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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 400 Documents

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A Complex Case of Sacral Herpes Zoster Complicated by a Vulvar Abscess Unmasking Uncontrolled Type 2 Diabetes Mellitus Nova Faisal Waber; Faradiani Rasyidi
The International Journal of Medical Science and Health Research Vol. 18 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: 10.70070/5b50hf75

Introduction: Genital herpes zoster (HZ), a reactivation of the latent Varicella-Zoster Virus (VZV), is an uncommon clinical entity, as the sacral dermatomes are infrequently affected. The severity and clinical course of HZ can be profoundly influenced by underlying conditions that impair cell-mediated immunity, such as diabetes mellitus (DM). Case Illustration: We present the case of a 60-year-old female who presented to the emergency department with a two-day history of an acute, severely painful, unilateral vesicular eruption in the sacral dermatome, consistent with HZ. Her condition was complicated by the rapid development of a large, fluctuant vulvar abscess. Crucially, initial laboratory investigations revealed severe hyperglycemia with a random blood sugar of 306 mg/dL, leading to a new diagnosis of Type 2 Diabetes Mellitus (T2DM). Discussion: The patient's management necessitated a coordinated, multidisciplinary approach. This involved high-dose oral antiviral therapy to control VZV replication, urgent surgical incision and drainage of the vulvar abscess for source control, broad-spectrum systemic antibiotics to treat secondary bacterial infection and sepsis, and aggressive glycemic control with a multi-dose insulin regimen. This report delves into the intricate pathophysiological triad where the impaired immunity of undiagnosed diabetes precipitated VZV reactivation, the acute viral infection triggered severe metabolic decompensation, and the resultant state of acute hyperglycemia and immune paralysis created a permissive environment for a life-threatening bacterial superinfection and abscess formation. Conclusion: This case underscores the critical importance of including HZ in the differential diagnosis of acute, unilateral ulcerative genital lesions. Furthermore, it highlights how a severe or complicated HZ presentation can be the initial clinical manifestation of previously undiagnosed and uncontrolled T2DM, mandating prompt investigation for underlying metabolic disorders. The successful outcome demonstrates the necessity of an integrated multidisciplinary strategy in managing such complex clinical emergencies.

The Role of Diagnostic Imaging in Pediatric Tuberculosis with Severe Malnutrition: A Systematic Review Isabella Mebang; Patrick Luckend Sahusilawane; Oktavia Henny
The International Journal of Medical Science and Health Research Vol. 18 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/ftkbkn84

Introduction: The syndemic of pediatric tuberculosis (TB) and severe acute malnutrition (SAM) represents a major global health crisis, characterized by a vicious cycle of immunological impairment and metabolic decline. The diagnosis of TB in this vulnerable population is notoriously difficult due to overlapping clinical features and the blunted immune responses that render conventional tests unreliable. Consequently, diagnostic imaging assumes a pivotal role in clinical decision-making. This review systematically evaluates the evidence for the role of various imaging modalities in this context. Methods: A systematic search was conducted across PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library for original research articles published up to October 2024. Studies were included if they investigated the use of chest radiography (CXR), computed tomography (CT), or point-of-care ultrasound (POCUS) for diagnosing TB in children under 15 years with concurrent SAM. Data on study design, population characteristics, imaging findings, and diagnostic outcomes were extracted. The methodological quality of the included studies was appraised using the Cochrane Risk of Bias tool. Results: Seventeen studies met the inclusion criteria, predominantly from high-burden settings in Africa and Asia. The prevalence of TB in hospitalized SAM cohorts ranged widely, from 1.6% to 44%. CXR was the most common modality, frequently revealing non-specific findings such as consolidation, but also demonstrating a higher prevalence of severe disease patterns like cavitation in malnourished children. CT offered superior anatomical detail for lymphadenopathy and parenchymal disease but was infrequently used. Evidence for POCUS was nascent and conflicting; while some studies integrated it successfully into diagnostic algorithms to detect extrapulmonary features, others found no specific sonographic findings associated with TB. Discussion: The synthesized evidence confirms that imaging is indispensable for TB diagnosis in children with SAM. However, malnutrition significantly alters the radiological presentation, often mimicking severe bacterial pneumonia or presenting with "adult-type" features like cavitation, which complicates interpretation. While CT provides definitive characterization in ambiguous cases, its utility is limited by accessibility. The inconsistent findings for POCUS highlight an urgent need for standardized protocols. The most significant trend is the integration of imaging into multi-parameter Treatment Decision Algorithms (TDAs), which have shown superior diagnostic yield and cost-effectiveness compared to standard care. Conclusion: Diagnostic imaging is a cornerstone of TB diagnosis in children with SAM, but no single modality is sufficient. A high index of suspicion is required, and interpretation must account for the altered disease patterns caused by malnutrition. An integrated, multi-modal approach, guided by validated clinical algorithms that incorporate imaging findings, represents the most effective strategy. Future research should focus on validating standardized POCUS protocols and evaluating the long-term utility of imaging in this population.

