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

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Articles 449 Documents

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A Comprehensive Systematic Review of Antimicrobial Resistance in Community - Acquired Infections Managed in Primary Health Care Agsion Marce Kombongan
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/f690zv31

Introduction: Antimicrobial resistance (AMR) in community-acquired infections presents a critical global health threat, disproportionately affecting primary healthcare settings where most antibiotics are prescribed. Despite two decades of stewardship efforts, antibiotic prescribing rates remain persistently high, and resistance patterns show alarming geographic and temporal trends. This systematic review synthesizes the current evidence on the prevalence, clinical impact, drivers, and management of AMR in community-acquired infections within primary care. Methods: We conducted a comprehensive systematic review following established guidelines. We screened studies based on predefined criteria focusing on community-acquired bacterial infections, primary healthcare settings, and AMR data. Data from 80 included studies were extracted across domains including study setting, pathogens, resistance methodologies, findings, associated factors, and intervention outcomes. Studies encompassed systematic reviews, randomized trials, observational studies, and quasi-experimental designs from diverse global regions. Results: AMR prevalence varies significantly by infection type and geography. In urinary tract infections (UTIs), E. coli resistance to ampicillin was 53.4% in OECD countries versus 79.8% in non-OECD countries. Ciprofloxacin resistance is rising in community-acquired UTIs (P=0.003). For respiratory tract infections, pneumococcal penicillin non-susceptibility reached 58% in some regions, though amoxicillin susceptibility remains preserved in many areas. Antibiotic-resistant infections lead to worse clinical outcomes, particularly in UTIs (OR 4.19 for clinical failure), increased healthcare utilization, and higher economic costs. Antibiotic exposure directly increases individual patient resistance, with effects persisting for up to 12 months. Inappropriate prescribing is pervasive (global pooled estimate 57.6%). Multifaceted antimicrobial stewardship (AMS) interventions, especially those incorporating education, audit/feedback, and decision support, are effective and cost-effective, reducing inappropriate prescribing by 4.2% to 63.69% without compromising patient safety. Discussion: The observed heterogeneity in resistance rates stems from differential antibiotic access policies, healthcare utilization patterns, and dynamic temporal evolution. The discrepancy in clinical impact between UTIs and respiratory tract infections is explained by the differing self-limiting nature of these illnesses and variations in empiric therapy efficacy. The persistence of resistance post-exposure varies by antibiotic class, influenced by the fitness costs of resistance mechanisms. Successful interventions must be context-specific, targeting high-prescribing settings with intensive, multifaceted programs. Conclusion: AMR in primary care is a complex, evolving challenge marked by stark global disparities. The direct link between antibiotic prescribing and individual-level resistance underscores the urgency of optimizing prescribing. Evidence-based, context-adapted AMS interventions are effective and should be widely implemented. Future efforts must prioritize equitable diagnostic access, shorter antibiotic courses, and ongoing surveillance to guide empiric therapy and steward our remaining antimicrobial arsenal.

A Comprehensive Systematic Review of Investigating the Antioxidant Effect of Vitamin E in Depression Oktaberika Putri Indah Yasinta; Eka Pramudian Rismayanti
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: 10.70070/2e5jra19

Introduction: Depression is a prevalent global mental health disorder with a complex, multifactorial pathophysiology. Emerging evidence suggests a significant role of oxidative stress and impaired antioxidant defense in its development and progression. Vitamin E, a potent lipid-soluble antioxidant, has been investigated for its potential therapeutic role in mitigating oxidative damage and alleviating depressive symptoms (Lee et al., 2022; Barbosa et al., 2020). Methods: This comprehensive systematic review synthesized evidence from 14 sources, including randomized controlled trials (RCTs), meta-analyses, and observational studies. Studies were screened and selected based on predefined criteria involving human participants with depression, vitamin E intervention (as monotherapy or co-intervention), measurement of antioxidant biomarkers and depression outcomes, and specific study designs that allowed for the isolation of vitamin E effects. Results: The pooled meta-analysis indicated a moderate beneficial effect of vitamin E supplementation on depression scores (SMD = -0.88, 95% CI: -1.54 to -0.21) (Lee et al., 2022). Observational data showed an inverse association between dietary vitamin E intake and depression risk (RR = 0.84) (Ding & Zhang, 2022). Significant improvements in antioxidant biomarkers, such as increased total antioxidant capacity (TAC) and reduced malondialdehyde (MDA), were consistently reported with vitamin E supplementation, particularly at doses of 400 IU or higher (Farshbaf-Khalili et al., 2022; Darabi et al., 2023). However, effects were more pronounced in populations with elevated oxidative stress (e.g., PCOS, occupational exposure) and when vitamin E was combined with other antioxidants or omega-3 fatty acids. Discussion: The antidepressant effects of vitamin E appear to be mediated through its ability to reduce oxidative stress and lipid peroxidation, modulate inflammatory pathways, and possibly influence gene expression related to neuroprotection (Lee et al., 2022; Almulla et al., 2023). Significant heterogeneity in study outcomes can be attributed to factors such as dosage, formulation, population characteristics, and the common use of vitamin E as a co-intervention. Conclusion: Vitamin E supplementation, particularly at higher doses and in populations with evident oxidative stress burden, may offer a safe and modest adjunctive benefit in the management of depression. Future research should prioritize large-scale, well-designed RCTs of vitamin E monotherapy, with stratified analyses based on baseline antioxidant status, to clarify its independent therapeutic role.

