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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.

Arjuna Subject : Kedokteran - Review dan Referensi, Kedokteran

Articles 400 Documents

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A Cascade of Catastrophes Following Total Knee Arthroplasty: A Case Report and Literature Review on Sequential Periprosthetic Joint Infection and Iatrogenic Geniculate Artery Pseudoaneurysm Agung Wahyudi; Yenti Sukarida
The International Journal of Medical Science and Health Research Vol. 18 No. 12 (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/hegkmq13

Introduction: Total Knee Replacement (TKR) is a highly successful, gold-standard procedure for end-stage osteoarthritis (OA), a condition with a rising global prevalence (Li et al., 2024). However, complications, while statistically rare, can be catastrophic. Periprosthetic Joint Infection (PJI), a leading cause of TKR failure (Ma et al., 2024), and iatrogenic vascular injuries represent two such devastating complications. This report details the unique and highly complex case of a patient who experienced both of these severe complications sequentially. It aims to elucidate the diagnostic challenges posed by this rare cascade of events, particularly the 'diagnostic masking' that occurs when a new, non-infectious complication mimics a septic recurrence. Case Illustration: We present the case of a 68-year-old male with a history of sub-optimally controlled Type-2 Diabetes Mellitus who underwent a primary TKR for severe osteoarthritis. Eight months postoperatively, he developed a chronic PJI with a draining sinus tract, definitively confirmed by the 2018 Musculoskeletal Infection Society (MSIS) criteria (Parvizi et al., 2018). The pathogen was identified as Methicillin-Sensitive Staphylococcus aureus (MSSA). This was successfully managed via the gold-standard two-stage revision, which included radical debridement, complete component explantation, insertion of a high-dose articulating antibiotic spacer (Welsh and Baumann, 2021), a 6-week course of intravenous antibiotics, and subsequent definitive reimplantation. Ten days following the final reimplantation, the patient presented to the Emergency Department with an acute, massive, and excruciatingly painful sterile hemarthrosis. Crucially, his systemic inflammatory markers were normal. A high-stakes diagnostic workup, including Duplex Ultrasound and CT Angiography, revealed a pseudoaneurysm of the superior lateral geniculate artery (SLGA). This vascular injury was successfully treated with minimally invasive endovascular coil embolization (Melian et al., 2023), leading to complete resolution of symptoms and definitive salvage of the revision prosthesis. Discussion: This case highlights the critical diagnostic challenge of a recurrently swollen knee, especially when a patient's recent history of PJI creates a strong 'anchoring bias' toward recurrent infection. We provide a comprehensive review of the distinct diagnostic and management pathways for both chronic PJI—including the utility of the 2018 MSIS criteria (Parvizi et al., 2018) and the gold-standard two-stage revision—and the rare but limb-threatening geniculate artery pseudoaneurysm. For the latter, endovascular embolization (Melian et al., 2023; Puijk et al., 2022) represents the modern treatment of choice, particularly in a surgically hostile, multi-operated field (Luyckx et al., 2019). Conclusion: This report underscores the necessity of maintaining a broad differential diagnosis for a painful, swollen TKR, even in the face of a convincing infectious history. In a patient presenting with acute, large-volume, sterile hemarthrosis—a presentation distinct from their prior septic picture—a vascular etiology must be aggressively pursued. Normal inflammatory markers and a purely bloody aspirate are the key laboratory pivots that should immediately override a suspected infection diagnosis and prompt an emergent vascular imaging workup.

A Systematic Review of Diagnostic Radiology Access, Barriers, and Novel Interventions in Low-Income Countries Belladina Mayyasha Martadipura; Raudina Fisabila Martadipura
The International Journal of Medical Science and Health Research Vol. 19 No. 1 (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/z08s4k08

