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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 231 Documents
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The Prognostic Superiority of Early ΔNLR Variations in Predicting In-Hospital Mortality among Emergency and Ward Patients with COVID-19: A Systematic Review and Meta-Analysis Ayu Sandra Manikasari; Ni Kadek Nadia Ayu Agustini
Archives of The Medicine and Case Reports Vol. 7 No. 2 (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.v7i2.870

Abstract

The neutrophil-to-lymphocyte ratio is an established biomarker reflecting systemic inflammation and immune dysregulation. However, single baseline measurements upon hospital admission often fail to capture the highly dynamic immunological trajectory of patients infected with the severe acute respiratory syndrome coronavirus 2. This study aimed to evaluate the prognostic superiority of early variations in the neutrophil-to-lymphocyte ratio, defined as ΔNLR, compared to static baseline measurements for predicting in-hospital mortality among patients admitted to the emergency department and general medical wards. A systematic review and meta-analysis were strictly conducted according to PRISMA guidelines. Data were meticulously extracted from ten selected observational cohort studies. The primary outcome assessed was in-hospital mortality. Standardized mean differences and 95 percent confidence intervals were calculated utilizing a DerSimonian-Laird random-effects model to appropriately account for anticipated clinical heterogeneity. The comprehensive meta-analysis integrated data from 4582 patients across ten independent studies. Both the baseline neutrophil-to-lymphocyte ratio and the early ΔNLR were significantly elevated in non-survivors compared to survivors. However, the early variation in the ratio, measured precisely at 24 to 48 hours post-admission, demonstrated a significantly higher predictive value for in-hospital mortality. The pooled standardized mean difference for baseline measurements between non-survivors and survivors was 0.82 (95 percent confidence interval: 0.61 to 1.03, p less than 0.001). In stark contrast, the pooled standardized mean difference for the early ΔNLR was 1.34 (95 percent confidence interval: 1.05 to 1.63, p less than 0.001), indicating a substantially stronger effect size and superior prognostic discrimination. In conclusion, early dynamic variations in the neutrophil-to-lymphocyte ratio offer superior prognostic value compared to static baseline measurements for predicting fatal outcomes in COVID-19 patients. Integrating kinetic monitoring into emergency and ward triage protocols can significantly optimize early risk stratification.
Re-evaluating Immediate, Adjuvant, and Salvage Intravesical Chemotherapy in Non-Muscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis of Gemcitabine Non-Inferiority to Mitomycin C Reza Abdia Jauhari
Archives of The Medicine and Case Reports Vol. 7 No. 2 (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.v7i2.863

Abstract

Non-muscle-invasive bladder cancer demonstrates a uniquely high propensity for recurrence following initial transurethral resection of bladder tumor. A single, immediate post-operative instillation of chemotherapy became the established standard to mitigate this risk. Mitomycin C historically functioned as the agent of choice; however, frequent drug shortages and significant local toxicity profiles necessitated the rigorous evaluation of viable alternatives. Gemcitabine, a pyrimidine nucleoside analogue, emerged as a promising candidate. This study aimed to evaluate the comparative efficacy and safety of gemcitabine versus mitomycin C across immediate post-operative, adjuvant, and salvage clinical settings. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. The analysis utilized data from seven key comparative trials evaluating gemcitabine versus mitomycin C. A highly specific search strategy isolated direct head-to-head comparative studies. Data extraction focused exclusively on recurrence rates, time to recurrence, and adverse events. Pooled Odds Ratios and Standardized Mean Differences were calculated using a DerSimonian-Laird random-effects model. Sensitivity analyses isolating randomized controlled trials and excluding upper tract urothelial carcinoma data were explicitly performed. Five primary studies provided head-to-head comparative data for recurrence, comprising 405 patients. Two additional studies evaluated sequential salvage therapy. Adjuvant gemcitabine regimens demonstrated a significant reduction in recurrence compared to mitomycin C (Odds Ratio 0.38, 95 percent Confidence Interval 0.19 to 0.75). In strictly immediate single-dose settings, mitomycin C demonstrated a trend toward superior recurrence prevention over gemcitabine (Odds Ratio 1.65). Toxicity analysis heavily favored gemcitabine, showing a significantly lower incidence of chemical cystitis (Odds Ratio 0.22). Sequential salvage therapy yielded a 30 percent to 37 percent long-term recurrence-free survival. In conclusion, gemcitabine demonstrated non-inferiority to Mitomycin C regarding overall oncological safety and exhibited a markedly superior tolerability profile. Mitomycin C retained a marginal advantage in the strict immediate post-operative window due to its potent cell-cycle-independent action. However, Gemcitabine's efficacy in adjuvant settings and favorable side-effect profile established it as a highly rational alternative.
Long-Term Renal Outcomes and Safety Profile of Non-Steroidal Mineralocorticoid Receptor Antagonists in Non-Diabetic Chronic Kidney Disease: A Retrospective Cohort Study Novia Wira Tungadi
Archives of The Medicine and Case Reports Vol. 7 No. 2 (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.v7i2.874

