremor, a positive Trousseau sign, and impaired finger-to-nose testing. Investigations showed severe hypocalcemia (4.4 mg/dL), HbA1c 9.7%, and electrocardiographic anterior ischemia with cardiomegaly on chest radiography. Non-contrast cranial computed tomography demonstrated extensive bilateral symmetric calcification of the basal ganglia, cerebellum, thalami, and corona radiata–centrum semiovale. She was diagnosed with Fahr's syndrome with hypocalcemia, type 2 diabetes mellitus, and coronary artery disease, and managed with insulin, calcium lactate, vitamin D3, aspirin, simvastatin, and bisoprolol, with symptomatic improvement by the third hospital day. Conclusion: Bilateral intracranial calcification warrants a structured search for secondary causes, particularly calcium–phosphate disturbance. The coexistence of uncontrolled diabetes, coronary artery disease, and progressive brain calcification supports a panvascular contribution and underscores the need for sustained metabolic control and longitudinal neurological follow-up, given that no curative therapy currently exists.

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