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Lower Body Negative Pressure for Spaceflight Associated Neuro-ocular Syndrome: A Systematic Review and Meta-Analysis Fabiola Supit; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1454

Background: Spaceflight associated neuro-ocular syndrome (SANS) is a critical health risk for astronauts on long-duration missions, characterized by potentially vision-altering ocular changes. Lower body negative pressure (LBNP) is a primary countermeasure designed to reverse the foundational cephalad fluid shifts. This study provides the first rigorous, quantitative synthesis of LBNP's efficacy on key SANS-related ocular parameters. Methods: Following PRISMA guidelines, a systematic search of PubMed, ScienceDirect, and the Cochrane Library (2015–2025) was conducted. Studies quantifying the effect of LBNP on intraocular pressure (IOP), optic nerve sheath diameter (ONSD), or choroidal thickness (CT) in microgravity or its ground-based analogs were included. A random-effects meta-analysis calculated the pooled mean difference (MD). Leave-one-out sensitivity analysis and assessment of publication bias were performed to ensure robustness. Results: Seven studies (N=89 subjects) met the criteria. The meta-analysis demonstrated that LBNP application resulted in statistically significant reductions in IOP (MD = -2.15 mmHg; 95% CI [-3.01, -1.29]; p < 0.001), ONSD (MD = -0.31 mm; 95% CI [-0.45, -0.17]; p < 0.001), and subfoveal Choroidal Thickness (MD = -18.50 µm; 95% CI [-25.65, -11.35]; p < 0.001). Subgroup analysis revealed a more pronounced effect in ground-based studies. The results were robust in sensitivity analyses, and funnel plots suggested a low risk of publication bias. Conclusion: This meta-analysis provides robust, quantitative evidence supporting LBNP's efficacy in acutely mitigating the cardinal structural signs of SANS. By directly counteracting the underlying pathophysiology, LBNP is affirmed as a cornerstone countermeasure technology essential for preserving astronaut ocular health during the upcoming era of deep space exploration.

Therapeutic Keratoplasty for Severe, Travel-Associated Fungal Keratitis: A Meta-Analysis of Globe Salvage and Visual Acuity Outcomes Putu Rima Adilitha Widyasari; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1457

Background: Severe, travel-associated fungal keratitis represents a formidable diagnostic and therapeutic challenge, often progressing to corneal perforation despite aggressive medical therapy. Therapeutic keratoplasty (TK) is frequently required to preserve globe integrity. However, its efficacy in this specific, epidemiologically distinct cohort of patients remains poorly quantified. This meta-analysis aimed to synthesize the available evidence on globe salvage and visual acuity outcomes following TK for severe fungal keratitis acquired during international travel. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2015 and December 2024, reporting outcomes of TK for travel-associated fungal keratitis. The primary outcome was the proportion of cases achieving globe salvage, defined as the avoidance of enucleation or evisceration. The secondary outcome was the mean improvement in Best-Corrected Visual Acuity (BCVA) measured in LogMAR units. Data were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic. Results: Seven retrospective case series met the inclusion criteria, comprising a total of 102 eyes. The included studies were geographically diverse, with patient travel histories predominantly linked to tropical and subtropical regions in Southeast Asia and South America. The pooled proportion for globe salvage was 89.2% (95% Confidence Interval [CI]: 82.5% to 94.1%). There was low to moderate heterogeneity among the studies for this outcome (I² = 31%, p=0.19). The pooled mean improvement in BCVA from pre-operative assessment to final follow-up was 1.21 LogMAR (95% CI: 0.98 to 1.44). Substantial heterogeneity was observed for the visual acuity outcome (I² = 78%, p<0.001). The most commonly identified fungal genera were Fusarium and Aspergillus. Conclusion: Therapeutic keratoplasty demonstrates a high rate of anatomical success, effectively salvaging the globe in the vast majority of patients with severe, travel-associated fungal keratitis. While visual acuity is significantly improved, the final outcomes remain guarded and are highly variable. These findings underscore the critical role of TK in the management of this sight-threatening condition and highlight the need for strategies to improve post-operative visual prognosis.

