Navigating a Rare Entity: Pancreatic Lipomatosis in a 34-Year-Old Female Without Classical Risk Factors – A Case Report

Background: Pancreatic lipomatosis (PL), characterized by the replacement of pancreatic acinar tissue with mature adipose cells, is an uncommon condition with an etiology that is often not fully understood. It is frequently identified incidentally during imaging studies. The aim of this case report is to contribute to and advance the clinical understanding of this exceedingly rare and atypical presentation of pancreatic lipomatosis. Case presentation: This report details the case of a 34-year-old female who presented for evaluation of nonspecific, intermittent epigastric discomfort. Her medical history was devoid of significant illnesses, alcohol abuse, or known genetic conditions predisposing to pancreatic disorders. Comprehensive laboratory evaluations, encompassing serum amylase, lipase, liver function tests, lipid profile, and HbA1c, yielded results entirely within normal parameters. Abdominal computed tomography (CT) imaging revealed a striking diffuse, homogeneous fatty replacement of the entire pancreatic parenchyma, a hallmark of total pancreatic lipomatosis. Importantly, there was no evidence of pancreatic ductal dilatation, calcifications, or any discrete pancreatic masses. The patient's management was conservative, involving lifestyle counseling and scheduled periodic monitoring for the potential, though infrequent, development of complications such as exocrine pancreatic insufficiency or secondary diabetes mellitus. Conclusion: This case distinctly illustrates the occurrence of extensive pancreatic lipomatosis in a young, otherwise healthy female lacking classical risk factors. The pivotal role of cross-sectional imaging, specifically CT, in accurately diagnosing this benign condition is emphasized, which is crucial for averting misdiagnosis and precluding unnecessary invasive interventions. Enhanced awareness among clinicians is vital for appropriate patient counseling, the implementation of conservative management strategies, and diligent long-term monitoring for any potential metabolic or functional sequelae

Non-Operative Management Accelerates Recovery: Reduced Length of Hospital Stay in Partial Small Bowel Obstruction with Virgin Abdomens

Background: Small bowel obstruction (SBO) represents a formidable challenge in surgical practice. Partial SBO (PSBO) in individuals without a history of abdominal surgery, termed "virgin abdomens," introduces distinct diagnostic and therapeutic considerations. While non-operative management (NOM) has become a cornerstone for adhesive SBO, comprehensive data elucidating its impact on PSBO in virgin abdomens, especially concerning the length of hospital stay (LOS), are not extensively available. This study was designed to meticulously compare the LOS between NOM and operative interventions in patients diagnosed with PSBO affecting virgin abdomens, specifically within a tertiary care setting in Indonesia. Methods: A retrospective analytic observational methodology, utilizing a cross-sectional design, was implemented at Dr. Kariadi General Hospital, Semarang, covering patients admitted from January through December 2024. The study included patients over 18 years of age with a confirmed diagnosis of PSBO in a virgin abdomen. Exclusion criteria encompassed total SBO, obstructions located in the colon, or any record of prior abdominal surgical procedures. The principal outcome measure, LOS, was rigorously compared between the cohort managed non-operatively and the cohort that underwent surgical procedures. Statistical analysis was performed using appropriate tests, with a p-value below 0.05 established as the threshold for statistical significance. Results: The study cohort comprised 167 eligible patients. For the 112 patients (67.1%) subjected to surgical intervention, the mean LOS was recorded at 13.2±8.72 days. Conversely, the 55 patients (32.9%) managed conservatively demonstrated a markedly shorter mean LOS of 7.74±6.12 days. This observed difference in LOS was statistically highly significant (p < 0.001). The mean age of the participants was 50.60±14.94 years, with females constituting 52.1% of the group. Conclusion: In clinically stable patients presenting with partial small bowel obstruction in virgin abdomens, non-operative management was associated with a significantly diminished length of hospital stay when compared to surgical intervention. This conservative strategy proves to be an effective and advantageous approach in appropriately selected patient populations, offering the potential to lessen hospital burden and enhance recovery timelines

Navigating Spheno-Orbital Meningioma in Indonesia: Clinical Characteristics and Diagnostic Considerations from a Decade of Experience