Introduction: Diagnostic radiology is an essential component of modern healthcare, yet billions of people in Low-Income Countries (LICs) lack access. This disparity, which impacts outcomes for both communicable and non-communicable diseases, remains a neglected area in global health policy. This review systematically synthesizes the evidence on radiology access, barriers, and the impact of novel interventions in LICs. Methods: This systematic review was conducted following PRISMA guidelines. We searched PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library for studies published between 1 January 2018 and 31 December 2025. We included primary studies and surveys focused on LICs (per World Bank GNI ≤ 1,135) that reported on outcomes related to radiology access, barriers, or interventions. Quality assessment was performed using the ROBINS-I and Newcastle-Ottawa Scale (NOS) tools. Results: Sixteen studies met the inclusion criteria. The results demonstrate a significant and catastrophic deficit in conventional imaging and workforce, with less than one CT scanner per million inhabitants in LICs and diagnostic availability near 0% at the primary care level. This gap is linked to severe outcome disparities, including a 3-month stroke mortality rate 4.5 times higher in LMICs than in HICs (7.7% vs. 1.7%). However, the review also identified significant evidence for novel interventions. Teleradiology implementation in the Democratic Republic of Congo changed patient diagnosis in 62% of cases and management in 41%. AI-assisted diagnostics show significant cost-effectiveness for conditions like tuberculosis in Malawi. Point-of-Care Ultrasound (POCUS) emerges as a critical, high-impact tool, though its implementation remains profoundly limited. Discussion: The evidence confirms a "diagnostic void" in LICs, driven by an ecosystem of barriers including lack of maintenance, cost, and workforce deficits. The significance of these findings is twofold: the access gap is directly linked to preventable mortality, and technological interventions provide a proven, cost-effective, and scalable "leapfrog" pathway to bridging this gap. Conclusion: LICs must prioritize a dual strategy: shoring up basic infrastructure for X-ray and ultrasound while simultaneously scaling up high-impact, technologically-driven solutions like POCUS, AI-assisted diagnosis, and teleradiology. Future investment must shift from sporadic equipment donation to building sustainable human and technical infrastructure.

The Clinical and Public Health Consequences of Delayed Scabies Diagnosis: A Systematic Review of Associated Complications Novita Saragih; Sherli Wahyuni; Cici Wulandari
The International Journal of Medical Science and Health Research Vol. 19 No. 1 (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: 10.70070/3sxp7c64

Introduction : Scabies, a parasitic infestation caused by Sarcoptes scabiei, is a neglected tropical disease with significant global morbidity. Diagnostic delays, stemming from its varied clinical presentation and mimicry of other dermatoses, are common and suspected to be a primary driver of severe complications. This review systematically evaluates the association between delayed or incorrect diagnosis of scabies and adverse patient and public health outcomes. Methods : A systematic search of PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library was conducted for observational studies, case series, and outbreak reports published from January 2000 to May 2024. Studies were included if they provided data linking delayed or misdiagnosed scabies to specific clinical, psychological, or public health complications. Data on study design, population, diagnostic delay, and outcomes were extracted. The methodological quality of observational studies was assessed using the Newcastle-Ottawa Scale. A narrative synthesis of the evidence was performed due to the heterogeneity of the included studies. Results : The synthesis included 17 studies involving thousands of patients and numerous institutional outbreaks. A significant association was found between diagnostic delay and multiple severe outcomes. The median time to correct diagnosis in severe cases was 3 months. Misdiagnosis rates were consistently high, frequently reported between 43% and 45%. Key complications strongly linked to diagnostic delay included: progression to crusted scabies, often precipitated by inappropriate corticosteroid treatment. secondary bacterial superinfections with Staphylococcus aureus and Streptococcus pyogenes, severe systemic sequelae including bacteremia, sepsis, post-streptococcal glomerulonephritis, and acute rheumatic fever and large-scale institutional outbreaks, with delayed diagnosis of an index case being the primary catalyst. Prolonged infestation was also correlated with significantly impaired quality of life, sleep disturbance, and psychological distress. Discussion : The evidence demonstrates that delayed diagnosis is not merely a temporal issue but a critical determinant of scabies-related morbidity and mortality. It transforms a treatable skin condition into a catalyst for life-threatening infections, systemic disease, and costly public health crises. The common iatrogenic pathway, where misdiagnosis leads to corticosteroid use and subsequent development of hyper-infestive crusted scabies, highlights a critical vulnerability in clinical practice. Conclusion : Timely and accurate diagnosis of scabies is paramount. Enhanced clinical suspicion, particularly in high-risk populations and individuals with atypical presentations, is essential to prevent severe complications and mitigate the substantial health and economic burden of this globally neglected disease.

