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Fakultas Kedokteran dan Ilmu Kesehatan Universitas Warmadewa Gedung F2 Lantai 3, Jl. Terompong No.24 , Sumerta Kelod, Kec. Denpasar Tim., Kota Denpasar, Bali 80239
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Aesculapius Medical Journal
Published by Universitas Warmadewa
ISSN : 28290712     EISSN : 28086848     DOI : https://doi.org/10.22225
Core Subject : Health, Science, Education,
Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health
AMJ (Aesculapius Medical Journal) is a peer-reviewed medical journal that published research articles and theoretical articles in medical science. This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge. It aims is to provide a place for academics and practitioners to publish original research articles, review articles, and book reviews. The scope of this journal area any topics concerning medical studies in all aspects. AMJ (Aesculapius Medical Journal) published by Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Warmadewa 3 times a year. AMJ (Aesculapius Medical Journal) is available in print and online version. AMJ (Aesculapius Medical Journal) is Available online at https://www.ejournal.warmadewa.ac.id/index.php/amj/index, since Volume 1 No 1 October, 2021.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 210 Documents
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Analisis SOFA Score terhadap Prognosis Pasien Sepsis di Rumah Sakit Ngoerah Denpasar Tahun 2024 Cokorda Agung Pratiwi; Ni Kadek Fitria Parahita; Cokorda Agung Wahyu Purnamasidhi; Ni Putu Dina Pradnyani; I Nyoman Wande; Saktivi Harkitasari
Aesculapius Medical Journal Vol 6 No 2 (2026): June
Publisher : Fakultas Ilmu Kedokteran dan Ilmu Kesehatan, Universitas Warmadewa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/amj.6.2.2026.397-404

Abstract

Abstrak Sepsis dikenal sebgai sindrom klinis yang kompleks dan mengancam jiwa akibat respons inflamasi sistemik yang tidak terkontrol sehingga sering berujung pada disfungsi multiorgan dengan angka morbiditas dan mortalitas yang tinggi. Penilaian prognosis secara dini memiliki peranan prima dalam menentukan tata laksana, salah satunya melalui penggunaan Sequential Organ Failure Assessment (SOFA) score. Penelitian ini bertujuan memberikan gambaran SOFA score serta outcome pasien sepsis di Rumah Sakit Ngoerah Denpasar tahun 2024. Desain penelitian adalah observasional deskriptif dengan pendekatan potong lintang. Data diperoleh melalui total sampling terhadap 90 pasien dewasa (>18 tahun) yang memenuhi kriteria inklusi. Variabel yang dianalisis meliputi karakteristik demografi, komorbiditas, skor SOFA awal, serta outcome klinis. Hasil menunjukkan kelompok usia ?60 tahun mendominasi kasus sepsis (57,2%) dan sebagian besar pasien berjenis kelamin laki-laki. Diabetes melitus (36,6%) merupakan komorbiditas terbanyak, diikuti penyakit kardiovaskular (32,2%). Distribusi SOFA score terbanyak pada rentang 4–8 (57,8%). Analisis outcome menunjukkan adanya peningkatan proporsi mortalitas seiring dengan peningkatan SOFA score, yaitu 55,6% pada skor 2–3, meningkat menjadi 76,9% pada skor 4–8, dan mencapai 90% pada skor 9–16. Temuan ini mengindikasikan bahwa SOFA score awal berpotensi menggambarkan prognosis pada pasien sepsis. Penggunaan SOFA score sejak awal diagnosis dapat dipertimbangkan sebagai acuan dalam stratifikasi risiko, pemilihan strategi terapeutik, serta perencanaan monitoring pasien secara lebih komprehensif. Kata Kunci: Sepsis, SOFA score, Prognosis, Rumah Sakit Ngoerah Denpasar   Abstract [An Overview of SOFA Scores and Patient Outcomes for Sepsis Patients Admitted to Ngoerah Hospital, Denpasar, in 2024] Sepsis is a complex and life-threatening clinical syndrome characterized by dysregulated systemic inflammation, frequently progressing to multiorgan dysfunction with high morbidity and mortality. Early prognostic assessment plays a crucial role in guiding clinical decision-making, with the Sequential Organ Failure Assessment (SOFA) score serving as one of the most reliable tools This study aims to provide an overview of SOFA scores and patient outcomes for sepsis at Ngoerah Hospital in Denpasar in 2024. A descriptive observational study with a cross-sectional design was conducted using total sampling of 90 adult patients (>18 years) who met the inclusion criteria. Data collected included demographic characteristics, comorbidities, initial SOFA score, and clinical outcomes. The results showed that sepsis occurred predominantly in patients aged ?60 years (57.2%) and was more frequent in males. Diabetes mellitus (36.6%) was the most common comorbidity, followed by cardiovascular disease (32.2%). The majority of patients had an initial SOFA score of 4–8 (57.8%). Outcome analysis revealed an increase in the mortality rate as the SOFA score rose, namely 55.6% for scores of 2–3, rising to 76.9% for scores of 4–8, and reaching 90% for scores of 9–16. These findings suggest that the initial SOFA score has the potential to predict the prognosis in patients with sepsis. The use of the SOFA score from the outset of diagnosis may be considered as a guide for risk stratification,the selection of therapeutic strategies, and the planning of more comprehensive patient monitoring. Keywords: Sepsis, SOFA score, Prognosis, Ngoerah Hospital Denpasar
Finerenone in Diabetic-Kidney Disease, True Result Renal and Cardiovascular Outcome: A Meta-Analysis Felicita Gracia; Arya Marganda Simanjuntak; Samira Amanda; Linda Ida Mustika; Juwanto; Ligat Pribadi Sembiring; Jazil Karimi; Sari Harahap; Rosmaliana
Aesculapius Medical Journal Vol 6 No 2 (2026): June
Publisher : Fakultas Ilmu Kedokteran dan Ilmu Kesehatan, Universitas Warmadewa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/amj.6.2.2026.374-385