A Comprehensive Systematic Review of The Relationship between Types of Combination Therapy (Oral and Topical) on the Healing Duration of Tinea Imbricata Agustina Vonny Moa
The International Journal of Medical Science and Health Research Vol. 22 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/vwjxwg84

Introduction: Tinea imbricata is a chronic, recalcitrant dermatophyte infection caused by Trichophyton concentricum, predominantly affecting populations in tropical and subtropical regions. The infection is characterized by concentric, scaly plaques that are often difficult to treat, leading to high relapse rates. Despite various available antifungals, optimal treatment strategies, particularly the role of combination therapy (oral and topical), remain inadequately defined, especially concerning healing duration (A. Leung et al., 2019; Al-Bassam Rana Abdulazeem et al., 2019). Methods: A comprehensive systematic review was conducted to evaluate the relationship between types of combination therapy (oral and topical) and the healing duration of tinea imbricata. Literature screening was performed across multiple databases using predefined criteria focusing on human studies with clinically/mycologically confirmed tinea imbricata, combination therapy interventions, and quantifiable healing outcomes. Data extraction covered treatment regimens, healing duration, patient characteristics, study design, long-term outcomes, and safety profiles from included studies. Results: Out of 33 identified sources, only three specifically addressed tinea imbricata, with the majority examining other dermatophytoses. Combination therapies, such as oral terbinafine or itraconazole paired with topical agents (e.g., amorolfine, sertaconazole, keratolytic ointments), demonstrated faster initial response and significantly lower relapse rates compared to monotherapy. For instance, at 2 weeks, itraconazole combined with topical iodine achieved 75.9% improvement versus 24.1% for itraconazole alone (Thamir Abdulmajeed Kubaisi, 2022). Complete cure typically required 4-8 weeks, with extended duration improving outcomes. Safety profiles were generally comparable to monotherapy, with gastrointestinal symptoms being the most common adverse events. Discussion: The synthesized evidence indicates that combination therapy is particularly advantageous for chronic, recalcitrant, or treatment-resistant infections, likely due to synergistic antifungal mechanisms and enhanced drug penetration. The heterogeneity in study findings can be attributed to variations in infection severity, patient populations, and study designs. The strongest evidence supporting combination therapy comes from comparative studies with adequate follow-up, showing substantial reductions in relapse rates (e.g., 7% vs. 57% for itraconazole + terbinafine vs. itraconazole alone) (Yagub S. Saleh et al., 2025). Conclusion: Combination antifungal therapy, integrating oral and topical agents, appears to reduce healing duration and relapse rates in difficult-to-treat dermatophytosis, including tinea imbricata. For uncomplicated cases, monotherapy may suffice with adequate duration. Future high-quality, randomized controlled trials focusing specifically on tinea imbricata are essential to establish standardized, evidence-based treatment protocols.

