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The International Journal of Medical Science and Health Research

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Published by International Medical Journal Corp. Ltd.

ISSN : 30481376 EISSN : 30481368 DOI : -

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

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The Relationship Between Pap Smear Screening Adherence and Cervical Cancer Mortality: A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 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/xnj3se72

INTRODUCTION: Cervical cancer remains a leading cause of cancer-related mortality for women globally, with a disproportionate burden concentrated in low- and middle-income countries (LMICs) (World Health Organization, 2024). This significant disparity is largely attributable to inadequate implementation of, and adherence to, preventive screening programs (Bray et al., 2024). This systematic review synthetically evaluates the quantitative association between adherence to Papanicolaou (Pap) smear screening and cervical cancer mortality. METHODS: A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Page et al., 2021). Major electronic databases (including PubMed, MEDLINE, Embase, and Web of Science) were searched for observational studies (cohort and case-control) that assessed cervical cancer mortality or the incidence of invasive cervical cancer as an outcome of cytology screening history (Peirson et al., 2013). Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS), the standard, validated tool for non-randomized studies (Wells et al., 2000). RESULTS: A total of 16 high-impact observational studies met the inclusion criteria. The findings are overwhelmingly consistent and statistically significant in demonstrating a profound protective effect. Large-scale cohort studies demonstrate that women adhering to screening have a substantially lower risk of mortality; one major study found a 70% reduction in cervical cancer mortality (Hazard Ratio: 0.30; 95% Confidence Interval [CI]: 0.12–0.74) (Makino et al., 2006). Case-control studies report exceptionally strong protective effects, with odds ratios (OR) for mortality as low as 0.08 (95% CI: 0.07–0.09) (Landy et al., 2016) and 0.34 (95% CI: 0.14–0.49) (Lönnberg et al., 2013). Furthermore, a meta-analysis of case-control studies on invasive cancer (the precursor to mortality) found a pooled protective effect (OR: 0.35; 95% CI: 0.30–0.41), signifying an approximate 65% reduction in risk (Peirson et al., 2013). DISCUSSION: The evidence irrefutably confirms a significant inverse relationship between screening adherence and mortality. The epidemiological findings demonstrate that the public health failure is not one of diagnostic efficacy but of implementation. This discussion synthesizes the quantitative efficacy of screening with the major documented barriers—economic, psychosocial, cultural, and provider-level—that suppress adherence rates and perpetuate this preventable mortality (Akin-Odanye et al., 2024). CONCLUSION: Adherence to Pap smear screening is a critical, primary determinant in the prevention of cervical cancer mortality. Public health strategies must shift from proving efficacy to aggressively dismantling the known structural and psychosocial barriers to adherence to achieve global elimination targets.

A Systematic Review of the Association of Preoperative Optimization of Diabetic Patients with Perioperative Glycemic Control and Postoperative Outcomes Pretika Prameswari; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 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/ptswat97