Background: Spheno-orbital meningiomas (SOM) represent a distinct subgroup of meningiomas originating from the sphenoid wing, characterized by orbital extension, significant bony invasion, and hyperostosis. These tumors present diagnostic and therapeutic challenges due to their complex anatomical location near critical neurovascular structures and a notable tendency for recurrence. Understanding the specific clinical profile of SOM patients is essential for timely diagnosis and effective management strategies. This study aimed to delineate these characteristics within an Indonesian population. Methods: A retrospective, descriptive, cross-sectional study was performed using medical record data from patients diagnosed with SOM between January 2012 and December 2022 at the Department of Neurosurgery, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Data collected included patient demographics, case history (new vs. recurrent), presenting symptoms, neurological status (Glasgow Coma Scale), and radiological findings (lesion singularity/multiplicity). Total sampling was employed, and data were analyzed descriptively. Results: The study included 252 subjects. A striking female predominance was observed (95.6%), with a mean patient age of 44.3 years (range 14-79). The vast majority were new cases (94.4%). Protrusion (proptosis) was the most frequent presenting symptom (79.0%), followed by headache (11.1%), blindness (5.2%), and blurred vision (4.0%). Most patients (97.2%) were fully conscious (GCS 15) upon admission. Radiological assessment revealed single lesions in 71.4% of cases. Conclusion: In this large Indonesian cohort, SOM predominantly affected middle-aged females and typically presented with proptosis. Awareness of this distinct clinical signature is crucial for improving diagnostic accuracy and facilitating prompt, comprehensive management. The findings underscore the need for high clinical suspicion, particularly in female patients presenting with orbital symptoms

A Case of Concurrent COPD Exacerbation, Osteoporosis, and Fracture: Unveiling the Interplay

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory condition with systemic effects, including an increased risk of osteoporosis and fractures. This case report presents a patient with acute COPD exacerbation, osteoporosis, and vertebral fractures, highlighting the complex interplay between these conditions. Case presentation: A 68-year-old male patient presented with acute exacerbation of COPD. He had a history of smoking, hypertension, and a previous diagnosis of pulmonary tuberculosis. Clinical examination revealed signs of respiratory distress, and imaging confirmed emphysema, pneumonia, osteoporosis, and vertebral fractures. The patient received treatment for COPD exacerbation and osteoporosis, showing improvement in respiratory symptoms and pain. Conclusion: This case underscores the importance of recognizing the association between COPD, osteoporosis, and fractures. Early diagnosis and appropriate management of these co-morbidities are crucial for improving patient outcomes and quality of life

The Efficacy of Phyllanthus niruri Linn in Modulating Inflammatory and Cancer Stem Cell Markers in Colorectal Cancer: A Stratified Systematic Review and Meta-Analysis

Background: The progression of colorectal cancer (CRC) is driven by a complex interplay between chronic inflammation and a resilient population of cancer stem cells (CSCs). Phyllanthus niruri Linn (PNL), a medicinal plant with established immunomodulatory effects, presents a promising adjuvant therapeutic strategy. This study aimed to move beyond qualitative summaries to quantitatively assess PNL's efficacy by synthesizing evidence on its modulation of key inflammatory and CSC biomarkers. Methods: Following PRISMA guidelines, a systematic search of PubMed, ScienceDirect, Google Scholar, and Scopus (2015–2025) was conducted. Studies quantifying the effects of PNL on Interleukin-8 (IL-8), Cyclooxygenase-2 (COX-2), or CD133 in CRC models were included. Recognizing the profound biological differences between experimental systems, a stratified meta-analysis was performed. Data were pooled using a random-effects model, stratified by study type (in vitro vs. in vivo) and intervention (monotherapy vs. combination therapy). The Standardized Mean Difference (SMD) was the primary effect measure. Results: Seven studies met the inclusion criteria. In a stratified analysis of in vivo models, PNL monotherapy significantly reduced COX-2 (SMD -2.11; 95% CI [-3.10, -1.12]) and IL-8 (SMD -1.95; 95% CI [-3.01, -0.89]). The effect on the CSC marker CD133 was most pronounced in vitro (SMD -2.98; 95% CI [-4.87, -1.09]), while still significant in in vivo models (SMD -2.15; 95% CI [-3.45, -0.85]). The analysis revealed that the biological context (in vitro vs. in vivo) is a significant determinant of the observed effect size. Conclusion: This stratified meta-analysis provides robust, context-specific evidence of PNL's ability to suppress key inflammatory and CSC markers in CRC. The findings reveal that PNL's potent anti-CSC activity observed in vitro is translated into a significant, though attenuated, effect in vivo, highlighting the critical influence of the tumor microenvironment and pharmacokinetics. This work substantiates the dual-pronged therapeutic potential of PNL as a promising bioactive adjuvant in CRC therapy

Procalcitonin Levels in Pulmonary Tuberculosis and Bacterial Pneumonia: A Cross-Sectional Study at a Tertiary Hospital in Indonesia

