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The International Journal of Medical Science and Health Research, published by International Medical Journal Corp. Ltd. is dedicated to providing physicians with the best research and important information in the world of medical research and science and to present the information in a format that is understandable and clinically useful. Committed to publishing multidisciplinary research that spans the entire spectrum of healthcare and medicine access, The American Journal of Medical Science and Health Research aims at an international audience of pharmacists, clinicians, medical ethicists, regulators, and researchers, providing an online forum for the rapid dissemination of recent research and perspectives in this area.

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A Correlation Between the Severity of Sleep-Disordered Breathing and the Frequency and Duration of Bradyarrhythmias in Patients with Cardiovascular Risk Factors: A Systematic Review Putri Rahmi Maharani; Robby Rachman; Kevin Habib Alhuda
The International Journal of Medical Science and Health Research Vol. 16 No. 2 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/vc992j87

INTRODUCTION : Sleep-disordered breathing (SDB) is a highly prevalent condition strongly associated with cardiovascular morbidity. While its link to tachyarrhythmias is well-established, the relationship with bradyarrhythmias is less synthesized. This systematic review aims to evaluate the correlation between SDB severity and the frequency and duration of bradyarrhythmias in patients with cardiovascular risk factors. METHODS : A systematic search of PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library was conducted for observational studies and clinical trials investigating the association between SDB severity and bradyarrhythmic events in adults with cardiovascular risk factors. Study selection, data extraction, and risk of bias assessment using the ROBINS-I tool were performed independently by two reviewers, adhering to PRISMA 2020 guidelines. Outcomes of interest included the incidence, frequency, and duration of sinus bradycardia, sinus pauses/arrest, and atrioventricular (AV) block, as well as mean/minimum nocturnal heart rate and adjusted risk estimates. RESULTS : The evidence consistently demonstrates a high comorbid disease burden, with a pooled prevalence of nocturnal bradycardia in patients with obstructive sleep apnea (OSA) of approximately 69.8% and a pooled prevalence of OSA in patients with bradycardia of 56.8%. A significant dose-response relationship was identified, with increasing SDB severity, measured by the Apnea-Hypopnea Index (AHI) or Oxygen Desaturation Index (ODI), correlating with a higher frequency and duration of bradyarrhythmic events. Patients with severe SDB had significantly higher odds of experiencing sinus pauses greater than 3 seconds (OR, 10.26; 95% CI, 2.18–48.40) and sinus bradycardia below 40 bpm (OR, 3.00; 95% CI, 1.36–6.60) compared to those with no or mild SDB. The highest prevalence and severity of SDB were observed in patients paced for high-degree AV block. DISCUSSION : The synthesized evidence supports a strong, dose-dependent relationship between SDB severity and the burden of nocturnal bradyarrhythmias. This association is primarily driven by intermittent hypoxia-induced vagal hyperactivity. The high prevalence of undiagnosed SDB in patients receiving pacemakers suggests that SDB may be a significant, reversible cause of bradyarrhythmias, potentially leading to avoidable implantations. Discrepancies between community-based and clinic-based cohort studies suggest that the arrhythmogenic risk of SDB is magnified in patients with a higher burden of underlying cardiovascular disease. CONCLUSION : The severity of SDB is a significant predictor of the frequency and duration of nocturnal bradyarrhythmias in patients with cardiovascular risk factors. Systematic screening for SDB is warranted in patients presenting with significant nocturnal bradycardia or AV block to identify a modifiable cause and potentially alter therapeutic management, including the need for permanent pacing.

How does Testosterone Therapy Impact Quality of Life and Cancer Recurrence Rates in High-Risk Prostate Cancer Survivors? : A Systematic Review Salman Alfarisi Kuddah; John M. Sangkai
The International Journal of Medical Science and Health Research Vol. 16 No. 2 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/j0xqbk37