Antenatal Education to Support Triple Elimination Program: A Systematic Literature Review Sulyastini, Ni Komang; Wirawan, I Made Ady
Jurnal Penelitian Pendidikan IPA Vol 9 No 8 (2023): August
Publisher : Postgraduate, University of Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29303/jppipa.v9i8.4234

This study aims to describe cases of transmission of HIV, hepatitis B and syphilis from mother to child and how the role of antenatal education in supporting the triple elimination program. This research was conducted using a systematic literature review approach. Researchers collected data from research articles that have been published in Scopus indexed international electronic journals. Data was collected using several keywords with the Google search engine and portals providing articles from Scopus indexed journals, such as ScienceDirect, MDPI, and NCBI. The data collected was then analyzed by researchers using an interactive data analysis model. The results of the analysis found that the implementation of triple elimination has been successfully carried out in various countries, although there are still various obstacles that must be faced in its implementation. Furthermore, several studies have also found that antenatal education has an important role in reducing the risk of transmission of HIV, hepatitis B and syphilis from mother to child. So, it can be concluded that antenatal education is crucial to provide in order to support the triple elimination program to prevent cases of transmission of HIV, hepatitis B and syphilis from mother to child

Prevalence and Etiology of Ocular Morbidity in Maritime Environments: A Systematic Review and Meta-Analysis of Passenger and Crew Data Iska Novi Udayani; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1526

Background: The maritime environment constitutes a unique epidemiological enclosure characterized by isolation, specific occupational hazards, and distinct environmental stressors including hyper-salinity and high ultraviolet (UV) albedo. While gastrointestinal and respiratory outbreaks at sea are well-documented, the burden of ocular morbidity remains under-quantified. This study aims to determine the prevalence and etiology of ocular emergencies, stratifying risks between industrial seafarers (crew) and recreational travelers (passengers). Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Data were extracted from eight observational studies (2014–2024) covering expedition cruises, commercial shipping, and leisure voyages. To address population heterogeneity, a stratified analysis was performed: Track A analyzed occupational trauma in crew, while track B analyzed environmental morbidity in passengers. A random-effects model was used to calculate pooled proportions with 95% Confidence Intervals (CI), accompanied by a leave-one-out sensitivity analysis. Results: The dataset represented a combined population of over 5,000 maritime subjects. The pooled prevalence of ocular involvement in maritime trauma cases was 18.4% (95% CI: 12.1%–25.5%). Etiological analysis of crew injuries revealed a dominance of mechanical trauma, specifically metallic foreign bodies (40.5%), followed by chemical burns (26.2%). In contrast, passenger morbidity was driven by environmental factors (photokeratitis, dry eye) and infectious conjunctivitis. Conclusion: Ocular emergencies represent a significant, preventable burden in maritime travel, with distinct risk profiles for crew and passengers. The high rate of occupational trauma suggests a failure in personal protective equipment (PPE) compliance, while the environmental burden reflects the dry ship phenomenon. Mandatory protective eyewear policies and the integration of anterior-segment tele-ophthalmology are critical interventions.

Prevalence and Etiology of Ocular Morbidity in Maritime Environments: A Systematic Review and Meta-Analysis of Passenger and Crew Data Iska Novi Udayani; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1526

Background: The maritime environment constitutes a unique epidemiological enclosure characterized by isolation, specific occupational hazards, and distinct environmental stressors including hyper-salinity and high ultraviolet (UV) albedo. While gastrointestinal and respiratory outbreaks at sea are well-documented, the burden of ocular morbidity remains under-quantified. This study aims to determine the prevalence and etiology of ocular emergencies, stratifying risks between industrial seafarers (crew) and recreational travelers (passengers). Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Data were extracted from eight observational studies (2014–2024) covering expedition cruises, commercial shipping, and leisure voyages. To address population heterogeneity, a stratified analysis was performed: Track A analyzed occupational trauma in crew, while track B analyzed environmental morbidity in passengers. A random-effects model was used to calculate pooled proportions with 95% Confidence Intervals (CI), accompanied by a leave-one-out sensitivity analysis. Results: The dataset represented a combined population of over 5,000 maritime subjects. The pooled prevalence of ocular involvement in maritime trauma cases was 18.4% (95% CI: 12.1%–25.5%). Etiological analysis of crew injuries revealed a dominance of mechanical trauma, specifically metallic foreign bodies (40.5%), followed by chemical burns (26.2%). In contrast, passenger morbidity was driven by environmental factors (photokeratitis, dry eye) and infectious conjunctivitis. Conclusion: Ocular emergencies represent a significant, preventable burden in maritime travel, with distinct risk profiles for crew and passengers. The high rate of occupational trauma suggests a failure in personal protective equipment (PPE) compliance, while the environmental burden reflects the dry ship phenomenon. Mandatory protective eyewear policies and the integration of anterior-segment tele-ophthalmology are critical interventions.