Introduction: The prevalence of diabetes mellitus (DM) in surgical populations is substantial and represents a significant independent risk factor for postoperative complications. Preoperative optimization of glycemic control has emerged as a key strategy to mitigate these risks by improving patients' physiological resilience to surgical stress. This review systematically evaluates the association between preoperative glycemic status and postoperative outcomes. Methods: A systematic search of PubMed and the Cochrane Library was conducted for studies published through 2024. Inclusion criteria specified randomized controlled trials and observational studies evaluating preoperative glycemic markers (e.g., glycated hemoglobin ( HbA1c ), blood glucose) or structured optimization interventions in adult diabetic patients undergoing surgery. Primary outcomes included surgical site infection (SSI), 30-day mortality, and major adverse cardiovascular events (MACE). Secondary outcomes included length of stay (LOS), acute kidney injury (AKI), and other morbidities. Study quality was appraised using the Cochrane Risk of Bias 2 and ROBINS-I tools. Results: Seventeen studies, encompassing randomized trials and large cohort analyses, met the inclusion criteria. The evidence consistently links poor preoperative glycemic control, indicated by elevated HbA1c or acute hyperglycemia, with a significantly increased risk of postoperative complications. Specifically, high HbA1c levels were strongly associated with higher rates of SSI (Odds Ratio ranging from 2.13 to 3.0) and prolonged hospital LOS. Acute perioperative hyperglycemia was a more direct predictor of MACE and mortality (Hazard Ratio 1.26 for adverse cardiac events). Structured interventions, such as multidisciplinary preoperative clinics, demonstrated efficacy in reducing preoperative HbA1c levels, particularly in patients with the poorest baseline control. Discussion: The synthesized evidence highlights a critical debate regarding the predictive primacy of chronic ( HbA1c ) versus acute (perioperative blood glucose) hyperglycemia. While acute hyperglycemia appears to be the more proximate driver for immediate adverse events like myocardial injury, HbA1c serves as an essential tool for risk stratification, identifying patients who will benefit most from intensive perioperative management. The heterogeneity of the existing literature, particularly the scarcity of high-quality randomized trials, underscores the complexity of this issue. Conclusion: Poor preoperative glycemic control is unequivocally associated with adverse postoperative outcomes in diabetic patients. While the optimal strategy for preoperative optimization remains to be defined by high-quality evidence, current data support a shift from using HbA1c as a rigid surgical gatekeeper to a trigger for activating comprehensive, multidisciplinary perioperative management pathways.

Association of Deep versus Moderate Neuromuscular Blockade with Surgical Conditions and Postoperative Pulmonary Complications: A Systematic Review of Randomized Controlled Trials Pretika Prameswari; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 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/b7aatk91

Introduction: The optimal depth of intraoperative neuromuscular blockade (NMB) remains a subject of clinical debate. Deep NMB is hypothesized to improve surgical conditions, particularly in minimally invasive surgery, but has historically been associated with an increased risk of postoperative pulmonary complications (PPCs) due to residual neuromuscular blockade (rNMB). This systematic review evaluates the evidence from randomized controlled trials (RCTs) to compare the effects of deep versus moderate NMB on surgical conditions and the incidence of PPCs. Methods: A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify RCTs comparing deep NMB (defined as a post-tetanic count of 1-2) with moderate NMB (defined as a train-of-four count of 1-2) in adult surgical patients. Primary outcomes were measures of surgical conditions (e.g., surgical rating scales, intraoperative patient movement) and the incidence of a composite of PPCs (e.g., pneumonia, atelectasis, respiratory failure). Secondary outcomes included postoperative pain, opioid consumption, recovery times, and other adverse events. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool. Results: Seventeen RCTs met the inclusion criteria. The evidence consistently demonstrated that deep NMB was significantly associated with improved surgical conditions, including higher surgeon-rated scores, a significantly lower incidence of intraoperative patient movement, and the facilitation of lower intra-abdominal pressures during laparoscopy. Regarding safety, when deep NMB was managed with quantitative neuromuscular monitoring and reversed with appropriate agents, particularly sugammadex, there was no statistically significant increase in the incidence of composite PPCs, pneumonia, or atelectasis compared to moderate NMB. Furthermore, deep NMB was significantly associated with beneficial secondary outcomes, including reduced postoperative pain scores, lower opioid consumption, and a decreased incidence of postoperative nausea and vomiting. Discussion: The findings suggest a clear dissociation between the intraoperative depth of NMB and postoperative pulmonary risk. The primary driver of PPCs is postoperative rNMB, a risk that can be effectively mitigated with precise neuromuscular monitoring and the use of reversal agents capable of reliably antagonizing deep block. The benefits of deep NMB on surgical quality are substantial and are complemented by improvements in postoperative pain and recovery metrics. Conclusion: Deep NMB provides significant intraoperative advantages over moderate NMB, enhancing surgical conditions and safety. When implemented as part of a comprehensive strategy that includes quantitative monitoring and effective pharmacological reversal to prevent residual paralysis, it is not associated with an increased risk of postoperative pulmonary complications and may improve aspects of postoperative recovery.