Abstract

Non-steroidal mineralocorticoid receptor antagonists, specifically finerenone, have demonstrated profound cardiorenal protective effects in diabetic kidney disease. However, their efficacy and safety in non-diabetic chronic kidney disease remain inadequately characterized, particularly within Southeast Asian populations experiencing high rates of hypertensive nephrosclerosis. A retrospective cohort study was conducted at a tertiary hospital in Makassar, Indonesia, evaluating 148 adult patients with non-diabetic chronic kidney disease (stages 3-4) who received finerenone between January 2022 and December 2024. Clinical data, including urinary albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and serum potassium, were analyzed using generalized and piecewise linear mixed-effects models over 24 months. The cohort (N=148) demonstrated a significant reduction in median UACR from a baseline of 845 mg/g to 460 mg/g at 24 months (p < 0.001). Following an initial hemodynamic eGFR dip in the first six months, the chronic annualized slope of decline stabilized at -2.2 mL/min/1.73 m² per year (95% CI: -2.8 to -1.6). Mild hyperkalemia occurred in 16.2% of patients, and moderate-to-severe hyperkalemia in 4.1%. Concomitant sodium-glucose cotransporter-2 inhibitor (SGLT2i) use was associated with a lower risk of incident hyperkalemia (OR 0.45, 95% CI 0.22-0.89). In conclusion, in this real-world observational cohort, adding finerenone to standard care in non-diabetic CKD patients was associated with significant reductions in UACR and an attenuation of eGFR decline over 24 months, alongside a manageable safety profile. These findings warrant further investigation in large, randomized trials.
Inverse Association between Platelet-to-Lymphocyte Ratio and Clinical Severity in Pediatric Dengue Infection: A Retrospective Cross-Sectional Analysis at Wangaya Hospital, Indonesia Desak Agung Indah Praharsini Dewi; I Gusti Ayu Wiradari Tedja; Made Ayu Vita Prianggandanni
Archives of The Medicine and Case Reports Vol. 7 No. 2 (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.v7i2.875

Abstract

Dengue heavily burdens endemic regions. Early prediction of disease progression in pediatric populations is critical for optimizing outcomes. This study evaluates the Platelet-to-Lymphocyte Ratio (PLR), an emerging inflammatory marker, as a correlative biomarker of clinical severity in pediatric dengue. A retrospective cross-sectional analysis included 139 pediatric patients with confirmed dengue at Wangaya Regional General Hospital, Denpasar, Indonesia. Patients were classified using 2009 World Health Organization criteria into Dengue Fever (DF), Dengue with Warning Signs (DWS), and Severe Dengue (SD). Hematological parameters were obtained strictly during the critical transition phase. Statistical analyses included Kruskal-Wallis tests, Spearman correlation, Receiver Operating Characteristic (ROC) curve analysis, and Ordinal Logistic Regression. The cohort, primarily school-aged children (92.1%), presented with 11.5% DF, 73.4% DWS, and 15.1% SD. A statistically significant, weak-to-moderate inverse correlation existed between the admission PLR and clinical severity (r = -0.293, p < 0.001). The median admission PLR declined progressively from 78.1 in DF, to 59.8 in DWS and further to 24.3 in SD. ROC analysis discriminating Severe Dengue yielded an Area Under the Curve of 0.685. Regression confirmed the PLR as an independent, modest correlative factor when adjusting for age, sex, and fever onset day. In conclusion, a statistically significant, weak-to-moderate inverse association exists between admission PLR and pediatric dengue severity. While offering accessible pathophysiological insights, its moderate diagnostic accuracy limits its use as an isolated triage tool. The PLR may assist early risk stratification in resource-limited settings when utilized alongside standard clinical assessments.
Transfusion-Refractory Warm Autoimmune Hemolytic Anemia with Dual Direct Antiglobulin Test Positivity and Marked Monocytosis in an Elderly Patient: A Case Report I Gusti Ngurah Bayu Paramartha; Dewa Gde Agung Wikananda Besang; Desak Agung Indah Praharsini Dewi
Archives of The Medicine and Case Reports Vol. 7 No. 2 (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.v7i2.882

