Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo

Systematic review and meta-analysis. To investigate the efficacy and safety of intradiscal mesenchymal stem cell (MSC) injection for patients with degenerative disc disease (DDD). DDD is a common cause of chronic low-back pain (CLBP). Studies have shown that MSC therapy may have the potential to reverse the degenerative process. However, the evidence remains inconclusive. A comprehensive search of Europe PMC, Cochrane Library, Scopus, and Medline was conducted up to April 30, 2025, using relevant keywords. Randomized controlled trials (RCTs) comparing intradiscal MSC injections with sham/placebo in patients with DDD were included. Random-effects models were used to calculate the odds ratios and mean differences (MDs). Seven RCTs were included. MSC injection was associated with significantly greater reductions in Visual Analog Scale pain scores (MD, 6.67; 95% confidence interval [CI], -9.31 to -4.02; p<0.00001, I2=29%) and Oswestry Disability Index (ODI) (MD, -4.05%; 95% CI, -5.24 to -2.87; p<0.00001, I2=32%) compared with sham/placebo. The magnitude of improvement increased with longer followup. No significant differences were observed between groups in treatment-emergent adverse events (AEs), serious AEs, treatment discontinuation due to AEs, or mortality. Intradiscal MSC injection appears to be a safe and effective therapy, offering modest improvements in pain and function for patients with CLBP due to DDD who do not respond to conservative treatments.

The optimal graft choice for urethral reconstruction remains debated. This umbrella review synthesised evidence from systematic reviews and meta-analyses on graft materials, focusing on success, complications, and long-term outcomes. PubMed and Scopus were searched to March 2025 for reviews of patients undergoing graft-based urethral reconstruction. Eligible studies reported outcomes including success, donor-site morbidity, complications, stricture recurrence, stricture-free survival, operative efficiency, and postoperative parameters. GRADE assessed certainty, with analyses stratified by graft type and, where available, by sex or indication. Twelve reviews (2012–2025) covering 9,829 patients met criteria. Ten examined males—nine adults (three mixed etiologies, others strictures) and one pediatric hypospadias. Two included both sexes, with female cases limited to anterior strictures. Buccal mucosa grafts (BMG) were most studied, showing success > 80%. Meta-analyses found no significant difference between BMG and penile skin grafts (OR 0.83, 95% CI 0.55–1.23, I²=88%) or lingual mucosa grafts (OR 1.18, 95% CI 0.79–1.77, I²=63%). Low review quality was found in studies involving females, children, and some males, due to small sample sizes, risk of bias, lack of PROSPERO registration, and inconsistencies with meta-analysis methods, resulting in low GRADE certainty. BMG remains most effective, but evidence for women and children is scarce. Future studies should prioritise sex-stratified data, scoping reviews, and clinical algorithms.

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Regional differences in the gut microbiota and CRC incidence and mortality rates are well-documented. However, studies on the microbiota associated with CRC in Indonesia remain scarce. This study aimed to chracterize the gut microbiota profile of CRC in Indonesia. We collected stool samples from 14 patients with CRC (CRC), 19 patients with non-CRC bowel diseases (non-CRC), and 16 healthy controls (HC). The gut microbiota profiles across the three groups were analyzed using 16 S rRNA gene amplicon sequencing. Data analysis was performed using several software packages: QIIME2, ANCOM-BC2, and PICRUSt2. In comparison to the non-CRC and HC groups, patients with CRC demonstrated significant differences in both alpha and beta diversity. The CRC group had lower evenness and richness than the HC group. Firmicutes and Bacteroidota were identified as the predominant phyla across all groups. The differential abundance analysis identified four beneficial genera that were substantially reduced in Indonesian CRC patients: Roseburia, Dialister, Agathobacter, and Muribaculaceae. No genera were found to be significantly enriched in CRC. Functional prediction analysis revealed multiple pathways such as mTOR, mRNA surveillance, basal transcription factors, phagosome, and proteasome, were reduced in CRC. Conversely, CRC demonstrated a significant upregulation of pathways related to lipid metabolism and the biosynthesis of flavonoids, stilbenoids, diarylheptanoids, and gingerols. Our study revealed distinct gut microbiota profiles in Indonesian CRC patients, highlighting the significance of decreased abundance of certain beneficial taxa.

