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Open Access Indonesian Journal of Medical Reviews
Published by HM Publisher
ISSN : -     EISSN : 28076257     DOI : https://doi.org/10.37275/oaijmr
Core Subject : Health,
Health Professions Medicine & Pharmacology
Open Access Indonesian Journal of Medical Reviews (OAIJMR) is a bi-monthly, international, peer-review, and open access journal dedicated to various disciplines of medicine, biology and life sciences. The journal publishes all type of review articles, narrative review, meta-analysis, systematic review, mini-reviews and book review.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 200 Documents
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Navigating Pneumoperitoneum in Severe HFrEF: A Case Report on a Physiology-Based Anesthetic Strategy Setia Hilmi Mustajabah; Andy Nugroho; Muhammad Ridho Aditya
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.806

Abstract

Laparoscopic surgery in patients with severe heart failure with reduced ejection fraction (HFrEF) presents a formidable anesthetic challenge. The cardiovascular sequelae of pneumoperitoneum can precipitate acute hemodynamic collapse in a myocardium with minimal contractile reserve. This report details the anesthetic management of a high-risk patient with an extremely low ejection fraction undergoing laparoscopic cholecystectomy, focusing on a physiology-based approach. A 63-year-old, 72 kg male with severe HFrEF (ejection fraction 24%) and NYHA class III symptoms was scheduled for laparoscopic cholecystectomy. His ASA physical status was IV. Preoperative optimization ensured he was euvolemic and on guideline-directed medical therapy. Anesthetic induction was achieved with fentanyl (1.4 mcg/kg), atracurium (0.35 mg/kg), and ketamine (1 mg/kg). Following CO₂ insufflation, the patient developed profound bradycardia (42 bpm) and hypotension (MAP 58 mmHg). This anticipated crisis was managed with atropine and a supplemental ketamine bolus (0.3 mg/kg), successfully restoring hemodynamic stability. The procedure was completed uneventfully. In conclusion, this case demonstrates that a tailored anesthetic regimen, focused on intrinsic hemodynamic support and proactive crisis management, can be a safe and effective strategy in this high-risk cohort. The successful outcome hinged not on a single agent but on a comprehensive perioperative process encompassing meticulous optimization, a deliberate choice of anesthetic modality based on patient pathophysiology, goal-directed intraoperative therapy, and a structured transition to postoperative care.
Malignant Pericardial Effusion in Lung Adenocarcinoma: When to Escalate from Pericardiocentesis to Open Pericardiostomy Ibnu Kharisman; Prima Kharisma Hayuningrat
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.810

Abstract

Malignant pericardial effusion (MPE) is a grave, life-limiting complication of advanced cancer, where lung adenocarcinoma is a leading cause. Its management is a cornerstone of palliative cardio-oncology, focused on alleviating debilitating dyspnea and enhancing the quality of remaining life. The optimal therapeutic pathway, especially following the failure of initial interventions, remains a critical challenge, demanding a careful balance between efficacy and treatment burden. A 58-year-old female with stage IV lung adenocarcinoma and a good baseline performance status (ECOG 1) presented with progressive, life-limiting dyspnea (NYHA Class IV). A massive pericardial effusion was diagnosed, and an initial pericardiocentesis provided only transient relief, with severe symptoms recurring within 48 hours. Following a multidisciplinary discussion centered on the patient’s goals of care, the decision was made to escalate to a definitive surgical procedure. A subxiphoid open pericardiostomy was performed, yielding hemorrhagic fluid and pericardial tissue that confirmed metastatic adenocarcinoma. The procedure resulted in complete, durable resolution of her symptoms. In conclusion, open pericardiostomy provides durable relief from the life-limiting dyspnea of MPE, a goal often unachievable with pericardiocentesis alone. For appropriately selected patients with advanced cancer, escalating to a definitive surgical procedure is not merely a treatment for effusion but a crucial intervention to restore function and dignity. This case underscores that for patients with recurrent MPE and adequate performance status, timely surgical intervention is a vital component of effective palliative care, maximizing quality of life.
The Paradox of Negative Antibody Screening and Positive Crossmatching: Implications for Transfusion Safety in a Developing Country Suryanto; Adang Muhammad Gugun
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.811

