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The International Journal of Medical Science and Health Research

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Published by International Medical Journal Corp. Ltd.

ISSN : 30481376 EISSN : 30481368 DOI : -

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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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Articles 529 Documents

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Estimating Glomerular Filtration Rate in Kidney Transplantation: A Systematic Review of the Diagnostic Accuracy of Creatinine and Cystatin C-Based Equations Wahyu Agus Prastyo; Artha Investari Nugraheni; Mutia Ruliana Ayuningrum
The International Journal of Medical Science and Health Research Vol. 17 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: 10.70070/0nkfxa61

Introduction: Accurate assessment of glomerular filtration rate (GFR) is paramount for monitoring allograft function and predicting outcomes in kidney transplant recipients (KTRs). Estimated GFR (eGFR) equations, based on endogenous biomarkers like serum creatinine (SCr) and cystatin C (CysC), are universally used, but their performance in the unique KTR population is variable. This systematic review synthesizes the evidence on the diagnostic accuracy of various eGFR equations in adult KTRs. Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted to identify diagnostic accuracy studies comparing eGFR equations to a measured GFR (mGFR) reference standard (e.g., inulin, iohexol, iothalamate, or radioisotope clearance) in adult KTRs. Data on study design, population characteristics, and performance metrics—including bias, precision, and accuracy (proportion of estimates within 30% of mGFR, P30)—were extracted. The methodological quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Results: Seventeen primary research studies involving over 20,000 KTRs were included. The evidence demonstrates that eGFR equations combining both SCr and CysC consistently outperform single-marker equations. The combined Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine-cystatin C equation achieved a P30 accuracy of 86.5% in a large cohort, superior to its creatinine-only (80.4%) and cystatin C-only (77.1%) counterparts. The recently developed, race-free, KTR-specific (KRS) equation showed high accuracy (P30 ranging from 73.0% to 91.3%) and outperformed the general population race-free CKD-EPI 2021 equation. Validation studies of the 2021 race-free CKD-EPI equations found their performance to be comparable to the previous 2009/2012 race-inclusive versions in KTRs, supporting their adoption in this population. Equations developed for specific subpopulations, such as the Berlin Initiative Study 1 (BIS-1) for the elderly, also demonstrated strong performance in older KTRs. Discussion: The superior accuracy of combined-marker equations is attributable to the mitigation of distinct non-GFR determinants associated with each biomarker. The development of the KRS equation marks a significant advancement, highlighting the benefit of population-specific formulas. The comparable performance of race-free equations alleviates concerns about compromising accuracy while promoting health equity. Conclusion: For the most accurate GFR estimation in KTRs, combined SCr-CysC equations are recommended. When only SCr is available, the KTR-specific KRS equation is the preferred choice over general population formulas. The transition to race-free equations is safe and appropriate in the kidney transplant setting.

The Association of Left Ventricular Hypertrophy with Sudden Cardiac Death in Hypertension: A Systematic Review Adzana Yasadhy Hangga Prasetyo
The International Journal of Medical Science and Health Research Vol. 17 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/qmgbrb16

