Indonesian Journal of Biomedicine and Clinical Sciences

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

Thu, 16 Jul 2026 00:00:00 +0700

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.

The association between risk factors and the occurrence of retinopathy of prematurity in premature infants: An exploratory study

Vera Sumual, Anugrah Handini Masloman, Salam Surbakti, Angelina Patricia Chandra — Thu, 13 Aug 2026 00:00:00 +0700

Retinopathy of prematurity (ROP) remains a leading cause of preventable childhood blindness. Although gestational age and birth weight are well-established risk factors, the contribution of other clinical factors may vary across settings, particularly in low-and-middle-income countries such as Indonesia. The study aimed to evaluate risk factors associated with the incidence of retinopathy of prematurity, including gestational age, birth weight, duration of oxygen therapy, and infection, in a tertiary-care hospital in Indonesia. This retrospective study reviewed medical records of premature infants with and without ROP at Prof Dr. RD Kandou General Hospital, Manado, Indonesia. Eligible infants underwent initial ophthalmologic examination at or before 1 years old. Data collected included sex, gestational age, birth weight, duration of oxygen therapy, presence of infection or sepsis, and ROP status. Associations were evaluated using Chi-square tests and bivariate logistic regression to estimate crude odds ratios (ORs). Multivariable logistic regression analysis was performed to adjust for potential confounding, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) reported. Multivariable results were interpreted as exploratory due to the limited number of ROP cases. A total of 51 infants were included, of whom 14 (27.5%) developed ROP. Lower gestational age (≤34 weeks), lower birth weight (≤1500 grams), and oxygen therapy duration ≥1 weeks were significantly associated with ROP in bivariate analyses. After multivariable adjustment, none of the variables remained statistically significant, although the direction of association persisted for gestational age, birth weight, and oxygen therapy. Infection or sepsis was not significantly associated with ROP. In conclusion, lower gestational age, lower birth weight, and prolonged oxygen therapy are associated with an increased incidence of ROP in this cohort. These findings emphasize the importance of targeted screening and careful oxygen management in premature infants. Larger prospective multicenter studies are needed to clarify independent risk factors for ROP in Indonesia.

The relationship between psychological stress, salivary cortisol levels, and psoriasis severity

Mon, 03 Aug 2026 00:00:00 +0700

Psychological stress has been associated with psoriasis, possibly through neuroendocrine pathways involving the hypothalamic-pituitary-adrenal axis. However, evidence on salivary cortisol levels in psoriasis vulgaris remains inconsistent, and data from Indonesian populations remain limited. This analytical cross-sectional study was conducted at Ngoerah Hospital, Bali, Indonesia, from July to October 2024. The study included 44 patients with psoriasis vulgaris and 41 non-psoriasis controls. Psychological stress was assessed using the Perceived Stress Scale; psoriasis severity was evaluated using the Psoriasis Area and Severity Index; and salivary cortisol levels were measured using an enzyme-linked immunosorbent assay. Between-group comparisons and correlation analyses were performed to evaluate the relationship between psychological stress, salivary cortisol levels, and psoriasis severity. Psychological stress scores and salivary cortisol levels did not differ significantly between the psoriasis and non-psoriasis groups. In the psoriasis group, salivary cortisol levels were not correlated with psychological stress. However, salivary cortisol levels showed a weak negative correlation with psoriasis severity, as measured by the PASI score (r=-0.33; p=0.03). This study found no significant correlation between salivary cortisol levels and psychological stress, but revealed a weak negative correlation between salivary cortisol levels and psoriasis severity.

Cryptococcal antigenemia in HIV/AIDS patients with neurological manifestations at a tertiary Hospital in Bali: a prevalence study and case series