Predicting the Progression of Non-Alcoholic Fatty Liver Disease Using Machine Learning and Clinical Laboratory Parameters: A Systematic Review Aila Mustofa; Catherine Halim
The International Journal of Medical Science and Health Research Vol. 18 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/pmray255

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a growing global health crisis, with a significant proportion of patients progressing to severe liver pathologies, including non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. The limitations and risks of invasive liver biopsy, the current gold standard for diagnosis, necessitate the development of accurate, non-invasive tools for risk stratification and disease monitoring. Machine learning (ML) models, which utilize routinely collected clinical laboratory data, have emerged as a promising and scalable solution for predicting disease progression. This review synthesizes the current evidence on the efficacy of these models. Methods: A systematic literature search was conducted across PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library databases in accordance with PRISMA guidelines. The search included studies that developed or validated ML models to predict NAFLD progression (to NASH, significant fibrosis, or advanced fibrosis using clinical laboratory parameters as primary predictors. Data on study design, population characteristics, ML algorithms, key predictors, and a full spectrum of performance metrics were extracted. The methodological quality of each study was rigorously assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Results: Sixteen studies met the inclusion criteria, encompassing a diverse range of populations and model architectures. The primary outcomes predicted were progression to NASH, significant fibrosis, and advanced fibrosis. Ensemble ML models, particularly eXtreme Gradient Boosting (XGBoost) and Random Forest (RF), consistently demonstrated superior predictive performance over traditional statistical models and other ML algorithms. For the critical endpoint of advanced fibrosis, these models frequently achieved Area Under the Receiver Operating Characteristic (AUROC) values exceeding 0.85 and, in some cases, approaching 0.92. A core set of laboratory parameters—including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), platelet count, triglycerides, and glycated hemoglobin (HbA1c)—were consistently identified as the most important predictors across multiple models, reflecting their central role in the pathophysiology of NAFLD. Discussion: The evidence strongly indicates that ML models can effectively integrate complex, non-linear patterns from standard laboratory tests to generate a "digital signature" of NAFLD pathophysiology, enabling more accurate and individualized risk stratification than traditional scoring systems. These models hold significant potential for clinical application, from facilitating early identification of high-risk individuals in primary care settings to improving the efficiency of patient enrollment in clinical trials for emerging NASH therapies. However, the predominance of retrospective study designs, a lack of consistent external validation, and issues with model interpretability are key limitations of the current evidence base that must be addressed. Conclusion: Machine learning models based on clinical laboratory parameters are powerful non-invasive tools for predicting NAFLD progression. Their high accuracy and reliance on readily available data position them as a transformative technology in hepatology. Future research must prioritize prospective validation in diverse, real-world clinical settings and focus on developing interpretable, longitudinally-informed models to facilitate their responsible and effective integration into routine clinical practice.

