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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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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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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Patient Profile of Erythroderma: A Multicenter Retrospective Study in East and North Kalimantan 2018–2022 Nurlaela Sari
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/q4knzq78

Introduction: Erythroderma is a severe, life-threatening dermatological condition characterized by universal erythema and scaling. Its etiology varies, including underlying skin diseases, drug reactions, systemic illnesses, and idiopathic causes. Data on the patient profile of erythroderma in East and North Kalimantan, Indonesia, is limited. This study aims to describe the profile of erythroderma patients in these regions from 2018 to 2022. Methods: This was a multicenter retrospective descriptive study using secondary data from the medical records of inpatients diagnosed with erythroderma at Abdul Wahab Sjahranie Hospital (Samarinda), dr. Abdul Rivai Hospital (Berau), and Nunukan Hospital (Nunukan) from 2018 to 2022. Total sampling was employed, resulting in 46 cases from 40 patients. Data on demographic, clinical, etiological, and laboratory profiles were collected and analyzed using univariate analysis. Results: A total of 46 cases were identified, with an incidence of 9.2 cases per year. The male-to-female ratio was 1.5:1, with a mean age of 51.3 ± 15.7 years. The most common clinical symptoms were scaling (97.8%), skin redness (84.8%), and pruritus (78.3%). The primary etiology was the exacerbation of a pre-existing skin disease (41.3%), most commonly psoriasis vulgaris (57.9%), followed by idiopathic causes (21.7%), drug reactions (19.6%), and systemic diseases (17.4%). Laboratory findings revealed anemia in 65.2% of cases, leukocytosis in 56.5%, and hypoalbuminemia in 76.0% of the tested cases. Electrolyte imbalances were also common: hyponatremia (51.9%), hypochloremia (33.3%), and hypokalemia (25.9%). The mortality rate was 8.7%. Discussion: The demographic and clinical profiles align with previous studies, showing a male predominance and common symptoms of pruritus and scaling. However, the mean age was younger, and the leading etiology was the exacerbation of skin diseases, contrasting with some studies that found drug reactions to be most common. The high rates of anemia, leukocytosis, hypoalbuminemia, and electrolyte imbalances highlight the systemic involvement and metabolic demands of erythroderma. The relatively high idiopathic rate may be attributed to limited histopathological facilities in some study sites. Conclusion: This study provides a comprehensive profile of erythroderma patients in East and North Kalimantan. The condition predominantly affects middle-aged males, with pre-existing skin diseases, particularly psoriasis, being the leading cause. Significant laboratory abnormalities are common. These findings can serve as a basis for improving diagnosis and management strategies for erythroderma in these regions.

Association of Maternal Short Stature to The Risk of Stunting in Low- and Middle-Income Countries: A Systematic Review of Intergenerational Nutritional Vulnerability Sekar Putri Ramadhani; Muhammad Hidayat
The International Journal of Medical Science and Health Research Vol. 19 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: 10.70070/8m483067

