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Archives of The Medicine and Case Reports
Published by HM Publisher
ISSN : -     EISSN : 27472051     DOI : https://doi.org/10.37275/amcr
Core Subject : Health,
Health Professions Medicine & Pharmacology Nursing Public Health
Archives of The Medicine and Case Reports (AMCR) is a broad scope journal aims to publish the most exciting Case studies/reports in Clinical and Medical Sciences. AMCR aims to provide an excellent platform for Clinical Practitioners, medical/ health practitioners, students, professionals, researchers in medicine. AMCR accept any original case report that expands the field of general medical knowledge, and original research relating to case reports including report of the symptoms, diagnosis, treatment, and follow-up of an individual patient. The journal covers all medical specialties including : • Oncology • Paediatrics • Respiratory disorders • Allergy • Radiology • Nephrology • Neurology • Haematology • Immunology • Radiology • Nuclear medicine • Medical imaging • Audiovestibular medicine • Cardiology and cardiovascular systems • Critical care medicine • Dermatology • Emergency medicine • Endocrinology and metabolism • Gastroenterology and hepatology • Geriatrics and gerontology • Infectious diseases and treatment • Medical disorders in pregnancy • Medical ophthalmology • Sports Medicine • Substance abuse • Palliative medicine • Psychiatry • Rheumatology • Sexual and reproductive health
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 217 Documents
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Cerebral Malaria from a Plasmodium falciparum and Plasmodium malariae Co-Infection: A Case Report on a Diagnostic Challenge Vera Akmilia; Anak Agung Ayu Yuli Gayatri; Anak Agung Wiradewi Lestari
Archives of The Medicine and Case Reports Vol. 6 No. 3 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i3.779

Abstract

Severe malaria, primarily caused by Plasmodium falciparum, is a life-threatening medical emergency. Its diagnosis can be significantly complicated by mixed-species infections, where the presence of a less virulent Plasmodium species may mask the true etiological agent of the severe disease, leading to potential delays in appropriate therapy. This report details a case of cerebral malaria where such a diagnostic challenge occurred. An 18-year-old male with a recent travel history to a malaria-endemic area in Indonesia presented with a one-day history of decreased consciousness (Glasgow Coma Scale score of 9) following a week-long febrile illness. The clinical presentation met the World Health Organization's criteria for severe malaria, specifically cerebral malaria. Initial microscopic examination of a peripheral blood smear exclusively identified Plasmodium malariae. However, a concurrently performed rapid diagnostic test (RDT) was positive for both the pan-malarial antigen and the P. falciparum-specific histidine-rich protein 2 (HRP-2) antigen. This critical discordance prompted treatment for severe falciparum malaria with intravenous artesunate and triggered an expert re-evaluation of the blood smears. Subsequent analysis confirmed a co-infection with both P. falciparum and P. malariae. The patient showed significant clinical improvement within three days of initiating appropriate therapy. In conclusion, this case underscores the peril of diagnostic anchoring in severe malaria. Clinical severity must supersede laboratory findings that are incongruent with the patient's condition. The presence of a Plasmodium species other than falciparum on an initial smear does not rule it out as the cause of a severe syndrome. Discordant results between microscopy and RDTs are a critical red flag for mixed infections and mandate immediate, expert parasitological re-evaluation to ensure timely, life-saving treatment.
Efficacy of Nutritional and Psychosocial Interventions on Linear Growth and Neurodevelopment in Stunted Children in East Java, Indonesia: A Systematic Review and Meta-Analysis Ananda Rizky
Archives of The Medicine and Case Reports Vol. 6 No. 3 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i3.783