Abstract

Abstract Diabetic kidney disease (DKD) is a major complication of type 2 diabetes, increasing cardiovascular risk. Existing treatments leave significant residual progression risk. Finerenone, a novel nonsteroidal mineralocorticoid receptor antagonist, shows promise. This meta-analysis evaluates finerenone's effects on renal and cardiovascular outcomes in DKD. A Systematic Review and Meta-Analysis (PROSPERO CRD420251122382) followed PRISMA guidelines. PubMed, ScienceDirect, and Epistemonikos utilized and used keywords "Finerenone AND Diabetes AND Chronic Kidney Disease AND Outcomes." RCTs comparing finerenone to placebo in DKD, reporting renal or cardiovascular outcomes, were included. Data extraction covered study characteristics and outcomes. RevMan 5.4 analyzed data using a random-effects model. Risk of bias (RoB2) and certainty of evidence (GRADE-PRO) were assessed. Three RCTs (19,027 participants) were included for renal outcomes, and two RCTs (13,026 participants) for cardiovascular outcomes. Finerenone significantly reduced odds of sustained eGFR decline ?40% (OR 0.83, p=0.0003), ?57% (OR 0.86, p=0.0001), and the major composite kidney outcome (OR 0.76, p<0.0001). ESKD odds reduction (21%) was not statistically significant. For cardiovascular outcomes, finerenone significantly reduced hospitalization for heart failure (OR 0.78, p=0.0001). Trends towards reduced cardiovascular death (OR 0.88, p=0.09) were noted. Studies had low bias risk, and most outcomes showed moderate evidence certainty.Finerenone offers robust renoprotection and significantly reduces heart failure hospitalizations in DKD. finerenone as a key nonsteroidal mineralocorticoid receptor antagonist for comprehensive management, improving both renal and cardiovascular outcomes in this high-risk group. Keywords: chronic kidney disease, cardiovascular, diabetes, finerenone, renal.
Inovasi Microneedle Transdermal Patch dalam Pengelolaan Terapi Diabetes Mellitus: Tinjauan Naratif Aditya Nugraha; Nur Mahdi
Aesculapius Medical Journal Vol 6 No 2 (2026): June
Publisher : Fakultas Ilmu Kedokteran dan Ilmu Kesehatan, Universitas Warmadewa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/amj.6.2.2026.386-396