Introduction Childhood stunting, defined as low height-for-age, is a persistent global health crisis associated with delayed developmental trajectories, impaired cognitive function, and increased chronic disease risk later in life (Semba et al., 2011). Maternal short stature (MSS), typically reflecting chronic nutritional deprivation and adverse environmental exposures during the mother’s own early life, is a highly recognized predictor of offspring stunting (Wirth et al., 2019). The objective of this systematic review and meta-analysis was to rigorously quantify the pooled association between MSS and childhood stunting and to analyze the critical biological and socioeconomic effect modifiers across Low- and Middle-Income Countries (LMICs). Methods This systematic review was conducted in adherence to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) guidelines (PRISMA Statement, 2020). A comprehensive search identified 15 large observational studies, predominantly based on Demographic and Health Survey (DHS) data, focusing on children aged 0–59 months. MSS was generally defined categorically (shortest quintile or fixed cutoffs, typically <145 cm or <150 cm) compared to the tallest reference group. Study quality was assessed using the Risk Of Bias In Non-Randomized Studies – of Interventions (ROBINS-I) tool, specifically focusing on bias due to confounding (ROBINS-I; Tadesse et al., 2015). Pooled effect sizes were calculated using random-effects models and presented as Adjusted Relative Risks (RRs) or Odds Ratios (ORs). Results Analysis of 15 studies revealed a strong and highly significant association between MSS and offspring stunting (p < 0.001). The pooled categorical analysis demonstrated that children born to the shortest mothers faced an Adjusted Relative Risk (RR) of 2.85 (95% CI: 2.50, 3.25) for stunting compared to children born to the tallest mothers, indicating nearly a three-fold increased risk. Continuous analysis confirmed this protective association, showing that a 1-cm increase in maternal height significantly reduced the risk of stunting (Semba et al., 2011; Baten et al., 2019). The intergenerational effect is primarily driven by maternal physiological constraints; the mother-offspring association (RR 1.89) was substantively larger than the father-offspring association (RR 1.56), even when controlling for shared environment (Tessema et al., 2021). Discussion The observed magnitude and consistency of the association underscore the role of MSS as a potent physiological determinant of child health, reflecting an intergenerational legacy of undernutrition and poor intrauterine environment (Wirth et al., 2019). Crucially, detailed risk stratification showed that the high stunting risk associated with MSS persists relatively unchanged across socioeconomic strata, suggesting that current household affluence cannot fully mitigate the physiological constraints imposed by the mother's own historical deprivation (Baten et al., 2019). Modifiable factors such as increased Antenatal Care (ANC) visits and higher maternal education provide independent risk mitigation, offering critical intervention pathways (Tekle et al., 2021). Conclusion Maternal short stature is confirmed as one of the most significant, non-modifiable risk factors for childhood stunting in LMICs. The dominance of the maternal effect and the resistance of this risk to current socioeconomic buffering necessitate targeted, life-course interventions focusing on enhanced prenatal nutritional support and adolescent girl nutrition programs to disrupt this potent intergenerational cycle.

Fecal Calprotectin: A Comprehensive Systematic Review of Its Diagnostic and Monitoring Efficacy in Inflammatory Bowel Disease Emilia Fitri Annisa; Charles Sanjaya
The International Journal of Medical Science and Health Research Vol. 19 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/x6r8d759

Introduction Inflammatory Bowel Disease (IBD), encompassing Ulcerative Colitis (UC) and Crohn's Disease (CD), is a chronic, relapsing condition demanding continuous, objective surveillance of mucosal inflammation. Due to the burdens associated with invasive endoscopy—the conventional gold standard for assessment—there is a critical need for accurate, non-invasive biomarkers. Fecal Calprotectin (FC), a stable protein released by activated neutrophils, serves as a quantitative surrogate marker that directly correlates with the level and extent of gastrointestinal inflammation. This comprehensive systematic review aggregates high-level meta-analytic evidence to define the precise utility of FC across IBD diagnosis, therapeutic monitoring, and prediction of long-term disease course. Methods This systematic review synthesized quantitative findings from high-quality diagnostic accuracy and prognostic meta-analyses, encompassing data pooled from over fifteen primary studies focusing on adults and children with IBD. The underlying systematic searches utilized extensive database coverage, including PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library. Key performance metrics rigorously extracted included pooled sensitivity, specificity, Area Under the Summary Receiver Operating Characteristic Curve (AUROC), Diagnostic Odds Ratio (DOR), Positive Likelihood Ratio (PLR), and Negative Likelihood Ratio (NLR). The methodological rigor of the aggregated evidence was assessed using the QUADAS-2 framework. Results FC demonstrated superior accuracy for differentiating IBD from functional gastrointestinal disorders. At the standard 50 mug/g cut-off, pooled analyses yield high sensitivity (89% to 99%) and a critically high Negative Predictive Value (NPV) of 0.99 for IBD exclusion. In monitoring, FC reliably correlates with endoscopic activity, with optimal performance in UC (AUROC 0.97) but diminished utility in isolated small bowel CD (SB-CD), where the AUROC drops to 0.72 at the 100 mug/g cut-off. For prognostic assessment, the optimal pooled cut-off of 152 mug/g for predicting clinical relapse in adult UC patients in remission yields a robust DOR of 10.54. Furthermore, distinct concentration ranges define Mucosal Healing (MH) targets: 60-75 mug/g for UC (AUC 0.88) versus a higher 180-250 mug/g range for CD (AUC 0.79). Discussion FC is confirmed as an essential biomarker, yet its optimal implementation requires careful consideration of its limitations, including significant quantitative variability (up to 5-fold differences) across commercial assays, which hinders the universal application of precise meta-analytic thresholds. The physiological barrier in detecting proximal small bowel inflammation necessitates integrating FC results with cross-sectional imaging and exploring complementary serum biomarkers. The greatest clinical value of FC lies in its use for continuous, longitudinal surveillance to proactively guide therapeutic intensification and reduce the need for unnecessary endoscopic procedures. Conclusion and Recommendations Fecal Calprotectin is established as an indispensable, non-invasive biomarker for IBD triage and continuous surveillance. Its clinical efficacy is maximized through the meticulous application of phenotype- and location-specific cut-offs tailored to the specific clinical query (diagnosis, MH, or relapse prediction). Standardizing commercial FC assays remains the most crucial outstanding challenge to ensure the consistent, reliable, and interchangeable application of these evidence-based thresholds across global healthcare settings.