Abstract

Modern antibody screening is a pillar of transfusion safety, intended to prevent hemolytic reactions. However, its ultimate effectiveness, particularly in diverse populations within developing nations where abbreviated crossmatch protocols are not feasible, remains a critical question. This study investigates the "safety gap" between negative screening results and final patient-donor compatibility, aiming to quantify the incidence of serological incompatibility detected by mandatory crossmatching in a tertiary hospital in Indonesia. A descriptive, cross-sectional study was conducted from March to June 2024 at the Blood Bank of PKU Muhammadiyah Yogyakarta Hospital. A total of 299 donor-recipient pairs were analyzed via total sampling. Donor units were screened for irregular antibodies using an automated Column Agglutination Technology (Gel Test) with comprehensive three-cell panels. Subsequently, major and minor crossmatches for all pairs were performed using a Gel Test-based Indirect Antiglobulin Test (IAT) incubated for 15 minutes at 37°C. All 299 donor samples (100%) yielded negative results for irregular antibodies during screening. However, the final crossmatch revealed serological incompatibilities. Major crossmatching (patient serum vs. donor cells) identified incompatibility in 4 cases (1.34%). Minor crossmatching (donor serum vs. patient cells) showed a significantly higher rate of incompatibility, found in 21 cases (7.03%). The predominant blood component transfused was Packed Red Cells (91.97%). In conclusion, the findings demonstrate a significant paradox where a substantial rate of serological incompatibility is only detected by the final crossmatch. This study quantitatively confirms that antibody screening alone is insufficient to guarantee blood compatibility. These results challenge the safety of adopting abbreviated crossmatch protocols in this setting and affirm that the physical crossmatch remains an indispensable, non-negotiable safeguard. This provides critical, region-specific evidence for strengthening hemovigilance systems and reinforcing transfusion policies in Indonesia and other resource-limited nations.
Anticoagulation Failure: Deep Vein Thrombosis Despite Severe Coagulopathy in a Patient with Mechanical Heart Valves Anak Agung Sagung Karinia Jaya; I Made Agus Endra Permana
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.813

Abstract

The management of patients with mechanical heart valves on chronic warfarin therapy is a delicate balance between preventing thromboembolism and avoiding hemorrhage. The emergence of an acute thrombotic event despite a critically elevated International Normalized Ratio (INR) represents a profound clinical paradox and a significant management dilemma. This report details such a case, offering a deep exploration of the underlying pathophysiology. A 34-year-old female with dual mechanical heart valves for severe rheumatic heart disease, maintained on a variable-dose warfarin regimen, presented with acute deep vein thrombosis (DVT) of the right lower limb. Her INR was critically elevated at 7.78. A detailed history revealed recent poor oral intake followed by inconsistent dietary changes, contributing to extreme INR lability. Diagnostic investigations confirmed a non-occlusive, distal DVT. The management strategy involved immediate cessation of warfarin without the administration of reversal agents, prioritizing the prevention of mechanical valve thrombosis. The INR was allowed to normalize gradually over 72 hours, with concurrent clinical improvement. Warfarin was cautiously re-initiated, and a long-term management plan focusing on intensive education and monitoring was established. In conclusion, this case demonstrates that a supratherapeutic INR does not confer absolute protection against venous thrombosis in patients with potent, underlying prothrombotic risk factors. The principles of Virchow's triad—particularly venous stasis from chronic heart failure and a persistent hypercoagulable state from prosthetic valves and systemic inflammation—can override the systemic anticoagulant effect measured by the INR. Management of this paradox requires a highly individualized, pathophysiology-driven strategy that carefully weighs the competing risks of hemorrhage, thrombus extension, and catastrophic valve thrombosis.
Efficacy of Oral Chemolytic Dissolution for Uric Acid and Cystine Urolithiasis: A Systematic Review and Meta-Analysis of Contemporary Primary Evidence Muhammad Bintang Iqbal; Jufriady Ismy
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.814