Introduction: The use of testosterone therapy (TRT) to manage hypogonadal symptoms in prostate cancer survivors is clinically contentious due to long-standing fears that it may promote cancer recurrence. Definitive treatments often lead to debilitating side effects like fatigue and loss of libido, creating a dilemma between improving quality of life (QoL) and ensuring oncological safety. This systematic review evaluates the impact of testosterone therapy on biochemical recurrence rates and QoL in high-risk prostate cancer survivors. Methods: Following PRISMA 2020 guidelines, a systematic search was conducted across PubMed, Springer, Google Scholar, and Semantic Scholar for studies published since 2015. Eligibility criteria targeted randomized controlled trials and prospective cohort studies assessing TRT in adult males after primary treatment for high-risk prostate cancer, with outcomes of cancer recurrence and/or QoL. After screening 763 records, 19 studies were included in the final analysis. Results: The synthesized evidence did not show a significant increase in biochemical recurrence with TRT. Several studies reported low recurrence rates, with one frequency-matched study finding that TRT was associated with a 1.4-year delay in recurrence. Conversely, a critical deficiency in QoL data was identified; 16 of the 19 included studies did not use validated assessment tools to measure patient-reported outcomes. Reported adverse events were generally low-grade and manageable. Conclusion: A notable discordance exists between the emerging oncological safety of TRT and the profound lack of evidence supporting its benefits for QoL in high-risk prostate cancer survivors. While the historical fear of cancer recurrence is not strongly supported by recent data, the therapy's actual benefit to patients remains largely unquantified. Future research must prioritize QoL as a primary endpoint to establish a definitive risk-benefit profile.

ARTIFICIAL INTELLIGENCE (AI) IN THE DIAGNOSIS OF PATHOLOGIST-CONFIRMED LUNG CANCER: A SYSTEMATIC REVIEW AND A DIAGNOSTIC TEST ACCURACY (DTA) META-ANALYSIS Maren Irgiwi Fadlilah; Wijaya Hadi Suryanto
The International Journal of Medical Science and Health Research Vol. 16 No. 2 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/rh9enw31

Objectives Lung cancer continues to be the primary cause of cancer-related deaths globally, with early detection essential for enhancing survival rates. Notwithstanding progress in imaging and pathology, existing diagnostic techniques encounter constraints including elevated false-positive rates, inter-observer variability, and difficulties in detecting smaller, early-stage nodules such as ground-glass nodules (GGNs). Artificial Intelligence (AI) provides prospective answers by improving diagnostic accuracy and efficiency. The objective of this study is to assess the efficacy of AI algorithms in diagnosing pathologist-confirmed lung cancer, emphasizing their diagnostic accuracy and potential to transform clinical practice. Methods A systematic review and meta-analysis were performed in accordance with PRISMA recommendations. A thorough literature search was conducted utilizing the Cochrane Library and PubMed until May 7, 2025, employing keywords pertinent to lung neoplasms and artificial intelligence. The inclusion criteria targeted research utilizing AI for the diagnosis of lung cancer, emphasizing diagnostic accuracy as the principal outcome. Data were extracted and evaluated for quality, and a meta-analysis was performed using Review Manager version 5.4, utilizing random-effects models to address clinical heterogeneity. Results The meta-analysis comprised six investigations with an aggregate sample size of 486 participants. AI methods, including Support Vector Machines, Random Forests, Artificial Neural Networks, and Computer-aided Diagnosis systems, had an overall sensitivity of 79.0% and specificity of 80,2%. The positive predictive value was 68.9%, while the negative predictive value was 87,3%, signifying a high reliability of negative test outcomes. AI algorithms have considerable expertise in diagnosing lung cancer, with the potential to augment early detection and increase patient outcomes. Standardizing AI models and integrating unpublished data may augment the robustness of forthcoming analyses. Conclusion AI possesses significant potential to enhance lung cancer diagnosis, providing advantages for both patients and healthcare professionals. Notwithstanding current obstacles, continuous research and development, coupled with meticulous application in clinical settings, may result in substantial progress in the early identification and therapy of cancer.

The Role of Probiotics in Improving Motor Function in Parkinson’s Disease: Evidence from a Systematic Review and Meta-Analysis Andra Danika; Paulus Alexander Supit
The International Journal of Medical Science and Health Research Vol. 16 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/qbay7381