Comparative Efficacy, Patient-Specific Predictive Factors, and Long-Term Safety of Extracorporeal Shockwave Lithotripsy for Urinary Calculi: A Systematic Review of Technical Optimization and Clinical Outcomes Mulya; Mutiara Farrah Dhiba
The International Journal of Medical Science and Health Research Vol. 19 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/k2rvwq64

Introduction Extracorporeal Shockwave Lithotripsy (SWL) remains a pivotal, non-invasive treatment modality for urolithiasis, having revolutionized the management of stone disease since its introduction in the 1980s (Preminger et al., 2024; Long & Matlaga, 2020). Despite its established role, the current clinical landscape sees SWL increasingly challenged by highly effective, though more invasive, endourological techniques such as Ureteroscopic Lithotripsy (URSL/RIRS) and Percutaneous Nephrolithotomy (PCNL). The enduring relevance of SWL hinges critically upon optimal patient selection and rigorous adherence to technical optimization protocols to maximize efficacy and minimize failure rates (Wang et al., 2020). Methods A systematic search compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed, synthesizing outcomes from high-level evidence studies, including meta-analyses encompassing a minimum of 15 randomized controlled trials (RCTs) (Li et al., 2023; Mokhtari et al., 2023). Data were extracted for 12 clinical outcomes. The quality of comparative trials was assessed using the Cochrane Risk of Bias tool, version 2 (RoB 2) (Higgins et al., 2024; Minozzi et al., 2022). Results Efficacy and Logistics: Contemporary endourological treatments generally yield higher efficacy; URSL/PCNL result in significantly superior overall stone-free rates (SFRs) compared to SWL, especially for stones exceeding 10 mm and those located in the lower pole calyx (Wang et al., 2015). SWL is associated with a significantly greater need for retreatment procedures, with an Odds Ratio (OR) of 0.08 favoring URSL (Li et al., 2023). However, SWL maintains substantial logistical advantages, including a significantly shorter operating time (Standardized Mean Difference -29.314 minutes favoring SWL) and shorter hospital stay (Mean Difference 1.14 days longer for URSL) (Mohamed et al., 2023; Li et al., 2023). Safety and Predictors: While overall complication rates are statistically similar across methods (Li et al., 2023), URSL carries a higher specific risk of perforation (OR 0.13 favoring SWL) (Mohamed et al., 2023). Successful SWL is highly predictable based on pre-treatment imaging, with optimal success linked to stone density HU < 1000 and SSD < 10 cm (Siddiqui & Ahmed, 2021; Türk et al., 2024; Ouzaid et al., 2014). Furthermore, technical refinement, such as decreasing the shock wave rate to 60 to 90 shocks per minute, substantially improves stone fragmentation efficacy (Long & Matlaga, 2020). Long-Term Safety: A significant association exists between SWL performed for nephrolithiasis and the development of new-onset hypertension, evidenced by an overall Relative Risk (RR) of 1.21 (95% CI 1.11–1.31) (Seo et al., 2021). This risk increases with the number of SWL sessions required (Rudnick et al., 2018). Conclusion Extracorporeal Shockwave Lithotripsy remains the optimal non-invasive intervention for highly favorable calculi (≤ 10 mm, low HU, short SSD), provided technical optimization is rigorously applied. For stones predicted to be resistant, early treatment pivot toward URSL or PCNL is warranted to maximize definitive stone clearance and to mitigate the potentially dose-dependent long-term risk of hypertension and the requirement for multiple auxiliary procedures.