Posterior Monteggia Fracture–Dislocation in a 70-Year-Old Woman After a Low-Energy Bicycle Fall: Successful Management in a Resource-Limited Setting: A Rare Case Report Danika Andri; Fauzan Andi Muhammad Ihsan; Putra Hisyam Hartaman; Muhammad Aan Tri Lutfi; Saribudaya Agus
The International Journal of Medical Science and Health Research Vol. 19 No. 1 (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/j069tm08

A Monteggia fracture occurs when the proximal ulna fractures and the proximal radioulnar joint (PRUJ) is disrupted. This type of fracture is uncommon in adults, making up approximately 1% to 5% of all elbow fractures. This fracture's aetiology follows a bimodal pattern: low-energy trauma, such as falls on the ground, is typically the cause in older women, whereas high-energy trauma, like falls from heights and sports injuries, is usually the cause in young men. A 70-year-old woman came to the hospital emergency room complaining of pain in her left elbow. The patient experienced pain 30 minutes after falling off their bicycle. The patient fell sideways, and their left elbow bore the weight during the fall. The patient is unable to move their elbow. The fingers can still be moved. On physical examination, the following findings were observed: deformity, PRUJ dislocation, tenderness to palpation, crepitus, and limited range of motion due to pain. After that, an X-ray of the elbow was taken in the AP-lateral view, which revealed a comminuted Monteggia fracture Bado type II on the left side. The PRUJ joint was openly repositioned during the surgery. Following that, the comminuted Monteggia fracture was internally fixed. Since a locking plate was not available, we used a modified (bent plate) small bone plate type D with 12 holes instead of the plate and screw that we used for ORIF. After that, the plate was attached using seven cortical screws. During the elbow joint ROM test, unfortunately the PRUJ dislocation was not stable. Furthermore, it was decided to perform pinning with a K-wire from the capitellum toward the head of the radius. After that, one cortical screw was inserted on the medial side to stabilize the fracture fragments, and a hydroxyapatite bone graft was added to the comminuted fracture area. Two days after the operation, the patient is allowed to go home. Our patient is a elderly woman who experienced a Monteggia fracture, Bado classification type II occurs due to low energy. In the elderly, this mechanisms are a common cause. In this case, it is recommended to use a locking compression plate (LCP), but due to limited resources, we used a modified (bending plate) small bone plate type D. This can provide an alternative and also a practical solution in the management of Monteggia-Bado classification type 2 fractures at the healthcare level with limited resources for modern plates.

The Association of Mechanism of Injury with Predictable Injury Patterns: A Systematic Review Marcella Jesslyn; Ryandi Satrio
The International Journal of Medical Science and Health Research Vol. 19 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/chcqha71

INTRODUCTION: The mechanism of injury (MOI) is a cornerstone of trauma assessment, founded on the principle that the transfer of kinetic energy to the body produces specific and predictable patterns of tissue damage. An understanding of these patterns is critical for effective prehospital triage, rapid in-hospital diagnosis, and anticipatory patient management. This systematic review aims to synthesize the existing evidence linking specific blunt and penetrating trauma mechanisms to their resultant injury constellations across diverse patient populations. METHODS: A systematic search of PubMed, Google Scholar, Semanthic Scholar, Springer was conducted for original research published between January 2000 and December 2024. Studies were included if they quantitatively evaluated the association between a defined MOI and specific injury patterns in human subjects. Data on study design, population, MOI, and outcomes were extracted. The quality of included studies was assessed using the Cochrane Risk of Bias tool for non-randomized studies. A qualitative synthesis of the findings was performed, categorizing results by MOI and patient demographic. RESULTS: A total of 18 studies met the inclusion criteria, encompassing a range of blunt and penetrating trauma mechanisms. Consistent and strong associations were identified. In blunt trauma, fall direction in the elderly was highly predictive of fracture location: sideways falls with hip fractures (Odds Ratio 3.68), forward falls with forearm/patella fractures, and backward falls with spinal fractures. High-energy falls from height were associated with a predictable pattern of axial loading injuries, including calcaneal, pelvic, and spinal fractures. Motor vehicle collisions (MVCs) demonstrated distinct patterns based on impact vector; side impacts were associated with a higher incidence of thoracic, pelvic, and proximal upper extremity injuries compared to frontal impacts. In pediatric MVCs, age-dependent patterns were observed, with severe head injuries predominating in young children (0-8 years) and abdominal injuries in adolescents (9-17 years). Penetrating trauma from gunshot wounds was associated with high mortality, particularly with cranial involvement (41% mortality), and a high degree of occult internal injury. DISCUSSION: The evidence robustly supports the hypothesis that MOI is a powerful predictor of injury patterns, grounded in fundamental biomechanical principles. However, the predictive utility of MOI is significantly modulated by patient-specific factors, most notably age and physiological reserve. In geriatric patients, low-energy mechanisms frequently produce injury patterns characteristic of high-energy trauma in younger adults. The clinical value of MOI lies not only in field triage but also as a cognitive tool to guide diagnostic strategy and maintain a high index of suspicion for occult injuries, particularly in patients who appear physiologically stable upon initial presentation. CONCLUSION: A strong, evidence-based association exists between the mechanism of injury and predictable patterns of injury. This knowledge is essential for optimizing trauma care, from prehospital triage to definitive management. Future research should focus on developing more sophisticated predictive models that integrate MOI with patient-level factors such as frailty to enhance triage accuracy and improve patient outcomes.