Introduction: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor deterioration that profoundly impacts functional independence and quality of life. Recent advances suggest that the gut–brain axis contributes to PD pathophysiology, with gut dysbiosis potentially exacerbating neuroinflammation and α-synuclein pathology. Probiotics have emerged as a novel therapeutic approach, but their effect on motor outcomes remains uncertain. Objective: To evaluate the efficacy of probiotic supplementation in alleviating motor deterioration in PD, with Unified Parkinson’s Disease Rating Scale Part III (UPDRS III) scores as the primary outcome. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed, Cochrane Library, and ScienceDirect were searched from inception to February 2025. Eligible studies were randomized controlled trials comparing probiotics with placebo or usual care in adults with PD. The primary outcome was mean change in UPDRS III scores. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was graded with GRADE methodology. Random-effects models were applied to calculate pooled mean differences (MD) with 95% confidence intervals (CI). Results: From 294 records, five RCTs comprising 317 participants met the inclusion criteria. Pooled analysis demonstrated a significant improvement in motor function with probiotics compared to control (MD –3.15, 95% CI –5.76 to –0.54; p = 0.02). The direction of effect consistently favored probiotics across all trials, although heterogeneity was moderate (I² = 65%). Adverse events were infrequent and mild, primarily consisting of transient gastrointestinal discomfort. No serious probiotic-related adverse events were reported. Discussion: This analysis highlights the potential role of probiotics as a safe and accessible adjunctive strategy in PD management. The magnitude of improvement in UPDRS III exceeds the minimal clinically important difference, suggesting clinically meaningful benefits. Nevertheless, variability in probiotic formulations, small sample sizes, and short treatment durations limit generalizability. Integration of microbiome profiling and biomarker assessment in future trials may clarify mechanisms of action and identify patient subgroups most likely to benefit. Conclusion: Probiotic supplementation appears to provide a modest but clinically relevant improvement in motor function in PD, as measured by UPDRS III. While promising, further large, standardized, and long-term RCTs are required before probiotics can be integrated into routine PD care.

Long-Term Neurodevelopmental Outcome Measures in Preterm Infants: A Systematic Review Nurul Purnamasari; Ririn Azhari
The International Journal of Medical Science and Health Research Vol. 16 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/jtxw1843

Introduction: Advances in neonatal care have significantly increased the survival of preterm infants, shifting the focus to long-term neurodevelopmental outcomes. Infants born before 37 weeks of gestation are at an elevated risk for a wide spectrum of impairments due to the interruption of critical in-utero brain development. This systematic review synthesizes the current evidence on long-term neurodevelopmental outcomes in preterm infants and the measures used for their assessment. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, and the Cochrane Library was performed to identify observational studies and randomized controlled trials that reported neurodevelopmental outcomes in preterm infants assessed at or after 12 months of age, compared to term-born controls or other preterm subgroups. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. A narrative synthesis was conducted, with results grouped by neurodevelopmental domain. Results: The search yielded 4,720 unique records, from which 8 studies met the inclusion criteria, encompassing a total of 72,974 preterm-born children. The evidence confirms a clear gradient of risk, with the prevalence and severity of impairment increasing with decreasing gestational age. Preterm infants demonstrate significantly higher rates of adverse outcomes across all major domains. Key findings include a pooled prevalence of overall neurodevelopmental impairment of 16% and cerebral palsy of 5% in low- and middle-income countries. Cognitive delays were the most frequently reported outcome, with preterm children scoring, on average, 11-13 points lower on IQ scales than their term-born peers. Increased risks were also consistently found for motor impairments, language delays, academic difficulties, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and internalizing and externalizing behavioral problems. A wide array of assessment tools was identified, with the Bayley Scales of Infant and Toddler Development and Wechsler Intelligence Scales being the most common. Discussion: The findings underscore the substantial and persistent burden of neurodevelopmental morbidity following preterm birth. The heterogeneity of assessment tools across studies presents a significant challenge for synthesizing evidence and comparing outcomes. The data suggest a developmental cascade, where early motor and language deficits may contribute to later cognitive and behavioral challenges. The necessity for long-term surveillance is highlighted by "sleeper effects," where some impairments only manifest later in childhood as academic and social demands increase. Conclusion: Preterm birth is a major risk factor for a wide spectrum of long-term neurodevelopmental impairments. Comprehensive, multidisciplinary follow-up programs using validated and context-appropriate assessment tools are essential for early identification and intervention to optimize the developmental potential of this vulnerable population.