Abstract

Stunting remains a critical public health challenge in East Java, Indonesia, with profound implications for long-term health and capital development. While various interventions have been implemented, their consolidated effect on both physical growth and neurodevelopment is not well-established. This study aimed to synthesize the highest-quality evidence on the effectiveness of these programs. Following PRISMA 2020 guidelines, we conducted a systematic review and meta-analysis of studies evaluating stunting interventions in children under five in East Java, published between January 2015 and June 2025. We searched PubMed, Scopus, Web of Science, and Garuda databases. Included studies were randomized controlled trials (RCTs) and high-quality quasi-experimental studies reporting changes in Height-for-Age Z-score (HAZ) and/or standardized developmental outcomes. A random-effects model was used to pool effect sizes, reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Of 1,824 articles identified, seven studies (n=2,985 children) met the stringent inclusion criteria. Interventions were categorized as nutrition-specific (n=2), nutrition-sensitive (n=2), and multi-component (n=3). Overall, interventions showed a significant positive effect on linear growth (SMD = 0.45; 95% CI [0.31, 0.59]; I²=68%). Subgroup analysis revealed that multi-component interventions combining nutritional support with psychosocial stimulation yielded a greater effect on HAZ (SMD = 0.61; 95% CI [0.42, 0.80]) than nutritional (SMD = 0.34; 95% CI [0.19, 0.49]) or psychosocial interventions alone. A significant, albeit smaller, effect was observed for developmental outcomes across four studies (SMD = 0.30; 95% CI [0.16, 0.44]). The pooled evidence from these core studies confirms that stunting interventions in East Java produce meaningful anthropometric improvements. The synergistic effect of combining nutrition with psychosocial support suggests that interventions must address not only nutrient deficits but also the behavioral and environmental factors that impair development. This dual approach likely mitigates the pathophysiological cycle of malnutrition, inflammation, and impaired cognitive development. In conclusion, multi-component stunting interventions appear to be most effective in East Java. Health policies should prioritize integrated programs that combine nutritional supplementation with responsive caregiving to maximize benefits for both physical growth and human potential.
When the Lungs Suffer for the Ovary: A Case of Meigs Syndrome Presenting as Severe Dyspnea and Massive Unilateral Pleural Effusion Nadila Ayu Putri; Fadel Fikri Suharto
Archives of The Medicine and Case Reports Vol. 6 No. 4 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i4.808

Abstract

Meigs syndrome is a rare clinical entity defined by the triad of a benign ovarian tumor, ascites, and pleural effusion. It characteristically resolves completely after the surgical removal of the primary tumor. Despite its benign nature, the clinical presentation often mimics advanced-stage ovarian malignancy, posing a significant diagnostic challenge. A 47-year-old nulligravid woman presented with a two-week history of severe dyspnea, orthopnea, and pleuritic chest pain, set against a four-month backdrop of progressive abdominal distension and a 10-kg weight loss. Physical examination revealed findings consistent with a massive right-sided pleural effusion, significant ascites, and a large, firm pelvic-abdominal mass. Imaging confirmed a massive right pleural effusion and a complex ovarian mass exceeding 16 cm. A diagnosis of Meigs syndrome was established after pleural fluid analysis revealed a cytologically negative, exudative fluid. The patient's acute respiratory distress was managed with serial therapeutic thoracentesis, with 5,000 mL of fluid removed over five days, leading to dramatic symptomatic improvement. She was subsequently stabilized for definitive surgical intervention. In conclusion, this case powerfully illustrates the critical importance of including Meigs syndrome in the differential diagnosis for women with an ovarian mass and concurrent pleuro-peritoneal effusions. Timely recognition and a staged, multidisciplinary management approach are paramount for alleviating life-threatening symptoms and achieving an excellent prognosis, reaffirming the clinician's highest duty: to diligently seek out the curable, even when faced with the seemingly incurable.
Squamous Papilloma of the External Auditory Canal as a High-Fidelity Mimic of Malignant Otitis Externa: A Case Report I Gusti Ayu Mahaprani Danastri; Ketut Tadeus Max Nurcahya Pinatih; Made Lely Rahayu
Archives of The Medicine and Case Reports Vol. 6 No. 4 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i4.816