How do Different Management Strategies (Standard Phototherapy, Intensive Phototherapy, and Pharmacological Interventions) to Neonatal Jaundice ? : A Systematic Review Putu Ardy Hartadi; Komang Vika Nariswari Ratna Kinasih; Wayan Suwidja Haryasa
The International Journal of Medical Science and Health Research Vol. 20 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: 10.70070/73724j90

Introduction: Neonatal jaundice is a common condition that requires effective management to prevent neurotoxic outcomes like kernicterus. While conventional phototherapy is the standard treatment, numerous advanced strategies have been developed to improve efficacy. This systematic review evaluates the comparative effectiveness of different management strategies, including intensive phototherapy, varying phototherapy modalities, and pharmacological interventions, to guide clinical practice. Methods: This review followed the PRISMA 2020 guidelines. A comprehensive search was conducted across PubMed, Springer, Semantic Scholar, Google Scholar, and Wiley Online Library for randomized controlled trials, systematic reviews, and prospective cohort studies published since 2014. The search focused on interventions such as intensive phototherapy and pharmacological adjuncts compared to standard phototherapy in neonates with jaundice. Key outcomes included bilirubin reduction, treatment duration, and adverse effects. After screening 281 records, 20 studies were included for data synthesis. Results: The 20 included studies showed that intensive and double-surface phototherapy significantly accelerate bilirubin reduction and shorten treatment duration compared to conventional methods. LED phototherapy demonstrated superior or comparable efficacy with fewer side effects than fluorescent lamps. Adjunctive therapies, including zinc, clofibrate, and Clostridium butyricum, consistently reduced bilirubin levels and therapy duration. Low-cost innovations like filtered sunlight and reflective curtains were found to be effective alternatives in resource-limited settings. Conclusion: Numerous advanced and adjunctive therapies are more effective than conventional phototherapy for neonatal jaundice. The evidence supports a tailored approach, selecting interventions like intensive phototherapy, LED technology, and pharmacological adjuncts based on clinical severity and resource availability. This allows for optimized, safer, and more efficient management of neonatal hyperbilirubinemia.

Diagnosis and Surgical Management of Uterine Cancer: A Comprehensive Systematic Review of Minimally Invasive Techniques, Molecular Staging, and Oncological Outcomes Ramos Silalahi; Silvia Witarsih
The International Journal of Medical Science and Health Research Vol. 20 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/r3ryfr59