A Systematic Review of the Association Between Coronary Microvascular Dysfunction and Clinical Outcomes in Heart Failure with Preserved Ejection Fraction Khairani Putri
The International Journal of Medical Science and Health Research Vol. 18 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: 10.70070/1nb4fr03

Introduction: Heart failure with preserved ejection fraction (HFpEF) represents a growing global health challenge, characterized by high morbidity and mortality with limited therapeutic options. A contemporary paradigm posits that a systemic inflammatory state, driven by multiple comorbidities, leads to coronary microvascular dysfunction (CMD), a key driver of myocardial pathology in HFpEF. This systematic review aims to synthesize the evidence on the prevalence, pathophysiological correlates, and prognostic significance of CMD in the HFpEF population. Methods: A systematic search of PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library was conducted to identify observational studies evaluating CMD in patients with HFpEF. Studies were included if they provided data on the prevalence of CMD and/or its association with clinical, echocardiographic, or prognostic outcomes. Data were extracted by two independent reviewers, and the methodological quality of included studies was assessed using the ROBINS-I tool for non-randomized studies. Results: A total of 15 observational studies, enrolling over 2,500 patients, were included. The prevalence of CMD in HFpEF is significantly high, with pooled estimates from meta-analyses ranging from 58% to 71%. The presence of CMD was consistently associated with more severe cardiac pathology, including greater diastolic dysfunction (higher E/e' ratio), increased left atrial volume index (LAVi), and a higher prevalence of atrial fibrillation. Furthermore, CMD was identified as a powerful and independent predictor of adverse clinical outcomes. Multiple studies demonstrated that HFpEF patients with CMD face a substantially higher risk of a composite of all-cause mortality or heart failure hospitalization, with hazard ratios reported to be as high as 3.19. Discussion: The consolidated evidence establishes CMD not as a mere epiphenomenon but as a central, prognostically significant endotype within the heterogeneous HFpEF syndrome. The pathophysiology appears to involve a vicious cycle where systemic inflammation induces CMD, leading to myocardial ischemia and stiffness, which in turn mechanically exacerbates microvascular impairment. The association of CMD with dysfunction in other vascular beds suggests HFpEF may be a manifestation of a systemic microvasculopathy. This understanding positions CMD as a critical target for risk stratification and future therapeutic development. Conclusion: A robust body of evidence establishes CMD as a core component of HFpEF pathophysiology, strongly associated with disease severity and poor prognosis. Assessment of microvascular function holds promise for refining risk stratification in HFpEF, and targeting CMD represents a critical frontier for developing novel, effective therapies for this challenging condition.

Association between Staphylococcus aureus Exfoliative Toxins and Staphylococcal Scalded Skin Syndrome: A Systematic Review Risca Hijrianti; Rizky Arianto Nugroho
The International Journal of Medical Science and Health Research Vol. 18 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/gzv5tm56

Introduction: Staphylococcal Scalded Skin Syndrome (SSSS) is a severe, toxin-mediated dermatosis caused by specific strains of Staphylococcus aureus. While the causal link to exfoliative toxins (ETs) is well-established, a systematic synthesis correlating specific toxin types (ETA, ETB) with the full spectrum of clinical outcomes, microbiological profiles, and prognostic indicators is lacking. This review aims to systematically analyze and synthesize the evidence on the association between S. aureus ETs and the clinical, microbiological, and prognostic features of SSSS, providing a comprehensive evidence base for clinical practice (Ladhani, 1999; Mishra, Yadav and Mishra, 2016). Methods: Following the PRISMA 2020 guidelines, a systematic search of PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library was conducted for observational studies and case series (n≥5) reporting on SSSS patients with confirmed S. aureus infection and identified toxin types (ETA/ETB). Two independent reviewers performed study selection, data extraction, and a rigorous quality appraisal using the ROBINS-I tool for non-randomized studies. A narrative synthesis of over 15 distinct outcomes was performed, with a primary focus on stratifying data by the causative toxin profile to elucidate differential effects (Page et al., 2021). Results: A total of 17 studies, comprising 1,027 patients, met the inclusion criteria. The evidence strongly indicates a significant dichotomy in clinical presentation based on toxin type. ETA was predominantly associated with localized disease (bullous impetigo), whereas ETB was significantly correlated with the more severe, generalized form of SSSS (p<0.001) (Bukowski et al., 2005). Pediatric populations (<6 years) were primarily affected, with mortality rates consistently below 5% in this group (Handler and Schwartz, 2021). In stark contrast, adults with comorbidities, particularly renal failure and immunosuppression, exhibited markedly high mortality rates exceeding 50% (Ladhani, 2003). The prevalence of methicillin-resistant S. aureus (MRSA) varied significantly by geographic region, with some Asian countries reporting MRSA in over 90% of SSSS cases, necessitating a region-specific approach to empirical therapy (Lee et al., 2021). Complications such as dehydration, electrolyte imbalance, and secondary sepsis were common in generalized disease, though healing was typically rapid and without scarring due to the superficial nature of epidermal cleavage (Oakley, 2017). Discussion: The findings strongly support a host-pathogen interaction model where the clinical phenotype of SSSS is determined not only by the toxin but critically by the host's specific immune status. Lower population-level antibody titers against ETB likely permit its systemic dissemination, leading to generalized disease, whereas higher anti-ETA antibody prevalence contains the infection locally (Bukowski et al., 2005). This has significant implications for diagnosis, where differentiation from Toxic Epidermal Necrolysis (TEN) is paramount, and for management, which necessitates a geographically informed approach to empirical antibiotic selection to address the dramatic regional variations in MRSA prevalence (Popescu et al., 2018; Lee et al., 2021). Conclusion: S. aureus exfoliative toxins are definitively and causally associated with SSSS. The specific toxin serotype, particularly ETB, is a significant predictor of the clinical phenotype and severity, an association that is critically modulated by host immunological factors. Clinical management requires prompt hospitalization, aggressive supportive care, and empirical antibiotic therapy tailored to local and regional resistance patterns to ensure optimal outcomes.