The Ocular Toll of Drug Tourism: A Systematic Review and Meta-Analysis of Cannabis and Methamphetamine Impact on Retinal Architecture and Pupillary Dynamics Fransiska Lavinia Gracella; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1584

Background: Drug tourism involves individuals traveling across international borders to access recreational illicit substances. While psychiatric and cardiovascular toxicities of substances like cannabis and methamphetamine are established, quantitative data regarding their impact on ocular microstructures and functional dynamics remain scarce. This study aims to systematically review and meta-analyze the structural and functional ocular alterations induced by these substances. Methods: A systematic review and meta-analysis complying with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were conducted. Electronic databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched from inception to January 2026. Data extraction targeted pupillary dynamics and structural optical coherence tomography measurements. Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tools. A DerSimonian-Laird random-effects model was utilized in Review Manager 5.4 to pool continuous data, calculating Standardized Mean Differences and 95% Confidence Intervals. Heterogeneity was evaluated via the I-squared statistic. Results: Nine primary research articles were included. The mean Newcastle-Ottawa Scale score was 8.1, indicating a low risk of bias. Chronic cannabis users exhibited significantly reduced pupillary constriction velocity (Standardized Mean Difference -0.85, 95% Confidence Interval -1.20 to -0.50, p < 0.001), prolonged reaction latency (Standardized Mean Difference 0.65, 95% Confidence Interval 0.30 to 1.00, p < 0.01), and decreased corneal endothelial cell density (Standardized Mean Difference -0.78, 95% Confidence Interval -1.15 to -0.41, p < 0.001). Methamphetamine abuse was associated with profound global retinal nerve fiber layer thinning (Standardized Mean Difference -1.12, 95% Confidence Interval -1.55 to -0.69, p < 0.001) and reduced minimum rim width (Standardized Mean Difference -0.95, p < 0.001). Conclusion: Recreational cannabis and methamphetamine abuse cause significant, quantifiable ocular morbidity. Methamphetamine induces ischemic neurodegenerative retinal loss, while cannabis disrupts autonomic pupillary pathways and corneal integrity. Comprehensive ophthalmological screening is critical for individuals with substance abuse histories.

The Ocular Toll of Drug Tourism: A Systematic Review and Meta-Analysis of Cannabis and Methamphetamine Impact on Retinal Architecture and Pupillary Dynamics Fransiska Lavinia Gracella; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1584

Background: Drug tourism involves individuals traveling across international borders to access recreational illicit substances. While psychiatric and cardiovascular toxicities of substances like cannabis and methamphetamine are established, quantitative data regarding their impact on ocular microstructures and functional dynamics remain scarce. This study aims to systematically review and meta-analyze the structural and functional ocular alterations induced by these substances. Methods: A systematic review and meta-analysis complying with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were conducted. Electronic databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched from inception to January 2026. Data extraction targeted pupillary dynamics and structural optical coherence tomography measurements. Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tools. A DerSimonian-Laird random-effects model was utilized in Review Manager 5.4 to pool continuous data, calculating Standardized Mean Differences and 95% Confidence Intervals. Heterogeneity was evaluated via the I-squared statistic. Results: Nine primary research articles were included. The mean Newcastle-Ottawa Scale score was 8.1, indicating a low risk of bias. Chronic cannabis users exhibited significantly reduced pupillary constriction velocity (Standardized Mean Difference -0.85, 95% Confidence Interval -1.20 to -0.50, p < 0.001), prolonged reaction latency (Standardized Mean Difference 0.65, 95% Confidence Interval 0.30 to 1.00, p < 0.01), and decreased corneal endothelial cell density (Standardized Mean Difference -0.78, 95% Confidence Interval -1.15 to -0.41, p < 0.001). Methamphetamine abuse was associated with profound global retinal nerve fiber layer thinning (Standardized Mean Difference -1.12, 95% Confidence Interval -1.55 to -0.69, p < 0.001) and reduced minimum rim width (Standardized Mean Difference -0.95, p < 0.001). Conclusion: Recreational cannabis and methamphetamine abuse cause significant, quantifiable ocular morbidity. Methamphetamine induces ischemic neurodegenerative retinal loss, while cannabis disrupts autonomic pupillary pathways and corneal integrity. Comprehensive ophthalmological screening is critical for individuals with substance abuse histories.

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