Effectiveness of Parent Training Programs for ADHD : A Systematic Review Fitria Luluk Mukhasona; Ratu Qurroh' Ain; Yuniar Pukuk Kesuma
The International Journal of Medical Science and Health Research Vol. 19 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/wyrczk22

Introduction Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder that significantly impacts children's functioning and family dynamics. Parent Training (PT) is a cornerstone non-pharmacological intervention designed to equip parents with skills to manage challenging behaviors. However, effectiveness varies across different programs, delivery formats, and combinations with medication, creating a need for clear evidence synthesis. This review systematically evaluates the evidence for PT's effectiveness on child symptoms, parenting, and family dynamics. Methods Following PRISMA 2020 guidelines , a systematic search of PubMed, Google Scholar, Springer, Wiley Online Library, and Semantic Scholar was conducted. Inclusion criteria targeted randomized controlled and quasi-experimental studies published in the last decade that evaluated a structured PT program for children with ADHD. After screening over 3,000 records, 40 studies were selected for the final qualitative analysis. Results The synthesis of 40 studies revealed that PT is highly effective; 35 studies reported significant reductions in core ADHD symptoms and related disruptive behaviors. Substantial secondary benefits were also found, with 27 studies documenting improved parenting practices, reduced parental stress, and increased parental competence. Therapist-led, in-person programs demonstrated advantages in adherence and satisfaction over blended or remote formats. Furthermore, combining PT with medication, particularly using a "behavior-first" approach, was found to be superior to medication alone. Discussion The findings confirm PT as a robust, evidence-based intervention with a dual benefit for both children and their caregivers. While broadly effective, the evidence underscores that a one-size-fits-all approach is insufficient. Optimal outcomes depend on tailoring the program type and delivery format to individual family needs, resources, and circumstances to maximize engagement and positive results. Conclusion Parent Training is a fundamental component of comprehensive ADHD care that effectively reduces child symptoms while enhancing parenting skills and overall family well-being. A personalized clinical approach is recommended, prioritizing behavioral interventions as a first-line treatment to achieve durable and meaningful success.

SOLITARY JUVENILE RECTAL POLYP IN A TODDLER PRESENTING WITH PROLAPSE AND HEMATOCHEZIA: A CASE REPORT AND COMPREHENSIVE REVIEW OF DESMOID-TYPE FIBROMATOSIS Hassita Wenda Mayrina; Harisma Widhanar
The International Journal of Medical Science and Health Research Vol. 19 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: 10.70070/01eh3p56

Introduction: Juvenile polyps are the most common cause of lower gastrointestinal bleeding in the pediatric population. These lesions are typically benign hamartomatous growths, and a solitary polyp is rarely associated with long-term morbidity. This report aims to present a classic case of a solitary juvenile polyp leading to significant clinical symptoms in a toddler. Additionally, it provides a comprehensive, state-of-the-art review of desmoid-type fibromatosis, a rare soft tissue neoplasm that, while unrelated to this case's final diagnosis, represents an important entity in the differential diagnosis of pediatric masses. Case Illustration: A 19-month-old male presented to the emergency department with a seven-day history of progressively worsening hematochezia and a one-day history of a prolapsed, irreducible rectal mass. The patient exhibited signs of weakness and anemia. Physical examination revealed a 3x2x2 cm, fresh red, pedunculated mass protruding from the anus. After initial stabilization, the patient underwent a transanal polypectomy. The post-operative course was complicated by significant hemorrhage on the second day, which was managed successfully with conservative measures, including tranexamic acid. Histopathological examination of the excised specimen confirmed the diagnosis of a benign hamartomatous juvenile polyp. Discussion: The diagnosis and management of the solitary juvenile polyp were consistent with established clinical practice. Simple polypectomy is curative, and further surveillance is generally not required in the absence of multiple polyps or a family history of polyposis syndromes. The main focus of this discussion is a detailed review of desmoid-type fibromatosis. This entity is defined as a locally aggressive, non-metastasizing fibroblastic neoplasm. Its pathogenesis is driven by dysregulation of the Wnt/β-catenin signaling pathway. A significant paradigm shift has occurred in its management, moving away from aggressive upfront surgery towards a more conservative approach centered on active surveillance, with systemic therapies like tyrosine kinase inhibitors and gamma-secretase inhibitors reserved for progressive or symptomatic disease. Conclusion: Solitary juvenile polyps are a common and highly treatable cause of rectal bleeding in children. This case highlights the typical presentation and a potential post-operative complication. The accompanying review of desmoid-type fibromatosis serves an important educational purpose, underscoring the evolving management strategies for rare soft tissue tumors, which prioritize balancing disease control with long-term quality of life.