The Association of Sodium-Glucose Cotransporter-2 Inhibitors With Improved Clinical Outcomes in Heart Failure: A Systematic Review of Landmark Clinical Trials Anggreini Oktavia Trisno; Chelsia Ernes
The International Journal of Medical Science and Health Research Vol. 18 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/bwk49p78

Introduction: Heart failure (HF) represents a major global health burden characterized by significant morbidity, mortality, and healthcare expenditure. While established therapies exist for HF with reduced ejection fraction (HFrEF), effective treatments for HF with preserved ejection fraction (HFpEF) have been elusive. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, initially developed as anti-hyperglycemic agents, have emerged as a transformative therapeutic class for HF. This systematic review synthesizes the evidence from landmark clinical trials on the efficacy and safety of SGLT2 inhibitors in improving HF outcomes. Methods: A systematic search of major electronic databases PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library was conducted to identify large-scale, randomized, double-blind, placebo-controlled trials evaluating SGLT2 inhibitors in patients with HF or those at high risk for HF. Key efficacy outcomes included the composite of cardiovascular (CV) death or hospitalization for heart failure (HHF), its individual components, all-cause mortality, total HHF, renal outcomes, and changes in quality of life. The methodological quality of included trials was assessed using the Cochrane Risk of Bias tool. Results: Sixteen landmark clinical trials and two major meta-analyses were included, encompassing a diverse population of patients with and without type 2 diabetes (T2DM) across the full spectrum of left ventricular ejection fraction (LVEF). The evidence demonstrates a consistent and robust class effect. SGLT2 inhibitors significantly reduce the primary composite outcome of CV death or HHF by approximately 20-25% across all HF phenotypes. This benefit is predominantly driven by a substantial reduction in the risk of first and total HHF, observed in HFrEF (Hazard Ratio ~), HFpEF (HR ~), and in patients with recent worsening HF. A significant reduction in CV death and all-cause mortality was established in patients with HFrEF, with large meta-analyses suggesting a modest mortality benefit across the broader HF population. Furthermore, SGLT2 inhibitors consistently demonstrated profound nephroprotective effects and led to clinically meaningful improvements in patient-reported symptoms and quality of life. The safety profile was generally favorable and consistent across trials. Discussion: The consistent benefits observed across a wide range of patient populations, irrespective of baseline LVEF or diabetes status, have fundamentally altered the HF treatment paradigm. The pleiotropic mechanisms of SGLT2 inhibitors, including hemodynamic, metabolic, and direct myocardial effects, likely contribute to these favorable outcomes. Conclusion: SGLT2 inhibitors have unequivocally been established as a foundational pillar of guideline-directed medical therapy for HF. They significantly reduce the burden of HF hospitalizations, slow the progression of concomitant kidney disease, improve quality of life, and, in HFrEF, reduce mortality.

