Cystic Fibrosis Lung Disease: A Narrative Literature Review

Cystic fibrosis (CF) is caused by mutations in autosomal recessive genes that code for proteins cystic fibrosis transmembrane conductance regulator (CFTR) which is located on chromosome seven. The CFTR protein under normal conditions acts as a chloride channel and helps the movement of sufficient electrolytes and water across the membrane. Mutations in CFTR cause abnormalities in chloride ion transport through epithelial cells and impaired sodium and water transport resulting in viscous secretions with low water content. This thick and sticky secretion will inhibit the normal function of various organs, although pulmonary complications are the most common cause of death. Cystic fibrosis has wide genotypic and phenotypic variations. There are six categories of mutations based on their effect on the CFTR protein, where these categories are not only used to predict the phenotype but also to determine better therapeutic strategies based on the identified mutations

Multilayered-Amniotic Membrane Transplantation in Gunshot Powder Injury: A Case Report

Background: Amniotic membrane transplantation has been widely used to repair various ocular surface conditions, including inflammatory, infectious, traumatic, and neoplastic conditions, with satisfactory results. a case of a 34-year-old male hit by a gunpowder explosion. Case presentation: We reported a case of a 34-year-old male hit by a gunpowder explosion. The right eye was hyperemic and felt blurry after the incident. On examination of the right eye, visual acuity was 20/150, and foreign bodies and erosion were found in the cornea. The patient planned to do foreign body extraction followed by a multilayered-amniotic membrane transplantation (ML-AMT) procedure. On the first and second day of follow-up, on the right eye, the visual acuity was 1/300, palpebral edema was decreased, and subconjunctival hemorrhage was found. On the cornea, there were ML-AMT and bandage contact lenses. Conclusion: Gunshot powder injury in the eyes is quite rare. The damage that can occur ranges from corneal epithelium abrasion to perforation and rupture of the eyeball. AMT has been successfully used in the management of eye trauma with defects on the ocular surface

Cross-Sectional Study of Efficacy, Effectiveness, and Safety of Combination Creams (Tretinoin 0.05%, Clindamycin 3%, and Dexamethasone 0.05%) Anti-Acne – An Online Study

Background: Acne vulgaris is a common skin condition that causes blackheads, whiteheads, and pimples. It is caused by a number of things, like too much oil, clogged pores, and inflammation. Topical combination creams are an alternative treatment for acne.  They can help reduce inflammation, kill bacteria that cause acne, and stop the skin from making too much oil. Topical combination creams like retinoids, antibiotics, and steroids are all mixed together in a single cream or gel. This study talks about the effectiveness and side effects of using combination creams (tretinoin 0.05%, clindamycin 3%, and dexamethasone 0.05%) to treat acne in the short and long term (local and systemic). Methods: This study is a survey that was done at the Sukma clinic with data from 2022 patients who were diagnosed with acne vulgaris. The survey was done on Google Forms, which is a website. In this study, different factors were looked at, such as demographics, efficacy (like reducing acne severity, making the skin brighter, getting rid of blackheads on the face, getting rid of acne scars, improving skin texture, hiding scars, minimizing facial pores, getting rid of wrinkles and dark spots), local adverse events (like burning, itching, stinging, eruptive papules, hypopigmentation, hyperpigmentation, erythema, scaling, and other), and systemic adverse events. Results: The results of this study show that a combination of tretinoin 0.05%, clindamycin 3%, and dexamethasone 0.05% is very effective and has minimal side effects. Local symptoms only show up during the first week of taking the drug (the "sensitization phase"), and then they tend to get less common over time. The only exceptions are hyperpigmentation and hypopigmentation, which show up later because they are caused by healing acne lesions. Conclusion: There was no direct link between the use of anti-acne combination cream drugs and the number of systemic side effects. This is because the patient had often had this happen before (constipation, GERD, and others)