Abstract

Warm autoimmune hemolytic anemia represents a significant clinical challenge in adult hematology, with corticosteroid refractoriness occurring in approximately thirty to forty percent of cases. Management becomes substantially more complex in elderly patients with multiple comorbidities, where standard immunosuppressive therapy frequently fails and alternative therapeutic strategies become necessary. A sixty-three-year-old male with three months of documented warm autoimmune hemolytic anemia presented with acute hemolytic crisis manifested by severe anemia (hemoglobin declining from five point three to four point four grams per deciliter over four days) and accelerated hemolysis. Direct antiglobulin testing demonstrated dual positivity with immunoglobulin G one plus and complement component three-d two plus, indicating complement-mediated hemolysis. Notably, marked monocytosis ranged from seventy to seventy-four percent across serial complete blood counts. The patient demonstrated rapid immunosuppressive treatment failure with escalated triple therapy (methylprednisolone, mycophenolate mofetil, azathioprine) failing within four days of initiation. Transfusion refractoriness was evident despite premedication protocols. Concurrent medical conditions included hypertensive heart disease with documented coronary artery disease, newly diagnosed type two diabetes mellitus with suboptimal glycemic control, benign prostatic hyperplasia requiring catheterization, and clinical immunosuppression complications. The patient was referred to a tertiary academic medical center for advanced therapeutic decision-making. In conclusion, this case illustrates the diagnostic and therapeutic complexity of warm autoimmune hemolytic anemia with complement activation in an elderly population, highlighting the necessity for rapid escalation to advanced therapeutic modalities beyond conventional immunosuppression when clinical deterioration occurs despite maximal standard therapy.
Clinical Outcomes of Rapid Versus Gradual Blood Pressure Normalisation in Asymptomatic Hypertensive Urgency: A Systematic Review and Meta-Analysis Abdullah; Rahyuni Devilia Nofa; Maimun Syukri; Desi Salwani
Archives of The Medicine and Case Reports Vol. 7 No. 2 (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.v7i2.878

Abstract

Hypertensive urgency presents a clinical dilemma regarding optimal blood pressure management. Whilst guidelines advocate gradual reduction to prevent organ damage through vascular autoregulation disruption, rapid normalisation remains common in clinical practice. This systematic review and meta-analysis synthesised evidence comparing rapid and gradual blood pressure normalisation strategies in asymptomatic hypertensive urgency. Systematic searches of Scopus, PubMed/MEDLINE, and Embase were conducted. Nine randomised or quasi-randomised controlled trials were included involving 4,195 adult participants with asymptomatic hypertensive urgency. Studies compared rapid blood pressure normalisation with gradual reduction over various timeframes. Primary outcomes included acute kidney injury (AKI), symptomatic hypotension, and major adverse cardiovascular events (MACE). Random-effects meta-analysis using standardised mean difference (Hedges' g) was performed. Rapid blood pressure normalisation was associated with significantly higher adverse events compared with gradual reduction (pooled SMD = 0.8854, 95% confidence interval [0.6235–1.1472], p < 0.000001; I² = 61.11%). Subgroup analysis revealed substantial effects for AKI (SMD = 0.9199, p = 0.000012) and symptomatic hypotension (SMD = 1.0103, p < 0.001), whilst MACE showed no significant difference (SMD = 0.3777, p = 0.435). Heterogeneity was moderate to substantial (I² = 61.11%, Tau² = 0.0881). Sensitivity analyses demonstrated robust findings. In conclusion, gradual blood pressure reduction in asymptomatic hypertensive urgency was superior to rapid normalisation, particularly for preventing acute kidney injury and symptomatic hypotension. These findings support current guideline recommendations for cautious, titrated antihypertensive strategies in this population.
Severity-Level Stratification and Robson Ten-Group Classification of Caesarean Sections at a Tertiary Referral Hospital in West Sumatra, Indonesia: A Cross-Sectional Study Muhammad Farhan Hawari; Aladin; Husnil Kadri
Archives of The Medicine and Case Reports Vol. 7 No. 3 (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.v7i3.907

