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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 449 Documents

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The Association of Dual Antiplatelet Therapy (DAPT) Duration with Ischemic and Bleeding Events Following Percutaneous Coronary Intervention (PCI): A Systematic Review Made Ngurah Bagus Sapta Nurgita
The International Journal of Medical Science and Health Research Vol. 21 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: 10.70070/9mhbw508

Introduction: Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) profoundly increases susceptibility to opportunistic ocular infections, most notably Cytomegalovirus (CMV) retinitis. The degree of immunosuppression, particularly CD4+ T-cell counts below 50 cells/μL, is the primary risk determinant. Despite advances in antiretroviral therapy (ART), CMV retinitis remains a leading cause of vision loss in advanced AIDS, especially in resource-limited settings. Methods: A systematic review was conducted by performing a PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library search across over 138 million academic papers. 40 studies meeting predefined inclusion criteria—focusing on HIV/AIDS populations, quantitative ocular outcome data, and appropriate study designs—were selected for final analysis. Data on study design, population characteristics, ocular manifestations, risk factors, diagnostics, treatments, and outcomes were extracted and synthesized. Results: CMV retinitis is the most common intraocular infection in AIDS, with a pooled prevalence of 14.0% in low- and middle-income countries. A majority (73.4%) of cases occur at CD4+ counts <50 cells/μL. Vision loss affects approximately one-third of patients. Treatment modalities include systemic antivirals (ganciclovir, valganciclovir, foscarnet, cidofovir), local therapies (intraocular implants, intravitreal injections), and combination regimens. Ganciclovir implants demonstrated the longest median time to disease progression (191-226 days). ART, particularly protease inhibitors, drastically reduces the incidence and recurrence of CMV retinitis. For patients achieving sustained immune reconstitution (CD4+ >75 cells/μL on ART for ≥18 months), discontinuation of CMV maintenance therapy is safe with a low relapse risk. Discussion: The relationship between HIV/AIDS and CMV retinitis is directly mediated by immunosuppression. Disparities in prevalence across settings are explained by late HIV diagnosis and ART initiation. Optimal management balances superior local control (e.g., implants) with systemic protection against contralateral and extraocular disease. In resource-limited settings, intravitreal injections offer a viable alternative. Crucially, early screening and diagnosis, prior to significant vision loss, are paramount as visual outcomes are largely determined by timing of intervention rather than treatment choice alone. Conclusion: CMV retinitis remains a significant cause of morbidity in advanced HIV/AIDS, tightly linked to severe immunosuppression. Successful management hinges on early diagnosis through regular ophthalmologic screening in high-risk patients (CD4+ <100 cells/μL), prompt initiation of combined local and systemic antiviral therapy, and sustained immune recovery via ART. Future efforts should focus on improving early HIV detection, expanding access to ART and antiviral therapies in resource-limited regions, and standardizing screening protocols to prevent irreversible blindness.

The Association of Autologous Mesenchymal Stem Cell Implantation to Clinical Outcomes in Knee Osteoarthritis Achmad Munif; Christa Gisella Pirsouw
The International Journal of Medical Science and Health Research Vol. 21 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/pk697216