Vitamin D Levels in Epilepsy Patients at the Neurology Polyclinic, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: In epilepsy patients, treatment is often lifelong and anti-epileptic drugs (AEDs) can be divided into two general groups, namely drugs that affect cytochrome P-450 (CYP-450) such as carbamazepine, phenytoin, primidone, or valproic acid, and those that affect minimal cytochrome P-450 such as gabapentin, vigabatrin, levetiracetam, oxcarbazepine, or topiramate. AEDs include various drugs that can cause a decrease in vitamin D levels. Therefore, this study was aimed at examining vitamin D levels in epilepsy patients who took AEDs at the neurology polyclinic at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Methods: This research is a descriptive study with a cross-sectional design using primary data obtained from the results of patient examinations using laboratory tests and secondary data from medical records. Results: As many as 78% (14 subjects) who received monotherapy had vitamin D levels below normal, and 16 subjects, or 76%, who received polytherapy had vitamin D levels below normal (p = 0.907). A total of 13 (72%) subjects who received phenytoin had vitamin D levels below normal, as well as 5 (63%) subjects who received carbamazepine and 12 (92%) subjects who received other therapies (p = 0.235). A total of 12 (67%) subjects who received therapy for 1-3 years and 18 (86%) subjects who received therapy > 3 years had vitamin D levels below normal (p = 0,406). Conclusion: Vitamin D deficiency is a crucial problem in epilepsy patients receiving AED therapy, where more than 75% of patients have vitamin D deficiency. In this study, vitamin D deficiency did not have a significant relationship with the type of therapy (monotherapy or polytherapy) or the type of drug used. used, duration of therapy, and frequency of sun exposure

Combination Procedure for Acne Scars Revision, Is It Needed?

Background: The treatment of acne scars is a problem for dermatologist. Varied morphology of acne scars makes the treatment more difficult. Combination technique has high efficacy than monotherapy. The challenge is how to select best combination procedure for scar revision. Case presentation: A 43-year-old male present with acne scars since 5 years ago. Dermatological findings revealed atrophic acne scars (ice pick, boxcar, rolling) types on forehead, nose and cheeks. Diagnosis established as moderate atrophic acne scars with global acne scarring system (GASS) is 21. Patient treated with blunt canula subcision, hyaluronic acid (HA) filler, microneedling radiofrequency, 90% trichloroacetic acid chemical reconstruction of skin scars (TCA CROSS) and application of salmon polydeoxyribonucleotide (PDRN). Patient also received topical 0.05% retinoic acid, 4% niacinamide, and sunscreen for daily. After 10 days, there is flattening and disappear of ice pick and boxcar, elevating of rolling scar, GASS score is 15. Blunt cannula subcision and HA filler is safe, effective for rolling scar through fibrous band breaking and prevent re-adhesion. Microneedling RF is effective for boxcar, otherwise 90% TCA CROSS preferrable for ice pick scars. This combination procedure leading cellular necrosis in epidermis, collagen in dermis, and stimulate regeneration. Application of Salmon PDRN may promote wound healing, hydrate the epidermis, and prevent dyschromia. Conclusion: Combination of subcision, dermal filler, microneedling radiofrequency, 90% TCA CROSS, and Salmon PDRN has high efficacy for scar revision through collagen remodelling and acceleration wound healing

A 56-Year-Old Man with an Unusual Projectile Trajectory of Gunshot Wound at Head and Neck Region: A Rare Case Report

Background: Gunshot injuries to the neck are linked to a substantial risk of high mortality and morbidity due to the presence of critical vascular and vital structures. However, there are rare instances where a bullet trajectory through the neck region avoids damaging these vital structures. In this context, we report a specific case involving a 56-year-old male who presented to the emergency department with a gunshot wound to the right maxilla through the left anterior neck region. Case presentation: During the examination, a hematoma was observed in the left neck without an apparent entrance wound. The occurrence of a bullet injury to the neck without affecting any vital structures is exceptionally uncommon. Effectively managing patients with high-velocity penetrating injuries to the head and neck entails prioritizing tasks such as securing the airway, controlling hemorrhage, and promptly addressing any residual traumatic deformities for optimal outcomes. The presented case involves a gunshot injury to the head and neck, and a comprehensive review of the literature is provided. Conclusion: Gunshot injuries to the head and neck are complex and serious, demanding swift and thorough medical attention. The case emphasizes the significance of post-surgery monitoring for potential complications, contributing valuable insights to the ongoing discourse on managing such injuries

The Role of CysC Levels as Biomarkers for Renal Function in the Use of Gentamicin for Preterm Infants Aged 28-36 Weeks with Neonatal Sepsis: A Narrative Literature Review

Premature infants with neonatal sepsis often require antibiotics, such as Gentamicin, commonly used in the NICU to treat suspected Gram-negative infections associated with neonatal sepsis. However, to limit the risk of nephrotoxicity associated with minimum levels, the use of high-dose Gentamicin with extended dosing intervals has been widely adopted in NICU clinical practice. Gentamicin use can impact kidney function. The examination of Cystatin C (CysC) levels as a biomarker to assess kidney function and nephrotoxicity due to antibiotic use is highly recommended, especially in premature infants. Gentamicin use in preterm infants can influence CysC levels as a biomarker for kidney function. The correlation between Gentamicin use, changes in CysC levels, and the impact on kidney function highlights the need for strict monitoring of these parameters. This study concludes that CysC levels can be a crucial indicator in assessing the impact of Gentamicin use on kidney function in preterm infants with neonatal sepsis. Routine monitoring of CysC levels can aid in early identification of potential kidney issues and support appropriate clinical decision-making in the use of antibiotics for this vulnerable preterm infant population