The Long-Term Spectrum of Neurological Sequelae After Stroke: A Systematic Review of Multidimensional Outcomes Chairunnisa; Ikchan Malik Napitupulu
The International Journal of Medical Science and Health Research Vol. 22 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/vnwqrk60

Introduction Stroke is the world's second leading cause of death and a dominant driver of long-term disability globally. The acute vascular insult initiates irreversible brain damage, characterized by the rapid loss of approximately 1.9 million neurons per minute during compromised cerebral perfusion (Lee et al., 2024). This systematic review evaluates the prevalence, trajectory, and key predictors of chronic neurological, cognitive, and psychosocial deficits following stroke, focusing on the multi-dimensional burden up to 10 years post-event. Methods This systematic review was conducted in adherence to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) guidelines (PRISMA 2020). We included longitudinal cohort studies and population registers that assessed outcomes at least six months post-stroke. Methodological rigor was ensured by applying the ROBINS-I Version 2 tool to evaluate the risk of bias across the included non-randomized studies (ROBINS-I V2). Results Fifteen high-quality longitudinal studies were included, aggregating data on over 15,000 stroke survivors. Neurological and functional deficits demonstrated a recovery plateau by one year, after which they remained chronically stable (Wolfe et al., 2011). Rates of severe disability (Barthel Index <15) stabilized at approximately 11.0%, and general cognitive impairment persisted at 18.0% one year post-stroke (Wolfe et al., 2011). The annual incidence of new dementia was found to be 1.7%, effectively doubling the risk compared to the non-stroke population (Chen et al., 2018). Critically, socioeconomic status (SES) emerged as a powerful prognostic determinant. Lower income was independently associated with poorer executive function and a lower total brain volume to total intracranial volume (TBV/TICV) ratio (Lee et al., 2024), while living in a socioeconomically deprived neighborhood increased the odds of a poor functional outcome by 55% (OR, 1.55; 95% CI, 1.25–1.92) (Robinson et al., 2024). Discussion The high and persistent prevalence of functional and psychosocial deficits, including anxiety (35.0-40.0%) and depression (31.0-35.0%), confirms stroke's classification as a chronic, long-term condition (Wolfe et al., 2011). The analysis suggests that socioeconomic vulnerability may accelerate underlying neurodegeneration, reducing the brain's structural resilience (TBV/TICV) and impairing neuroplastic potential, thereby explaining the observed disparity in chronic outcomes (Lee et al., 2024). Effective management strategies must target integrated rehabilitation and address the systemic social determinants that modulate neurological recovery. Conclusion Long-term neurological deficits after stroke are highly prevalent and persistently debilitating. The significant and negative association between lower socioeconomic status and neurological outcomes necessitates policy interventions to mitigate these social determinants of health and restructure care toward a chronic disease model.

A Comprehensive Systematic Review of Medical And Non Medical Correlates Of Carpal Tunnel Syndrome Laela Nurrochmah; Dhian Pangestiningrum
The International Journal of Medical Science and Health Research Vol. 22 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/a3c6na62

Introduction: Carpal Tunnel Syndrome (CTS) is a common entrapment neuropathy with a multifactorial etiology involving medical, occupational, anatomical, and lifestyle factors. Understanding its diverse correlates is crucial for prevention, diagnosis, and management. Methods: A systematic evidence synthesis was conducted. Forty sources were included after screening based on predefined criteria, including established CTS diagnosis, examination of correlates, robust study design, quantitative association measures, adult population, and human studies. Data were extracted on study design, population, CTS definition, correlates examined, measurement methods, association results, and limitations. Results: Medical correlates with strong evidence include diabetes mellitus (OR=1.90), obesity (OR=2.02), rheumatoid arthritis (OR=1.96), and hypothyroidism (ES=1.44). Pregnancy-related CTS is prevalent (31-62%) and often persists postpartum. Non-medical correlates include occupational biomechanical exposures like vibration (OR=5.40) and hand force (OR=4.23), anatomical factors like a square-shaped wrist (OR=4.56), and female sex (OR=9.99). Psychosocial factors such as high job strain (HR=1.86) and low social support (HR=0.54) are also influential. Genetic factors, including variants in SERPINA1, explain approximately 2% of CTS risk. Notable heterogeneity exists for factors like computer use and smoking, largely dependent on study design and comparison groups. Discussion: The synthesis reconciles heterogeneous findings by emphasizing the impact of diagnostic rigor, study design, confounding, and population context. Diabetes and obesity show consistent, mechanistically plausible links. Occupational risks are hierarchical and potent. Discordant findings for hormone replacement therapy (observational vs. RCT) and smoking (cross-sectional vs. longitudinal) highlight the critical role of study design in causal inference. CTS may serve as an early indicator of systemic conditions like cardiac amyloidosis. Conclusion: CTS is a condition with diverse and interconnected correlates. A holistic, multidisciplinary approach to prevention and management is warranted, considering individual medical history, occupational exposure, anatomical predisposition, and psychosocial context. Future research should prioritize longitudinal designs, standardized diagnostic criteria, and exploration of gene-environment interactions.