Introduction Uterine cancer, overwhelmingly represented by endometrial carcinoma (EC), is the most frequently diagnosed gynecologic malignancy in developed nations, with incidence rates steadily rising. Definitive surgical staging—historically involving hysterectomy, bilateral salpingo-oophorectomy, and comprehensive lymphadenectomy—is the cornerstone of management, dictating prognosis and the requirement for adjuvant therapy. This review systematically synthesizes high-level evidence on comparative diagnostic accuracy, the oncological safety of minimally invasive surgery (MIS) versus open surgery (OS), and the non-inferiority of Sentinel Lymph Node Biopsy (SLNB) in the context of emerging molecular risk stratification frameworks, notably the 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system. Methods A rigorous systematic search was executed across major medical literature databases (PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library) for comparative studies, systematic reviews, and meta-analyses published since 2017. Inclusion was restricted to studies comparing diagnostic modalities (Transvaginal Ultrasound vs. Hysteroscopy) and surgical interventions (Minimally Invasive Surgery vs. Open Surgery; SLNB vs. comprehensive Lymphadenectomy) in EC patients. Data extraction focused on 15 specific outcomes encompassing long-term survival endpoints (Overall Survival, Disease-Free Survival), perioperative morbidity (blood loss, lymphedema), and staging accuracy. Given the observational nature of most surgical comparisons, the Risk of Bias in Non-randomized Studies – of Interventions (ROBINS-I) tool was employed for quality assessment (Cochrane Methods Bias, 2024). Results The synthesis incorporated evidence from 16 high-quality publications, integrating data from meta-analyses pooling over 10,000 patients. Diagnostic accuracy studies confirmed the superior performance of hysteroscopy, achieving an overall accuracy of 93.3% versus 83.5% for TVUS (Huang et al., 2023). For surgical safety, the comparison of MIS versus OS confirmed oncological non-inferiority, even in high-risk EC, with comparable 5-year Disease-Free Survival (DFS) (Relative Risk 0.93, 95% CI 0.82–1.05) and Overall Survival (OS) (RR 0.92, 95% CI 0.77–1.11) (Mariani et al., 2023). Nodal management data decisively favored SLNB, which demonstrated significantly reduced operative blood loss (Mean Difference -54.40) and minimized the long-term risk of debilitating lymphedema (RR 0.25) (Chen et al., 2020; SGO/Mayo Clinic, 2021). Furthermore, SLNB proved superior in detecting positive pelvic nodes (Odds Ratio 1.35) due to mandatory ultra-staging protocols (Toro et al., 2019). Discussion The collective, high-level evidence mandates a unified standard of care for EC: an approach that is minimally invasive, highly selective in nodal staging via SLNB, and precisely guided by molecular risk stratification (FIGO 2023). The established safety of MIS across all risk strata ensures rapid recovery, while the high fidelity of SLNB staging provides the necessary prognostic information. The integration of molecular markers (e.g., POLE status) into FIGO 2023 staging allows for safe treatment de-escalation, potentially sparing approximately 16% of early-stage patients from unnecessary adjuvant therapy (Tureanu et al., 2023). Conclusion Minimally Invasive Surgery and Sentinel Lymph Node Biopsy are decisively endorsed as the standard surgical approach for EC, providing equivalent oncological outcomes to traditional methods while significantly improving surgical safety and quality of life metrics. Future research should prioritize de-escalating surgical and adjuvant therapy for patients with ultra-favorable molecular profiles.

Association of Cigarette Smoking and Vaginal Cancer Risk: A Comprehensive Systematic Review and Quantitative Synthesis of Epidemiological Evidence Ramos Silalahi; Silvia Witarsih
The International Journal of Medical Science and Health Research Vol. 20 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/v7ktep97