Introduction: Knee osteoarthritis (OA) is a leading cause of pain and disability globally, driving the search for regenerative therapies. Autologous mesenchymal stem cell (MSC) implantation has emerged as a promising intervention aimed at pain relief, functional improvement, and potential cartilage repair. Methods: This systematic review synthesized evidence from 35 clinical studies (randomized controlled trials, cohort studies, and meta-analyses) investigating intra-articular autologous MSC therapy for knee OA. Studies were screened based on stringent criteria, including adult patients (≥18 years) with radiographically confirmed knee OA, autologous MSC source, intra-articular delivery, minimum 3-month follow-up, and reported clinical outcomes. Data were extracted on MSC characteristics, study design, patient demographics, clinical and structural outcomes, safety, and durability. Results: The analysis demonstrated that autologous MSC therapy yields statistically significant improvements in pain (e.g., VAS, WOMAC) and function (e.g., WOMAC, KOOS) compared to controls such as hyaluronic acid, saline, or placebo, with benefits often sustained for 12–24 months and up to 5 years in some studies (Lee et al., 2019; Lamo-Espinosa et al., 2018; Zhang et al., 2022). However, a substantial proportion of the observed improvement (approximately 50–66%) may be attributable to contextual (placebo) effects (Yin et al., 2025). Structural outcomes on MRI were heterogeneous, with significant cartilage regeneration reported primarily in early-stage OA (Kellgren-Lawrence grades I–II) (Tangkanjanavelukul et al., 2025; Ren et al., 2023), but not consistently in advanced disease. The dose-response relationship was inconsistent, and adipose-derived MSCs showed potentially superior efficacy to bone marrow-derived cells in some analyses (Zhang et al., 2022). The safety profile was favorable, with mostly transient local reactions and no serious treatment-related adverse events reported (Wiggers et al., 2021; Shoukrie et al., 2022). Discussion: The clinical benefits of MSC therapy appear most pronounced in patients with early to moderate OA, where regenerative potential remains. The dissociation between symptomatic improvement and structural changes highlights the role of MSCs' paracrine anti-inflammatory and immunomodulatory effects. Variability in outcomes can be explained by differences in OA severity, MSC source, processing methods, study design, and the significant influence of contextual effects. Conclusion: Autologous MSC injection is a safe and effective treatment for symptomatic knee OA, particularly in early to moderate stages. It provides meaningful, though modest, incremental benefit beyond placebo. Future research should prioritize standardized protocols, patient stratification by disease severity, and longer-term imaging studies to clarify disease-modifying potential.

Effectiveness of Rosmarinus officinalis for Androgenetic Alopecia: A Literature Review Cintantya Prakasita; Desak Nyoman Trisepti Utami; Natasha Caroline Gigir; Ni Ketut Putri Ratih Sindunata
The International Journal of Medical Science and Health Research Vol. 21 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/khjhbh24

Androgenetic alopecia (AGA), also known as androgenic alopecia or male pattern baldness, is the most common type of progressive hair loss.. Androgenetic alopecia is hereditary and is transmitted through an autosomal dominant genetic pattern. This genetic predisposition is directly associated with androgen hormones, in which androgens induce miniaturization of hair follicles on the scalp and a progressive shortening of the anagen phase in the hair cycle. There are evidence-based therapeutic interventions for androgenetic alopecia, including both pharmacological and non-pharmacological approaches. The 5α-reductase inhibitors, finasteride and dutasteride, effectively suppress dihydrotestosterone (DHT) synthesis but are associated with sexual dysfunction including erectile dysfunction, reduced libido, and ejaculatory disorder as well as gynecomastia. Androgen receptor antagonists such as spironolactone may induce postural hypotension and hyperkalemia, cyproterone acetate carries risks of mood disturbances and hepatotoxicity, and flutamide is linked to dose-dependent severe hepatic injury. This literature review explores the therapeutic potential of herbal remedies Rosmarinus Officinalis known for their anti inflammatory agent, anti androgenic agent, anti fungal agent, photoprotective agent, and a vasodilator. This review emphasizes the potential and effectiveness of Rosmarinus Officinalis in advancing dermatological care and providing effective, plant-based solutions for Androgenetic Alopecia with minimal side effects.

The Association Between Passive Smoke Exposure and the Incidence of Pneumonia in Children Under Five: A Systematic Review Khujaefah; Ilham Prayogo
The International Journal of Medical Science and Health Research Vol. 21 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/qfhg2x50