A Comprehensive Systematic Review of Management of Otolaryngology Conditions in Low-Income Communities Reza Gusni Saputra; Guntur Surya; Anggina Diksita Pamasya
The International Journal of Medical Science and Health Research Vol. 22 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/e06ba965

Introduction: Otolaryngology (ENT) care in low-income and resource-limited communities faces profound challenges due to systemic inequities, financial constraints, and limited access to specialists. Chronic suppurative otitis media (CSOM) and other ENT conditions disproportionately affect disadvantaged populations, leading to significant morbidity and preventable complications. Methods: This comprehensive systematic review synthesized evidence from 80 studies identified through rigorous screening. We included primary research and systematic reviews focusing on ENT condition management in low-income settings, low-resource environments, or among economically disadvantaged groups. Data extraction encompassed ENT conditions, population characteristics, management approaches, outcomes, barriers, facilitators, and resource requirements. Results: Chronic suppurative otitis media (CSOM) was the most frequently studied condition, with high prevalence linked to poverty, overcrowding, and poor hygiene (Minja et al., 2006; Clarke et al., 2015). Effective management strategies included community-based task-shifting, such as training community health workers (CHWs) in Malawi, which was both feasible and cost-effective at approximately $189 per CHW trained (Mulwafu et al., 2017). Telemedicine demonstrated high diagnostic concordance (>80%) and improved access (Ning et al., 2020; Dash et al., 2024). Low-cost pharmacological alternatives, like topical acetic acid and vinegar wash, showed comparable efficacy to more expensive antibiotics (Vishwakarma et al., 2015; Shenoy et al., 2017). Major barriers included financial limitations, geographic isolation, and systemic gaps in provider knowledge and resources (Beaudoin et al., 2020; Khoza-Shangase et al., 2020). Discussion: The evidence underscores the context-dependent success of interventions. Success hinged on community integration, the use of affordable and effective treatments, and technology-enhanced delivery models. Culturally appropriate, community-codesigned programs were essential for sustainability, particularly for Indigenous and marginalized populations (Gotis-graham et al., 2020). Conclusion: Prioritizing scalable, low-cost interventions—such as CHW training, telemedicine, and task-shifted care models—is crucial for improving ENT care equity in low-income communities. Future efforts must address long-term sustainability, contextual adaptation, and the integration of community-based and specialist services.

A Comprehensive Systematic Review of Prevalence, Diagnosis, and Management of Internet Addiction Disorder Anindi Putri Harjanti
The International Journal of Medical Science and Health Research Vol. 22 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: 10.70070/59k1b162

Introduction: Internet Addiction Disorder (IAD) and Internet Gaming Disorder (IGD) represent significant public mental health challenges worldwide, with varying prevalence rates across regions and populations. The absence of standardized diagnostic criteria and assessment tools has led to considerable heterogeneity in reported rates and treatment outcomes. Methods: A systematic review was conducted, screening 80 peer-reviewed studies that investigated the prevalence, diagnostic methods, and management of IAD and IGD. Studies were included based on predefined criteria focusing on validated assessment tools, human participants, and appropriate study designs. Data extraction covered study characteristics, diagnostic instruments, prevalence estimates, associated factors, and treatment efficacy. Results: Global prevalence estimates vary widely, ranging from 2.6% in Northern/Western Europe to 44.6% in Northern Africa. University students are particularly vulnerable, with a pooled prevalence of 41.84%. Significant regional and demographic variations exist, with males generally exhibiting higher prevalence, except in Gulf Cooperation Council countries where females show higher rates. Cognitive-behavioral therapy (CBT) is the most evidence-based intervention, with effect sizes ranging from g = 0.92 to 1.61, though methodological limitations and cultural specificity constrain generalizability. Discussion: The heterogeneity in prevalence is largely attributable to methodological differences, including choice of assessment tools and diagnostic criteria. Effective management requires culturally adapted, multimodal interventions, with emerging evidence supporting digital and online treatment formats. Critical gaps remain in longitudinal research, female representation, and standardized diagnostic frameworks. Conclusion: IAD/IGD is a globally prevalent condition with substantial psychosocial impacts. Future research should prioritize longitudinal designs, culturally validated tools, and inclusive sampling to improve diagnostic accuracy and treatment applicability.

