PHARMACOLOGY, MEDICAL REPORTS, ORTHOPEDIC, AND ILLNESS DETAILS

Dynamic Renal Deterioration in Flood-Associated Severe Leptospiral Multiorgan Dysfunction

Novilia Puspitasari — 2026-06-10

Severe leptospirosis remains an under-recognized cause of rapidly progressive multiorgan dysfunction in tropical, flood-prone regions, where delayed risk stratification contributes to preventable renal failure and mortality. Acute kidney injury (AKI) represents a pivotal determinant of outcome, yet its clinical trajectory may be dynamic and misleading. This case report aimed to characterize the temporal clinical and biochemical progression of severe leptospiral infection complicated by Stage 3 AKI and to identify practical implications for early bedside recognition in endemic settings. We conducted a retrospective case report in accordance with CARE guidelines. Clinical, epidemiological, laboratory, and radiological data were systematically extracted from hospital records. Diagnosis was established based on compatible clinical manifestations, documented floodwater exposure with skin barrier disruption, positive serology, structured scoring using Modified Faine’s Criteria, and AKI staging according to KDIGO guidelines. Serial laboratory monitoring enabled assessment of organ involvement and disease evolution. The patient developed cholestatic jaundice, thrombocytopenia, pulmonary inflammatory changes, profound electrolyte imbalance, and rapidly progressive renal dysfunction fulfilling KDIGO Stage 3 criteria. Notably, transient improvement in serum creatinine preceded abrupt deterioration requiring hemodialysis, underscoring the non-linear course of leptospiral AKI. Integrated supportive management and tailored antimicrobial therapy resulted in subsequent stabilization. This report highlights the need for dynamic renal monitoring and early escalation strategies in high-risk patients with environmental exposure. Incorporating structured diagnostic scoring and continuous biochemical surveillance into frontline care may improve prognostic accuracy and reduce severe renal complications in climate-vulnerable populations.

Comparison of LI-RADS Scores Before and After Transarterial Chemoembolization (TACE) in Hepatocellular Carcinoma Patients

Taufik Rahman — 2026-06-10

Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy, notorious for its elevated mortality. In intermediate-stage HCC where surgical resection is contraindicated, transarterial chemoembolization (TACE) is the primary treatment modality. Accurate evaluation of therapeutic response is essential to guide ongoing patient management. The Liver Imaging Reporting and Data System (LI-RADS), particularly its Treatment Response (LI-RADS TR) criteria, provides a validated radiographic method for assessing lesions before and after locoregional interventions. This study compared LI-RADS scores before and after TACE in patients at Dr. Soetomo Regional General Hospital, Surabaya. A retrospective observational design was employed, involving 37 HCC patients who underwent TACE and abdominal CT between January 2024 and July 2025. Statistical analysis used the paired t-test or Wilcoxon test (p < 0.05). The majority of patients were male (67.6%) with a mean age of 55.3 years. Before TACE, the most common categories were LR-5 (51.4%) and LR-4 (48.6%). Following TACE, 78.4% of tumors were classified as viable and 21.6% as non-viable by LI-RADS TR. No significant difference in tumor size was observed, but tumor-to-liver ratio was significantly reduced (p < 0.001). No significant association was identified between pre-TACE LI-RADS characteristics and post-TACE LI-RADS TR categories, except for the pre-treatment tumor-to-liver ratio. TACE significantly reduced the tumor-to-liver ratio; however, most lesions remained viable by LI-RADS TR. LI-RADS and LI-RADS TR are important tools for evaluating treatment response and guiding further management in HCC patients.