Abstract

Uric acid (UA) and cystine urolithiasis pose unique treatment challenges due to their metabolic origin and high recurrence rates. Oral chemolysis, which targets their underlying pathophysiology, is an alternative to surgical intervention. This study aims to provide a quantitative synthesis of its dissolution efficacy and impact on recurrence based on contemporary primary data. Following PRISMA guidelines, we systematically searched PubMed, Scopus, and the Cochrane Library from January 2015 to October 2025. We included randomized controlled trials (RCTs) and observational studies evaluating oral chemolysis (alkalizing agents for UA; thiol-based agents for cystine) in adults. Primary outcomes (complete stone dissolution) and secondary outcomes (recurrence) were pooled using a random-effects model with Restricted Maximum Likelihood (REML) estimation. Nine primary studies involving 812 patients met the inclusion criteria. For uric acid stones (6 studies, n=597), the pooled proportion of complete dissolution was 69.2% (95% CI: 62.1% - 76.3%; I²=48%). Continuous alkalization therapy was associated with a 66% reduction in 2-year recurrence (Risk Ratio [RR] 0.34; 95% CI: 0.23 - 0.50). For cystine stones (3 studies, n=215), the pooled dissolution rate based on a small cohort was 33.1% (95% CI: 25.0% - 41.2%; I²=29%). Thiol-based therapy was associated with a 40% reduction in 2-year recurrence (RR 0.60; 95% CI: 0.41 - 0.88). In conclusion, oral alkalization is a highly effective primary therapy for appropriately selected patients with uric acid stones. For the more recalcitrant cystine stones, dissolution efficacy is modest and based on limited data, positioning chemolysis as a critical adjunctive therapy. These findings reinforce clinical guideline recommendations for a pathophysiology-based medical approach in non-obstructing metabolic stones.
A Hematological Triad: Dissecting Synergistic Oxidative and Immune Hemolysis in Dapsone-Treated G6PD Deficiency Devina Ravelia Tiffany Subroto; I Putu Bayu Triguna
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.817

Abstract

Dapsone, a key component of leprosy multidrug therapy (MDT), is a well-known precipitant of oxidative hemolytic anemia in individuals with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency. Conversely, Dapsone-induced immune hemolytic anemia (DIIHA) is exceedingly rare. The concurrent presentation of both severe oxidative hemolysis and a positive Direct Antiglobulin Test (DAT) in a patient also receiving Rifampicin creates a profound diagnostic and mechanistic challenge. We present the case of a 42-year-old female with multibacillary leprosy who developed life-threatening, multifactorial hemolytic anemia (Hemoglobin 5.3 g/dL) three months after initiating MDT (Dapsone, Rifampicin, Clofazimine). A comprehensive diagnostic workup was performed, including detailed hematopathology and quantitative G6PD assay. The immunohematological evaluation was positive (DAT and IAT), but critical sub-testing, including monospecific DATs, was unavailable. The workup confirmed severe oxidative hemolysis (Heinz bodies, degmacytes) in the setting of G6PD deficiency (6.0 U/g Hb measured during 12.5% reticulocytosis). Concurrently, the polyspecific DAT and IAT were strongly positive with a pan-reactive antibody, confirming a simultaneous immune-mediated process. Due to polypharmacy (Dapsone, Rifampicin) and incomplete immunohematological data, the precise trigger for the DIIHA component—whether a rare Dapsone-induced autoantibody, a Rifampicin-induced immune-complex, or an oxidative-trigger mechanism—could not be definitively isolated. In conclusion, this case unmasks a complex, synergistic pathophysiology of concurrent oxidative and immune hemolysis. The inability to attribute the autoimmune component definitively to either Dapsone or Rifampicin highlights a critical diagnostic gap. This report underscores the necessity of a complete immunohematological workup (including monospecific DATs) in such cases and demonstrates that management must be multifaceted—addressing both the oxidative insult (drug cessation) and the severe immune-mediated destruction (immunosuppression), even in the face of etiological uncertainty.
Comparative Efficacy and Safety of Individual SGLT2 Inhibitors (Dapagliflozin, Empagliflozin, and Canagliflozin) on Kidney Function Decline in CKD: A Systematic Review and Network Meta-Analysis Krismeikesari Krismeikesari
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.818