Responsive versus Scheduled Interval Feeding for Preterm and Low Birth Weight Infants: A Systematic Review Nurul Purnamasari; Ririn Azhari
The International Journal of Medical Science and Health Research Vol. 16 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/ev8p0z60

Introduction: Optimal feeding for preterm and low birth weight (LBW) infants is critical for growth and development, yet the ideal feeding strategy remains debated. This systematic review evaluates the effects of responsive (cue-based) feeding compared with traditional scheduled interval feeding on a comprehensive range of outcomes in this vulnerable population. Methods: Following PRISMA guidelines, we conducted a systematic search of CENTRAL, MEDLINE, EMBASE, and CINAHL for randomized controlled trials (RCTs) comparing responsive versus scheduled feeding in preterm (<37 weeks' gestation) or LBW (<2500 g) infants. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Cochrane RoB 2 tool. Data were synthesized using random-effects meta-analysis for homogeneous outcomes, with results reported as mean difference (MD) or risk ratio (RR) with 95% confidence intervals (CI). A narrative synthesis was performed for heterogeneous data. The certainty of evidence was assessed using the GRADE framework. Results: Nine RCTs involving over 650 infants were included. Meta-analysis revealed that responsive feeding resulted in a slower rate of weight gain compared to scheduled feeding (MD −1.36 g/kg/day, 95% CI −2.44 to −0.29; low certainty) but significantly reduced the time to achieve full oral feeding (MD −5.53 days, 95% CI −6.80 to −4.25; low certainty). There was no consistent or statistically significant effect on the overall duration of hospital admission (MD −1.42 days, 95% CI −5.43 to 2.59; very low certainty). Data on critical outcomes, including long-term neurodevelopment, parental satisfaction, breastfeeding duration, and specific adverse events like necrotizing enterocolitis, were systematically absent across the included trials. Most included studies were small and possessed methodological limitations, primarily a high risk of bias due to lack of blinding. Discussion: The evidence highlights a central clinical trade-off: responsive feeding appears to accelerate the acquisition of oral feeding skills at the potential cost of slower short-term weight gain. The lack of a corresponding reduction in hospital stay suggests that other discharge criteria, such as achieving a specific weight, may negate the benefits of earlier feeding proficiency. A profound misalignment exists between the developmental philosophy of responsive feeding and the predominantly biomedical outcomes measured in existing trials. Conclusion: The current evidence, which is of low to very low certainty, is insufficient to recommend the universal adoption of responsive feeding over scheduled feeding to improve growth or shorten hospitalization for preterm and LBW infants. Responsive feeding appears to be a safe alternative that may hasten the transition to full oral feeding. High-quality, large-scale RCTs that measure patient- and family-centered outcomes are urgently needed.

The Relation Between 25-Hydroxyvitamin D Levels and Sepsis in Neonatal Intensive Care Unit Infants: A Comprehensive Systematic Review Nurul Purnamasari; Ririn Azhari
The International Journal of Medical Science and Health Research Vol. 16 No. 4 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/zhjype47

Introduction: Neonatal sepsis is a leading cause of morbidity and mortality worldwide, characterized by a dysregulated host immune response to infection. Vitamin D, recognized for its potent immunomodulatory functions, has been implicated as a potential modifiable risk factor. This systematic review aims to comprehensively evaluate the association between 25-hydroxyvitamin D levels and the incidence and severity of sepsis in infants admitted to the Neonatal Intensive Care Unit (NICU). Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted to identify observational (case-control and cohort) studies assessing maternal, cord, or neonatal 25(OH)D levels in NICU infants with and without sepsis. Data on study characteristics, participant demographics, vitamin D status, and a minimum of 15 clinical and laboratory outcomes were extracted. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). Results: The review included a robust selection of observational studies. A consistent and statistically significant association was found between lower 25(OH)D levels and the presence of neonatal sepsis. Neonates with sepsis had markedly lower mean 25(OH)D concentrations compared to non-septic controls across multiple studies. Furthermore, low maternal and cord blood 25(OH)D levels were identified as significant independent risk factors for developing neonatal sepsis, with neonates born to vitamin D-deficient mothers having substantially increased odds of infection. Vitamin D deficiency was also significantly associated with increased sepsis severity, longer hospital and NICU stays, greater need for mechanical ventilation and inotropic support, and adverse laboratory profiles, including elevated C-reactive protein (CRP) and lower platelet counts. Discussion: The evidence strongly suggests that pre-existing vitamin D deficiency is a critical predisposing factor for neonatal sepsis, rather than merely a consequence of the acute illness. The immunomodulatory role of vitamin D—enhancing innate antimicrobial defenses while tempering excessive inflammation—provides a strong biological rationale for these clinical findings. Low vitamin D status appears to impair the neonate's ability to mount an effective yet controlled immune response, thereby increasing susceptibility to infection and the risk of progression to severe sepsis and organ dysfunction. Methodological challenges, including variability in 25(OH)D assays and the unmeasured influence of Vitamin D Binding Protein (VDBP), are important limitations in the current literature. Conclusion: There is a robust association between vitamin D deficiency and an increased risk and severity of neonatal sepsis. Optimizing perinatal vitamin D status represents a promising preventative strategy. High-quality, large-scale randomized controlled trials are urgently needed to establish causality and to formulate evidence-based guidelines for vitamin D supplementation in pregnant women and high-risk neonates for the prevention of sepsis.