Introduction: Left ventricular hypertrophy (LVH), a common manifestation of hypertension-mediated organ damage, is a potent predictor of adverse cardiovascular outcomes. However, a comprehensive synthesis of its specific association with sudden cardiac death (SCD) in hypertensive populations is needed. This systematic review aims to identify, appraise, and synthesize the evidence quantifying the link between LVH and SCD in hypertension, exploring the prognostic value of various anatomic and electrical markers of hypertrophy. Methods: Following PRISMA guidelines, a systematic search of PubMed, Scopus, Embase, and the Cochrane Library was conducted to identify prospective cohort studies and clinical trials reporting on the association between LVH and SCD in hypertensive adults. Studies were screened for eligibility, and data on study design, population, LVH assessment, and risk estimates were extracted. The methodological quality of included studies was assessed using the ROBINS-I tool for non-randomized studies. Results: Seventeen cohort studies and post-hoc analyses of clinical trials, encompassing over 50,000 patients, were included. The evidence consistently demonstrates that LVH is a powerful and independent predictor of SCD. Echocardiographically defined LVH was associated with a more than two-fold increase in SCD risk (Hazard Ratio 2.16; 95% Confidence Interval [CI] 1.22–3.81), while electrocardiographically (ECG) defined LVH conferred a nearly three-fold increased risk (adjusted HR 2.99; 95% CI 1.47–6.09). Specific LVH phenotypes, including concentric geometry, the presence of an ECG strain pattern (adjusted HR for cardiovascular mortality 1.53; 95% CI 1.18–2.00), prolonged QRS duration (HR per 10 ms increase 1.22; p<0.001), and QTc interval prolongation (Odds Ratio 1.72; 95% CI 1.23–2.40), were identified as markers of particularly high risk. Furthermore, therapeutic regression of LVH was associated with a significant reduction in SCD risk, with the absence of in-treatment LVH lowering the risk by up to 30% (HR 0.70; 95% CI 0.54–0.92). Discussion: The association between LVH and SCD is underpinned by a triad of arrhythmogenic mechanisms: structural remodeling (myocardial fibrosis), electrophysiological instability (altered ion channel function and repolarization abnormalities), and relative myocardial ischemia. These pathophysiological changes create a vulnerable substrate for fatal ventricular arrhythmias. The findings highlight that ECG and echocardiography provide complementary, rather than redundant, prognostic information, reflecting distinct electrical and anatomic aspects of myocardial remodeling. Conclusion: LVH is a clinically significant and modifiable risk factor for SCD in patients with hypertension. Risk stratification in hypertension should extend beyond blood pressure measurement to include a comprehensive assessment of LVH. The presence of high-risk features, such as concentric geometry or an ECG strain pattern, warrants more aggressive management aimed at LVH regression to mitigate the risk of sudden death.

The Association of Acute Kidney Injury with the Development and Progression of Chronic Kidney Disease: A Systematic Review Adzana Yasadhy Hangga Prasetyo
The International Journal of Medical Science and Health Research Vol. 17 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/ba1rs540

Background: The incidence of acute kidney injury (AKI) is rising globally, representing a significant burden on healthcare systems. Historically considered a transient and fully reversible condition, a substantial body of evidence now suggests that an episode of AKI is a major independent risk factor for adverse long-term sequelae, most notably the development and progression of chronic kidney disease (CKD). This systematic review aims to synthesize and critically appraise the current evidence from observational cohort studies to quantify the long-term risks associated with AKI. Methods: A systematic search of the PubMed and Embase databases was conducted to identify cohort studies published from inception to September 2025 that evaluated long-term outcomes in adult patients following an episode of AKI, with a non-AKI comparator group. Studies were selected based on predefined Population, Intervention/Exposure, Comparison, Outcomes, and Study Design (PICOS) criteria, requiring a minimum follow-up of one year. Data on study design, population characteristics, definitions of AKI and CKD, follow-up duration, and reported outcomes were systematically extracted. The methodological quality and risk of bias for each included study were assessed using the Newcastle-Ottawa Scale (NOS). Results: Seventeen cohort studies, encompassing a total of 2,546,812 participants, met the inclusion criteria. The evidence consistently demonstrated that patients who survive an episode of AKI have a significantly higher risk of adverse long-term outcomes compared to those without AKI. The pooled adjusted Hazard Ratio (HR) for developing incident CKD was 2.72 (95% CI 2.01–3.69). The risk for progressing to end-stage renal disease (ESRD) was even more pronounced, with a pooled adjusted HR of 4.15 (95% CI 2.58–6.67). Furthermore, AKI was associated with a nearly doubled risk of long-term all-cause mortality (pooled adjusted HR 1.85, 95% CI 1.65–2.08). The risk for all outcomes was graded, increasing with the severity and duration of the initial AKI episode. Notably, even mild (Stage 1) or transient (<3 days) AKI was associated with a significantly increased risk of incident CKD. Other significant adverse outcomes included increased risks of heart failure, myocardial infarction, and recurrent AKI. Discussion: The synthesized evidence robustly demonstrates that AKI is not merely a transient event but a sentinel insult that can initiate a persistent trajectory toward chronic disease and premature death. The pathophysiological transition from AKI to CKD is driven by complex processes of maladaptive repair, including persistent inflammation, endothelial dysfunction, cellular senescence, and ultimately, renal fibrosis. These findings challenge the conventional clinical paradigm of "renal recovery" based solely on the normalization of serum creatinine and highlight a critical need for structured, long-term surveillance of AKI survivors. Conclusion: AKI is a potent and independent risk factor for the development of incident CKD, the progression of pre-existing CKD, ESRD, and premature mortality. Survivors of an AKI episode represent a high-risk population that warrants systematic, long-term nephrological follow-up to monitor for and mitigate these adverse cardiorenal outcomes.