Background: Pulmonary tuberculosis (TB) and bacterial pneumonia are respiratory infections with high morbidity and mortality rates. Despite having similar clinical symptoms and radiological findings, these conditions require different treatment approaches. Procalcitonin is a potential biomarker to differentiate these conditions, as its levels tend to increase in bacterial infections but not in TB. This study aims to compare procalcitonin levels in patients with pulmonary TB and bacterial pneumonia. Methods: This research employed an observational analytic design with a cross-sectional approach conducted at Dr. Mohammad Hoesin General Hospital (RSMH), Palembang. The study subjects were patients with pulmonary TB and bacterial pneumonia who met the inclusion and exclusion criteria. Procalcitonin levels were measured using ELISA methods. Data were analyzed to determine differences in procalcitonin levels between the two groups. Results: The study found that procalcitonin levels in bacterial pneumonia patients were significantly higher than those in pulmonary TB patients (p<0.05). These findings indicate that procalcitonin levels can serve as a diagnostic parameter to distinguish between the two conditions. Conclusion: Procalcitonin levels can be a useful biomarker for differentiating pulmonary TB from bacterial pneumonia. This biomarker is expected to assist clinicians in making more accurate diagnoses and expediting clinical decision-making

The Efficacy of Antimalarial Therapy in the Treatment of Pulmonary Malaria: A Meta-Analysis

Background: Pulmonary malaria, a severe form of malaria that affects the lungs, is associated with high mortality rates. Antimalarial therapy is the cornerstone of treatment, but the optimal regimen remains a subject of debate. This meta-analysis aimed to evaluate the efficacy of different antimalarial therapies in the treatment of pulmonary malaria. Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) was conducted to identify randomized controlled trials (RCTs) comparing different antimalarial therapies for pulmonary malaria. The primary outcome was mortality. Secondary outcomes included parasite clearance time, respiratory distress resolution, and length of hospital stay. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results: Seven RCTs met the inclusion criteria, enrolling a total of 1,245 patients with pulmonary malaria. The studies compared various antimalarial regimens, including artemisinin-based combination therapy (ACT), quinine, and artesunate. The meta-analysis showed that ACT was associated with a significantly lower risk of mortality compared to quinine (RR 0.67, 95% CI 0.52-0.86, p = 0.002). There was no significant difference in mortality between ACT and artesunate (RR 0.92, 95% CI 0.75-1.13, p = 0.43). ACT was also associated with a faster parasite clearance time and quicker resolution of respiratory distress compared to quinine. Conclusion: ACT is an effective treatment for pulmonary malaria, associated with reduced mortality and improved clinical outcomes compared to quinine. There was no significant difference in efficacy between ACT and artesunate. These findings support the use of ACT as the preferred antimalarial regimen for patients with pulmonary malaria

Programmed Intermittent Epidural Bolus (PIEB) Versus Patient-Controlled Epidural Analgesia (PCEA) with Continuous Basal Infusion for Labor Analgesia: A Meta-Analysis

Background: Maintaining effective labor epidural analgesia while optimizing maternal satisfaction and minimizing drug consumption remains a key objective in obstetric anesthesia. Programmed intermittent epidural bolus (PIEB) techniques have emerged as an alternative to traditional continuous epidural infusion (CEI) combined with patient-controlled epidural analgesia (PCEA). This meta-analysis aimed to compare the efficacy, local anesthetic (LA) consumption, and maternal satisfaction between PIEB regimens (typically combined with PCEA for rescue) and PCEA regimens supplemented with a continuous basal infusion (PCEA+Basal). Methods: A systematic literature search was conducted for PubMed, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) published between January 2013 and December 2024 comparing PIEB (+/- PCEA) with PCEA+Basal for labor analgesia. Primary outcomes were hourly LA consumption, maternal satisfaction (rated as high/excellent), and need for clinician rescue analgesia (breakthrough pain). Secondary outcomes included pain scores (Visual Analog Scale - VAS), mode of delivery, duration of labor stages, motor blockade incidence, and neonatal outcomes (Apgar scores). Data were extracted from suitable studies identified through the search. A random-effects model was used for meta-analysis using RevMan software. Mean Differences (MD) or Odds Ratios (OR) with 95% Confidence Intervals (CI) were calculated. Heterogeneity was assessed using the I² statistic. Results: Five studies involving a total of 1158 parturients met the inclusion criteria. The pooled analysis indicated that PIEB regimens were associated with a trend towards lower hourly LA consumption compared to PCEA+Basal (MD: -1.2 mL/hour; 95% CI: -2.5 to 0.1; P=0.07; I²=78%), although heterogeneity was high. Maternal satisfaction rated as 'high' or 'excellent' was significantly more frequent in the PIEB group (OR: 1.85; 95% CI: 1.20 to 2.85; P=0.005; I²=35%). The need for clinician rescue analgesia was numerically lower with PIEB, but the difference did not reach statistical significance (OR: 0.70; 95% CI: 0.45 to 1.10; P=0.12; I²=45%). No significant differences were noted in VAS pain scores during established labor, mode of delivery, or Apgar scores. Incidence of motor block appeared potentially lower with PIEB regimens. Conclusion: Based on this meta-analysis, PIEB regimens appear promising for labor analgesia, potentially offering comparable efficacy to PCEA+Basal while possibly reducing local anesthetic consumption and enhancing maternal satisfaction. However, significant heterogeneity was observed for some outcomes. High-quality, large-scale RCTs directly comparing optimized PIEB+PCEA protocols with PCEA+Basal infusion are crucial to definitively establish the relative benefits and risks of these techniques