The Effectiveness of Platelet-Rich Plasma in Reducing Pain and Improving Functional Outcomes for Patients with Knee Osteoarthritis: A Systematic Review Millsep Sieroka; Sherrina Oktaviani Gosandra
The International Journal of Medical Science and Health Research Vol. 16 No. 4 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/35xjma24

INTRODUCTION Knee osteoarthritis (KOA) is a leading cause of global disability, characterized by chronic pain and functional decline. Current intra-articular therapies, such as corticosteroids and hyaluronic acid, offer limited or transient benefits. Platelet-rich plasma (PRP), an autologous concentration of growth factors, has emerged as a biological therapy with the potential to modulate the joint environment. This systematic review aims to synthesize the highest-level evidence on the effectiveness of intra-articular PRP for reducing pain and improving function in patients with KOA. METHODS This review was conducted following PRISMA guidelines. A comprehensive search of PubMed, Google Scholar, Semanthic Scholar, Springer, and Wiley Online Library was performed to identify randomized controlled trials (RCTs) comparing intra-articular PRP with placebo (saline), hyaluronic acid (HA), or corticosteroids (CS) for symptomatic KOA. Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS) for pain. A broad range of secondary outcomes, including KOOS, IKDC, Lequesne Index, quality of life scores, and adverse events, were also assessed. Methodological quality was evaluated using the Cochrane Risk of Bias 2.0 tool. RESULTS The analysis included evidence from numerous RCTs comprising thousands of patients. The results demonstrate a distinct temporal pattern of efficacy for PRP. Compared to placebo, HA, and CS, PRP injections provide statistically and clinically significant improvements in pain and function, with benefits becoming most pronounced at mid- to long-term follow-up (6 to 12 months). Network meta-analyses consistently rank PRP as the most effective injectable therapy for sustained improvement. Efficacy is greatest in patients with mild-to-moderate KOA (Kellgren-Lawrence grades I–III), and leukocyte-poor PRP formulations appear to yield superior outcomes. PRP is safe, with the most common adverse events being minor, transient local reactions like pain and swelling. DISCUSSION The synthesized evidence indicates that the primary advantage of PRP over traditional injectables is the durability of its clinical benefit, which aligns with its proposed biological, disease-modulating mechanism of action rather than a purely palliative effect. However, the clinical applicability of these findings is challenged by significant heterogeneity across studies in PRP preparation protocols, injection schedules, and patient populations. This lack of standardization, coupled with methodological limitations in the primary literature, tempers the overall certainty of the evidence. CONCLUSION Intra-articular PRP is a safe and effective treatment for KOA, offering superior and more durable pain relief and functional improvement compared to HA and CS, particularly for patients with early-to-moderate disease. Standardization of PRP formulation and treatment protocols is critical to optimize outcomes and establish its definitive role in the clinical management of KOA.

The Effect of Maternal Micronutrient Supplementation During Lactation on Breast Milk Composition and Infant Nutritional Outcomes: A Systematic Review of Vitamin D, Iron, and Omega-3 Fatty Acids Allysa; Arlinda
The International Journal of Medical Science and Health Research Vol. 16 No. 4 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/6bt79w34