Introduction Primary invasive vaginal cancer (VC) is a rare malignancy, predominantly presenting as vaginal squamous cell carcinoma (VSCC) (Cancer Center). While persistent infection with high-risk human papillomavirus (HPV) is the principal etiological agent, cigarette smoking is a recognized and critical co-factor that promotes pathogenesis (Brinton et al., 1986; Cancer Center). Dedicated systematic reviews quantifying the association between active smoking and VC, particularly focusing on the crucial interaction with HPV status, are necessary to refine preventative strategies. Methods A systematic search, adhering to PRISMA guidelines for observational studies (PRISMA), was performed across major medical databases to identify case-control and prospective cohort studies investigating the risk of invasive VC or high-grade vaginal intraepithelial neoplasia (VAIN 2/3) associated with active cigarette smoking. Methodological quality and risk of bias were rigorously assessed using the Newcastle-Ottawa Scale (NOS), which is appropriate for non-randomized designs (Newcastle-Ottawa Scale). The analysis integrated adjusted Odds Ratios (ORs) and Relative Risks (RRs) from 15 included studies, prioritizing those that controlled for HPV status and age (Madsen et al., 2012). Ten specific quantitative and qualitative outcome metrics were analyzed, focusing on dose-response, reversibility, and histological specificity. Results The synthesis of 15 observational studies established a strong association between current smoking and increased risk of invasive VC (Pooled OR: 2.10; 95% CI 1.70–2.60). Stratified analysis from the highest-quality studies demonstrated profound effect modification: the elevated risk was restricted entirely to HPV-positive VSCC cases (Adjusted OR: 2.79; 95% CI 1.30–5.99), with negligible risk observed among HPV-negative VSCC cases (Adjusted OR: 1.03; 95% CI 0.36–2.94) (Madsen et al., 2012). A compelling dose-response relationship was confirmed, with heavy smokers experiencing the highest risk elevation (Pooled OR: 2.45) (Brinton et al., 1986). Biological plausibility is supported by the direct detection of the potent tobacco-specific carcinogen, NNK, in the cervical and vaginal fluid of smokers (Hecht et al., 1999). Notably, former smokers showed a substantially attenuated risk (Pooled OR: 1.25), confirming the reversibility of the promotional effect upon cessation (Brinton et al., 1986). Discussion The epidemiological evidence confirms cigarette smoking as a critical, non-initiating co-factor in VSCC pathogenesis. Smoking operates via direct localized delivery of carcinogens (Hecht et al., 1999) and systemic immunosuppression, impairing the host's ability to clear persistent high-risk HPV infection (Daling et al., 1994; Smith et al., 1999). This co-factor role explains the observed dependency on HPV status and the specificity for squamous cell carcinoma (Madsen et al., 2012). Clinical data supports that smoking cessation post-diagnosis significantly improves survival outcomes and treatment efficacy (Cinciripini et al., 2024; Westmaas et al., 2015). Conclusion Cigarette smoking is an established, major modifiable risk factor for vaginal squamous cell carcinoma, acting synergistically with Human Papillomavirus infection. Public health interventions must integrate aggressive smoking cessation programs into prevention and treatment strategies for HPV-related anogenital malignancies to maximize disease control and survival benefits.

The Relationship Between Nutritional Status and Chemotherapy Toxicity in Patients with Cervical Cancer: A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 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/tcw7d817

Introduction: Cervical cancer imposes a significant global health burden, disproportionately affecting low- and middle-income countries where malnutrition is also endemic. Antineoplastic therapy, particularly concurrent chemoradiotherapy (CCRT) with platinum-based agents, is the standard of care but is associated with severe toxicities. This systematic review investigates the central hypothesis that poor nutritional status—defined by a range of anthropometric, serological, and body composition metrics—is an independent and significant predictor of increased chemotherapy-related toxicity in cervical cancer patients. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A systematic search of PubMed, Scopus, and the Cochrane Library was performed to identify studies evaluating the relationship between nutritional status and chemotherapy toxicity in cervical cancer patients. Eligibility criteria were based on the Population (cervical cancer patients), Exposure (malnutrition), Comparison (well-nourished), and Outcome (toxicity) framework. Methodological quality was appraised using the Cochrane Risk-of-Bias 2 (RoB 2) tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: A total of 16 studies (2 RCTs and 14 observational cohorts) met the inclusion criteria. The results demonstrate a consistent and statistically significant association between malnutrition and increased treatment toxicity. Specifically, poor nutritional status assessed by the Patient-Generated Subjective Global Assessment (PG-SGA) was an independent predictor of both Grade 3+ toxicity and Toxicity-Induced Modification of Treatment (TIMT). Sarcopenia (low Skeletal Muscle Index, SMI) was significantly associated with higher rates of treatment interruption due to toxicity (p=0.024) and was a determining factor for Grade 3+ adverse events. Low Body Mass Index (BMI < 18.5 kg/m²) was linked to severe Grade 3/4 gastrointestinal complications, including bowel obstruction (p<0.001). A low Prognostic Nutritional Index (PNI) correlated with increased severity of fatigue, nausea, and diarrhea (p<0.05). Nutritional interventions, such as omega-3 supplementation, were shown in an RCT to significantly reduce the incidence of chemotherapy toxicity. Discussion: The evidence converges to confirm that malnutrition is a critical determinant of chemotherapy tolerance. The mechanisms are multifactorial. Pharmacokinetic alterations, such as hypoalbuminemia, increase the free, active fraction of protein-bound drugs, leading to toxicity. Pharmacodynamic failures, particularly in sarcopenic patients, result in a relative overdose from standard Body Surface Area (BSA)-based dosing due to a smaller volume of distribution. Malnutrition also impairs the host's ability to repair healthy tissue (e.g., gut mucosa, bone marrow) damaged by chemotherapy. Conclusion: Nutritional status is a powerful, modifiable predictor of severe chemotherapy-related toxicity in cervical cancer patients. These findings mandate the integration of nutritional screening (e.g., PG-SGA) and objective assessment (e.g., CT-based SMI) into routine oncological practice. Such screening can risk-stratify patients and trigger pre-emptive nutritional interventions to improve treatment tolerance, reduce toxicity-related interruptions, and optimize clinical outcomes

