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Contact Name
Rachmat Hidayat
Contact Email
dr.rachmat.hidayat@gmail.com
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+6281949581088
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editor.bioscmed@gmail.com
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Jl. Sirna Raga no 99, 8 Ilir, Ilir Timur 3, Palembang
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Kota palembang,
Sumatera selatan
INDONESIA
Bioscientia Medicina : Journal of Biomedicine and Translational Research
Published by HM Publisher
ISSN : -     EISSN : 25980580     DOI : https://doi.org/10.37275/bsm
Core Subject : Health, Science,
This journal welcomes the submission of articles that offering a sensible transfer of basic research to applied clinical medicine. BioScientia Medicina covers the latest developments in various fields of biomedicine with special attention to : 1.Rhemumatology 2.Molecular aspect of Indonesia Traditional Herb 3.Cardiology and Cardiovascular diseases 4.Genetics 5.Immunology 6.Environmental health 7.Toxicology 8. Neurology 9. Pharmacology 10. Oncology 11. Other multidisciplinary studies related medicine. The views of experts on current advances in nanotechnology and molecular/cell biology will be also considered for publication as long as they have a direct clinical impact on human health.
Articles 1,518 Documents
Comparative Efficacy, Safety, and Patient Preference of One-Month (1HP) versus Three-Month (3HP) Rifapentine-Based Regimens for Latent Tuberculosis: A Network Meta-Analysis of HIV, Silicosis, and General Risk Populations Muhammad Ridwan; Roza Kurniati; Fauzar
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.v10i3.1544

Abstract

Background: The programmatic management of latent tuberculosis infection (LTBI) is undergoing a paradigm shift from long-course isoniazid monotherapy to short-course rifamycin-based regimens. While the 3-month weekly rifapentine/isoniazid (3HP) regimen is well-established, the ultra-short 1-month daily rifapentine/isoniazid (1HP) regimen offers a potential advancement in adherence. However, concerns regarding systemic hypersensitivity reactions, hepatotoxicity mechanisms, and efficacy in non-HIV populations like silicosis remain. Methods: We conducted a systematic review and network meta-analysis (NMA) utilizing a random-effects frequentist model. We executed a comprehensive search of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials to identify randomized controlled trials comparing rifapentine-based regimens. We analyzed data comprising over 10,000 participants to evaluate the efficacy (prevention of active TB), safety (hepatotoxicity and hypersensitivity), and completion rates of 1HP, 3HP, 4-month rifampin (4R), and 9-month isoniazid (9H). We specifically integrated novel data on silicosis patients and patient preference metrics. Results: The network analysis demonstrated that 1HP was non-inferior to 9H in preventing active tuberculosis (Incidence Rate Difference: -0.02 per 100 person-years). 1HP achieved the highest treatment completion rate (97%), significantly superior to 3HP (82%) and 9H (69%). Safety analysis revealed a distinct divergence: 3HP was associated with a higher incidence of systemic flu-like drug reactions (3.5%) compared to 9H (0.4%), whereas 1HP demonstrated a safety profile that minimized both the hepatotoxicity of isoniazid and the hypersensitivity of intermittent rifapentine. In silicosis patients, modified 1-month regimens proved safe. However, preference analysis indicated that 81% of patients preferred the weekly dosing of 3HP over the daily burden of 1HP. Conclusion: 1HP represents the most effective strategy for maximizing treatment completion without compromising bactericidal activity. The daily dosing of 1HP appears to induce immune tolerance, mitigating the hypersensitivity reactions observed in weekly 3HP dosing. While 3HP remains a viable option for those preferring less frequent dosing, 1HP is the superior clinical recommendation for rapid sterilization of latent reservoirs.
Vitamin D Supplementation Efficacy in Severe Vitamin D-Deficient versus Insufficient COPD Patients: A Stratified Meta-Analysis of Exacerbation Risk Ikhsan Tri Kurnia; Dewi Wijaya
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.v10i3.1545