Unseen Danger: Peripartum Cardiomyopathy in a Preeclamptic Mother with Irregular Antenatal Care at a Secondary Hospital in Jayapura, PapuaA Case Report and Literature Review Theresia Herestuwito Naru; Kadek Yunior K; Henny Rumaropen
The International Journal of Medical Science and Health Research Vol. 20 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/zfczxg83

Introduction Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that occurs in the last month of pregnancy or within the first five months postpartum. Preeclampsia, characterized by hypertension and organ dysfunction, increases the risk of long-term maternal cardiovascular complications. Antenatal Care (ANC) has a key role in the early detection and prevention of conditions like PPCM in women with preeclampsia. Case Illustration:A 22-year-old primiparous woman presented with severe difficulty breathing, fatigue, and leg swelling. She had given birth 35 days earlier who had prior episodes of preeclampsia and intrauterine growth restriction (IUGR). Examination revealed lung crackles, murmur, a gallop heart rhythm, and pitting edema. ECG showed sinus tachycardia and right ventricular enlargement, while chest X-ray indicated cardiomegaly with pulmonary edema. Treatment consisted of diuretics, beta-blockers, fluid restriction, and ICU care. During her last pregnancy, she had experienced leg swelling since 37 weeks gestation but had irregular ANC visits, no obstetric ultrasound, and only took vitamins from a primary healthcare center. Discussion:This case highlights the association between preeclampsia and PPCM, a severe Peripartum cardiovascular complication. The patient exhibited classic PPCM symptoms, including shortness of breath, fatigue, and leg edema, with clear signs of cardiac dysfunction. A key factor was poor pregnancy monitoring, as she did not attend ANC regularly, leading to undiagnosed preeclampsia and its complications. Conclusion:PPCM is a serious cardiovascular complication related to preeclampsia. Regular ANC, including ultrasound screening and blood pressure monitoring, is essential to early detection and prevention of adverse maternal and fetal outcomes.

Tapia Syndrome as a Postoperative Complication of LMA Use During TFCC Reconstruction: A Rare Case Report Conni Nabilla Nur Shabrina; Yanti Nurrhokmawati; Fansuri Ikhsan; Realita Malik
The International Journal of Medical Science and Health Research Vol. 20 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/yd8bs465

Background: Tapia Syndrome is a rare neurological condition characterized by concurrent paralysis of the hypoglossal nerve (XII) and the laryngeal branch of the vagus nerve (X), typically resulting from mechanical trauma or excessive pressure to the neck area during general anesthesia. It typically presents with symptoms such as dysarthria, dysphagia, and ipsilateral tongue deviation. One reported risk factor is the use of airway devices such as the Laryngeal Mask Airway (LMA), which can exert localized pressure on these cranial nerves. Although uncommon, this complication is important to recognize, particularly among anesthesiologists and otolaryngologists, due to its impact on speech and swallowing functions. Objective : To report a case and management of a patient with Tapia Syndrome Methods: The study employs a case report methodology supported by a literature review through Pubmed, Cochrane Library, and NCBI using the keywords tapia syndrome, paralysis of nervus XII and IX. 15 articles were found, and articles were selected based on inclusion and exclusion criteria, and 11 relevant studies were obtained. Results: The patient presented with dysarthria and tongue deviation on the first postoperative day, with no signs of central neurological deficits. A clinical diagnosis of Tapia Syndrome was made based on the symptoms and aesthesia history. Supportive therapy and speech rehabilitation were initiated, resulting in gradual recovery over several weeks. Literature review suggests that most similar cases show good outcomes with conservative management. Conclusion: Tapia Syndrome is a rare but significant complication of LMA use during general anesthesia. Awareness of potential cranial nerve injury during airway device placement is essential, particularly in surgeries involving head and neck positioning. Early diagnosis and multidisciplinary management were critical in the patient’s recovery