COVID-19 can cause acute respiratory distress syndrome (ARDS), and artificial intelligence (AI) algorithms for chest X-ray (CXR) analysis have been developed to assess pulmonary damage in COVID-19 patients. We evaluated the combination of AI-CXR and hematological parameters to predict mortality and intubation events for COVID-19 patients. This study is a retrospective cohort study of COVID-19 patients for which we have collected data during the 2020–2022 period at Airlangga University Hospital, Surabaya, Indonesia. The total number of patients involved in this study was 312. The results of the scoring evaluation using a combination of AI-CXR, hematology parameters, respiratory rate (RR), and SaO2 showed ROC 0.854; p = 0.000; sensitivity: 74.2%; specificity: 89% in predicting 30-day mortality events, and ROC 0.846; p = 0.000; sensitivity: 80.3%; specificity: 80.9% in predicting 30-day intubation events. Meanwhile, without using AI-CXR, it shows ROC 0.822; p = 0.000; sensitivity: 80.3%; specificity: 81.7% in predicting 30-day mortality events, and ROC 0.815; p = 0.000; sensitivity: 77.3%; specificity: 81.7% in predicting 30-day intubation events. The combination of hematology parameters with or without AI-CXR has excellent sensitivity and specificity in predicting the incidence of mortality and intubation in COVID-19 patients. Not applicable.

Introduction: High-fiber diabetes-specific formulas (DSFs) are designed to support glycemic control in patients with type 2 diabetes mellitus (T2DM), particularly those requiring nutritional support. Despite their potential benefits, evidence regarding their short-term effects on blood glucose levels and insulin requirements remains limited. This case report explores the impact of an oral DSF on glycemic control in an elderly patient with T2DM over a four-day inpatient period. Case: A 70-year-old overweight woman (BMI 24.6 kg/m²) was hospitalized due touncontrolled hyperglycemia (HbA1c 10.6%, fasting glucose 469 mg/dL) with poor oral intake (&lt; 50% of needs) secondary to nausea and vomiting. A standardized DSF was administered orally alongside a diabetic soft diet for 4 days. DSF was introduced at 150 mL three times daily and titrated to 200 mL twice daily, contributing to a total intake of approximately 1,500 kcal/day. Insulin doses (10 IU regular insulin three times a day) remained unchanged. Monitoring included daily fasting glucose and clinical tolerance. Fasting blood glucose decreased from 469 mg/dL on day 1 to 260 mg/dL by day 4. The patient showed improved oral intake (up to 75% of caloric needs) and better appetite without gastrointestinal complaints. No hypoglycemia episodes or insulin dose adjustments were necessary. Discussion: During the four-day observation period, fasting blood glucose decreased progressively from 469 mg/dL to 260 mg/dL without modification of insulin dosage. Oral intake improved to approximately 75% of estimated needs, and no hypoglycemic episodes or gastrointestinal intolerance were observed. The improvement in glycemic trends occurred alongside structured nutritional support and consistent insulin therapy. Conclusion: Short-term administration of a high-fiber DSF improved glycemic trends and nutritional intake in an elderly T2DM patient without adverse effects. DSF can be an effective adjunct in individualized medical nutrition therapy to support glycemic stabilization during hospitalization.

BackgroundHigh mortality in children awaiting liver transplantation is a significant concern. At Cipto Mangunkusumo Hospital, the only active and established pediatric living-donor liver transplantation (LDLT) center in Indonesia, similar challenges persist. This study aims to determine the mortality rate, time to death or transplantation and causes of death in children listed for LDLT at our center.MethodsThis prospective single-center cohort study was conducted from January 2023 to December 2024. Consecutive sampling included all eligible children age 0–18 listed for LDLT. Participants were monitored from listing until pretransplant death, transplantation, loss to follow-up or study completion. The primary outcome was all-cause mortality on the LDLT waiting list.ResultsSixty-two children were enrolled; 64.51% (n=40) were female with biliary atresia accounting for 72.58% of diagnoses. Malnutrition was identified in 70.97% (n=44) and 35.48% (n=22) had a history of cytomegalovirus (CMV) infection. Median duration from listing to death was 87.5 days. Median time to transplantation was 263.5 days. During follow-up, 22 children died with sepsis as the leading cause, 22 underwent LDLT, 13 were lost to follow-up and 5 remained on the waiting list. Donor scarcity contributed substantially to prolonged listing and loss to follow-up.ConclusionsChildren listed for liver transplantation experience a high waiting list mortality at our center. This is primarily due to infection, malnutrition and socioeconomic factors. Sepsis persists as the principal cause of death. LDLT remains the only feasible option for children requiring liver transplantation in Indonesia.