Awake Intubation for a Predicted Difficult Airway in a Patient with Giant Goiter-Induced Tracheomalacia: A Case Report

Background: The management of a predicted difficult airway in patients with giant goiters presents a significant anesthetic challenge. Chronic tracheal compression can lead to secondary tracheomalacia, a condition characterized by tracheal weakness that can precipitate catastrophic airway collapse upon induction of general anesthesia. We present a case where a high index of suspicion for tracheomalacia guided the decision to perform awake tracheal intubation. Case presentation: A 22-year-old female presented with a massive, non-toxic nodular goiter that had been growing for eight years, causing significant positional dyspnea. Airway assessment revealed a 10x10 cm neck mass with tracheal deviation, indicating a high risk for difficult intubation and ventilation. Preoperative suspicion of tracheomalasia was high due to symptoms and chronicity. The airway was secured using awake intubation with topical and intravenous lidocaine prior to the induction of general anesthesia. The patient underwent a total thyroidectomy. Intraoperative palpation confirmed flaccid tracheal rings, supporting the diagnosis. The endotracheal tube was retained postoperatively, and the patient was monitored in the intensive care unit. She was successfully extubated on the third postoperative day without complications. Conclusion: This case underscores the critical importance of maintaining a high index of suspicion for tracheomalacia in patients with long-standing, giant goiters. Awake tracheal intubation is a cornerstone technique, providing a safe and effective method to secure the airway while preserving spontaneous ventilation, thereby mitigating the risk of life-threatening airway obstruction. A meticulous, multidisciplinary perioperative plan is paramount for optimal patient outcomes

The Dual Role of Hypoxia-Inducible Factor-1α in Sepsis-Induced Immunomodulation and Organ Dysfunction: A Systematic Review and Meta-Analysis

Background: Sepsis, a life-threatening organ dysfunction caused by a dysregulated host response to infection, remains a leading cause of global mortality. Hypoxia-inducible factor-1α (HIF-1α) is a master transcriptional regulator of the cellular adaptive response to hypoxia but plays a complex, paradoxical role in sepsis. While essential for innate immune function, its sustained activation may amplify inflammation and drive organ damage. This meta-analysis was conducted to synthesize the evidence on the association of HIF-1α with key markers of immunomodulation and organ dysfunction in sepsis. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines. A comprehensive search of PubMed, Scopus, and Web of Science was conducted for studies published between January 2014 and December 2024. We included observational studies that measured HIF-1α levels in adult sepsis patients and reported outcomes related to organ dysfunction (Sequential Organ Failure Assessment [SOFA] score) or mortality, and immunomodulation (Interleukin-6 [IL-6] levels). Seven studies meeting the inclusion criteria were included in the final analysis. Data were pooled using a random-effects model. Standardized Mean Difference (SMD) and Odds Ratios (OR) with 95% confidence intervals (CI) were calculated. Results: The seven included studies comprised 1,288 patients. The overall quality of the included studies was moderate to high as per the Newcastle-Ottawa Scale. The pooled analysis revealed that HIF-1α levels were significantly elevated in sepsis patients who died compared to those who survived (OR = 2.68, 95% CI: 1.55–4.64, p < 0.001), with moderate heterogeneity (I² = 45%). Furthermore, HIF-1α levels were strongly associated with greater organ dysfunction, as measured by the SOFA score (5 studies; SMD = 0.92, 95% CI: 0.51–1.33, p < 0.0001), with substantial heterogeneity (I² = 78%). HIF-1α levels also showed a significant positive correlation with the pro-inflammatory cytokine IL-6 (4 studies; SMD = 1.15, 95% CI: 0.65–1.65, p < 0.00001), with high heterogeneity (I² = 82%). Conclusion: This meta-analysis provides robust evidence that elevated HIF-1α levels are significantly associated with increased sepsis severity, characterized by greater organ dysfunction, a heightened pro-inflammatory state, and a higher risk of mortality. These findings underscore the maladaptive consequences of sustained HIF-1α activation in sepsis, positioning it as a critical prognostic biomarker and a complex, high-value target for future therapeutic modulation