What Are The Most Effective Non-Pharmacological Interventions For Preventing Osteoporosis And Sarcopenia In Adults Over 65 Years Old? Calista Giovani; Yudhi Hajianto Nugroho; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 17 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/e6em4w32

Introduction: Osteoporosis and sarcopenia are prevalent conditions among older adults, particularly those over 65, leading to increased fracture risk and functional decline. Understanding effective non-pharmacological strategies for prevention is crucial as the global population ages. This study evaluates the efficacy of exercise and dietary modifications in preventing these conditions. Methods: This systematic review adhered to PRISMA guidelines, focusing on randomized controlled trials that evaluated non-pharmacological interventions in adults aged 65 and older. Eligible studies were screened for their focus on primary prevention, intervention type, and outcome measures related to bone mineral density, muscle mass, and physical performance. Results: A total of 39 studies were included, revealing that high-intensity resistance training significantly improved bone mineral density and muscle strength. Nutritional interventions, particularly protein supplementation, enhanced the effects of exercise on muscle mass and functional performance. Multicomponent exercise programs integrating balance, aerobic, and resistance training also showed positive outcomes in reducing fall risk. Discussion: The findings underscore the importance of structured exercise programs and dietary modifications in preventing osteoporosis and sarcopenia. Community-based interventions demonstrated higher adherence rates, while home-based programs offered flexibility for older adults. Conclusion: Non-pharmacological interventions, particularly high-intensity resistance training combined with dietary support, are effective strategies for preventing osteoporosis and sarcopenia in older adults. Future research should focus on enhancing long-term adherence to these interventions to improve health outcomes in this vulnerable population.

How Do Medication Management Interventions Reduce Polypharmacy- Related Risks In Older Adults With Multiple Chronic Conditions? Calista Giovani; Yudhi Hajianto Nugroho; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 17 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: 10.70070/20sx4161

Introduction: Polypharmacy, defined as the concurrent use of five or more medications, is prevalent among older adults with multiple chronic conditions, increasing the risk of adverse drug events and diminished quality of life. Addressing these risks through effective medication management has become a critical healthcare priority. Methods: This systematic review evaluated 40 studies, primarily randomized controlled trials (RCTs), focusing on medication management interventions such as structured medication reviews, deprescribing protocols, and electronic decision support systems. The inclusion criteria targeted older adults aged 65 years and above, taking five or more medications. Results: The review revealed that medication management interventions significantly reduced the number of medications and potentially inappropriate medications (PIMs). Notably, 10 out of 14 studies reported a decrease in medication counts, and 5 out of 8 studies showed reductions in PIMs. Clinical benefits included improved quality-adjusted life years and fewer hospital admissions. Discussion: A multidisciplinary approach, involving pharmacists, physicians, and nurses, was essential for the success of these interventions. The integration of technology and patient-centered strategies enhanced medication adherence and safety. However, challenges such as time constraints and resource intensity hindered broader implementation. Conclusion: Medication management interventions effectively reduce polypharmacy-related risks in older adults. Continued focus on multidisciplinary collaboration, technology integration, and addressing implementation barriers is crucial for optimizing medication safety and health outcomes.