Abstract

Malignant otitis externa (MOE) is a life-threatening osteomyelitis of the skull base, typically affecting geriatric patients with diabetes mellitus. Its initial presentation of otalgia, otorrhea, and an external auditory canal (EAC) mass demands an immediate, high index of suspicion. Squamous papilloma, a benign human papillomavirus (HPV)-related neoplasm, is exceedingly rare in the EAC. This report details a case where this rare benign entity presented as a high-fidelity clinical and laboratory mimic of MOE. We present the case of a 71-year-old female with poorly controlled Type 2 Diabetes Mellitus who presented with a three-week history of severe, refractory otalgia. A systematic diagnostic evaluation was performed, including clinical examination, full audiological assessment, serum inflammatory markers, and high-resolution computed tomography (HRCT) of the temporal bones. The patient's presentation was a textbook surrogate for MOE, including severe otalgia, purulent otorrhea, a friable EAC mass, and markedly elevated erythrocyte sedimentation rate (ESR) (78 mm/hr) and C-Reactive Protein (CRP) (45.2 mg/L). However, HRCT demonstrated an occluding soft-tissue mass without the hallmark finding of temporal bone erosion. The patient underwent transcanal excisional biopsy. Histopathological (H&E) analysis provided the definitive diagnosis of a benign squamous papilloma, with pathognomonic koilocytosis consistent with HPV infection. The patient's severe symptoms resolved completely upon excision. In conclusion, this case highlights a critical diagnostic pitfall. A secondarily infected EAC squamous papilloma can create a clinical and laboratory picture indistinguishable from early-stage MOE. The absence of bony erosion on HRCT is the single most critical finding to pivot the diagnosis away from invasive osteomyelitis. This report underscores the mandatory role of a systematic diagnostic pathway combining imaging and histopathology to prevent misdiagnosis and avoid unnecessary, prolonged, and toxic systemic antimicrobial therapy.
A Comparative Analysis of Ipsilateral, Contralateral, and Bilateral Average ONSD in Correlating with Cerebral Midline Shift: Re-framing a Non-Invasive Tool from a Quantitative Predictor to a Clinical Classifier Ramadina Putri Cahyanti Ghofar; Buyung Hartiyo Laksono; Taufiq Agus Siswagama
Archives of The Medicine and Case Reports Vol. 6 No. 4 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i4.823

Abstract

In traumatic brain injury (TBI), non-invasive proxies for mass effect are crucial. The optic nerve sheath diameter (ONSD) is used to estimate intracranial pressure (ICP), but its correlation with structural outcomes like midline shift (MLS) is poorly defined, particularly regarding the optimal measurement method (unilateral vs. bilateral). We prospectively enrolled 38 adult TBI patients who received both a CT scan and a bedside ONSD ultrasound within 24 hours. Data was re-analyzed to classify ONSD relative to lesion location (Ipsilateral, Contralateral) and to correlate these, plus the Bilateral Average (ONSD-Avg), with CT-measured MLS using Spearman's correlation. We used linear regression to assess quantitative prediction (R-square) and binary logistic regression (ROC curve) to assess clinical classification (AUC) for predicting MLS >5mm. A significant, positive correlation was found between MLS and Ipsilateral-ONSD (rs = 0.450, p = 0.005) and ONSD-Avg (rs = 0.383, p = 0.018). The Contralateral-ONSD correlation was not significant (rs = 0.210, p = 0.206). A Wilcoxon test confirmed Ipsilateral-ONSD was significantly wider than Contralateral-ONSD (p < 0.01). The linear regression model for MLS quantification was statistically significant (p = 0.015) but had a very low predictive power (R-square = 0.153). In contrast, the logistic regression model found ONSD-Avg to be an excellent classifier for detecting surgical MLS (> 5mm), with an Area Under the Curve (AUC) of 0.88 (95% CI 0.75-0.96). In conclusion, ONSD measurement is significantly affected by asymmetric, unilateral TBI pathology. The bilateral average (ONSD-Avg) is the most reliable screening method, as it compensates for unilateral pressure gradients. The low R-square (15.3%) confirms ONSD is a poor quantitative predictor of MLS, reflecting the non-linear pressure-volume relationship. However, the high AUC (0.88) proves ONSD is an excellent clinical classifier for identifying patients with surgical-threshold mass effect. ONSD should not be used to "quantify" MLS, but rather to "classify" patient risk.
Liquid Nitrogen-Recycled Autograft Augmented with a Non-Vascularized Fibular Strut for Refractory Pediatric Osteosarcoma: A Case Report of the Cryo-Immunological Reconstruction Mujjadid Idulhaq; Khrisna Purwa Satyaksa; Rachmad Faisal
Archives of The Medicine and Case Reports Vol. 6 No. 4 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i4.827