Introduction: Pneumonia remains the foremost infectious cause of mortality in children under five years of age globally, disproportionately affecting those in low- and middle-income countries. Concurrently, a substantial proportion of this vulnerable population is involuntarily exposed to passive tobacco smoke, a known and modifiable risk factor for respiratory illness. This systematic review aims to synthesize and critically evaluate the contemporary evidence on the association between passive smoke exposure and the incidence and severity of pneumonia in young children. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search of PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library was performed to identify observational studies (cohort, case-control, cross-sectional) that quantified the risk of pneumonia or lower respiratory tract infection (LRTI) associated with passive smoke exposure in children under five. Two independent reviewers performed study selection, data extraction, and quality appraisal using the Cochrane Risk of Bias in Non-randomized Studies – of Interventions (ROBINS-I) tool. Results: Seventeen primary observational studies and several supporting meta-analyses met the inclusion criteria. The synthesized evidence demonstrates a consistent and statistically significant association between passive smoke exposure and an increased risk of pneumonia. Pooled data from prior meta-analyses indicate that smoking by any household member increases the risk of LRTI by approximately 54% (OR=1.54, 95% CI 1.40–1.69). Postnatal maternal smoking was identified as the most potent risk factor (OR=1.58, 95% CI 1.45–1.73), conferring a greater risk than paternal smoking alone (OR=1.22, 95% CI 1.10–1.35). A clear dose-response relationship was observed, with risk escalating with the number of smokers in the household and the quantity of cigarettes smoked. Furthermore, exposure was linked to increased disease severity, including a higher likelihood of hospitalization (aOR 1.55, 95% CI 1.25–1.92), longer hospital stays, and increased need for intensive care (aOR 1.44, 95% CI 1.05–1.96). Discussion: The strength, consistency, and dose-response nature of the observed association across diverse global populations, combined with established biological mechanisms, strongly support a causal relationship. Passive smoke exposure impairs lung development in utero, disrupts postnatal mucociliary clearance, suppresses local immune function, and increases nasopharyngeal carriage of key respiratory pathogens. The heightened risk associated with maternal smoking is likely attributable to the combined effects of prenatal exposure on lung architecture and intense postnatal proximity. Conclusion: There is robust and conclusive evidence that passive smoke exposure is a major, preventable cause of pneumonia incidence and severity in children under five. These findings mandate urgent public health action, including strengthening smoke-free legislation and integrating smoking cessation support into routine maternal and child health services to protect this vulnerable population.

A Comprehensive Systematic Review of Comparative Effectiveness of Pharmacological and Lifestyle-Based Treatments for Painful Diabetic Peripheral Neuropathy Pyarkatariana Putri Eka Pertiwi; Mayvita Muntadiroh
The International Journal of Medical Science and Health Research Vol. 21 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/fsnfcy13

Introduction: Painful diabetic peripheral neuropathy (PDPN) is a prevalent and debilitating complication of diabetes, characterized by chronic neuropathic pain that significantly impairs quality of life. The management landscape includes diverse pharmacological and lifestyle-based interventions, yet a comprehensive, comparative synthesis of their effectiveness, safety, and suitability across different patient contexts is needed. Methods: A systematic review was conducted. We screened sources based on predefined criteria including adult PDPN populations, and quantifiable pain outcomes. Data from 40 included sources were extracted on treatment comparisons, patient characteristics, effectiveness and safety outcomes, and study methodology. Results: Pharmacological treatments, particularly anticonvulsants (e.g., pregabalin, Level A evidence) and antidepressants (e.g., duloxetine, SNRIs), demonstrate robust efficacy, with combination therapies (e.g., pregabalin + lacosamide) showing superior response rates (80.6%) versus monotherapy (58.2%) (Muhamamd Riaz et al., 2025; S. Tesfaye et al., 2022). However, they are associated with significant side effects leading to dropouts. Conversely, lifestyle-based interventions like Transcutaneous Electrical Nerve Stimulation (TENS) showed equivalent efficacy to pregabalin with minimal adverse events (Metka Moharič et al., 2009). Psychological interventions (MBSR, CBT) yielded large, sustained effect sizes on pain and interference (Simona Racaru et al., 2020; H. Nathan et al., 2017). Direct comparisons revealed trade-offs; nortriptyline was more effective than TENS but had higher side-effect rates (Mehrnoosh Zakerkish et al., 2019). Discussion: The findings highlight that optimal treatment is not one-size-fits-all. Heterogeneity in outcomes is explained by treatment duration, baseline pain severity, and the superiority of multimodal approaches. Long-term durability favors behavioral and neuromodulation therapies, while pharmacological benefits may plateau. Safety profiles strongly favor non-pharmacological options. Conclusion: A personalized, stepped-care approach is recommended. For treatment-naïve patients with moderate pain, SNRIs or TENS are viable first-line options based on patient preference and comorbidities. Combination therapy is advised for partial responders. For refractory cases, interventional therapies like spinal cord stimulation may be considered. Future research should focus on long-term comparative trials and predictive biomarkers for treatment response.