Abstract

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a cornerstone therapy for chronic kidney disease (CKD). However, direct head-to-head randomized controlled trials (RCTs) comparing individual agents are absent. We aimed to compare the relative efficacy and safety of dapagliflozin, empagliflozin, and canagliflozin on kidney function decline in CKD patients. We conducted a PRISMA-NMA compliant systematic review and Bayesian network meta-analysis (NMA). MEDLINE, Embase, and CENTRAL were searched for Phase 3 RCTs with more than 1000 participants comparing dapagliflozin, empagliflozin, or canagliflozin with placebo in adults with CKD. The primary efficacy outcome was a composite of sustained greater than or equal to 50 percent estimated GFR (eGFR) decline, end-stage kidney disease (ESKD), or renal/cardiovascular (CV) death. Nine landmark RCTs (DAPA-CKD, EMPA-KIDNEY, CREDENCE, DECLARE-TIMI 58, EMPA-REG OUTCOME, CANVAS, DAPA-HF, EMPEROR-Pooled, and DELIVER) enrolling a total of 89,452 patients were included. All agents were significantly superior to placebo. The NMA found no statistically significant evidence of superiority for any agent over another for the primary outcome: dapagliflozin vs. empagliflozin (Hazard Ratio [HR] 0.92; 95% Credible Interval [CrI] 0.81-1.06), dapagliflozin vs. canagliflozin (HR 0.94; 95% CrI 0.82-1.09), and empagliflozin vs. canagliflozin (HR 1.02; 95% CrI 0.89-1.17). These findings were robust across multiple sensitivity analyses and consistent for secondary renal and key safety outcomes, including acute kidney injury (AKI) and diabetic ketoacidosis (DKA). This comprehensive NMA found no statistically significant differences in the renoprotective efficacy or safety of dapagliflozin, empagliflozin, and canagliflozin. The findings are consistent with a potent class effect, but do not establish formal equivalence. This suggests the choice among these three agents can be guided by patient-specific co-morbidities, cost, and formulary availability rather than an assumed difference in relative kidney efficacy.
Comparative Efficacy and Safety of Finerenone, Eplerenone, and Spironolactone on Cardiorenal Outcomes in Type 2 Diabetes with Chronic Kidney Disease: A Systematic Review and Network Meta-Analysis Krismeikesari Krismeikesari
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.819

Abstract

Mineralocorticoid receptor antagonists (MRAs) are critical for managing chronic kidney disease (CKD) in type 2 diabetes (T2D), yet a "residual risk" of cardiorenal progression persists. The comparative efficacy and safety of the novel non-steroidal MRA, finerenone, versus the traditional steroidal MRAs, spironolactone and eplerenone, have not been established in a comprehensive analysis. We conducted a network meta-analysis (NMA) to create an evidence-based hierarchy for these three agents. We performed a systematic review searching MEDLINE, Embase, and Cochrane CENTRAL through March 2025 for randomized controlled trials (RCTs) in patients with CKD and albuminuria (predominantly T2D) on baseline renin-angiotensin system (RAS) blockade. We compared finerenone, spironolactone, eplerenone, and placebo. The primary efficacy outcome was the percent change in urinary albumin-to-creatinine ratio (UACR). The primary safety outcome was the relative risk (RR) of hyperkalemia (serum potassium ³ 5.5 mmol/L). A Bayesian random-effects NMA was performed. Seven RCTs involving 15,749 patients were included. For UACR reduction, all MRAs were superior to placebo. Spironolactone (Surface Under the Cumulative Ranking [SUCRA]: 91.2%) and finerenone (SUCRA: 88.5%) were the most effective agents and were statistically indistinguishable. Both were significantly more potent than eplerenone (SUCRA: 58.1%). For hyperkalemia risk, spironolactone was definitively the least safe (SUCRA: 9.5%). Finerenone (RR vs. Spironolactone: 0.63; 95% Credible Interval [CrI]: 0.48–0.82) and eplerenone (RR vs. Spironolactone: 0.65; 95% CrI: 0.45–0.94) were significantly safer. The safety profiles of finerenone (SUCRA: 65.4%) and eplerenone (SUCRA: 62.1%) were comparable.In conclusion, finerenone and spironolactone demonstrate equivalent, superior anti-albuminuric efficacy. However, finerenone uniquely dissociates this high potency from the significant risk of hyperkalemia, offering a safety profile comparable to the less-potent eplerenone. Finerenone, therefore, represents an optimized therapeutic choice, balancing maximal renoprotective efficacy with a superior safety profile for patients with T2D and CKD.
Neurohormonal Synchronization in the Face of Exhaustion: Unveiling the Cortisol-Oxytocin Crosstalk in Type 2 Diabetes Patients with Severe Distress and HPA Axis Blunting Adang Muhammad Gugun; Yusuf Alam Romadhon; Suryanto; Alyssa Sindy Jatiningtyas; Sania Nurul Qurrata
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.824