Background : Human milk is the optimal source of nutrition for infants, providing a complex matrix of components essential for growth and development. The composition of breast milk is dynamic and can be influenced by maternal nutritional status. Specific micronutrient supplementation during lactation is a proposed strategy to enhance milk quality and improve infant health outcomes, yet the efficacy of this approach varies significantly by nutrient. Objectives : To systematically review and critically evaluate the evidence from randomized controlled trials (RCTs) on the effects of maternal supplementation with vitamin D, iron, and omega-3 fatty acids during lactation on breast milk composition and a comprehensive range of corresponding infant nutritional, health, and developmental outcomes. Methods : A systematic search of PubMed, Google Scholar, Semanthic Scholar, Springer, and Wiley Online Library was conducted. The review included RCTs of maternal oral supplementation with vitamin D, iron, or omega-3s during lactation in mothers of exclusively or predominantly breastfed infants. Primary outcomes included breast milk composition and infant biochemical status (e.g., serum 25-hydroxyvitamin D, hemoglobin, serum ferritin, red blood cell docosahexaenoic acid). Secondary outcomes included infant anthropometry, neurodevelopment, immune function, gut microbiome composition, allergic disease incidence, and maternal mental health. Results : Vitamin D: High-dose maternal vitamin D supplementation (e.g., 4000–6400 IU/day) robustly increases vitamin D levels in breast milk and is as effective as direct infant supplementation (400 IU/day) in achieving vitamin D sufficiency (serum 25(OH)D >50 nmol/L) in breastfed infants. Maternal iron supplementation has a minimal effect on the iron concentration of breast milk due to tight homeostatic regulation. Postpartum maternal supplementation effectively treats maternal anemia, significantly reducing maternal fatigue and depression. Omega-3 Fatty Acids: Maternal supplementation with omega-3s, particularly DHA, reliably increases their concentration in breast milk. However, large, high-quality RCTs have consistently failed to demonstrate a significant benefit for infant neurodevelopmental or cognitive outcomes, including in long-term follow-ups. Conclusion : The efficacy of maternal micronutrient supplementation during lactation is highly nutrient-specific, dictated by distinct biological transfer mechanisms. High-dose vitamin D supplementation for the mother is a safe and effective public health strategy for preventing infant deficiency. The role of iron supplementation is more nuanced; it is critical for maternal mental health, but direct infant supplementation for healthy term infants is questionable due to potential adverse effects on growth and the gut microbiome. For omega-3s, the evidence does not support claims of cognitive or visual enhancement but points toward a promising role in allergy prevention.

How do laparoscopic versus open surgical repair techniques compare in terms of patient recovery, complication rates, and mortality for perforated peptic ulcers : A Systematic Review Ruditya Lukman Hakim; Rezky Putri Wahyu Agustine
The International Journal of Medical Science and Health Research Vol. 16 No. 5 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/e05z6z96

Introduction: Perforated peptic ulcer (PPU) is a life-threatening surgical emergency traditionally managed by open laparotomy. In recent decades, laparoscopic repair has emerged as a prominent minimally invasive alternative. While benefits such as reduced pain and shorter hospital stays are reported, concerns remain regarding longer operative times, specific complications like suture leakage, and inconclusive mortality data. This systematic review aims to comprehensively compare patient recovery, complication rates, and mortality between laparoscopic and open surgical techniques for PPU. Methods: A systematic review was conducted following the PRISMA 2020 guidelines. A comprehensive search of five electronic databases (PubMed, Springer, Semantic Scholar, Google Scholar, Wiley Online Library) was performed to identify comparative studies published in the last decade. The review included randomized controlled trials and observational studies comparing laparoscopic and open repair in adult patients with PPU. After screening and eligibility assessment, 26 studies were included for qualitative synthesis. Results: The synthesis of 26 studies revealed that laparoscopic repair was consistently associated with a significantly shorter postoperative hospital stay (reported in all 16 studies measuring this outcome) and reduced postoperative pain. Furthermore, rates of overall complications and surgical site infections were substantially lower in the laparoscopic group. Conversely, laparoscopy was associated with a longer mean operative time in a majority of studies and a potentially increased risk of suture leakage. The evidence regarding mortality remained inconclusive, as most individual studies were underpowered to demonstrate a statistically significant difference. Conclusion: Laparoscopic repair offers clear and significant advantages over open surgery regarding postoperative recovery, including shorter hospitalization, less pain, and markedly fewer surgical site infections. It should be considered the standard of care for clinically suitable patients. However, the decision must be tempered by the realities of longer operative times and a small but serious risk of suture leakage, which necessitates careful patient selection and adequate surgical expertise. Future large-scale trials are needed to provide definitive conclusions on mortality.

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Indra Hadi

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Equity Tower. 49th Floor. Sudirman Street. Special Region of Jakarta, Indonesia

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INDONESIA