How Do Early Screening Interventions For Frailty Impact The Prevention Of Delirium In Older Adult Patients? Calista Giovani; Yudhi Hajianto Nugroho; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 17 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: 10.70070/57w91833

Introduction: Frailty and delirium are common and interrelated conditions affecting older adults, especially those undergoing hospitalization or surgery. Early screening for frailty has been proposed as a strategy to identify vulnerable patients and implement preventive measures to reduce the incidence of delirium. Methods: This review analyzed interventional studies published within the last decade that assessed the impact of early frailty screening combined with individualized care plans on delirium prevention in older adults. Studies included randomized controlled trials, quasi-experimental designs, and prospective interventions involving patients aged 65 years or older across various healthcare settings. Frailty screening tools and delirium assessment methods were evaluated alongside intervention timing and types. Results: Multiple studies demonstrated significant reductions in delirium incidence following early frailty screening and targeted interventions. For example, delirium rates decreased from 10.0% to 3.3% in vascular surgery patients after geriatric comanagement, and from 29.2% to 11.3% in colorectal surgery patients receiving comprehensive geriatric assessment. Interventions ranged from preoperative cognitive exercises and multimodal prehabilitation to in-hospital multidisciplinary care models. Some studies reported improved functional and cognitive outcomes, while a few noted no significant changes in longer-term results. Discussion: Early frailty screening enables proactive identification of at-risk older adults, facilitating the delivery of personalized, multidisciplinary interventions that effectively reduce delirium incidence. The timing of intervention—particularly preoperative assessments—plays a crucial role in optimizing outcomes. Multidisciplinary collaboration and individualized care plans are common success factors. However, challenges such as patient non-compliance, small sample sizes, and external factors like the COVID-19 pandemic may limit effectiveness in some contexts. Conclusion: Early screening for frailty combined with tailored, multidisciplinary care is an effective approach to delirium prevention in older adults. Continued research is needed to refine screening tools, intervention protocols, and implementation strategies to enhance patient outcomes and broaden applicability across healthcare settings.

The Study of Risk Factors and Management of Obesity in Children : A Comprehensive Systematic Review Patrick Luckend Sahusilawane; Oktavia Henny
The International Journal of Medical Science and Health Research Vol. 17 No. 6 (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: 10.70070/4pqj7193

Background: Childhood obesity is a significant global public health issue, with a significant association between risk factors and management. Factors such as reduced physical activity and increased access to processed foods contribute to this trend. Management is crucial to prevent obesity-related health issues in adulthood, as obesity can lead to complications like type 2 diabetes, dyslipidemia, and cardiovascular diseases. Early intervention and lifestyle modifications can reduce the risk of obesity-related comorbidities, but the feasibility of implementing intensive programs may be challenging. Methods: This systematic review focused on full-text English literature published between 2014 and 2024, adhering to PRISMA 2020 principles. Without a DOI, editorials and review papers that were published in the same journal as the submission were not accepted. ScienceDirect, PubMed, and SagePub were among the many web resources used to compile the literature. Result: Utilizing dependable sources such as Science Direct, SagePub, and PubMed, the investigation scrutinized nearly 100,000 articles. After determining that ten publications required additional investigation, a more comprehensive review of the entire corpus was carried out. Conclusion: Pediatric obesity is a complex issue influenced by behavioral, genetic, socioeconomic, and environmental factors. Environmental factors, such as high-calorie foods and fast-food, disrupt prefrontal executive-control responses. Genetic similarities between obese adults and children have been discovered. Treatment options include nutrition, exercise, psychological therapy, pharmacotherapy, and surgical procedures. However, treatment outcomes can vary widely, necessitating a comprehensive baseline assessment.