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airway inflammation and recurrent exacerbations that accelerate disease progression. Vitamin D deficiency is highly prevalent in this population and correlates with impaired macrophage function. However, randomized controlled trials regarding supplementation have yielded conflicting results. We hypothesized that efficacy is limited by a ceiling effect, where benefits are strictly restricted to patients with profound baseline deficiency. Methods: We conducted a systematic review and stratified meta-analysis of randomized controlled trials comparing Vitamin D supplementation to placebo in COPD. To ensure methodological homogeneity and avoid data duplication, we strictly included only primary RCTs and excluded aggregate IPD meta-analyses. Studies investigating acute treatment of active exacerbations were also excluded. Data were stratified by baseline serum 25-hydroxyvitamin D [25(OH)D] levels into Severe Deficiency (<10 ng/mL) versus Insufficiency/Sufficiency (≥10 ng/mL). The primary outcome was the risk of moderate-to-severe exacerbations, analyzed using pooled Odds Ratios (OR) with a random-effects model. Results: Five pivotal prevention trials (Lehouck, PRECOVID, ViDA, Hornikx, and Rafiq Pilot) comprising approximately 1,212 participants were included in the quantitative synthesis. In the unstratified analysis, Vitamin D showed no significant benefit (OR 0.78; 95% CI 0.55–1.10). However, stratification revealed a distinct therapeutic window. Patients with severe deficiency (<10 ng/mL) experienced a statistically significant reduction in exacerbation risk (Pooled OR 0.51; 95% CI 0.32–0.87; p=0.012). This effect was driven primarily by trials utilizing high-dose bolus supplementation. Conversely, patients with baseline levels ≥10 ng/mL showed no benefit (OR 0.98; p=0.72), confirming the biological ceiling effect. Conclusion: Vitamin D supplementation confers a significant protective benefit against COPD exacerbations exclusively in patients with severe baseline deficiency (<10 ng/mL). The results support a precision medicine approach—screen, stratify, and target—while cautioning that efficacy appears dependent on correcting profound deficiency, potentially utilizing high-dose intermittent regimens.
Thresholds of Cytoprotection: Ethanolic Propolis Extract Mitigates Ischemia-Reperfusion Injury via the MDA/IL-6 Axis in a Graded Rat Skin Flap Model Dinar Kukuh Prasetyo; Amru Sungkar; Brian Wasita
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.v10i3.1546

Abstract

Background: Distal necrosis in reconstructive skin flaps results from ischemia-reperfusion (I/R) injury, driven by reactive oxygen species (ROS) and pro-inflammatory cytokines. While Propolis exhibits antioxidant properties, its efficacy limit relative to the severity of ischemic challenge remains undefined. Methods: A randomized, controlled experimental study was conducted using 36 male Wistar rats. A graded ischemia model was engineered using modified McFarlane flaps with increasing length-to-width ratios: Mild (2:1), moderate (3:1), and severe (4:1). Subjects were stratified into vehicle (Control) and treatment (Propolis 800 mg/kg/day, oral) groups across all dimensions. The primary endpoint was the percentage of viable flap area on Day 7. Secondary endpoints included serum Malondialdehyde (MDA), Interleukin-6 (IL-6), and histological scoring of inflammation. Results: All animals survived the procedure. Propolis significantly increased viable tissue area in the moderate ischemia group (76.4 ± 4.2%) compared to Vehicle (52.1 ± 5.8%; p < 0.001). In Mild ischemia, survival was near-maximal in both groups (>92%). However, in Severe ischemia, Propolis failed to prevent significant necrosis (34.2 ± 6.1% survival vs. 28.5 ± 5.4% in Vehicle; p = 0.092), indicating a therapeutic ceiling. Biochemically, Propolis suppressed MDA (11.92 ± 0.45 nmol/mL) and IL-6 (121.0 ± 4.71 pg/mL) significantly in moderate challenges but was overwhelmed by the oxidative surge in severe ischemia (MDA > 12.0 nmol/mL). Conclusion: Propolis confers significant protection against I/R injury by dampening lipid peroxidation and systemic inflammation, but this effect exhibits a distinct threshold. It is highly effective in moderate ischemic challenges but insufficient for severe vascular compromise.
Levator Ani Avulsion as the Key Mediator Between Vaginal Delivery and Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis of Imaging Studies Heristanto; Rahajeng
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (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.v10i4.1547