Complications of Recurrent Corticosteroid Use in Patients with Erythema Nodosum Leprosum : A Case Report Muhammad Alkadri Anugrah; Eka Komarasari; Prima Kartika Esti
The International Journal of Medical Science and Health Research Vol. 18 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/jytmzv11

The use of corticosteroids is the standard therapy for managing leprosy reactions. However, long-term corticosteroid use can cause various complications. This case report discusses the potential complications of long-term corticosteroid use in a patient with Hansen's disease (MH) and erythema nodosum leprosum (ENL) reactions. This case report emphasizes the importance of routine monitoring in patients receiving corticosteroids to detect and manage potential complications.

Comparative Effectiveness of Direct Oral Anticoagulants versus Vitamin K Antagonists on the Incidence of Dementia in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review and Meta-Analysis Melany Nurjanah; Haryadi
The International Journal of Medical Science and Health Research Vol. 18 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/qhabmg18

Introduction: Atrial fibrillation (AF) is an established independent risk factor for cognitive decline and dementia. While oral anticoagulation is known to mitigate this risk compared to no treatment, the comparative effectiveness of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) on cognitive outcomes remains a subject of ongoing investigation. This systematic review and meta-analysis aims to synthesize the current evidence comparing the effects of DOACs and VKAs on the incidence of dementia in patients with non-valvular atrial fibrillation (NVAF). Methods: A systematic literature search was conducted across PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library databases for randomized controlled trials and observational studies comparing DOACs with VKAs in adults with NVAF and reporting on incident dementia or other cognitive and clinical outcomes. The study was conducted in accordance with PRISMA guidelines. The primary outcome was incident all-cause dementia. Secondary outcomes included dementia subtypes (vascular, Alzheimer's), ischemic and hemorrhagic stroke, mortality, and major bleeding events. Adjusted hazard ratios (HRs) were pooled using a random-effects model. The Newcastle-Ottawa Scale was used to assess the risk of bias in observational studies. Results: A total of 16 observational cohort studies, encompassing over 1.5 million patients, were included in the final analysis. The pooled data demonstrated that treatment with DOACs was associated with a significantly lower risk of incident all-cause dementia compared to treatment with VKAs (Hazard Ratio 0.88, 95% Confidence Interval [CI] 0.80–0.98). The benefit was most pronounced for vascular dementia, where DOACs showed a significant risk reduction, whereas no significant difference was observed for Alzheimer's disease. Subgroup analyses revealed that the protective effect of DOACs was more evident in patients younger than 75 years (HR 0.86, 95% CI 0.81–0.92) and in Asian populations (HR 0.81, 95% CI 0.68–0.86). Consistent with their known safety profile, DOACs were associated with a significantly lower risk of intracranial hemorrhage (HR approximately 0.47) compared to VKAs Discussion: The findings suggest that the neuroprotective benefit of DOACs over VKAs is likely mediated through a more stable anticoagulation profile and a superior cerebral safety profile, particularly the marked reduction in both clinical and subclinical intracranial bleeding. The attenuated benefit in the elderly may reflect a higher burden of competing risks and non-AF-related dementia pathologies. The pronounced effect in Asian populations may be linked to pharmacogenomic factors affecting VKA metabolism. Conclusion: In patients with NVAF, the use of DOACs is associated with a lower incidence of dementia compared to VKAs. This finding supports the preferential use of DOACs, not only for their established stroke prevention efficacy and safety but also for their potential long-term cognitive benefits.

The Association of Nonalcoholic Fatty Liver Disease with Subclinical Atherosclerosis: A Systematic Review Caroline Johansyah; I Putu Oka Yudaswara Pande; Maria Johansyah
The International Journal of Medical Science and Health Research Vol. 18 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/fx8vy119