A Comprehensive Systematic Review of Intraoperative Wound Irrigation for The Prevention of Surgical Site Infection after Laparotomy Satya Agung Nugroho; Fathan Sulistyo Widodo; Hasnan Habib Affifudin
The International Journal of Medical Science and Health Research Vol. 20 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/nje93559

Introduction: Surgical site infections (SSIs) remain a significant complication following laparotomy, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. Intraoperative wound irrigation (IOWI) has been proposed as a preventive measure, but the optimal solution and technique remain debated. Methods: This systematic review analyzed 40 sources, including randomized controlled trials, meta-analyses, and systematic reviews, retrieved via PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library. Studies were screened based on population (adult laparotomy patients), intervention (IOWI), outcome (SSI incidence), and design (RCTs, meta-analyses). Data extraction was performed using a large language model to capture intervention details, surgical context, SSI definitions, outcomes, and effect measures. Results: IOWI significantly reduces SSI rates compared to no irrigation (RR 0.52, 95% CI 0.37–0.74). Antiseptic solutions, particularly povidone-iodine and polyhexanide, may offer additional benefit over saline in certain contexts, though evidence is heterogeneous. Antibiotic irrigation shows strong benefits in contaminated wounds and colorectal surgery. Pulse lavage is superior to standard pouring, while excessive irrigation volume may be counterproductive. Discussion: The efficacy of IOWI is highly context-dependent, influenced by surgical type, contamination level, irrigation technique, and study quality. Antiseptic and antibiotic irrigations are most beneficial in high-risk settings, whereas saline irrigation remains effective in clean-contaminated cases. Conclusion: Routine IOWI before skin closure is recommended for laparotomy patients. Antiseptic or antibiotic solutions should be considered in contaminated or colorectal surgery, and pulse lavage may enhance effectiveness. Future research should standardize protocols and focus on high-risk populations.

A Comprehensive Systematic Review of The Impact of HIV/AIDS on Ocular Manifestations: A Focus on HIV Retinopathy and Opportunistic Infections such as Cytomegalovirus (CMV) Retinitis Dewi Dwipayanti Giri; Ray Ratnansari Giri
The International Journal of Medical Science and Health Research Vol. 21 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: 10.70070/79zyrq45