Abstract

Abstract [Innovative Microneedle Transdermal Patches for Diabetes Mellitus Management: A Narrative Review]. This narrative review summarizes recent advances in microneedle transdermal patches for diabetes mellitus, highlighting design innovations, material selection, glucose-responsive mechanisms, preclinical efficacy, and translational barriers. Methods comprised literature searches on Google Scholar, PubMed, PMC, Scopus, and ScienceDirect performed between April-August 2025; inclusion criteria targeted original studies published from 2015 to 2025 that focused on microneedle applications in type 1 and type 2 diabetes. Seventeen original articles were selected for descriptive analysis. Results indicate predominant utilization of biodegradable polymers (hyaluronic acid, gelatin, carboxymethyl cellulose) combined with smart components such as glucose oxidase, phenylboronic acid, and mesoporous nanoparticles. Device formats include dissolving and hollow microneedles as well as biosensor-integrated systems with micropumps, evidencing a trend toward closed-loop platforms. Preclinical findings report improved pharmacokinetics (intradermal Tmax ? 35 min versus subcutaneous ? 87.5 min), extended glycemic control (>20 hours in minipigs; 1–2 days in mice), and dual-hormone approaches to reduce hypoglycemia risk. Major challenges remain: enzyme stability and byproduct toxicity (e.g., H?O?), mechanical robustness of microneedles, scarce human clinical data, and high manufacturing complexity and cost. In conclusion, microneedle patches represent a promising minimally invasive and adaptive platform for diabetes therapy, but multidisciplinary research, long-term clinical evaluation, and scalable manufacturing innovations are essential for broad clinical translation.. Keywords: Microneedle patch, Microneedle innovation, Transdermal delivery, Diabetes therapy.
Efektivitas Manajemen Diri dan Pemberdayaan terhadap Luaran Psikososial dan Klinis Pasien Hemodialisis Dewasa Cokorda Gede Bagus Muladhara Cakra Kailasa; I Gusti Agung Istri Mahaiswari; Anak Agung Ngurah Agung Bagus Tri Laksamana Putra; I Komang Surya Prawira Tangkas
Aesculapius Medical Journal Vol 6 No 2 (2026): June
Publisher : Fakultas Ilmu Kedokteran dan Ilmu Kesehatan, Universitas Warmadewa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/amj.6.2.2026.405-420

Abstract

Abstract Effectiveness of Self-Management and Empowerment on Psychosocial and Clinical Outcomes of Adult Hemodialysis Patients Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are major global health problems, particularly among patients undergoing hemodialysis. Patients’ ability to manage their condition is strongly influenced by self-management and empowerment interventions, which aim to improve psychosocial outcomes such as self-efficacy and self-care knowledge, as well as clinical outcomes including blood pressure control and weight management. This systematic review aimed to evaluate the effectiveness of self-management and empowerment interventions on psychosocial and clinical outcomes in adult hemodialysis patients by synthesizing existing evidence, comparing findings between randomized controlled trials (RCTs) and non-RCTs, and assessing the potential for publication bias. Literature searches were conducted in PubMed, Scopus, and Cochrane CENTRAL according to predefined inclusion criteria. Study screening and data extraction were performed using Rayyan, risk of bias was assessed with RoB 2.0 for RCTs and ROBINS-I for non-RCTs, while statistical analyses were carried out using Jamovi, including subgroup analyses, sensitivity analyses, and publication bias testing. A total of eight studies met the inclusion criteria. The results indicated that self-management and empowerment interventions produced moderate improvements in self-efficacy (Cohen’s d = 0.58) and favorable clinical outcomes, including a mean reduction in blood pressure of 5.6 mmHg. Subgroup analyses showed no significant differences between RCTs and non-RCTs (p = 0.15), sensitivity analyses confirmed the robustness of the findings, and publication bias testing revealed no significant bias. This review supports the effectiveness of self-management and empowerment interventions in improving psychosocial and clinical outcomes among hemodialysis patients, and recommends future research with long-term follow-up, standardized outcome measures, and high-quality RCTs to confirm effectiveness across more diverse patient populations. Keywords: Chronic Kidney Disease, Hemodialysis, Self-Management, Empowerment, Self-Efficacy.
Case Report : Penerapan Prone Positioning dan Nesting dalam Menstabilkan Status Hemodinamik pada Bayi RDS Dinda Asmara Varnelia; Cantika Azahra; Erna Julianti
Aesculapius Medical Journal Vol 6 No 2 (2026): June
Publisher : Fakultas Ilmu Kedokteran dan Ilmu Kesehatan, Universitas Warmadewa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/amj.6.2.2026.421-430