Abstract

Reconstruction of large segmental bone defects following limb salvage surgery for osteosarcoma presents a significant challenge in pediatric populations, particularly in resource-limited settings where expandable endoprostheses are inaccessible. This study evaluates the efficacy of a biological reconstruction technique using Liquid Nitrogen-treated recycled autograft augmented with a fibular strut, known as the Modified Capanna Technique. We present the case of an 8-year-old female with Enneking Stage IIB high-grade osteoblastic osteosarcoma of the distal femur. The patient exhibited a refractory response (Huvos Grade II) to a neoadjuvant non-methotrexate chemotherapy regimen. Wide resection was performed, followed by a specific cryo-protocol: the tumor-bearing bone was frozen in Liquid Nitrogen (−196°C) for 20 minutes, thawed physiologically, augmented with an intramedullary non-vascularized fibular strut, and stabilized with a locking compression plate. At 12 months postoperative, the patient achieved solid radiographic union with a Radiographic Union Scale for Tibial fractures score of 11/12. No local recurrence or distant metastasis was detected. The Musculoskeletal Tumor Society score improved from 10% pre-operatively to 80% post-operatively, reflecting independent ambulation. A comparative analysis revealed that the procedure cost was approximately 12% of a standard imported megaprosthesis. In conclusion, the liquid nitrogen-recycled autograft, when mechanically augmented, offers a theoretically sound and cost-effective limb salvage solution. It provides immediate anatomical restoration and potential cryo-immunological benefits, making it a viable alternative for refractory cases in developing healthcare systems.
Navigating the Perfect Storm: Ultrasound-Guided Peripheral Nerve Block for Emergency Amputation in a Patient with Acute STEMI and Failed PCI Ella Priliandini; Ruddi Hartono; Ahmad Feza Fadhlurrahman; Muhammad Farlyzhar Yusuf
Archives of The Medicine and Case Reports Vol. 6 No. 4 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i4.829

Abstract

Acute limb ischemia presenting concurrently with acute coronary syndrome creates a precarious clinical dilemma, often termed the "cardiac cripple" scenario. The mortality risk is compounded when patients have a history of failed percutaneous coronary intervention, severe left ventricular dysfunction, and require emergency major amputation while on active dual antiplatelet therapy. In these patients, general anesthesia poses a risk of hemodynamic collapse, while neuraxial anesthesia is contraindicated due to bleeding risks. A 75-year-old male presented with a Rutherford Grade III-IV "dead limb" of the right lower extremity and concurrent Acute Anterior STEMI (Killip II, TIMI 7/14, GRACE 137). His history included a failed percutaneous coronary intervention two months prior and three-vessel disease, resulting in a left ventricular ejection fraction of 32%. General anesthesia posed an unacceptable risk of exacerbating myocardial pump failure, while spinal anesthesia was contraindicated due to recent clopidogrel ingestion. A decision was made to perform a below-knee amputation using an ultrasound-guided femoral nerve block and a popliteal sciatic nerve block via the crosswise approach. The procedure utilized 0.5% ropivacaine with 2 mg dexamethasone. The patient remained hemodynamically stable without vasopressor support, reported a Visual Analogue Scale score of 0 intraoperatively, and avoided adverse cardiac events. In conclusion, peripheral nerve blockade, specifically the combined femoral and crosswise popliteal sciatic approach, serves as a superior anesthetic alternative in high-risk cardiac patients. It bypasses the sympatholytic risks of general anesthesia and the coagulation constraints of neuraxial techniques, offering a safe corridor for life-saving surgery.
Cerebral Toxoplasmosis with Preserved CD4 Count (>300 cells/µL) in the HAART Era: Unmasking Immune Reconstitution Inflammatory Syndrome and the Diagnostic Utility of Cotrimoxazole I Made Eryana; Made Nopriantha
Archives of The Medicine and Case Reports Vol. 6 No. 4 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i4.830

Abstract

Cerebral toxoplasmosis (TE) typically presents in HIV-positive patients with severe immunosuppression (CD4 <100 cells/µL). However, in the era of Highly Active Antiretroviral Therapy (HAART), presentations have become atypical. We report a rare case of TE in a patient with a preserved CD4 count (>300 cells/µL), highlighting the phenomenon of unmasking immune reconstitution inflammatory syndrome (IRIS). A 22-year-old female, HIV-positive on a Tenofovir-Lamivudine-Efavirenz (TLE) regimen for one month, presented with subacute hemicrania, focal motor seizures, and complex visual hallucinations (zoopsia). Despite a CD4 count of 307 cells/µL and a suppressed viral load (<40 copies/mL), Contrast-Enhanced Computerized Tomography (CE-CT) revealed multiple ring-enhancing lesions with significant perilesional edema. The patient was diagnosed with TE-associated Unmasking IRIS. Due to the unavailability of Pyrimethamine, she was treated with high-dose Cotrimoxazole (960 mg q6h). Significant clinical improvement was observed by day 4, characterized by the cessation of seizures and hallucinations. Follow-up at two weeks confirmed sustained neurological recovery. In conclusion, a preserved CD4 count does not exclude opportunistic infections in the early post-HAART period. This case underscores the diagnostic pitfall of immune discordance and validates the efficacy of Cotrimoxazole as a primary therapeutic intervention in resource-limited settings.
Efficacy and Safety of CD19-Targeted Chimeric Antigen Receptor (CAR) T-Cell Therapy in Refractory Systemic Lupus Erythematosus: A Systematic Review of Clinical Outcomes and B-Cell Depletion Kinetics I Made Eryana; Ni Putu Ayu Windari Putri; Cokorda Agung Paramadika
Archives of The Medicine and Case Reports Vol. 7 No. 1 (2026): Archives of The Medicine and Case Reports
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v7i1.831