Abstract

Background: Vaginal childbirth is universally recognized as the primary etiological factor for pelvic organ prolapse (POP), yet the precise biomechanical cascade remains a subject of intense investigation. While connective tissue attenuation contributes to support failure, recent advanced imaging evidence suggests that levator ani avulsion (LAA)—a macroscopic traumatic detachment of the puborectalis muscle from the pubic ramus—acts as the fundamental structural mediator. This study aimed to systematically review and meta-analyze imaging-based literature to quantify the mediating role of LAA in the pathogenesis of POP. Methods: We conducted a systematic review and meta-analysis of observational studies utilizing magnetic resonance imaging (MRI) and 3D/4D Transperineal Ultrasound. The search strategy targeted longitudinal and cross-sectional studies comparing women with confirmed LAA to those with intact pelvic floors following vaginal delivery. Data were extracted regarding the prevalence of avulsion, pelvic organ prolapse quantification (POP-Q) stages, and levator hiatus dimensions. The primary outcome was the Odds Ratio (OR) of significant POP (Stage ³2). Secondary outcomes included quantitative analysis of hiatal ballooning. Data were synthesized using a random-effects model. Results: The analysis included 3,218 women across 9 high-quality imaging studies. The pooled analysis revealed a profound and statistically significant association between LAA and POP, with a pooled Odds Ratio of 3.84 (95% CI: 2.65–5.56; p < 0.0001). Women with LAA demonstrated a significantly larger levator hiatal area on Valsalva compared to those with intact muscles (Mean Difference: +6.03 cm²), confirming that avulsion leads to intractable hiatal ballooning. Long-term follow-up data (up to 23 years) indicated that this muscular defect does not heal and is associated with a progressive deterioration in pelvic organ support over time. Conclusion: Levator ani avulsion is the critical biomechanical mediator converting the event of vaginal delivery into the chronic pathology of prolapse. The injury compromises the dynamic closure of the levator hiatus, resulting in hiatal ballooning and subsequent apical and anterior compartment descent. These findings necessitate a paradigm shift in obstetric counseling and emphasize the need for preventative strategies to minimize traumatic muscle injury during the second stage of labor.
The FAPI-FDG Mismatch: Unmasking an Occult Pancreatic Lesion via Fibroblast Activation Imaging Amidst Negative Glucose Metabolism and Morphological Findings Nur Rohmat Maulana Saepudin; Hendra Budiawan; Arifudin Achmad; Trias Nugrahadi; A Hussein S Kartamihardja
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1548

Abstract

Background: Fibroblast activation protein inhibitor (FAPI) positron emission tomography (PET) has emerged as a promising modality for imaging the tumor microenvironment, specifically targeting cancer-associated fibroblasts (CAFs). While 18F-FDG targets glucose metabolism, 68Ga-FAPI targets stromal activation. Discrepancies between these modalities can offer unique insights into early pathogenesis. We report a rare case of incidental focal pancreatic uptake on 68Ga-FAPI PET/CT in a patient with prostate cancer, occurring in the absence of metabolic activity on 18F-FDG PET/CT or anatomical abnormalities on contrast-enhanced CT. Case presentation: A 75-year-old male with a history of acinar adenocarcinoma of the prostate (Gleason 7, post-TURP) underwent multimodal staging to evaluate for metastasis. 68Ga-PSMA PET/CT showed intermediate uptake in the prostate but no distant metastasis. Subsequent 68Ga-FAPI-04 PET/CT revealed a striking, intense focal uptake in the pancreatic body. Conversely, follow-up 18F-FDG PET/CT demonstrated physiological background uptake in the pancreas, and abdominal CT showed no pancreatic mass. Laboratory results indicated a slightly elevated CA 19-9 (45.6 U/mL). The findings present a diagnostic dilemma between early stromal-rich malignancy and focal inflammatory processes. Conclusion: This case highlights the FAPI-FDG Mismatch, suggesting that stromal remodeling may precede metabolic reprogramming and morphological changes in pancreatic lesions. 68Ga-FAPI PET/CT demonstrates superior sensitivity for detecting occult stromal activity, necessitating new diagnostic algorithms for incidentalomas in the era of stromal imaging.
Circulating Syndecan-1 as a Biomarker of Endothelial Injury and Survival in Hemodialysis: A Systematic Review and Meta-Analysis of Hemodynamic and Prognostic Associations Redo Augusta M Sabebegen; Deka Viotra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1549