Introduction: Ocular complications represent a significant cause of morbidity in individuals with advanced Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS). Among these, Cytomegalovirus (CMV) retinitis stands as the most prevalent and vision-threatening intraocular opportunistic infection. Its pathogenesis is intrinsically linked to the state of severe immunosuppression induced by HIV, particularly the depletion of CD4+ T lymphocytes. While the advent of combination Antiretroviral Therapy (ART) has dramatically altered the epidemiology and prognosis of CMV retinitis, it remains a persistent clinical challenge, especially in resource-limited settings and among patients presenting with late-stage HIV disease. This systematic review synthesizes contemporary evidence to delineate the epidemiological burden, pathophysiological determinants, diagnostic standards, therapeutic efficacy, and clinical outcomes associated with CMV retinitis in the global HIV/AIDS population. Methods: A comprehensive systematic review was conducted utilizing the PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library search engine, which interrogated over 138 million academic papers from databases iScreening criteria mandated that studies include an HIV/AIDS population, examine HIV retinopathy or opportunistic ocular infections (especially CMV retinitis) as outcomes, report quantitative data on the relationship, and employ appropriate designs (observational studies, systematic reviews, or meta-analyses). Additional filters ensured clear HIV diagnosis criteria, focus on HIV-positive patients, adequate sample size (>10), and peer-reviewed full-text status. The final analysis and this report are based on the 40 sources with the highest screening scores. Data extraction encompassed: study design and setting; detailed HIV population characteristics (CD4+ count, ART status); ocular manifestation prevalence and features; associated risk factors; diagnostic methodologies; treatment interventions (systemic, local, combination); clinical outcomes (visual acuity, progression, survival); and geographic/healthcare context. Results: The analysis of 40 studies confirms CMV retinitis as the dominant ocular opportunistic infection in AIDS, with a pooled prevalence of 14.0% (95% CI: 11.8%-16.2%) in low- and middle-income countries (LMICs), and historically affecting 20-40% of AIDS patients pre-ART. The degree of immunosuppression is the paramount risk factor, with 73.4% of CMV retinitis cases occurring at CD4+ T cell counts below 50 cells/μL. Vision loss affects approximately one-third of patients (31.6%, 95% CI: 27.6%-35.8%). Treatment efficacy varied: the ganciclovir implant provided the longest median time to progression (221 days), significantly outperforming intravenous ganciclovir (71 days) (Musch et al., 1997). Combination systemic therapy (foscarnet + ganciclovir) was superior for relapsed disease (Sha, 1996). The introduction of ART, particularly protease inhibitors, fundamentally modified outcomes, reducing inflammation recurrence from 33% in untreated to 10% in ART-treated patients. For patients achieving sustained immune reconstitution (CD4 >75 cells/μL on HAART for ≥18 months), discontinuation of CMV maintenance therapy was safe with a 48-week relapse probability of only 2.2% (Wohl et al., 2005). Critically, early screening and diagnosis (CD4 <100 cells/μL) resulted in significantly better baseline visual acuity (median 20/30 vs. 20/80 for late diagnosis), underscoring that timing is a crucial determinant of visual prognosis (Ausayakhun et al., 2018). Discussion: The evidence unequivocally establishes that the risk of CMV retinitis is mediated almost exclusively by the depth of HIV-associated immunosuppression. The persistent high burden in certain settings, despite ART availability, is directly attributable to late presentation and diagnosis of HIV, at which point patients have already crossed the critical immunologic threshold. ART serves as the most effective prophylactic and therapeutic intervention by enabling immune recovery. The evolution of treatment—from systemic antivirals to local sustained-release devices—reflects a pursuit of maximizing intraocular drug levels while managing systemic toxicity. However, a key paradigm elucidated is that local therapy alone, while excellent for controlling the treated eye, may inadequately protect the contralateral eye and systemic sites, favoring combined local-systemic strategies where feasible (Martin et al., 1999; D. Jabs, 2001). The review also highlights the critical disparity between resource settings, where access to costly implants or oral valganciclovir may be limited, making intravitreal injection protocols a vital, effective alternative (Liang et al., 2023; Teoh et al., 2012). The irreversible nature of retinal necrosis makes early detection through systematic screening the single most important modifiable factor for preserving vision. Conclusion: CMV retinitis remains a serious complication of advanced HIV/AIDS, serving as a clinical marker of severe immunosuppression. Its management is multifaceted, requiring: 1) early HIV diagnosis and prompt initiation of ART for prevention; 2) regular ophthalmologic screening of high-risk patients (CD4+ count <100 cells/μL); 3) a tailored treatment approach that balances local disease control with systemic protection, considering resource availability; and 4) in the context of successful immune reconstitution, consideration for discontinuing maintenance therapy with appropriate monitoring. The goal of modern management is not merely to treat retinitis but to preserve vision and quality of life through integrated HIV and ophthalmologic care.