Association of Febuxostat to Cardiovascular Mortality in Gout: A Systematic Review Satria Dharma Setiawan; Dina Anggraini
The International Journal of Medical Science and Health Research Vol. 17 No. 6 (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: 10.70070/2twpyp76

Introduction: Gout, a systemic metabolic disorder characterized by hyperuricemia, is an independent risk factor for cardiovascular (CV) disease. Febuxostat, a potent xanthine oxidase inhibitor, has demonstrated superior urate-lowering efficacy compared to allopurinol. However, its CV safety profile has been the subject of significant controversy following conflicting results from two major randomized controlled trials (RCTs), the CARES and FAST trials, and a subsequent FDA black box warning regarding increased mortality risk. This systematic review aims to synthesize the current evidence on the association between febuxostat and CV mortality in patients with gout. Methods: A systematic search was conducted in PubMed/MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for RCTs and observational cohort studies comparing the CV safety of febuxostat with allopurinol or other controls in patients with gout or hyperuricemia. Data on primary outcomes (CV mortality, all-cause mortality) and numerous secondary CV outcomes were extracted. The quality of RCTs was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, and observational studies were assessed with the Newcastle-Ottawa Scale. Results: Seventeen studies, including five major RCTs and twelve observational studies and meta-analyses, were included. A significant signal for increased mortality was identified. The pivotal CARES trial, involving 6,190 high-risk CV patients, found that febuxostat was associated with a statistically significant increase in CV mortality (Hazard Ratio 1.34, 95% Confidence Interval [CI] 1.03–1.73) and all-cause mortality (HR 1.22, 95% CI 1.01–1.47) compared to allopurinol. This finding was supported by a meta-analysis by Cuenca et al. (2019) (Relative Risk for CV death 1.29, 95% CI 1.01–1.66) and an Austrian cohort study. However, a substantial body of conflicting evidence exists. The FAST trial (n=6,128) found febuxostat to be non-inferior to allopurinol, with no increased risk of CV or all-cause mortality. Multiple large-scale cohort studies and meta-analyses corroborated the findings of the FAST trial, reporting no significant difference in mortality or major adverse cardiovascular events (MACE). Discussion: The discrepancy in findings is largely attributable to critical differences in study populations and methodologies between the CARES and FAST trials. CARES enrolled patients with established, severe CV disease who were often initiating urate-lowering therapy, whereas FAST studied a lower-risk population already stable on allopurinol. The high rate of participant discontinuation in the CARES trial represents a significant risk of bias. Emerging evidence suggests the increased risk may be concentrated in the treatment initiation phase or may be linked to sUA fluctuations following treatment discontinuation, rather than a direct pharmacological effect of the drug itself. Conclusion: A significant association between febuxostat and increased cardiovascular mortality has been demonstrated, primarily driven by the CARES trial in a specific high-risk population. While this signal warrants significant clinical caution, it is contradicted by other high-quality evidence. The risk appears conditional rather than universal. Clinical decisions should involve careful patient selection and shared decision-making, reserving febuxostat for patients intolerant to allopurinol, particularly those with a high CV burden.

The Role of Exercise in Preventing Low Back Pain: A Systematic Review Fatia Rachmatina; Muhammad Rifqi Farizan Akbar
The International Journal of Medical Science and Health Research Vol. 17 No. 6 (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/qvfndz85