Abstract

Abstract Respiratory Distress Syndrome (RDS) is a major cause of morbidity and mortality in neonates, especially premature infants, due to impaired gas exchange and ineffective breathing patterns. Evidence-based management is needed to maintain physiological stability. This study aims to apply prone positioning and nesting in stabilizing the fisiology of infants with RDS. This is a descriptive study with a case study approach consisting of assessment, diagnosis, intervention, implementation, and evaluation. The sample in this study amounted to 2 infants with inclusion criteria of 32 weeks gestation, weight less than 2,500 grams and using CPAP with PEEP 6 FiO2 21%. The intervention was given in the form of a prone position fixed with nesting for 3 hours, twice a day, for three days. Parameters of respiratory frequency (RR), heart rate (HR), and oxygen saturation (SpO?) were monitored before, during, and after the intervention. The results showed a mean decrease in HR of 1.8–6%, a decrease in RR of up to 12.5%, and an increase in SpO? of 1–2%, with all parameters within the normal neonatal range. This combination of interventions has been shown to help optimize oxygenation, reduce respiratory workload, and maintain fisiology, stability. In conclusion, the application of prone positioning and nesting showed improvements in infant physiological parameters, so this non-pharmacological intervention can support the respiratory function of infants with RDS and is worthy of recommendation for care practices in the NICU. Keywords: Ineffective breathing pattern, nesting, preterm infants, prone positioning, Respiratory Distress Syndrome, CPAP
Efektivitas Transcutaneous Electrical Nerve Stimulation dan Manual Terapi terhadap Penurunan Nyeri pada Pelari Marathon dengan Patellofemoral Pain Syndrome: A Systematic Review Adelia Gita Pratiwi; Suci Nurmarisa; Jacinda Nasya Nathania Zahra
Aesculapius Medical Journal Vol 6 No 2 (2026): June
Publisher : Fakultas Ilmu Kedokteran dan Ilmu Kesehatan, Universitas Warmadewa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/amj.6.2.2026.431-436

Abstract

Abstract Patellofemoral Pain Syndrome (PFPS) is a musculoskeletal disorder characterized by anterior knee pain and commonly experienced by long-distance runners, including marathon runners. This condition may cause decreased knee function, physical activity limitations, and reduced athletic performance. This study aimed to analyze the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) and manual therapy in reducing pain and improving knee function in marathon runners with PFPS using a Systematic Literature Review (SLR) approach. Articles were obtained from Google Scholar, PubMed, and ScienceDirect databases published between 2020 and 2025 using predetermined inclusion and exclusion criteria. A total of 10 relevant journals were analyzed focusing on TENS intervention, manual therapy, and therapeutic exercises related to pain reduction and improvement of knee function. The findings showed that TENS was effective in reducing pain intensity through pain modulation mechanisms in the nervous system, while manual therapy and therapeutic exercises improved knee function, proprioception, and functional activity in patients with PFPS. The combination of TENS with exercise therapy and manual therapy provided more optimal rehabilitation outcomes compared to single interventions. Based on the review results, it can be concluded that TENS and manual therapy are effective physiotherapy interventions for reducing pain and improving knee function in marathon runners with PFPS. Keywords: Patellofemoral Pain Syndrome, TENS, Manual Therapy, Marathon Runners, Physiotherapy, Rehabilitation
Tinjauan Sistematis: Peran Kultur Hanging Drop 3D terhadap Ekspresi OCT4 dan NANOG pada Sel Punca Mesenkimal Tali Pusat dengan Suplementasi PRP dan FBS Muhammad Faishal Budi Utomo; Wahyunia L. Septiana; Sastia Winda Astuti; Helsy Junaidi
Aesculapius Medical Journal Vol 6 No 2 (2026): June
Publisher : Fakultas Ilmu Kedokteran dan Ilmu Kesehatan, Universitas Warmadewa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/amj.6.2.2026.437-449