Abstract

Type 2 diabetes mellitus (T2DM) is increasingly conceptualized as a complex psychoneuroendocrine disorder. While acute physiological stress typically induces hypercortisolemia, chronic diabetes distress may lead to allostatic overload and Hypothalamic-Pituitary-Adrenal (HPA) axis blunting. The compensatory role of oxytocin, a stress-buffering neuropeptide, remains underexplored in this specific clinical phenotype. This study aimed to characterize the neuroendocrine phenotype of patients with uncontrolled T2DM and severe distress, specifically investigating the synchronization between serum cortisol and oxytocin as a marker of homeostatic regulation. In this analytic cross-sectional study, 86 patients with uncontrolled T2DM (HbA1c greater than or equal to 7.0%) and severe diabetes distress (Diabetes Distress Scale-17 mean score greater than or equal to 3.0) were recruited via purposive sampling. Strict exclusion criteria were applied for exogenous steroid use and renal failure to ensure biological validity. Fasting morning serum cortisol and oxytocin were analyzed using Enzyme-Linked Immunosorbent Assays (ELISA). Statistical analysis utilized Spearman’s rank correlation and multivariate linear regression, controlling for Body Mass Index and age. The cohort exhibited severe metabolic dysregulation (Mean HbA1c: 10.03 ± 2.10%) and psychological distress (Mean DDS: 4.65 ± 0.35). Paradoxically, mean morning cortisol was low-normal (170.32 ± 135.43 nmol/L), suggestive of HPA axis blunting rather than the expected hypercortisolemia. A robust positive correlation was observed between cortisol and oxytocin (r = 0.555, p < 0.001). Multivariate regression confirmed cortisol as a significant independent predictor of oxytocin levels (b = 0.521, p < 0.001), independent of metabolic confounders. In conclusion, patients with severe diabetes distress display a distinct phenotype of HPA axis exhaustion coupled with synchronized oxytocinergic activity. This suggests a preserved reactive mobilization mechanism where oxytocin is upregulated in tandem with adrenal output to buffer chronic allostatic load. These findings highlight the potential of the oxytocinergic system as a therapeutic target in diabetes burnout.
Severe Hyponatremia with Normokalemia in Pembrolizumab-Lenvatinib Combination Therapy for Metastatic Renal Cell Carcinoma: A Case of Suspected Secondary Adrenal Insufficiency and Clinical Differentials Devina Ravelia Tiffany Subroto; Steven Jonathan; I Putu Bayu Triguna
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.826

Abstract

The combination of Pembrolizumab and Lenvatinib has become the standard first-line treatment for advanced renal cell carcinoma (RCC). However, the overlapping toxicity profiles of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) create significant diagnostic challenges, particularly regarding electrolyte disturbances. Differentiating ICI-induced secondary adrenal insufficiency from TKI-induced toxicity or syndrome of inappropriate antidiuretic hormone (SIADH) is critical, especially in resource-limited settings where rapid hormonal assays are unavailable. A 67-year-old male with metastatic clear cell RCC presented with confusion, fatigue, and nausea 14 days after initiating palliative Pembrolizumab and Lenvatinib. He had a history of partial nephrectomy and was on Candesartan. Evaluation revealed severe hypotonic hyponatremia (113 mmol/L), acute kidney injury (Creatinine 2.2 mg/dL), and a hypertensive crisis (BP 229/138 mmHg). Notably, despite renal impairment and angiotensin receptor blocker therapy, potassium levels were normal (4.2 mmol/L). The hyponatremia was refractory to 3% hypertonic saline. Suspecting secondary adrenal insufficiency, empiric high-dose corticosteroids were administered, resulting in rapid normalization of serum sodium and resolution of symptoms. In conclusion, in patients receiving ICI-TKI therapy, the specific profile of severe hyponatremia with normokalemia—particularly in the context of renal insufficiency and RAAS blockade—serves as a high-value clinical indicator of preserved mineralocorticoid function. This points toward secondary adrenal insufficiency rather than primary adrenal injury or TKI-induced renal tubular acidosis. This case underscores the utility of deductive physiology in oncology practice.

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