Introduction: Low back pain (LBP) represents the leading cause of disability globally, characterized by high recurrence rates that impose a significant and escalating socioeconomic burden. This clinical landscape necessitates a paradigm shift from reactive treatment to proactive prevention, for which exercise has emerged as a primary intervention strategy. This systematic review aims to critically evaluate and synthesize the current evidence from randomized controlled trials on the efficacy of exercise in preventing LBP. Methods: Following PRISMA guidelines, a systematic search of the PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library databases was conducted to identify randomized controlled trials (RCTs) evaluating exercise-based interventions for the prevention of non-specific LBP in adults. Two independent reviewers performed study selection, data extraction, and quality appraisal. The methodological quality of included trials was rigorously assessed using the revised Cochrane Risk of Bias tool (RoB 2). Results: This review included 17 RCTs involving a total of 21,455 participants. The synthesized evidence demonstrates a statistically significant and clinically meaningful protective effect of exercise. Meta-analyses consistently show that exercise alone reduces the risk of an LBP episode by approximately 33% (Relative Risk 0.67). When combined with education, exercise reduces the risk of an LBP episode by 27% to 45% (RR ranging from 0.55 to 0.73). Furthermore, exercise interventions were found to significantly reduce secondary outcomes, including future pain intensity, functional disability, and, in some analyses, work absenteeism. In contrast, interventions such as education alone, back belts, and shoe insoles were found to be ineffective. Discussion: The findings robustly affirm that exercise is an effective primary and secondary preventive intervention for LBP. The superiority of active exercise over passive or educational-only approaches suggests its efficacy is driven by a combination of biomechanical, neurophysiological, and psychosocial adaptations. These mechanisms collectively enhance spinal resilience, modulate pain perception, and improve functional confidence. The evidence also suggests that exercise is a cost-effective intervention compared to usual care. Conclusion: Exercise, implemented either as a standalone intervention or in conjunction with education, is a significantly effective, evidence-based strategy for preventing LBP and its associated consequences. Its integration into clinical practice and public health policy is strongly recommended to mitigate the global burden of this condition.

Association Between Non-O Blood Groups and Mortality in Pediatric Cerebral Malaria: A Systematic Review of Sequestration-Related Outcomes Karina Agusta Putri
The International Journal of Medical Science and Health Research Vol. 17 No. 7 (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/p91h4g40

INTRODUCTION: Cerebral malaria (CM) remains a leading cause of pediatric mortality, driven by the sequestration of Plasmodium falciparum-infected erythrocytes (iRBCs). Host genetic factors, particularly the ABO blood group system, are implicated in disease severity. This review systematically evaluates the association between non-O blood groups (A, B, AB) and mortality in pediatric CM, with a specific focus on outcomes related to the pathophysiology of sequestration. METHODS: Following PRISMA guidelines, a systematic search of PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library was conducted for observational studies published up to December 2025. Studies were included if they assessed pediatric populations with CM, compared outcomes between ABO blood groups, and reported on mortality or sequestration-related markers. Data were extracted for a primary outcome of all-cause mortality and seventeen secondary outcomes. The risk of bias in included non-randomized studies was assessed using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool. RESULTS: A total of 17 observational studies met the inclusion criteria. A consistent and significant association was found between non-O blood groups and increased risk of severe malaria and mortality. Compared to blood group O, non-O phenotypes were associated with higher odds of severe disease, with odds ratios (ORs) ranging from 1.27 to 6.28 in various comparisons. Mechanistically, non-O groups were linked to enhanced rosetting, a key driver of sequestration. This was accompanied by adverse biomarker profiles indicative of severe endothelial activation and dysfunction, including elevated von Willebrand factor (vWF) and Angiopoietin-2 (Ang-2), and decreased Angiopoietin-1 (Ang-1). Furthermore, non-O groups were associated with higher parasite densities in some studies, an increased incidence of severe anemia, and a greater risk of long-term neurological sequelae, completing the link between phenotype and clinical outcome. DISCUSSION: The synthesized evidence strongly supports a mechanistic link wherein A and B antigens on the surface of uninfected erythrocytes act as receptors for parasite ligands (PfEMP1) on iRBCs, promoting the formation of larger and more stable rosettes. This enhanced sequestration obstructs cerebral microvasculature, drives a cascade of endothelial dysfunction and inflammation, and culminates in the severe clinical manifestations and higher mortality observed in children with non-O blood groups. CONCLUSION: The non-O blood group is a significant and clinically relevant risk factor for mortality and adverse sequestration-related outcomes in pediatric cerebral malaria. ABO typing, a widely available and low-cost test, represents a valuable potential tool for early risk stratification and may inform clinical management decisions, such as transfusion strategies, in high-risk pediatric populations.

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Indra Hadi

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

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Kota adm. jakarta selatan,

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INDONESIA