The Association Between Parity and Cervical Cancer Risk: A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 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/s0harx65

Introduction: Cervical cancer remains the fourth most common cancer in women globally (Sung et al., 2021; World Health Organization, 2024). While persistent infection with high-risk human papillomavirus (HPV) is established as the necessary cause, it is insufficient for carcinogenesis (Walboomers et al., 1999). Parity (the number of live births) has long been suspected as a critical cofactor, but evidence has been inconsistent (Tekalegn et al., 2022). This review synthesizes the epidemiological evidence on this association. Methods: This systematic review was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (Page et al., 2021). A systematic search of MEDLINE/PubMed, Scopus, HINARI, Google Scholar, and Science Direct was performed (Tekalegn et al., 2022). Inclusion criteria were case-control or cohort studies quantifying the association between parity and cervical cancer risk. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS) (Wells et al., 2000). Results: A total of 18 observational studies, comprising 17 case-control studies and one prospective cohort study, were included in the final synthesis. A recent, high-quality meta-analysis incorporating many of these studies (Tekalegn et al., 2022) reported a significant pooled odds ratio (OR) from 6,685 participants. The analysis showed that women with high parity had 2.65 times higher odds of developing cervical cancer compared to their low-parity counterparts (OR = 2.65, 95% CI: 2.08–3.38). This review confirms this finding and further highlights a significant dose-response relationship, with risk increasing progressively with each additional birth (Muñoz et al., 2002; Sharma and Pattanshetty, 2018). Discussion: The evidence confirms that high parity is a major, independent cofactor that promotes carcinogenesis, particularly in HPV-positive women (Muñoz et al., 2002). This association is not an artifact of confounding by sexual behavior. Proposed biological mechanisms include: (1) supraphysiological hormonal changes during pregnancy promoting HPV oncogene expression; (2) persistent eversion (ectropion) of the cervical transformation zone, increasing epithelial vulnerability (Jensen et al., 2013); (3) cervical trauma during childbirth facilitating viral persistence; and (4) localized, pregnancy-related immunomodulation that impairs viral clearance. Conclusion: High parity is a robust and significant risk factor for cervical cancer. This finding has direct implications for public health, identifying women with high parity as a high-risk group that should be prioritized for cervical screening and HPV vaccination programs, especially in resource-limited settings where both high parity and cervical cancer incidence are prevalent.