The Efficacy of Multifaceted Breastfeeding Promotion Programs on Maternal and Infant Outcomes: A Systematic Review Ade Rahma Anggraini; Fauzan Azim
The International Journal of Medical Science and Health Research Vol. 19 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/akfz0745

Introduction: Despite the well-documented health benefits of breastfeeding for mothers and infants, global rates of exclusive and continued breastfeeding fall significantly short of World Health Organization (WHO) recommendations. This systematic review synthesizes and evaluates the evidence on the efficacy of various breastfeeding promotion programs designed to address this critical public health gap. Methods: A systematic review of randomized controlled trials (RCTs) and cluster-RCTs was conducted. Major electronic databases, including PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library, were searched for studies evaluating any structured intervention aimed at improving breastfeeding outcomes compared to usual care. The methodological quality of included studies was rigorously assessed using the Cochrane Risk of Bias tool. A narrative synthesis of the findings was performed, structured by intervention type, with quantitative data pooled for meta-analysis where appropriate. Results: The evidence from 17 high-quality trials and meta-analyses demonstrates that structured breastfeeding promotion programs yield significant positive effects. Multi-component interventions that combine education with proactive, ongoing support consistently improve rates of exclusive breastfeeding (EBF) at key postpartum intervals, including 4-6 weeks and up to 6 months. Specifically, system-level policies like the Baby-Friendly Hospital Initiative (BFHI) significantly increase EBF at 3 months (43.3% vs 6.4%) and reduce infant gastrointestinal infections (Odds Ratio 0.60). Peer and lay support models are highly effective, increasing breastfeeding duration and exclusivity while reducing infant morbidity. Furthermore, technology-mediated interventions (e.g., mHealth, web-based support) represent a powerful and scalable approach, significantly increasing EBF rates at 6 months (Risk Ratio 1.87) and nearly doubling the median duration of EBF in some trials. Interventions targeting fathers also show substantial benefits, increasing full breastfeeding rates at 6 months (25% vs 15%). Discussion: The synthesized evidence strongly supports a paradigm shift from passive, single-component educational approaches to proactive, multi-faceted, and sustained support systems. The most effective interventions enhance maternal self-efficacy, provide timely and accessible information, and create a supportive ecosystem involving healthcare professionals, peers, and family. Scalable models, including peer counseling and technology-based platforms, offer promising solutions for widespread implementation. Conclusion: Breastfeeding promotion programs are a demonstrably effective public health strategy for improving breastfeeding rates and associated maternal and infant health outcomes. To maximize impact, programs should be structured, continuous, and leverage a synergistic combination of professional, peer, and technological support tailored to the needs of the target population.

Comparative Diagnostic Accuracy of Computed Tomography, Magnetic Resonance Imaging, and Ultrasonography for Acute Appendicitis: A Systematic Review Arvin Diego Tandoyo; Hendwell
The International Journal of Medical Science and Health Research Vol. 19 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/k38zr345