A Comprehensive Systematic Review of The Effect of Topical Corticosteroid and Vitamin D Analog Combination Therapy on Psoriasis Remission Duration Dio Vaszdly Pramana Sukardi; Finda Rahmanisa
The International Journal of Medical Science and Health Research Vol. 21 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/jws7as47

Introduction: Topical therapy remains a cornerstone for mild-to-moderate psoriasis, but relapse after treatment cessation is a major challenge. The combination of topical corticosteroids (TCS) and vitamin D analogs (VDAs) has demonstrated superior efficacy over monotherapies for active treatment, yet comprehensive evidence on its long-term impact on remission duration is needed. Methods: A systematic review was conducted based on a structured screening of literature from databases, adhering to predefined criteria. Studies involving adult patients with cutaneous psoriasis, evaluating concurrent topical TCS/VDA combination therapy, reporting remission duration or relapse data with ≥4 weeks follow-up, and employing controlled designs were included. Data on treatment regimens, remission definitions, relapse times, safety, and patient characteristics were extracted from 40 eligible sources. Results: Proactive, long-term management with co-formulated calcipotriol/betamethasone dipropionate (Cal/BD) foam was the most effective strategy. The pivotal PSO-LONG trial demonstrated that twice-weekly proactive application nearly doubled the median time to first relapse (56 vs. 30 days) compared to reactive management, resulting in 41 additional days in remission per year (Lebwohl et al., 2020). Similar benefits were observed for other combinations, such as halobetasol/tazarotene lotion, which maintained treatment success in 38.2% of patients 4 weeks post-cessation versus 21.0% with halobetasol alone (Pariser et al., 2018). Systematic reviews confirmed the combination's superiority over VDA monotherapy (RR 2.28 for clearance) and a modest but significant benefit over potent corticosteroid monotherapy (RR 1.22) (Samarasekera et al., 2013; Queirós et al., 2017). The therapy was well-tolerated long-term, with no significant safety concerns over 52 weeks. Discussion: The combination's efficacy stems from complementary anti-inflammatory, immunosuppressive, and keratinocyte-normalizing effects. The proactive regimen's success highlights the importance of treating subclinical inflammation to prevent relapse. Heterogeneity in outcomes is explained by differences in protocols (proactive vs. reactive), formulations (foam superiority), baseline disease severity, and combination types (co-formulated vs. sequential). The therapy offers a favorable risk-benefit profile, reducing overall corticosteroid exposure through sustained remission. Conclusion: Proactive, long-term maintenance therapy with topical corticosteroid and vitamin D analog combinations, particularly Cal/BD foam, significantly prolongs psoriasis remission, reduces relapse frequency, and is a safe and effective first-line strategy for long-term disease control.

Evaluating the Efficacy of Nerve Blocks in Chronic Pain: A Comprehensive Systematic Review Martin Gabe Tua Sihotang; Ida Bagus Krisna Jaya Sutawan
The International Journal of Medical Science and Health Research Vol. 21 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/tdx2y710