Abstract

Abstract Systematic Review: The Role of Three-Dimensional Hanging Drop Culture in OCT4 and NANOG Expression in Umbilical Cord-Derived Mesenchymal Stem Cells Supplemented with PRP and FBS Umbilical cord-derived mesenchymal stem cells (UC-MSCs) have considerable potential in regenerative medicine due to their multipotent capacity, high proliferative ability, and self-renewal properties. Three-dimensional (3D) hanging drop culture has been shown to promote spheroid formation that closely mimics the in vivo microenvironment, thereby supporting stemness maintenance and enhancing the expression of pluripotency-related genes, such as OCT4 and NANOG. However, the use of Fetal Bovine Serum (FBS) as a culture supplement remains limited by concerns regarding immunogenicity and the potential transmission of biological contaminants, highlighting the need for xeno-free alternatives such as Platelet-Rich Plasma (PRP). This systematic review aimed to evaluate the effects of PRP and FBS supplementation on the biological characteristics of UC-MSCs cultured using the 3D hanging drop method. A literature search was conducted using PubMed, ScienceDirect (Elsevier), and Google Scholar databases for studies published between 2015 and 2025, employing keywords related to UC-MSCs, 3D hanging drop culture, PRP, FBS, OCT4, and NANOG. Eligible studies were critically analyzed based on methodological quality and relevance to the review objectives. The findings indicate that 3D hanging drop culture enhances spheroid formation, preserves cell viability, and increases the expression of stemness markers OCT4 and NANOG compared with conventional two-dimensional culture. Several studies also reported that PRP supplementation supports cell proliferation and viability while maintaining pluripotency-related gene expression at levels comparable to or higher than those achieved with FBS. These findings suggest that PRP represents a promising xeno-free alternative for maintaining the stemness of UC-MSCs and supporting their future clinical applications in regenerative medicine. Keywords: umbilical cord-derived mesenchymal stem cells, 3D hanging drop culture, platelet-rich plasma, fetal bovine serum, OCT4, NANOG.
Review Artikel: Aktivitas Farmakologis dari Metabolit Sekunder Tanaman Rambai (Baccaurea motleyana) Ira Qadariah
Aesculapius Medical Journal Vol 6 No 2 (2026): June
Publisher : Fakultas Ilmu Kedokteran dan Ilmu Kesehatan, Universitas Warmadewa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/amj.6.2.2026.450-461

Abstract

Abstract [Review Article: Pharmacological Activity of the Secondary Metabolites of the Rambai (Baccaurea motleyana) Plant] Rambai (Baccaurea motleyana) is used empirically in Indonesia and has been investigated as a source of secondary metabolites. However, evidence on the plant parts studied, extraction methods, solvents, metabolite profiles, and pharmacological activities remains scattered. This narrative review synthesized primary studies published in 2020–2025. Google Scholar was searched using the core phrase “Baccaurea motleyana” combined with phytochemical/fitokimia, secondary metabolite/metabolit sekunder, pharmacological activity/aktivitas farmakologis, and bioactivity/bioaktivitas. Eligible articles comprised laboratory experimental studies conducted in vitro and/or in vivo and phytochemical analyses. Sixteen articles met the inclusion criteria. Leaves were the most frequently investigated plant part (9/16; 56.25%), and maceration was the predominant extraction method (14/16; 87.5%). Methanol was reported as a solvent in 8 of 16 articles (50%); individual articles could report more than one solvent. Reported metabolites included flavonoids, steroids, phenolics, saponins, terpenoids, alkaloids, tannins, eugenol, 4-ethyl-2-methoxy-phenol, beta-carotene, and ascorbic acid. Reported activities included antibacterial, antioxidant, antidiabetic, antipyretic, analgesic, antianemic, antidiarrheal, and antidepressant effects. Antiproliferative activity was demonstrated only in vitro in PANC-1 cells, whereas anticancer potential in several studies was primarily inferred from BSLT/BSLA toxicity assays or chemical-component identification and therefore does not establish anticancer efficacy in humans. The evidence remains predominantly preclinical. Standardized extracts, isolation and characterization of active compounds, robust toxicity testing, and further in vivo and clinical studies are required to establish efficacy and safety. Keywords: Baccaurea motleyana, pharmacological activity, phytochemicals, rambai, secondary metabolites
Potensi Terapi Antibodi Bispesifik sebagai Pengobatan Antikanker: Tinjauan Literatur Yurafi Kun Naviaghani; Muhammad Aziz Hidayat
Aesculapius Medical Journal Vol 6 No 2 (2026): June
Publisher : Fakultas Ilmu Kedokteran dan Ilmu Kesehatan, Universitas Warmadewa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/amj.6.2.2026.462-469