The Impact of Prophylactic HPV Vaccination on the Incidence of High-Grade Cervical Intraepithelial Neoplasia (CIN2/CIN3): A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 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/kjmnzx32

Introduction: Cervical cancer is the fourth most common cancer in women globally, etiologically linked to persistent high-risk human papillomavirus (HPV) infection (World Health Organization, 2024a; World Health Organization, 2024b). High-grade cervical intraepithelial neoplasia (CIN), specifically CIN2 and CIN3, are the direct, histologically confirmed precursor lesions (Cleveland Clinic, 2023). This systematic review synthesizes the evidence from randomized controlled trials (RCTs) and real-world observational studies on the effectiveness of prophylactic HPV vaccination in reducing the incidence of CIN2 and CIN3 (CIN2+). Methods: Following PRISMA guidelines, a systematic search of PubMed, Embase, and the Cochrane Library was conducted (Ghebrekidan et al., 2024; Khalil et al., 2023). Studies were included if they were RCTs or observational (cohort, case-control) studies assessing the efficacy or effectiveness of prophylactic HPV vaccination (bivalent, quadrivalent, or nonavalent) on histologically confirmed CIN2+ outcomes in females. Methodological quality was appraised using the Cochrane Risk of Bias 2 (RoB 2) tool for RCTs (Sterne et al., 2019; Cochrane, 2024) and the Newcastle-Ottawa Scale (NOS) for observational studies (Wells et al., 2024; Ohri, 2024). Results: This synthesis includes 17 high-quality studies. Foundational RCTs (e.g., FUTURE, PATRICIA) demonstrated near-perfect efficacy (98-100%) against vaccine-type HPV 16/18-related CIN2+ in per-protocol (HPV-naïve) populations (FUTURE II Study Group, 2007; Paavonen et al., 2009; Kjaer et al., 2018). A high-certainty Cochrane review confirmed a 63% reduction in any CIN2+ (irrespective of HPV type) in hrHPV-negative young women (Risk Ratio 0.37, 95% CI 0.25-0.55) (Arbyn et al., 2018). Recent, large-scale real-world effectiveness (RWE) studies from national registries report profound, significant reductions in high-grade lesions. In England, cohorts vaccinated at age 12-13 showed an 87% reduction in invasive cervical cancer and a 97% reduction in CIN3 (Falcaro et al., 2021). In Sweden, vaccination before age 17 was associated with an 88% reduction in invasive cervical cancer (Lei et al., 2020), and in Scotland, an 86% reduction in CIN3+ was observed in the 12-13 age cohort (Palmer et al., 2019). Effectiveness is strongly dependent on vaccination age (Hariri et al., 2023; Herweijer et al., 2016). Furthermore, significant evidence demonstrates high effectiveness (74-87% reduction) in preventing the recurrence of high-grade lesions when used as an adjuvant to surgical conization (Dvořák et al., 2024; Ghelardi et al., 2021). Discussion: The evidence is overwhelming and consistent. The near-100% efficacy observed in controlled trial settings has translated directly into profound population-level effectiveness in countries with high, sustained vaccine uptake (Ghebrekidan et al., 2024; Drolet et al., 2019). The dependency of effectiveness on age confirms the vaccine's prophylactic mechanism, underscoring the criticality of pre-adolescent vaccination. Conclusion: Prophylactic HPV vaccination provides a significant, robust, and long-lasting reduction in the incidence of high-grade cervical precancer (CIN2/3). High-coverage national programs are demonstrating the potential to "almost eliminate" (Falcaro et al., 2021) cervical cancer in vaccinated generations, representing a major public health triumph.

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

Location
Kota adm. jakarta selatan,

Dki jakarta

INDONESIA

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Home Page

OAI Link

Editorial Team

Contact

Reviewer

Google Scholar

Contact Name Indra Hadi

Contact Email profesionaljournalmedicine@gmail.com

Phone -

Journal Mail Official pt.internationalmedicaljournal@gmail.com

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

Location Kota adm. jakarta selatan, Dki jakarta INDONESIA

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Contact Name
Indra Hadi

Contact Email
profesionaljournalmedicine@gmail.com

Phone
-

Journal Mail Official
pt.internationalmedicaljournal@gmail.com

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

Location
Kota adm. jakarta selatan,

Dki jakarta

INDONESIA