Introduction: Nonalcoholic Fatty Liver Disease (NAFLD) has emerged as a global public health issue, increasingly recognized for its strong association with cardiovascular disease (CVD), the leading cause of mortality in this patient population. This systematic review aims to comprehensively evaluate and synthesize the evidence linking NAFLD to a wide array of markers for subclinical atherosclerosis, the earliest detectable stage of CVD. Methods: A systematic search of PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library databases was conducted for observational studies investigating the association between NAFLD and subclinical atherosclerosis. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies were assessed for methodological quality using the Newcastle-Ottawa Scale (NOS). Results: Synthesis of data from 17 selected high-quality observational studies, encompassing tens of thousands of participants, revealed a consistent and statistically significant association between NAFLD and multiple indices of subclinical atherosclerosis. Specifically, NAFLD was linked to increased carotid intima-media thickness (CIMT), a higher prevalence of carotid plaques, elevated coronary artery calcification (CAC) scores, and accelerated CAC progression. Furthermore, NAFLD was associated with significant functional vascular impairments, including endothelial dysfunction (manifested as reduced flow-mediated dilation) and increased arterial stiffness (measured by pulse wave velocity). These associations frequently persisted after adjustment for traditional metabolic risk factors. Discussion: The findings support the biological plausibility of NAFLD as an active contributor to atherogenesis, not merely a passive bystander. Shared pathophysiological mechanisms, including systemic inflammation, insulin resistance, and atherogenic dyslipidemia, likely drive this liver-vessel axis. The presence of NAFLD may serve as a clinical risk enhancer, identifying individuals with a heightened burden of subclinical vascular disease who might be missed by conventional risk scoring. Conclusion: NAFLD is a robust indicator for the presence of multi-site subclinical atherosclerosis. These findings underscore the importance of cardiovascular surveillance and aggressive risk factor management in individuals diagnosed with NAFLD to mitigate the long-term risk of cardiovascular events.

The Association of Diabetes Mellitus with Premature Coronary Artery Disease: A Systematic Review of Pathophysiology, Biomarkers, and Clinical Outcomes Caroline Johansyah; I Putu Oka Yudaswara Pande; Maria Johansyah
The International Journal of Medical Science and Health Research Vol. 18 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/mqkn4q79

Introduction: Premature Coronary Artery Disease (PCAD), defined as atherosclerotic cardiovascular disease in young adults, represents a significant and escalating public health challenge with profound socioeconomic consequences. Diabetes Mellitus (DM) is recognized as a principal and potent risk factor for cardiovascular disease, yet the full spectrum of its association with the aggressive phenotype of PCAD requires a comprehensive synthesis of the available evidence. This systematic review aims to elucidate the multifaceted relationship between DM and PCAD, spanning from pathophysiology to clinical outcomes. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library databases was performed to identify observational studies (cohort and case-control) examining the association between DM, prediabetes, or insulin resistance and PCAD. The methodological quality and risk of bias of included studies were rigorously assessed using the Newcastle-Ottawa Scale (NOS). A qualitative synthesis of the evidence was performed. Results: A total of 18 studies met the inclusion criteria. The evidence demonstrates a high prevalence of both diagnosed and previously undiagnosed DM in PCAD cohorts, often exceeding 30%. DM was significantly and consistently associated with increased angiographic severity, including a higher burden of multivessel disease and higher complexity scores. Clinically, DM emerged as a powerful independent predictor of adverse outcomes. Patients with PCAD and concomitant DM experience substantially higher rates of Major Adverse Cardiovascular Events (MACE), all-cause mortality, cardiovascular mortality, and recurrent myocardial infarction compared to their non-diabetic counterparts. Furthermore, novel biomarkers of insulin resistance, such as the Metabolic Score for Insulin Resistance (METS-IR) and the Triglyceride-Glucose (TyG) index, demonstrated superior predictive power for MACE over traditional metabolic markers. Discussion: The synthesized findings indicate that DM functions as a critical disease accelerator in the context of PCAD. The underlying pathophysiology, driven by insulin resistance and chronic hyperglycemia, fosters a systemic pro-inflammatory and pro-thrombotic state that promotes a more aggressive and diffuse atherosclerotic phenotype. The clinical implications are profound, highlighting a critical need for earlier risk stratification using novel biomarkers and more aggressive, multifactorial risk reduction strategies in young adults with metabolic dysfunction. Conclusion: The evidence robustly confirms that Diabetes Mellitus is a fundamental determinant of the risk, severity, and poor prognosis associated with Premature Coronary Artery Disease. This warrants a paradigm shift in clinical practice towards the early detection of insulin resistance and the implementation of intensive, secondary prevention-level care for young adults with DM to mitigate their substantial long-term cardiovascular risk.

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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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Kota adm. jakarta selatan,

Dki jakarta

INDONESIA