Introduction: Chronic pain, defined as persistent pain lasting beyond three months, represents a formidable global health challenge, contributing to profound disability, diminished quality of life, and immense socioeconomic burdens. Within the multidisciplinary management armamentarium, interventional pain management techniques, particularly nerve blocks, have emerged as critical therapeutic options for patients unresponsive to conservative measures. However, the literature on the efficacy of these procedures is characterized by significant heterogeneity, with variable reported success rates, durations of benefit, and levels of evidence across different anatomical targets and chronic pain conditions. This necessitates a comprehensive, systematic, and critical synthesis of the available evidence to guide clinical practice and future research directions (Manchikanti et al., 2024; Kaye et al., 2015; Boswell et al., 2015). Methods: This systematic review was conducted following a rigorous, multi-stage methodology. Across PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library. For the final report, the 40 sources with the highest screening scores were synthesized. Results: The synthesis of 40 high-quality sources reveals a nuanced landscape of efficacy. For spinal facet joint pain, therapeutic lumbar and cervical medial branch blocks, especially when preceded by positive diagnostic blocks, demonstrate Level II evidence for sustained, long-term improvement. RCTs report 82-90% of patients achieving ≥50% pain relief at 2-year follow-up, with each treatment providing a mean relief duration of 15-19 weeks, necessitating approximately 3-6 treatments over two years for sustained benefit (Manchikanti et al., 2007, 2008, 2010; Falco et al., 2012). Radiofrequency neurotomy for facet joint pain shows good to Level II evidence (Janapala et al., 2021). For chronic migraine, greater occipital nerve blocks (GONB) demonstrate significant efficacy, with meta-analyses showing a pooled reduction of 3.6 headache days per month and a 2.2-point reduction in pain severity (Shauly et al., 2019; Mustafa et al., 2024). In knee osteoarthritis, genicular nerve radiofrequency ablation (GnRFA) shows moderate-certainty evidence, with approximately 51% of patients achieving ≥50% pain reduction at 6 months; notably, large lesion techniques (55% success) significantly outperform small lesion techniques (34% success) at 12 months (Kanjanapanang et al., 2025; Zeitlinger et al., 2019). For vertebrogenic low back pain with Modic changes, basivertebral nerve ablation (BVNA) shows robust superiority over standard care (RR 4.16 for ≥50% pain reduction) but a much more modest advantage over sham procedures (RR 1.25), indicating a substantial placebo component (Khalil et al., 2019; Conger et al., 2021). Suprascapular nerve blocks are superior to both placebo (SMD=0.70) and physical therapy (SMD=0.75) for chronic shoulder pain at 12 weeks (Chang et al., 2016). Epidural steroid injections show variable evidence, with transforminal approaches having stronger long-term support for radicular pain than interlaminar approaches (Abdi et al., 2007). Specialized blocks for cancer pain (splanchnic neurolysis) and other conditions (cryoneurolysis, impar ganglion block) also show promising results. The safety profile across all modalities is favorable, with minimal serious adverse events reported. Discussion: The discussion reconciles the apparent heterogeneity in findings by analyzing key moderating variables. Efficacy is profoundly context-dependent, influenced by anatomical precision, technical parameters (e.g., lesion size in GnRFA, approach in epidurals), and rigorous patient selection via diagnostic blocks. A universal finding is the temporal decay of therapeutic effect, underscoring that nerve blocks often provide time-limited relief, logically leading to a paradigm of planned, repeat interventions for chronic conditions. A critical appraisal reveals the powerful influence of the placebo effect, particularly evident in BVNA trials, and highlights concerns regarding evidence quality, including potential bias from industry funding and a relative paucity of high-quality, independent, long-term, sham-controlled RCTs. The evidence hierarchy established allows for condition-specific, evidence-based recommendations. Conclusion: Nerve block interventions are effective and safe for a range of specific, well-defined chronic pain conditions, including facet joint-mediated spinal pain, chronic migraine, knee osteoarthritis (with optimized technique), and vertebrogenic back pain. However, their benefits are frequently not permanent, and optimal outcomes depend on accurate diagnosis, precise technique, and realistic expectation management involving potential repeat treatments. Future research must prioritize independent, sham-controlled RCTs with long-term follow-up, direct comparative effectiveness studies, and investigations into predictive biomarkers to personalize therapy.

