Indonesian Journal of Biomedicine and Clinical Sciences

The association between PD-L1 expression and the survival rate of patients with undifferentiated nasopharyngeal carcinoma

Indrawati — 2026-07-16

Programmed cell death ligand-1 (PD-L1) plays a key role in tumor immune evasion. However, its prognostic significance in nasopharyngeal carcinoma (NPC) remains unclear. This study evaluated the association between PD-L1 expression and clinicopathological features and survival outcomes in patients with NPC. We conducted a retrospective analysis of 80 patients diagnosed with non-keratinizing undifferentiated NPC between 2015 and 2019. PD-L1 expression was assessed by immunohistochemistry using the 22C3 antibody and quantified as the tumor proportion score. Associations with clinicopathological variables were analyzed, and overall survival was evaluated using Kaplan–Meier and Cox regression analysis. PD-L1 expression was negative in 72.5% of cases, positive in 18.8% of cases, and strongly positive in 8.7% of cases. PD-L1 expression was not significantly associated with age, sex, disease stage, treatment modality, or overall survival (HR 1.71; p = 0.494). PD-L1 expression on tumor cells was not associated with clinicopathological characteristics or survival in non-keratinizing undifferentiated NPC. These findings suggest that PD-L1 alone is not a reliable prognostic biomarker for this NPC subtype, highlighting the need for integrated immune and molecular analyses in future studies.

Brief cognitive behavioral therapy for chronic insomnia in a primary care setting: a case report

Dellma Anggini — 2026-07-29

Chronic insomnia with anxiety disorders is a common non-specialist mental health condition frequently encountered in primary care. Although the WHO Mental Health Gap Action Programme (mhGAP) recommends psychosocial interventions at this level, skepticism persists regarding the feasibility of implementing brief psychotherapy within the high-volume workflow of Indonesian community health centers. This case report aims to illustrate the clinical application and operational feasibility of Brief Cognitive Behavioral Therapy (BCBT) in a primary health center setting. We report a 40-year-old female with chronic insomnia accompanied by somatic symptoms, including palpitations and tachycardia, without underlying medical comorbidities. The patient exhibited significant cognitive distortion in the form of sleep state misperception. As the primary treatment modality, a four-session BCBT intervention was conducted every two weeks (30–45 minutes per session). The curriculum included autonomic, behavioral, and cognitive (ABC) model psychoeducation, cognitive restructuring, scheduled worry period, behavioral activation, relaxation, lifestyle modification, and relapse prevention. Evaluation was performed using the insomnia severity index (ISI), subjective units of distress scale (SUDS), and collaborative patient-reported outcome measures (PROM) encompassing three domains: sleep duration, frequency, and anxiety levels. The collaborative goal setting (CGS) of at least 5 hours of sleep, 5 days a week without anxiety, was fully achieved by the third session and remained stable until thereafter. This case illustrates that structured psychotherapy such as BCBT is potentially feasible within a busy PHC workflow, provided there is institutional commitment from facility leadership, a dedicated psychotherapy schedule for trained mental health providers at least once a week, and functional early detection within general outpatient services. While these results are promising for this individual case, further studies are needed to evaluate the scalability and standardized implementation of this model across diverse primary care settings in Indonesia.

Clinical profile, manifestation, and treatment of dermatophytosis patients at Ngoerah Hospital Bali in 2021-2023

Kevin Jonathan Djuanda — 2026-07-30

Dermatophytosis is a common superficial fungal infection of keratinized tissues, caused by the fungal family of Microsporum, Epidermophyton, and Trichophyton. It is highly prevalent in tropical regions due to favorable environmental conditions. Local hospital-based data are still needed to describe the clinical pattern of dermatophytosis in Bali. This study aimed to describe the clinical profile, manifestations, laboratory findings, and treatment of dermatophytosis patients treated at the Dermatology and Venereology Outpatient Clinic of Ngoerah Hospital Bali. This descriptive observational study utilized a cross-sectional retrospective design, analyzing medical records of dermatophytosis patients treated since January 2021 to December 2023, and the data were analyzed descriptively. A total of 135 patients were included, with a mean patient age of 30.4 ± 17.5 years old (range 1–73 years old), most cases occurring in females (53.3%), students (35.6%), and showed high prevalence in the 25-44 age group. The majority of patients live in private residences (57%) with the primary transmission route being intrafamilial contact (39.3%). Based on 153 clinical presentations, the most frequent type was tinea corporis (39.2%), followed by tinea cruris (19.0%), tinea unguium (19.0%), and tinea capitis (18.3%). The potassium hydroxide (KOH) examination was documented in 124 patients and fungal culture results were available in 99 patients. Dermatophytosis remains a significant health concern, with tinea corporis as the predominant type in our study. Antifungal systemic and topical treatment were used in this study. Awareness and early diagnosis are essential for effective disease control.