Abstract

Abstract Bispecific antibodies are engineered antibodies capable of recognizing two targets simultaneously, thereby redirecting immune effector cells toward tumor cells or inhibiting two molecular pathways involved in cancer growth and therapeutic resistance. This literature review aimed to evaluate the mechanisms of action, efficacy, safety, and developmental challenges of bispecific antibodies in cancer treatment based on publications from 2020 to 2025. A literature search was conducted through Google Scholar using the phrase bispecific antibodies cancer therapy. Twenty articles were reviewed, comprising 17 primary studies and three review articles used as supporting sources. The investigated agents mainly acted through T-cell or natural killer-cell redirection, simultaneous blockade of two signaling pathways, and modulation of the tumor microenvironment. The strongest clinical evidence was identified for cadonilimab in cervical cancer, while zenocutuzumab demonstrated clinical activity in tumors harboring NRG1 fusions. Most other agents remained at the preclinical stage. Major challenges included cytokine release syndrome, immune-related toxicity, antigen heterogeneity, tumor resistance, and limited translation of preclinical efficacy into clinical benefit. Bispecific antibodies represent a promising therapeutic approach in oncology; however, their clinical implementation requires biomarker-guided patient selection, dose optimization, and comprehensive safety evaluation in adequately designed clinical trials. Keywords: bispecific antibodies, cancer, immunotherapy, targeted therapy.
Silent Advanced Moyamoya Disease in an Asymptomatic Elderly Patient: A Rare Case Report Putu Ayu Dyah Meita Wulandari; Shahifa Audy Rahima; I Gusti Agung Ayu Pramasinthya Aguseny Yudana; Yoanes Gondowardaja; Desie Yuliani
Aesculapius Medical Journal Vol 6 No 2 (2026): June
Publisher : Fakultas Ilmu Kedokteran dan Ilmu Kesehatan, Universitas Warmadewa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/amj.6.2.2026.470-476

Abstract

Abstract Background: Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive non-atherosclerotic steno-occlusion of the terminal portion of the internal carotid artery (ICA) and its major branches, leading to the formation of abnormal collateral vessels. The diagnosis of MMD is generally established based on the evaluation of neurological symptoms and brain imaging findings. However, asymptomatic MMD in elderly patients is rare and is often detected incidentally. Case Report: A 77-year-old man presented to the neurology outpatient clinic for a routine health evaluation. He had a history of hypertension and was compliant with regular antihypertensive medication, with no reported neurological symptoms. Neurological examination revealed no abnormalities. Brain magnetic resonance imaging (MRI) demonstrated occlusion of the M1 segment of the middle cerebral artery. Digital Subtraction Angiography (DSA) showed total occlusion of the left middle cerebral artery (M1 segment) with collateral circulation from the anterior cerebral artery, posterior cerebral artery, and superficial temporal artery, without delayed arterial filling, consistent with advanced-stage MMD (stage V–VI). The patient was managed conservatively with antiplatelet therapy, statins, and control of vascular risk factors. Discussion: The asymptomatic clinical presentation in advanced stages may be attributed to the development of adequate collateral circulation capable of maintaining cerebral perfusion. This hemodynamic compensatory mechanism may allow some patients to remain free of neurological deficits despite occlusion of major cerebral arteries. Conclusion: This case highlights that MMD can remain asymptomatic in elderly patients. Imaging modalities such as MRI and DSA play a crucial role in detecting occult cerebrovascular abnormalities and enabling appropriate monitoring and prevention of future cerebrovascular complications. Keywords: Moyamoya disease, cerebral collateral circulation, Digital Subtraction Angiography, silent cerebrovascular disease.

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