Hypokalemic Periodic Paralysis (HPP) as the Initial Presentation of Uncontrolled Non-Ketotic Diabetes: A Case Report Highlighting the Importance of Screening for Maturity-Onset Diabetes of the Young (MODY) in an Adolescent Female Rahayuning Utami; Imarra Nusaibah
The International Journal of Medical Science and Health Research Vol. 21 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/n3m1v533

Introduction Hypokalemic Periodic Paralysis (HPP) constitutes a rare subgroup of neuromuscular channelopathies characterized by sudden, reversible episodes of flaccid muscle weakness that coincide with profound hypokalemia (serum potassium <3.5 mmol/L). While the majority of HPP cases are attributed to inherited familial disorders (FPP), secondary forms are recognized, often precipitated by hormonal or metabolic imbalances. The co-occurrence of severe HPP manifesting as the primary acute complication of uncontrolled non-ketoacidotic diabetes is exceptionally uncommon and poses a significant diagnostic and therapeutic challenge, especially when the clinical picture suggests an underlying monogenic etiology, such as Maturity-Onset Diabetes of the Young (MODY). Case Illustration This report presents a detailed account of a 19-year-old female (Nn. R) who presented to the emergency department on November 7, 2025, with acute and complete flaccid paralysis of the lower extremities (Motor Strength 2/2). Initial biochemical analysis revealed life-threatening hypokalemia (Serum K+=1.50 mEq/L) concomitant with severe, non-ketotic hyperglycemia (Glucose 451 mg/dL, Keton 0.1). The presence of QT prolongation on the electrocardiogram (ECG) indicated high cardiac risk and necessitated immediate admission to the Intensive Care Unit (ICU) for aggressive intravenous potassium replacement and continuous cardiac monitoring. Complete motor function was successfully restored following the normalization of potassium levels (K+ = 3.81 mEq/L) over a six-day hospitalization period. Discussion The rapid and complete recovery of muscle strength upon correction of the potassium deficit confirmed the diagnosis of secondary HPP induced by a massive transcellular shift. This shift was triggered by the potent Na+/K+-ATPase activity stimulated by acute metabolic stress (hyperglycemia). Significantly, the patient's presentation—young age, absence of ketoacidosis, and the high efficacy observed upon clinical transition to long-term sulfonylurea (Glikuidone 30 mg) therapy at discharge—strongly suggests an underlying HNF1A- or HNF4A-MODY phenotype. This clinical finding underscores the utility of recognizing atypical diabetic presentations to ensure appropriate, precision-guided long-term care. Conclusion This case emphasizes the necessity of prompt, aggressive, and strategically administered potassium management in severe HPP to avert fatal cardiac events. Furthermore, the report highlights the critical diagnostic pathway required to identify underlying MODY in patients with HPP and atypical diabetic features, ensuring the selection of appropriate therapy (sulfonylureas) to prevent recurrent paralytic episodes.

Prognostic Performance Of Artificial Intelligence Models In Predicting 12-Week Healing of Chronic Wounds: A Systematic Review And Meta-Analysis Jeany Thalia Hartono; Fanny Evasari Lesmanawati; Rosalyn Devina Santoso
The International Journal of Medical Science and Health Research Vol. 21 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/ewjesj02