Novel Therapeutics in Sjögren's Disease: A Systematic Literature Review Bernie
The International Journal of Medical Science and Health Research Vol. 21 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/nmhtsd48

Introduction: Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease with significant morbidity and unmet therapeutic needs. Current treatments are largely palliative. This systematic review synthesizes evidence on novel biologic and immunomodulatory therapies aimed at disease modification. Methods: A systematic search was conducted across multiple databases (PubMed, Semantic Scholar, Springer, etc.) for studies (RCTs, systematic reviews) evaluating novel therapeutics (biologics, immunomodulators) in pSS patients. Data on therapy, population, design, efficacy (ESSDAI, ESSPRI, glandular function), and safety were extracted. Results: Thirty-two studies were included. Agents targeting the CD40/CD40L pathway (iscalimab, dazodalibep) and FcRn (nipocalimab) demonstrated statistically significant and clinically meaningful improvements in systemic disease activity (ESSDAI) and patient-reported symptoms (ESSPRI). In contrast, abatacept, tocilizumab, and JAK/SYK/BTK inhibitors showed limited efficacy. A critical finding was that patients with early disease (≤3 years duration) responded significantly better to biologics. Safety analysis confirmed a higher risk of serious adverse events with biological therapies, though profiles varied by drug class. Glandular function improvements were modest overall but more pronounced with regenerative approaches like stem cell therapy. Discussion: The CD40/CD40L pathway is a validated, high-priority therapeutic target in pSS. Disease duration is a key modifier of treatment response, highlighting a therapeutic window for early intervention. Heterogeneity in trial results is explained by factors including disease duration, dosing, and outcome measurement sensitivity. Conclusion: This review establishes a hierarchy of efficacy, with CD40/CD40L and FcRn blockade as the most promising strategies. Early intervention is crucial for optimal outcomes. Future research must focus on trials in early disease, predictive biomarkers, long-term safety, and regenerative therapies.

A Rigorous Systematic Review of Probiotics for the Prevention of Antibiotic-Associated Diarrhea: Efficacy, Safety, Strain Specificity, and Risk Stratification in Adult and Populations I Dewa Ayu Meyta Putri Sandradevi
The International Journal of Medical Science and Health Research Vol. 21 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/d7awbn76

Introduction Antibiotic-associated diarrhea (AAD) represents the most frequent gastrointestinal adverse event associated with antimicrobial therapy, affecting between 5% and 35% of patients depending on the drug and host factors.1 This adverse effect arises from antibiotic-induced gut microbiota dysbiosis, which compromises colonization resistance and favors the overgrowth of opportunistic pathogens, most severely Clostridium difficile.1 Probiotics—live microbial preparations—are hypothesized to restore intestinal microbiota balance, thereby preventing diarrhea.3 This systematic review and meta-analysis synthesizes the latest evidence from 42 adult and 24 randomized controlled trials (RCTs) to quantify the efficacy and safety profile of probiotics for AAD and Clostridium difficile-associated diarrhea (CDAD) prophylaxis. Methods A systematic literature search was conducted across PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library, targeting RCTs in adult and populations receiving antibiotics.4 Study selection and data extraction rigorously adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.6 Pooled analyses were performed using a Random Effects Model to calculate the Risk Ratio (RR), Mean Difference (MD), and the Number Needed to Treat for an additional beneficial outcome (NNTB) across twelve primary and secondary outcomes.4 Results Probiotics demonstrated a statistically significant protective effect against AAD in the overall analysis for adults (RR 0.63, 95% CI 0.54 to 0.73, p<0.00001; NNT 20) and a stronger effect in (RR 0.45, 95% CI 0.36 to 0.56; NNTB 9).3 The protective effect against the severe outcome, CDAD, was highly significant (RR 0.40, 95% CI 0.30 to 0.52), particularly in trials enrolling participants with a baseline CDAD risk exceeding 5% (RR 0.30, NNTB 12).7 Subgroup analyses confirmed superior efficacy with specific strains (Lactobacillus rhamnosus GG and Saccharomyces boulardii) and a dose-response relationship, with high doses (≥5 billion CFUs/day) showing superior efficacy (RR 0.37 vs. RR 0.68 for low dose).3 Sensitivity analysis, excluding studies with high bias, showed the protective effect against AAD was no longer statistically significant in adults (RR 0.78, 95% CI 0.57 to 1.07, p=0.13).4 Overall adverse events were slightly reduced in the probiotic group (RR 0.83), and no serious adverse events were reported in the included RCT populations.3 Discussion The significant overall reduction in AAD incidence supports the prophylactic use of probiotics, but the critical sensitivity analysis reveals that this generalized benefit is highly susceptible to methodological bias in adult studies.4 Therefore, clinical recommendations must emphasize risk stratification, prioritizing prophylaxis for patients and high-risk adults (CDAD risk >5%), where the evidence remains robust and clinically meaningful (NNTB 9 and 12, respectively).3 The failure to reduce C. difficile detection rates suggests that the primary protective mechanism involves toxin neutralization and barrier function enhancement rather than pathogen eradication.7 Conclusion Probiotics are effective and generally safe agents for AAD prevention, with definitive utility in populations and for targeted CDAD prevention in high-risk groups. Future research must focus on high-quality, blinded RCTs to establish definitive efficacy and cost-effectiveness in low-risk adults.