Abstract

Caesarean section rates have risen worldwide, and the World Health Organization endorses the Robson Ten-Group Classification System as the global standard for facility-level audit. Severity-stratified Robson data remain scarce in Indonesia, and none exist for central Sumatra. This cross-sectional census characterised the clinical-severity distribution and Robson classification of caesarean sections at RSUP Dr. M. Djamil, the sole tertiary (type A) referral hospital for central Sumatra, during 2021. All 679 deliveries were reviewed by total sampling; 560 (82.47%, 95% CI 79.43–85.15) were caesareans, a fraction reflecting the apex-referral casemix rather than population practice. Proportions were estimated with Wilson confidence intervals, distributions tested by goodness-of-fit chi-square with Cohen's w, and indicators benchmarked against national and WHO standards. Severity level II predominated (48.93%, 95% CI 44.81–53.06), with level I (47.86%) and level III (3.21%) (chi-square=228.700, p<0.001, w=0.639). Robson Group 10 was largest (30.19%, 95% CI 26.86–33.75), followed by Group 5 (21.80%) and Group 2 (15.02%); Groups 5 and 10 together contributed 51.99%. Group 10 exceeded the Indonesian mean of 14.20% (prevalence ratio 2.13, 95% CI 1.90–2.38, p<0.001). Preterm single-cephalic pregnancies dominate this casemix and represent the priority target for severity-stratified caesarean audit and preterm-referral optimisation in Indonesian tertiary obstetric practice.
Perioperative Shift in Respiratory Bacterial Colonization and Post-operative Pneumonia in Spine Surgery Patients Requiring Intensive Care: A Prospective Cohort Study Agil Murthala; Rieva Ermawan; Rhyan Darma Saputra
Archives of The Medicine and Case Reports Vol. 7 No. 3 (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.v7i3.912

Abstract

Spine surgery frequently requires post-operative intensive care and endotracheal intubation, both of which predispose to nosocomial respiratory infection, yet the perioperative dynamics of airway bacterial colonization in spine surgery patients and their relationship to pneumonia are poorly characterised, particularly in Indonesian practice. We conducted a prospective cohort study of 34 patients undergoing elective spine surgery with post-operative care in the ICU/PICU of Dr. Moewardi Regional General Hospital, Surakarta. Paired pharyngeal swab cultures were obtained at induction and during intubated intensive care, with disk-diffusion susceptibility testing. Post-operative pneumonia was defined by chest-radiographic infiltrate plus leukocytosis or leukopenia. Associations were assessed using Fisher exact tests, Haldane-Anscombe corrected odds ratios, rank correlation, and Cohen's h, with 95% confidence intervals. Most patients underwent decompressive laminectomy with posterior spinal fusion (76.5%). Pre-operative pathogenic colonization was present in 21/34 patients (61.8%; 95% CI 45.0-76.1). The flora shifted toward pathogens post-operatively, with Staphylococcus aureus rising from 6 to 9 isolates (+50%), Acinetobacter baumannii from 2 to 4, and new Serratia marcescens and Proteus mirabilis; ciprofloxacin resistance predominated and increased. Post-operative pneumonia occurred in 1/34 patients (2.94%; 95% CI 0.52-14.92). Pre-operative colonization was not associated with pneumonia (Fisher p=1.000; OR 1.98, 95% CI 0.07-52.17). ICU stay >48 h and endotracheal-tube duration >24 h were each strongly rank-correlated with pneumonia (rho=0.696), although, given a single event, the exact test was not significant (p=0.059). Intensive-care exposure rather than pre-operative colonization characterised pneumonia risk, while resistant Gram-negative organisms emerged perioperatively. Duration-focused prevention and antimicrobial stewardship are warranted in orthopedic critical care.
Reversible Movement Disorder Unmasking Secondary Fahr Syndrome after Total Thyroidectomy: A Case of Bilateral Basal Ganglia and Cerebellar Calcification from Chronic Hypoparathyroidism Made Ngurah Jiyesta Wibawa; I Putu Ananta Wijaya Sabudi
Archives of The Medicine and Case Reports Vol. 7 No. 3 (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.v7i3.918