Thu, 10 Sep 2026 00:00:00 +0700

Cryptococcal meningitis is among the most frequent opportunistic infections causing meningitis in individuals with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), contributing substantially to morbidity and mortality, particularly in patients with severely low CD4 counts or without antiretroviral therapy (ART). Data on cryptococcal antigenemia (CrAg) among HIV/AIDS patients in tertiary hospitals in Bali have not been previously reported. This study aimed to determine the prevalence of CrAg positivity in HIV/AIDS patients presenting with neurological manifestations. This study was conducted as a single-center cross-sectional study with a small descriptive case series involving HIV/AIDS patients with neurological symptoms from August 2024 to June 2025. CrAg testing was performed with an immunochromatographic lateral flow assay (LFA) device (IMMY, USA). The study enrolled 80 participants, consisting of 53 males (66.3%) and 27 females (33.8%), with a median age of 36 years (range: 19–64). CrAg positivity occurred in 5 individuals (6.33%). Headache represented the most common neurological symptom (31.3%), followed by impaired consciousness (26.3%) and seizures (12.5%). All CrAg-positive individuals were male, aged 24–64 years. Most were newly diagnosed with HIV infection, while one had discontinued ART. The majority presented with moderate-to-severe headaches. All demonstrated profoundly low CD4 counts, with only one patient showing a CD4 level above 10 cells/mm³. India ink staining was positive in two CrAg-positive individuals, while Cryptococcus neoformans culture was positive in three, including one patient with concordant positivity on both tests. Brain imaging most frequently revealed leptomeningeal enhancement. Four patients survived with clinical improvement, whereas one patient with the lowest CD4 succumbed. Cryptococcal antigenemia prevalence reached 6.33% among HIV/AIDS patients with neurological manifestations. The finding that all CrAg-positive individuals exhibited markedly low CD4 counts and inadequate ART exposure highlighted the importance of CrAg screening in severely immunosuppressed HIV/AIDS patients.

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

Dellma Anggini, Mualimin — Wed, 29 Jul 2026 00:00:00 +0700

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.

Squamous cell carcinoma of the tongue in an elderly female: a case report

Thu, 06 Aug 2026 00:00:00 +0700

Oral squamous cell carcinoma (OSCC) accounts for approximately 90% of oral malignancies and most frequently involves the mobile tongue, where it is associated with substantial functional impairment and mortality. Although OSCC is classically associated with tobacco and alcohol exposure, it may also occur in patients without a history of active smoking or alcohol use. We report a case of HPV DNA-negative, well-differentiated invasive squamous cell carcinoma of the ventrolateral mobile tongue in a 72-year-old woman. The patient presented with a three-month history of a progressively enlarging tongue lesion accompanied by pain, difficulty eating, and unintentional weight loss. She denied active smoking, alcohol consumption, and betel quid use but reported passive exposure to tobacco smoke. Clinical examination revealed an exophytic erythroleukoplakic lesion involving the ventrolateral tongue, along with multiple missing teeth and untreated dental caries. Histopathological examination of a punch biopsy demonstrated invasive nests of malignant squamous epithelial cells with keratin pearl formation, prominent intercellular bridges, and invasion into the underlying connective tissue and muscle, consistent with well-differentiated HPV-negative squamous cell carcinoma.. Following multidisciplinary evaluation, the patient underwent induction TPF chemotherapy (docetaxel, cisplatin, and fluorouracil), followed by hemiglossectomy with modified radical neck dissection and adjuvant radiotherapy. This case highlights that persistent lesions of the mobile tongue in elderly patients warrant careful evaluation, even in the absence of active smoking and alcohol use history. Early biopsy, thorough histopathological assessment, and multidisciplinary management are essential for timely diagnosis and appropriate treatment planning.

Methotrexate therapy in generalized pustular psoriasis: a report of two cases

Rizka Fauziyah, Hardyanto Soebono, Sri Awalia Febriana — Fri, 21 Aug 2026 00:00:00 +0700

Generalized pustular psoriasis (GPP) is a rare, severe inflammatory skin disease associated with systemic complications and significant morbidity. Management remains challenging because of the lack of standardized treatment protocols. Methotrexate is a conventional systemic therapy for psoriasis; however, evidence regarding structured pulse-dose regimens for GPP is limited. We report two adult patients with generalized pustular psoriasis managed at the Dermatology and Venereology Clinic of Sardjito General Hospital, Yogyakarta. Diagnosis was established through clinical evaluation, laboratory examination, and histopathological assessment. Both patients received weekly pulse-dose methotrexate injections (50 mg) for six cycles, with serial clinical monitoring using the Generalized Pustular Psoriasis Area and Severity Index (GPPASI). Both patients demonstrated marked clinical improvement following treatment. GPPASI scores decreased significantly after six cycles of therapy, accompanied by an improvement in laboratory inflammatory parameters, without significant hepatic or renal impairment. This report highlights the use of structured pulse-dose methotrexate therapy with serial GPPASI monitoring in adult patients with generalized pustular psoriasis managed in a resource-limited setting. Significant clinical improvement was observed after six cycles of therapy. Further studies are required to evaluate its long-term efficacy and safety.

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

Kevin Jonathan Djuanda; I.G.A.A. Dwi Karmila, Kevin Jonathan Djuanda — Thu, 30 Jul 2026 00:00:00 +0700

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.