Comparison of Meniscal Tear Location and Zone in Athletes: A Systematic Review of Implications for Return to Sport I Nyoman Gede Witriadnyana; I Wayan Subawa; I Gede Mahardika Putra
The International Journal of Medical Science and Health Research Vol. 21 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/np55k665

Introduction: Meniscal injury represents one of the most prevalent knee injuries observed in the athletic population, carrying a substantial risk of threatening career longevity. The selection between the two primary management strategies—partial meniscectomy or meniscal repair—presents a critical clinical dilemma, balancing the need for rapid recovery against the imperative of preserving long-term joint health. The specific characteristics of the tear, including its anatomical location (medial versus lateral) and its vascularization zone, are recognized as major determinants influencing the final functional outcome. Methods: This systematic review was rigorously executed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was performed across major electronic databases, including PubMed, Semantic Scholar, Springer, and Google Scholar. The search utilized a detailed set of Boolean keywords targeting the athlete population, meniscal repair interventions, comparisons with meniscectomy and tear location, and return-to-sport outcomes. Following the screening of 6,756 initial records, a total of 32 eligible studies were ultimately included in the final analysis. These studies involved athletes with arthroscopically or radiologically confirmed meniscal tears, explicitly reported recovery outcomes, and utilized appropriate study designs. Results: The findings demonstrate a clear difference in recovery timelines: Meniscectomy consistently enabled athletes to achieve a faster return to sport (RTS), typically within 1 to 4.3 months, compared to the longer duration required for meniscal repair (5.6–7.6 months). Despite this variance in timing, the overall return-to-sport rate was generally comparable between the two procedures, consistently falling within the range of 77% to 93%. Repair of the lateral meniscus is clinically favored due to its inherently superior healing potential. Conversely, the rate of repair failure exhibited significant variation contingent on the tear morphology, reaching up to 27.4% for specific patterns such as bucket-handle tears. The rates at which athletes successfully returned to their pre-injury performance level were broadly distributed (53.9% to 92.6%) and tended to be lower following complex interventions, such as meniscal allograft transplantation. Discussion: The evidence highlights a fundamental trade-off: the rapid functional recovery afforded by meniscectomy contrasts sharply with the long-term joint preservation advantages provided by meniscal repair. The optimal treatment strategy requires meticulous individualization, demanding careful consideration of the specific tear location (with repair strongly advocated for the lateral meniscus), the tear pattern, the athlete’s age, and their professional activity level. Furthermore, the systematic review established that accelerated rehabilitation protocols do not correlate with an increased risk of repair failure, thereby supporting the implementation of earlier functional recovery programs. Conclusion: The clinical management of meniscal tears in athletes should prioritize tissue preservation through meniscal repair whenever technically feasible, particularly in the context of lateral tears and for young athletes. Although this preservation approach mandates a longer period of rehabilitation, it constitutes a vital investment in the athlete’s long-term joint health and the sustainability of their athletic career.

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Contact Name
Indra Hadi

Contact Email
profesionaljournalmedicine@gmail.com

Phone
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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