Challenges in Diagnosing and Managing Uterus Didelphys: A Case Report

Background: This medical case report provides an insightful examination of a 22-year-old pregnant woman with uterus didelphys, a rare congenital anomaly of the Müllerian ducts. The introduction section sets the stage by discussing the embryological origins of congenital uterine anomalies and their varied clinical manifestations. It emphasizes the challenges in detecting these conditions due to their often asymptomatic nature and highlights their significant impact on reproductive health, including increased risks of miscarriage, preterm labor, and perinatal mortality. Case presentation: The case report segment details the patient’s clinical presentation, initially misdiagnosed as an ectopic pregnancy, later revealed to be an intrauterine pregnancy coexisting with uterus didelphys. The diagnosis was substantiated by her history of irregular menstruation, lower abdominal pain since menarche, and a previously diagnosed ovarian cyst, illustrating the critical role of a thorough medical history in guiding diagnosis. The discussion section delves into the implications of uterus didelphys on fertility and pregnancy outcomes, advocating for individualized management strategies and highlighting the psychological impact of such congenital anomalies. It underscores the necessity of a multidisciplinary approach to care involving obstetricians, radiologists, and reproductive specialists. Conclusion: The conclusion emphasizes the importance of clinical awareness, meticulous history-taking, and personalized care in the management of uterus didelphys. It calls for further research to enhance understanding and improve outcomes in reproductive medicine, stressing the complexity of diagnosing and managing pregnancies in women with Müllerian anomalies and the need to consider congenital uterine anomalies in differential diagnoses, particularly in young women with atypical gynecological histories

One and a Half Syndrome and Internuclear Ophthalmoplegia as Neuro-Ophthalmological Manifestations in Patients with Brainstem Stroke: A Case Series

Background: Brainstem stroke syndrome accounts for 10-15% of all types of strokes, which may result in relatively rare neuroophthalmological manifestations. The aim of this case report is to report findings of one and a half syndrome (OAHS) and internuclear ophthalmoplegia in a patient with brainstem stroke. Case presentation: First case, female, 56 years old, came with sudden weakness on the right side of the body. One and a half syndrome was found, namely when asked to glance to the left, conjugate gaze palsy was obtained horizontally, and when asked to glance to the right, there was adduction inability of the left eye (ipsilateral). Right eye abduction was normal with present nystagmus. Paresis of right central CN. VII, XII was present, along with hemiparesis dextra (contralateral). Head CT scan shows hemorrhage in pons and intraventricular. Second case, female, 65 years old, came with a protruding mouth, vertigo, and sudden double vision Internuclear ophthalmoplegia was present, namely an adduction inability of the left eye (ipsilateral) when asked to glance to the right. Right eye abduction was normal with present nystagmus. no abnormalities were seen in the primary position and when asked to glance to the left. Paresis of right peripheral CN. VII, hemiparesis and right (contralateral) hemihypesthesia was present. MRI shows multiple chronic infarcts as well as subacute infarcts in bilateral parietal and pons. Conclusion: Clinical knowledge is necessary for topic determination, rehabilitation process and evaluation

Hair Transplant Follicular Unit Extraction Technique as a Current Treatment Option for Androgenetic Alopecia

The therapy for androgenetic alopecia currently varies, and there is no generally efficacious form of treatment. Despite receiving therapy, a portion of individuals with alopecia still do not achieve the anticipated hair regrowth outcomes. The absence of efficacious medical intervention typically necessitates the exploration of alternative therapy modalities. A significant number of patients who do not get satisfactory results from medical treatment explore other therapeutic approaches, such as hair transplantation. Advancements in hair transplantation procedures have seen substantial progress since the 1960s. Men frequently seek hair transplantation, making it a popular cosmetic treatment. Over 11,000 operations took place in the United States in 2014. Commonly practiced contemporary hair transplant procedures include follicular unit transplantation (FUT) and follicular unit extraction (FUE). The FUE technique is gaining popularity due to its non-invasive nature, quicker recovery time, reduced post-operative discomfort, and fewer surgical scars, in contrast to the FUT approach