Abstract

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune pathology characterized by a breakdown in self-tolerance, B-cell hyperactivity, and the production of pathogenic autoantibodies. While conventional B-cell depletion strategies utilizing monoclonal antibodies often fail to achieve deep tissue clearance, CD19-targeted chimeric antigen receptor (CAR) T-cell therapy has emerged as a transformative modality capable of inducing durable drug-free remission. This systematic review and meta-analysis evaluate the clinical efficacy, pharmacodynamics of B-cell depletion, and safety profile of both autologous and allogeneic CD19 CAR T-cell therapies in refractory SLE. We conducted a systematic literature review on manuscripts published between January 1st, 2014, and March 1st, 2025, focusing on interventional clinical trials and high-quality case series. Primary endpoints included the Definition of Remission in SLE (DORIS) and reduction in SLEDAI-2K scores. Secondary endpoints analyzed B-cell aplasia kinetics, seroconversion of anti-dsDNA, and adverse events, including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and novel autoimmune-specific toxicities. Statistical synthesis utilized weighted averages for continuous variables and event rates for categorical outcomes. The analysis synthesized data from 20 distinct patients with refractory SLE across three pivotal cohorts. The pooled rate of DORIS remission at three months post-infusion was 100%. The mean SLEDAI-2K score decreased from a baseline of 12.5 to 0.8 at three months. Deep B-cell depletion was achieved in all patients, with a mean duration of aplasia of 112 days. Reconstitution of the B-cell compartment was characterized by a naïve phenotype (IgD+/CD27-), indicating a comprehensive immunological reset. Safety analysis revealed that while CRS occurred in 88% of patients, it was predominantly Grade 1 or 2. No high-grade ICANS occurred. Unique toxicity signals, including local immune effector cell-associated toxicity syndrome (LICATS), were identified. In conclusion, CD19-targeted CAR T-cell therapy induces rapid, profound, and sustained drug-free remission in patients with refractory SLE. The mechanism involves deep tissue depletion of B-cells and plasmablasts, facilitating a reset of the humoral immune system.
The Healthy Weight Paradox: Unmasking High Dyslipidemia Prevalence in Normoweight Adults with Normal Waist Circumference Raden Chantika Nur Annisa
Archives of The Medicine and Case Reports Vol. 7 No. 1 (2026): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v7i1.837

Abstract

The reliance on body mass index (BMI) as the sole anthropometric indicator for cardiovascular risk is increasingly debated. A distinct phenotype, metabolically obese normal weight (MONW), suggests that individuals with normal BMI and normal waist circumference (WC) may still harbor significant metabolic derangements. This study aims to quantify the prevalence of dyslipidemia in a normoweight occupational cohort and analyze the healthy weight paradox. This descriptive observational study utilized secondary data from the 2024 Medical Check-Up of employees at the Geological Agency, Bandung, Indonesia. A total of 142 subjects met the strict inclusion criteria: BMI 18.5–22.9 kg/m² and normal waist circumference (<90 cm for men, <80 cm for women). Lipid profiles—Total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and Triglycerides (TG)—were analyzed. Statistical evaluation included Chi-square testing for categorical variables and multivariate logistic regression to identify determinants of dyslipidemia. Despite normal anthropometry, 54.93% (n=78) of subjects exhibited dyslipidemia. The most prevalent abnormalities were borderline high TC (24.65%) and mixed dyslipidemia (20.42%). A significant gender disparity was observed, with 62.0% of males exhibiting dyslipidemia compared to 38.1% of females (p < 0.05). Age was a critical determinant; subjects aged 40 years or older had significantly higher rates of dyslipidemia (71.62%) compared to those younger than 40 years (p < 0.01). In conclusion, normal BMI and WC are insufficient to rule out metabolic risk. The high prevalence of dyslipidemia (>50%) in this healthy phenotype suggests a silent burden of cardiovascular risk driven by metabolic factors rather than overt adiposity. Routine lipid profiling and body composition analysis should be mandatory, irrespective of BMI.

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