Assessment of Iron Loss in Menstruating Female Students in a Nigerian University

Polit Umanka Yelpoji — 2026-09-02

Menstruation is a periodic physiological process of blood discharge in women of reproductive age. It is associated with normal adaptive variation in iron depletion, which could lead to pathological depletion of iron stores. This study assessed iron status before and after menstruation among menstruating female students. A longitudinal and paired comparative study was conducted in 42 female students. A structured questionnaire was administered, and blood samples were collected pre- and post-menstruation. A semi-automated analyzer (Chem 535) was used to measure serum iron (SI) and total iron-binding capacity (TIBC), while transferrin saturation (TSAT) was calculated. Data were analyzed according to age, duration of menstrual flow, and degree of menstrual flow, with p < 0.05 considered significant. Serum iron recorded a significant decrease from 19.41 ± µmol/L before menstruation to 16.14 µmol/L after menstruation (p = 0.001), while TIBC recorded a significant increase from 30.81 µmol/L pre-menstruation to 36.04 µmol/L post-menstruation (p = 0.001). TSAT declined significantly from 66.67% pre-menstruation to 48.44% post-menstruation (p = 0.001). Although all age groups showed reductions in serum iron and TSAT and increases in TIBC following menstruation, the differences between age groups were not statistically significant (serum iron, p = 0.078; TIBC, p = 0.150; TSAT, p = 0.082). Menstruation was associated with an acute reduction in serum iron and transferrin saturation, with increased total iron-binding capacity, indicating measurable acute iron loss among menstruating female students. The duration and degree of menstrual flow did not influence the extent of these changes.

Mangosteen (Garcinia mangostana) Pericarp Extract as a Promising Natural Stain for Erythrocyte Morphology in Thalassemia Patients: A Comparative Evaluation

Novi Ersanto — 2026-09-24

Erythrocyte morphology evaluation via peripheral blood smear is essential for thalassemia patients. While Wright and Giemsa stains remain the established standard, eco-friendly natural dyes are gaining research interest. Mangosteen (Garcinia mangostana) pericarp contains natural pigments with potential biological staining applications. This study comparatively evaluated erythrocyte staining quality using Wright stain, Giemsa stain, and mangosteen pericarp extract as a natural alternative. This laboratory experimental study used 25 peripheral blood samples from thalassemia patients. Three peripheral blood smears were prepared per sample and stained using the three methods. Staining quality was assessed semi-quantitatively based on color intensity, morphological clarity, and background contrast by two observers. Statistical analysis (Friedman test, Wilcoxon signed-rank test) revealed significant differences among methods (p < 0.001). Wright stain yielded the highest quality, followed by Giemsa, while mangosteen pericarp extract showed lower performance but still allowed identification of basic erythrocyte morphology. These findings confirm the novelty of mangosteen peel extract as an environmentally friendly natural stain in hematology. Practically, this extract may support basic erythrocyte morphological observation in laboratory settings, though optimization of extract concentration and fixation methods is needed to improve staining quality. Further development could yield a more sustainable alternative staining agent for erythrocyte morphology examination. In conclusion, mangosteen pericarp extract shows potential as a natural alternative stain for erythrocyte morphology analysis in thalassemia patients. However, achieving effectiveness comparable to standard stains requires further optimization, particularly regarding extract concentration and fixation methods.

Assessment of Antigen Retrieval Solution in Immunohistochemistry

Jonathan Madukwe — 2026-09-28

Immunohistochemistry (IHC) is a critical diagnostic tool that depends on antigen–antibody interactions to detect protein expression in formalin-fixed paraffin-embedded tissues. However, formalin fixation often masks antigenic sites, necessitating antigen retrieval to restore epitope accessibility. This study evaluated seven antigen retrieval solutions; hydrochloric acid, glacial acetic acid, formic acid, citric acid, oxalic acid, ethylene diamine tetra acetic acid, and water across three concentrations (0.1%, 0.2%, and 0.3%) using breast and appendix tissues. The Quick Score method, which combines staining intensity and the proportion of positive cells, was applied to assess the performance of each solution in detecting three antigen markers: Progesterone receptor (PR), CD20, and Pan-cytokeratin. Results demonstrated that citric acid consistently produced the highest Quick Scores at 0.1% and 0.3%, with a slight decrease in CD20 expression at 0.2%, indicating that minor concentration-dependent fluctuations may influence some antigens. Hydrochloric acid, glacial acetic acid, and formic acid at 0.1%, 0.2%, and 0.3% also showed strong retrieval efficiency, although responses varied across concentrations. In contrast, oxalic acid was highly effective for Pan-cytokeratin at 0.1%, 0.2%, and 0.3%, but performed poorly for PR and CD20 across concentrations, indicating antigen-specific retrieval capacity. Staining response varied when different retrieval solutions were used. The citric acid solution showed a relatively consistent staining pattern in the examination of PR, CD20, and Pan-cytokeratin compared with several other retrieval solutions. This finding indicates that the type of retrieval solution and its concentration need to be considered in the antigen retrieval process to obtain optimal immunohistochemical staining results.