A Comprehensive Systematic Review of Efficacy of Exercise in Managing COPD Aditya Kafi Amrullah; Syarifudin; Reza Gusni Saputra
The International Journal of Medical Science and Health Research Vol. 22 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/nd6z7246

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, characterized by persistent respiratory symptoms and airflow limitation. Beyond pharmacological management, non-pharmacological interventions, particularly structured exercise training, are cornerstones of comprehensive care. This systematic review synthesizes evidence on the efficacy of various exercise interventions across the spectrum of COPD severity. Methods: A systematic literature screening was conducted on 80 sources, including randomized controlled trials (RCTs), systematic reviews, and meta-analyses. Studies were included if they involved adults (≥18 years) with confirmed COPD, examined structured exercise interventions (e.g., pulmonary rehabilitation, aerobic, resistance, traditional exercises), and reported on COPD management outcomes (exercise capacity, quality of life, dyspnea, exacerbations). Data were extracted on intervention characteristics, population demographics, primary and secondary outcomes, effect sustainability, study quality, and proposed mechanisms. Results: Exercise training consistently produced clinically significant improvements. Functional exercise capacity (6-minute walk distance) improved by a mean difference (MD) of 43.93 meters (exceeding the MCID of 30m) (McCarthy et al., 2015). Health-related quality of life showed meaningful gains in Chronic Respiratory Disease Questionnaire (CRQ) domains (MD 0.56-0.79) and St. George's Respiratory Questionnaire (SGRQ) total score (MD -6.89) (McCarthy et al., 2015). Dyspnea was significantly reduced (MRC score MD -0.64), and muscle strength increased (SMD 0.6 for resistance training) (Troosters et al., 2010; de Lima et al., 2020). Benefits were observed across settings (hospital, community, home), with home-based programs proving non-inferior to hospital-based for dyspnea outcomes (Wuytack et al., 2018). Supervised maintenance exercise reduced respiratory hospital admissions (RR 0.62) (Jenkins et al., 2018). Effects on lung function were generally modest, though traditional Chinese exercises showed significant improvements in FEV1 (Luo et al., 2016). Benefits tended to attenuate after 12 months without structured maintenance. Discussion: Exercise efficacy is mediated by multifaceted physiological (improved muscle oxidative capacity, reduced dynamic hyperinflation) and psychological (enhanced self-efficacy) mechanisms. Heterogeneity in outcomes is influenced by disease severity, intervention characteristics (duration, intensity, modality), and program setting. Key challenges include sustaining long-term benefits and ensuring adherence. The integration of behavioral strategies and accessible formats (home-based, telerehabilitation) is crucial for lasting impact. Conclusion: Structured exercise is a highly effective, safe, and essential component of COPD management, delivering clinically meaningful improvements in exercise capacity, symptoms, quality of life, and healthcare utilization across all disease stages. Future efforts should focus on personalizing interventions, developing effective long-term maintenance strategies, and improving equitable access through innovative delivery models.

The Comprehensive Systematic Review of Relationship of Intravitreal Steroid Implants to the Progression of Cataracts and Glaucoma Arsya Firdaus; Setiawan Arif Wibowo
The International Journal of Medical Science and Health Research Vol. 22 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/d80vbp65