Abstract

Background: Cardiovascular disease remains the primary cause of mortality in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). Conventional risk factors fail to fully explain the high prevalence of resistant hypertension and intradialytic hemodynamic instability in this population. Emerging evidence points to the degradation of the endothelial glycocalyx (eGC), a protective luminal layer regulating vascular tone and permeability. Syndecan-1 (SDC-1), a core component of the eGC, sheds into the circulation during vascular stress. This study aimed to synthesize evidence regarding the magnitude of dialysis-induced SDC-1 shedding and its validity as a prognostic biomarker for survival and vascular stiffness. M ethods: We conducted a systematic review and associative meta-analysis of observational studies and clinical trials. We searched Scopus, PubMed, and Web of Science for studies quantifying serum SDC-1 in HD patients and relevant physiologic comparators. Data were stratified to analyze three domains: the second hit phenomenon (acute pre- vs. post-dialysis shedding), diagnostic correlations with pulse wave velocity (PWV) and fluid status, and prognostic hazard ratios (HR) for all-cause mortality. A random-effects model was employed to account for population heterogeneity, specifically stratifying hemodialysis cohorts from heart failure comparators. Results: Ten pivotal studies involving over 1,500 patients were included. The analysis confirmed a substantial acute surge in serum SDC-1 post-hemodialysis (Standardized Mean Difference = 1.24, p < 0.001), indicating that the dialysis procedure actively injures the endothelium. Elevated baseline SDC-1 correlated significantly with arterial stiffness (PWV) and sodium overload, supporting a mechanism of salt-induced vascular stiffening. In prognostic analysis, high SDC-1 was a robust independent predictor of mortality (Pooled HR = 1.65, 95% CI: 1.12–2.43). Conclusion: Hemodialysis acts as a vascular stressor, triggering acute shedding of the endothelial glycocalyx. This shedding is mechanistically linked to sodium dysregulation and vascular stiffness, independent of traditional uremic toxins. SDC-1 serves as a valuable prognostic marker for endothelial health and survival, suggesting a need for endothelium-protective dialysis strategies.
Utility of Tc-99m DTPA Hybrid SPECT/CT Cisternography in the Detection of Occult Postoperative CSF Fistula in an Infant with Lipomeningomyelocele: A Diagnostic Challenge and Technical Considerations I Kadek Herry Hermawan; Achmad Hussein Sundawa Kartamihardja; Trias Nugrahadi; Reza Rinaldy Harahap
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1550

Abstract

Background: Lipomeningomyelocele represents a complex spectrum of closed spinal dysraphism where surgical repair is frequently complicated by cerebrospinal fluid leakage. While overt fistulas are clinically apparent, occult or intermittent leaks in the pediatric population pose a severe diagnostic challenge. Magnetic resonance imaging, despite being the anatomical gold standard, frequently fails to distinguish active extravasation from postoperative seroma or edema due to overlapping signal intensities. This study evaluates the diagnostic superiority of Tc-99m DTPA Hybrid SPECT/CT cisternography in resolving this dilemma. Case presentation: A 5-month-old female underwent resection of a large lumbosacral lipomeningomyelocele. Postoperatively, she developed persistent, clear fluid discharge from the incision, suggestive of a fistula, yet initial surgical re-exploration was inconclusive. The patient underwent radionuclide cisternography using 37 MBq of intrathecal Tc-99m DTPA. Standard planar scintigraphy at 1 hour and 3 hours was equivocal due to background renal activity. However, Hybrid SPECT/CT performed at 3 hours precisely localized an abnormal radiotracer tract extending from the thecal sac at L5 into the right multifidus muscle, a finding invisible on conventional imaging. Conclusion: The integration of physiological flow data from scintigraphy with the anatomical specificity of low-dose CT allows for the detection of slow-flow, occult leaks that evade MRI. In infants with distorted post-surgical anatomy, Hybrid SPECT/CT should be elevated from a problem-solving tool to a primary diagnostic modality when clinical suspicion persists. The technique facilitates targeted repair, minimizing morbidity in this vulnerable population.
Metabolic Dysfunction Precedes Dopaminergic Loss in Early MSA-C: A Discordant 18F-FDG PET and 99mTc-TRODAT-1 Case Study Arvian Muhammad Barid; Kharisma Perdani; Trias Nugrahadi; A Hussein S Kartamihardja
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1551

Abstract

Background: Differentiating early-stage multiple system atrophy-cerebellar type (MSA-C) from other ataxia syndromes presents a significant diagnostic challenge. While striatal dopaminergic denervation is a hallmark of synucleinopathies, it may be absent in the early stages of the cerebellar subtype. This study investigates the temporal dissociation between metabolic and dopaminergic biomarkers. Case Presentation: We report a 48-year-old male presenting with a 5-year history of progressive cerebellar ataxia and mild Parkinsonism, resistant to dopaminergic therapy. Written informed consent was obtained from the patient for the publication of this case details and images. To exclude mimics, a basic metabolic workup and High-resolution 3T MRI were performed. MRI revealed mild cerebellar atrophy but lacked the specific hot cross bun sign. Wilson’s disease screening was negative. Due to limited resources, advanced genetic panels for spinocerebellar ataxias were not performed. The patient underwent dual-modality molecular imaging. On Day 1, 18F-FDG PET/CT demonstrated profound hypometabolism in the cerebellum (Cerebellum/Whole-Brain SUVr: 0.68) and pons (SUVr: 0.72). Conversely, on Day 30, 99mTc-TRODAT-1 SPECT revealed robust, symmetrical striatal uptake with Specific Binding Ratios (SBR) of 1.15 (Right) and 1.12 (Left), indicating preserved presynaptic dopamine transporter density. Conclusion: This case illustrates a critical temporal dissociation in MSA-C pathophysiology: widespread pontocerebellar metabolic failure occurs prior to structural nigrostriatal degeneration. Clinicians must recognize that a normal DAT scan does not exclude MSA-C. In limited-resource settings where genetic testing is unavailable, 18F-FDG PET offers superior sensitivity in the early diagnostic window to support the diagnosis.
Therapeutic Outcomes of Secukinumab 300 mg in Severe Psoriasis Vulgaris with Metabolic Comorbidities: A Retrospective Cohort Study in Bali Prima Sanjiwani Saraswati Sudarsa; Mario Korwa; Nyoman Suryawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1552