Introduction Chronic wounds pose a substantial health burden, requiring intensive, long-term management and carrying a high risk of debilitating complications. Accurate prognosis regarding the probability and rate of healing within the critical 12-week timeframe is essential for optimizing specific care strategies and ensuring the effective allocation of scarce medical resources. Artificial Intelligence (AI), particularly through its foundation in Machine Learning (ML), offers significant potential to enhance prognostic accuracy by rigorously processing vast quantities of Electronic Medical Record (EMR) data and advanced wound imagery. Methods This systematic review and meta-analysis was conducted in strict adherence to the PRISMA 2020 reporting guidelines. Included studies specifically evaluated AI models designed to predict chronic wound healing outcomes within 12 weeks. The methodological quality of these studies was critically assessed using the specialized Prediction Model Risk of Bias Assessment Tool for Artificial Intelligence (PROBAST+AI). Quantitative synthesis was executed to determine the pooled discrimination performance metric, the Area Under the Curve (AUC), and to measure the independent effects of key predictors using pooled Hazard Ratios (HR). Results The analysis incorporated two large-scale primary studies boasting high data volumes, alongside several supporting methodological studies. The resultant pooled AUC for AI models reached 0.805 (95% CI: 0.778–0.832), definitively confirming significant prognostic capability. Specifically, models utilizing Gradient-Boosted Decision Tree (GBDT) algorithms achieved an AUC of 0.853, a performance level that substantially outperformed conventional Logistic Regression models (AUC 0.712). Assessment utilizing PROBAST+AI consistently highlighted systemic methodological quality issues, predominantly stemming from weak internal validation within the Analysis Domain, which consequently elevated the Overall Risk of Bias. The pooled HR analysis, synthesizing data for 10 critical prognostic predictors, confirmed that local wound characteristics are the paramount determinants of prognosis. High-Grade Wound Depth (Stage 3/4) was identified as the single strongest inhibitor of healing (HR 0.65 (95% CI: 0.59–0.71)), whereas Normal/Good Vascularization Status represented the strongest accelerator (HR 1.30 (95% CI: 1.22–1.39)). Discussion and Conclusion The prognostic performance demonstrated by AI models is statistically significant and definitively exceeds that of conventional statistical methods. This heightened accuracy is attributed to the inherent capacity of non-linear models to effectively capture complex multi-variable interactions central to wound healing pathophysiology. Notwithstanding the encouraging performance metrics, the documented high risk of overfitting due to analytical bias necessitates strict and rigorous external validation prior to any extensive clinical implementation.

Mirogabalin 15 mg Twice Daily for Reduction of Average Daily Pain Score in Neuropathic Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials Andra Danika; Paulus Alexander Supit
The International Journal of Medical Science and Health Research Vol. 22 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/zz360g32

Background: Neuropathic pain is a chronic condition that significantly impairs quality of life, causing sleep disturbance, depression, and functional disability. Standard first-line treatments such as pregabalin and gabapentin are frequently limited by insufficient efficacy or poor tolerability. Mirogabalin is a novel α2δ ligand with slower dissociation from the α2δ-1 subunit of voltage-gated calcium channels, potentially offering sustained analgesia with improved tolerability. Objective: To systematically review and meta-analyze randomized controlled trials (RCTs) assessing the efficacy and safety of mirogabalin 15 mg twice daily compared with placebo in adult patients with neuropathic pain. Methods: This systematic review and meta-analysis followed PRISMA 2020 guidelines. PubMed, Embase, and Cochrane CENTRAL were searched from database through September 2025 for double-blind, placebo-controlled RCTs. The primary outcome was mean change from baseline in average daily pain score (ADPS). Secondary outcomes included ≥30% pain responder rate and treatment-emergent adverse events. Random-effects meta-analysis was performed to calculate pooled mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CIs). Risk of bias was assessed using Cochrane RoB 2.0. Results: Four RCTs with a total of 1,819 participants were included. Mirogabalin significantly reduced ADPS compared with placebo (pooled MD −0.57, 95% CI −0.73 to −0.41; p < 0.00001; I² = 0%). Pooled analysis of dichotomous outcomes demonstrated a significantly greater likelihood of achieving ≥30% pain reduction with mirogabalin (RR 1.26, 95% CI 1.11–1.44; p < 0.01). Most studies had low risk of bias. The most common adverse events were somnolence and dizziness, which were generally mild to moderate. Conclusions: Mirogabalin 15 mg twice daily significantly improves pain outcomes compared with placebo, both in mean ADPS reduction and responder rate, and is generally well tolerated. Although the mean pain reduction is modest, the improved responder rate suggests that a clinically meaningful proportion of patients may benefit. Further research should explore long-term efficacy, optimal dosing, and predictors of response.

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

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Kota adm. jakarta selatan,

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INDONESIA