Abstract

Fahr syndrome denotes bilateral, symmetrical calcification of the basal ganglia and other deep brain structures occurring secondary to an identifiable disorder, most often hypoparathyroidism, and must be distinguished from idiopathic Fahr disease. Clinical data from Indonesia remain limited, and the movement disorder that heralds the condition is frequently mistaken for primary neurological disease. We report a 35-year-old woman who presented with a one-hour history of involuntary movements of the face and all four limbs and dysarthria from excessive facial muscle contraction, superimposed on a seven-year history of intermittent right-hand paraesthesia. Her background included a total thyroidectomy seven years earlier with subsequent levothyroxine-treated hypothyroidism, chronic hypocalcaemia presumed to reflect post-surgical hypoparathyroidism (calcium carbonate 500 mg every 12 hours), and a six-year diagnosis of “idiopathic” generalised epilepsy made without neuroimaging. Examination showed full consciousness, a positive Chvostek sign, mild four-limb ataxia and minor memory impairment. Non-contrast cranial computed tomography demonstrated multiple calcifications in both parietal lobes, the basal ganglia and both cerebellar hemispheres, without haemorrhage or infection. Serum calcium was 4.5 mg/dL and parathyroid hormone was below 6 pg/mL, confirming secondary Fahr syndrome from post-thyroidectomy hypoparathyroidism. Treatment with calcium carbonate, phenytoin, levothyroxine and vitamin B complex produced complete resolution of the involuntary movements and seizures and marked improvement of ataxia within six weeks, sustained at two months. This case underscores the need to screen phosphocalcic metabolism and obtain neuroimaging before labelling epilepsy idiopathic in any thyroidectomised patient, and the value of sustained metabolic control as both treatment and secondary prevention.
Chronic Hyperglycemia Assessed by HbA1c and Hematocrit Values in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study at a Tertiary Laboratory in Makassar, Indonesia Amirah; Hana Yurlin; Arlitha Deka Yana Akbar; Desyani Ariza; Kasmuddin
Archives of The Medicine and Case Reports Vol. 7 No. 3 (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.v7i3.923

Abstract

Type 2 Diabetes Mellitus (T2DM) is characterized by persistent hyperglycemia that may impair erythrocyte function, elevate oxidative stress, and provoke osmotic diuresis, all of which could theoretically alter the hematocrit; because glycated hemoglobin (HbA1c) and hematocrit are among the most frequently requested tests in diabetes care, clarifying their relationship has direct laboratory-medicine relevance, yet reported associations remain inconsistent. This analytical cross-sectional study aimed to determine the relationship between chronic hyperglycemia, quantified by HbA1c, and hematocrit in patients with T2DM at the Clinical Laboratory of Stella Maris Hospital, Makassar, Indonesia. Forty-four outpatients with T2DM meeting predefined criteria were enrolled consecutively by purposive sampling from 27 February to 4 March 2025, and same-day HbA1c and hematocrit were analyzed. The association was assessed by Spearman rank correlation with a bootstrap 95% confidence interval (CI), at p<0.05. The mean age was 62.98 ± 11.14 years and 23 participants (52.3%) were female; mean diabetes duration was 8.80 ± 2.99 years, mean HbA1c 7.77 ± 2.52% (61.4 mmol/mol), and mean hematocrit 38.47 ± 5.45%, with only 20 patients (45.5%) reaching the HbA1c target of <7%. Spearman analysis showed no significant correlation between HbA1c and hematocrit (ρ = −0.001; 95% CI −0.30 to 0.30; p = 0.996), a negligible effect size. In conclusion, among Indonesian patients with T2DM, HbA1c was not significantly correlated with hematocrit; the hematocrit should not be used as a surrogate for long-term glycemic control, while HbA1c remains the reference standard and the hematocrit retains independent value within the complete blood count.

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