Abstract

Background: Psoriasis vulgaris is a systemic inflammatory disease increasingly prevalent in Southeast Asia, often complicated by metabolic syndrome. While Secukinumab, an IL-17A inhibitor, is established in Western cohorts, real-world data on its efficacy in Indonesian populations with high adiposity burdens are scarce. This study evaluates the therapeutic response and safety of Secukinumab 300 mg in a Balinese cohort characterized by severe disease and metabolic risk factors. Methods: We conducted a retrospective cohort study at a tertiary referral center in Bali from January 2023 to December 2024. The study included 39 adult patients with moderate-to-severe psoriasis treated with Secukinumab 300 mg. The primary endpoint was the proportion of patients achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI 75) at Week 17. Fisher’s Exact Test was employed to analyze response differences between obese and non-obese subgroups. Results: The cohort exhibited a high systemic burden: 44.2% were obese (Body Mass Index greater than or equal to 25 kg/m2), and 53.8% had concomitant psoriatic arthritis. Baseline disease severity was high with a median body surface area of 25.0%. At week 17, 32 patients (82.1%; 95% confidence interval: 67.3–91.0%) achieved PASI 75. Subgroup analysis revealed no statistically significant difference in response rates between obese and non-obese patients (p > 0.99), suggesting efficacy is maintained despite metabolic burden. No severe adverse events or discontinuations were documented in the medical records. Conclusion: Secukinumab 300 mg demonstrates substantial efficacy in an Indonesian population with a severe phenotypic profile, maintaining therapeutic clearance in metabolically compromised patients. The safety profile appears favorable, though limited by retrospective data capture.
The Cardiovascular Burden of Fine Particulate Matter in Asia: A Systematic Review and Meta-Analysis of Hypertension Risk Hafizah Latif; Wahyudi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1553

Abstract

Background: The epidemiological transition in Asia has precipitated a double burden of disease, where rapid industrialization intersects with an aging demographic to drive a surge in cardiovascular mortality. Hypertension remains the predominant modifiable risk factor in this context. While the correlation between fine particulate matter (PM2.5) and elevated blood pressure is documented in Western literature, evidence regarding Asian populations remains fragmented. This region faces a unique toxicological phenotype characterized by extreme exposure concentrations, distinct particulate composition including biomass and dust, and specific genetic susceptibilities, necessitating a dedicated regional analysis. Methods: We conducted a systematic review and meta-analysis of observational studies published between 2017 and 2024, searching PubMed, Scopus, and Embase. We critically appraised exposure assessment methods, distinguishing between satellite-based estimates and ground monitoring, and performed a quality audit using the Newcastle-Ottawa Scale. To minimize temporal bias, we stratified analyses by study design into Incident Hypertension (Cohort studies) and Prevalent Hypertension (Cross-sectional studies). Results: Nine pivotal studies encompassing over 600,000 participants from China, Taiwan, India, South Korea, and Thailand were synthesized. The random-effects meta-analysis revealed a significant pooled Hazard Ratio of 1.12 (95% CI 1.06 to 1.18) per 10 micrograms per cubic meter increase in long-term PM2.5. Heterogeneity was significant (I2 equals 90.2%), driven by regional variations. High-altitude cohorts in Tibet and high-exposure regions in India demonstrated synergistic risks with Odds Ratios exceeding 1.50 compared to moderate-exposure regions in Taiwan. Conclusion: Long-term PM2.5 exposure is a potent, independent driver of hypertension in Asia. The data suggest a synergistic interaction between hypoxia and pollution, and a non-linear dose-response curve at high concentrations. Clinicians should consider residence in high-pollution zones a cardiovascular risk enhancer equivalent to traditional risk factors.

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