Introduction: The diagnosis of acute appendicitis (AA) remains a significant clinical challenge. While multiple imaging modalities are available, their comparative diagnostic accuracy is a subject of ongoing debate, particularly regarding the balance between diagnostic certainty and the risks associated with radiation or procedural limitations. Methods: This systematic review was conducted in accordance with the PRISMA-DTA (Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies) guidelines (Salameh et al., 2018). We performed a comprehensive search of PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library for diagnostic accuracy studies comparing Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasonography (USG), and plain X-ray for acute appendicitis. A total of 18 primary studies were included. Methodological quality was assessed using the rigorous QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool (Whiting et al., 2011). Pooled sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were synthesized for each modality, utilizing a bivariate random-effects model where appropriate. Results: A clear three-tiered hierarchy of diagnostic accuracy was identified. Tier 1 (Superior) includes CT and MRI, which demonstrated statistically comparable and excellent accuracy. CT showed a pooled sensitivity of 97.2% and specificity of 95.6% (Kim et al., 2022). MRI showed a pooled sensitivity of 96.6% and specificity of 95.9% (Repplinger et al., 2016). Both modalities demonstrated exceptionally high negative predictive values (NPV) (> 98-99%) (Apisarnthanarak et al., 2015; Oto et al., 2009). Tier 2 (Situational) includes USG, which had lower and more heterogeneous accuracy (pooled sensitivity 81-87%, specificity 87-93%) (Anjum et al., 2024; Shen et al., 2023). The utility of USG was significantly limited by operator-dependence and a high non-diagnostic (indeterminate) scan rate, reported as high as 35.7% (SAGES, 2022). Tier 3 (Obsolete) includes plain X-ray, which was confirmed to have no diagnostic value in the modern workup of AA (Rao et al., 1998; Bhangu, 2020). Discussion: The diagnostic equivalence of CT and MRI (Moore et al., 2017) suggests the choice of modality should be based on patient factors rather than diagnostic performance alone. CT remains the most efficient modality for non-pregnant adults, aligning with 2024 IDSA guidelines (Bonomo et al., 2024). The "US-first" algorithm is validated as a radiation-mitigation strategy in pediatric and pregnant populations, but the high rate of inconclusive scans necessitates a reflex pathway to MRI, which serves as the definitive non-radiation test in these groups (Oh et al., 2016). Conclusion: CT and MRI are the most accurate imaging modalities for acute appendicitis. Ultrasonography serves as a critical, first-line triage tool in radiation-sensitive populations. Plain X-ray is obsolete for this indication. We recommend a stratified diagnostic algorithm, with the choice of modality tailored to the specific patient population (non-pregnant adult, pregnant, or pediatric) to optimize accuracy while minimizing harm.

A Comprehensive Systematic Review of Comparative Outcomes Following Laparoscopic Versus Open Cholecystectomy for Gallbladder Disease: Evidence Synthesis from Randomized Controlled Trials and High-Quality Comparative Studies Afdhona Wiranata; John M.Sangkai
The International Journal of Medical Science and Health Research Vol. 19 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/gypwxh67

Introduction Laparoscopic Cholecystectomy (LC) has become the global standard for symptomatic gallbladder disease, replacing Open Cholecystectomy (OC). However, the critical need for continuous, rigorous systematic evaluation across a broad spectrum of clinical, safety, and socioeconomic outcomes persists to validate modern surgical policy, especially for high-risk and complex patients. This review provides a definitive, quantitative synthesis comparing LC and OC. Methods Following PRISMA guidelines, a systematic search identified over 15 high-quality comparative studies, primarily Randomized Controlled Trials (RCTs), published through 2025. Data were extracted for 17 specific outcomes spanning efficiency, safety, morbidity, and cost. Methodological integrity was assessed using the Cochrane Risk of Bias tool (RoB 2.0). Meta-analytical synthesis employed random-effects models to pool comparable outcomes, calculating Risk Ratios (RR) or Odds Ratios (OR) and Weighted Mean Differences (WMD) with 95% Confidence Intervals (CI). Results Laparoscopic Cholecystectomy demonstrated overwhelming superiority in recovery and systemic safety. Key findings include a substantial reduction in Length of Hospital Stay (LOHS) (WMD \approx -3 days) and accelerated Time to Return to Normal Activity (WMD \approx -22.5 days) (Cochrane Review, 2007). LC significantly reduced overall morbidity (12% vs 22%) (Kamal, 2025) and provided robust protection against systemic complications, including respiratory (OR 0.55, P < 0.00001) and cardiac events (OR 0.55, P = 0.002), particularly in the elderly (Wang et al., 2014). Economically, LC resulted in lower projected 5-year cumulative charges (Cost-Effectiveness Study, 1993) and markedly fewer sick leaves (OR 0.34, P = 0.01). Discussion The synthesized evidence firmly establishes LC as the standard of care due to its superior short-term clinical benefits, reduced systemic inflammatory stress, and demonstrable economic advantages. The consistent reduction in LOHS and convalescence time translates directly into greater societal productivity. While conversion rates exist (2–10%), they serve as a critical safety valve, preserving the overall low morbidity profile of the laparoscopic approach. Conclusion Laparoscopic Cholecystectomy offers superior clinical outcomes, enhanced patient safety, and a lower overall socioeconomic burden compared to Open Cholecystectomy. LC should be maintained as the primary operative modality for the management of gallbladder disease.

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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,

Dki jakarta

INDONESIA