Introduction: Intravitreal steroid implants, such as dexamethasone (DEX) and fluocinolone acetonide (FAc), represent a significant advancement in managing chronic, vision-threatening conditions like diabetic macular edema (DME), retinal vein occlusion (RVO), and non-infectious uveitis. While their sustained-release mechanism offers prolonged therapeutic effect, concerns persist regarding their association with the progression of steroid-induced cataracts and glaucoma, which are common ocular complications of corticosteroid therapy (Kuppermann et al., 2007; Kempen et al., 2011). Methods: This systematic review screened and included studies based on stringent criteria: human studies of FDA-approved intravitreal steroid implants, with quantifiable outcomes on cataract and/or glaucoma progression, follow-up ≥6 months, and appropriate study designs (RCTs, cohort, case-control, systematic reviews). Data from 80 studies were extracted concerning implant type, patient characteristics, follow-up, cataract progression/surgery rates, intraocular pressure (IOP) elevation, glaucoma incidence, and association strength. Results: The evidence demonstrates a clear and significant association between intravitreal steroid implants and both cataract and glaucoma progression, with risk profiles varying markedly by implant type. Fluocinolone acetonide implants (Retisert, Iluvien) showed the highest risk, with cataract surgery required in 64.6% to 100% of phakic eyes and IOP elevation ≥10 mmHg in 65-79% of patients over extended follow-up (Callanan et al., 2008; Goldstein et al., 2007; Jaffe et al., 2005). Dexamethasone implants (Ozurdex) presented a lower but still elevated risk: cataract-related adverse events in 67.9% vs. 20.4% sham (Boyer et al., 2014), and IOP elevation rates of 11-41%, though rarely requiring surgical intervention (Maturi et al., 2016). Key risk factors included phakic status for cataract, and Black race, pre-existing glaucoma, and baseline uveitis activity for glaucoma (Friedman et al., 2013; Kempen et al., 2015). Discussion: The heterogeneity in outcomes is primarily explained by pharmacokinetics: FAc provides continuous release for 2.5-3 years, leading to cumulative toxicity, whereas DEX releases over 4-6 months, resulting in more transient effects. This necessitates a risk-stratified clinical approach, favoring DEX in phakic or glaucoma-prone patients, and considering FAc primarily in pseudophakic, low-glaucoma-risk patients requiring long-term control (Vieira et al., 2020; Liao et al., 2022). The long-term efficacy-safety balance, as seen in the MUST trial, indicates that while implants offer superior inflammation control, systemic therapy may yield better long-term visual acuity due to avoided ocular complications (Kempen et al., 2017). Conclusion: Intravitreal steroid implants are effective but carry a substantial, implant-dependent risk of cataract and glaucoma. Fluocinolone acetonide implants pose the highest risk, while dexamethasone implants offer a more favorable safety profile. Clinical management must involve careful patient selection, rigorous pre-treatment assessment of risk factors, and diligent, long-term monitoring for cataract progression and IOP elevation.

Management of Chronic Urticaria : A Systematic Review of Allergic and Immunology Ade Rahmanda Kamil; Robby Alfadli
The International Journal of Medical Science and Health Research Vol. 22 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/tftgbs90

Introduction: Chronic urticaria (CU), characterized by recurrent wheals and/or angioedema lasting over six weeks, presents a significant therapeutic challenge due to its heterogeneous pathophysiology and frequent inadequate response to first-line H1-antihistamines. The expanding arsenal of biologics and immunomodulators necessitates a comprehensive synthesis of their comparative efficacy and safety. Methods: A systematic review was conducted following a predefined protocol to identify and synthesize evidence from randomized controlled trials, systematic reviews, and meta-analyses focusing on allergic and immunological treatments for chronic spontaneous urticaria (CSU). Studies were screened based on population, treatment focus, design, and outcome criteria. Data extraction encompassed treatment details, patient characteristics, effectiveness outcomes, safety profiles, and study quality. Evidence was synthesized narratively and quantitatively where possible. Results: The review included 66 studies. Second-generation H1-antihistamines are effective first-line therapy, with up-dosing providing modest additional benefit at the cost of increased somnolence (Phinyo et al., 2020; Xiao et al., 2022, 2023). For antihistamine-refractory CSU, omalizumab 300 mg every 4 weeks is highly effective and safe, with rapid and sustained improvements in urticaria activity scores and quality of life (Agache et al., 2020; Zhao et al., 2016; Maurer et al., 2013). Novel agents like ligelizumab (a next-generation anti-IgE), remibrutinib (a BTK inhibitor), and dupilumab (anti-IL-4Rα) show significant promise (Khan et al., 2025; Maurer et al., 2022; Metz et al., 2025; Maurer et al., 2022a). Cyclosporine, while effective, carries a less favorable safety profile (Grattan et al., 2000; Kulthanan et al., 2017). Emerging therapies such as barzolvolimab (anti-KIT) and TLL-018 (TYK2/JAK1 inhibitor) demonstrate encouraging early results (Maurer et al., 2023; Lu et al., 2024). Discussion: The evidence reveals a clear treatment hierarchy and elucidates dose-response relationships, time-to-onset profiles, and distinct safety-efficacy trade-offs. A key research gap is the lack of long-term comparative effectiveness data between newer agents (e.g., BTK inhibitors vs. biologics). Real-world data suggest omalizumab's efficacy is maintained in clinical practice, yet a substantial proportion of patients remain non-responsive to antihistamine-based regimens. Conclusion: The management of CSU has evolved significantly with targeted biologics and novel small molecules. Omalizumab remains the cornerstone of third-line therapy, while emerging agents offer new mechanisms of action. Future research should focus on head-to-head comparisons, long-term safety, predictive biomarkers for treatment selection, and strategies for managing complete non-responders.

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Indra Hadi

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

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Kota adm. jakarta selatan,

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INDONESIA