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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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The Comprehensive Systematic Review of Association of Positive Surgical Margins to Biochemichal Recurrence in Prostate Cancer Andi Dedi Pradana Putra; Khaeriah B
The International Journal of Medical Science and Health Research Vol. 24 No. 2 (2026): 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/c19rae16

Introduction: Positive surgical margins (PSM) following radical prostatectomy (RP) represent a critical prognostic factor in prostate cancer management, yet their precise impact on biochemical recurrence (BCR) and long-term oncological outcomes remains heterogeneous across studies. A systematic synthesis of the evidence is required to clarify this association and guide clinical decision-making. Methods: This comprehensive systematic review adhered to PRISMA guidelines, screening studies from multiple databases. Inclusion criteria encompassed observational studies or systematic reviews/meta-analyses investigating the PSM-BCR association in men undergoing RP for non-metastatic prostate cancer, with a minimum 6-month follow-up. Data extraction was performed systematically, focusing on study design, PSM and BCR definitions, patient demographics, surgical details, association findings, and the impact of adjuvant therapies. Results: The review incorporated 80 studies. PSM was consistently associated with a significantly increased risk of BCR, with pooled hazard ratios (HR) ranging from 1.35 to 2.37 in multivariate analyses (Zhang et al., 2018; Kim et al., 2022). The risk was modulated by PSM characteristics: Gleason grade 4/5 at the margin (HR 1.87 vs. grade 3), margin length >3mm (HR 1.99), and multifocality (HR 1.38) conferred higher BCR risk (Lysenko et al., 2020; John et al., 2023; Guo et al., 2024). PSM rates varied by surgical approach and pathological stage, with nerve-sparing techniques and surgeon experience influencing outcomes (Moris et al., 2021; Bianco et al., 2006). While adjuvant radiotherapy (RT) improved BCR-free survival, early salvage RT demonstrated comparable long-term metastasis-free and overall survival (Hackman et al., 2019; Schneider, 2020). Discussion: The heterogeneity in effect estimates is attributable to differences in study populations, methodological rigor, and the granularity of PSM characterization. PSM should not be interpreted in isolation but as part of a multimodal risk profile including pathological stage and Gleason grade. The evolving paradigm favors risk-adapted strategies, potentially reserving immediate adjuvant RT for the highest-risk profiles while employing early salvage for others. Conclusion: PSM is a significant, independent predictor of BCR after RP, but its prognostic weight is contingent upon specific margin characteristics and coexisting pathological features. Clinical management should integrate detailed margin assessment with other risk factors to personalize postoperative strategies, emphasizing refined risk stratification and judicious use of adjuvant therapies.

The Systematic Review of Diagnosis and Management of Acute Appendicitis in Adults Averina Sutoko; Venansius Alvent; Sean Gerry Santoso
The International Journal of Medical Science and Health Research Vol. 24 No. 2 (2026): 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/s7tye075

Introduction: Acute appendicitis remains one of the most common surgical emergencies worldwide, traditionally managed by appendectomy. In recent decades, the paradigm has shifted towards exploring non-operative management with antibiotics and refining diagnostic and surgical approaches. This systematic review synthesizes contemporary evidence on the diagnosis and management of acute appendicitis in adults (Rushing et al., 2019). Methods: A systematic review was conducted by screening literature from multiple databases. Inclusion criteria encompassed studies involving adult patients (≥18 years) with suspected or confirmed acute appendicitis, evaluating diagnostic methods or management strategies, employing robust study designs (RCTs, cohort studies, systematic reviews, etc.), reporting clinically relevant outcomes, and representing unique publications. Data were extracted on study design, patient population, diagnostic and management approaches, outcomes, clinical context, and study quality from 80 included sources (Salminen et al., 2015; Coda Collaborative et al., 2020). Results: Computed Tomography (CT) is the most accurate diagnostic modality (sensitivity 92.7-97.2%, specificity 94.2-96.1%), significantly reducing negative appendectomy rates (Weston et al., 2005; van Randen et al., 2008). For uncomplicated appendicitis, antibiotic therapy is a viable but less effective alternative to surgery, with a one-year success rate of approximately 72.7% declining to 60.9% at five years (Salminen et al., 2018). The presence of an appendicolith is a critical predictor of antibiotic failure and higher complication rates (Coda Collaborative et al., 2020). Laparoscopic appendectomy is superior to open surgery, offering reduced infections and shorter hospital stays, especially in the elderly (Athanasiou et al., 2017; Southgate et al., 2012). Delayed appendectomy and outpatient management are safe and effective strategies (Patel et al., 2023; Jordi Elvira Lopez et al., 2022). Discussion: The evidence supports a tailored, patient-centered approach. Antibiotic therapy is a reasonable first-line option for uncomplicated appendicitis without an appendicolith, particularly when surgery is contraindicated or declined, offering cost savings and comparable long-term quality of life despite higher recurrence and readmission rates (Haijanen et al., 2019; Sippola et al., 2020). Appendectomy remains the definitive treatment, especially for those with an appendicolith or complicated disease. Advances in minimally invasive surgery and optimized perioperative care have improved outcomes. Conclusion: The management of acute appendicitis in adults has evolved from a purely surgical model to an individualized strategy incorporating accurate CT imaging, risk stratification (notably for appendicolith), and shared decision-making between antibiotics and surgery. Laparoscopic appendectomy is the preferred surgical approach. Future research should focus on long-term outcomes, optimization of outpatient antibiotic regimens, and protocols for low-resource settings.

Association of Time-to-“Association of STONE Score Calculation To Reduced CT Scan Usage in the Emergency Department: A Systematic Review Raynaldo Adnan Dinarwanto; Mochamad Sri Herlambang
The International Journal of Medical Science and Health Research Vol. 24 No. 2 (2026): 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/x497wz69

Introduction: The increasing use of computed tomography (CT) in emergency departments (EDs) for suspected renal colic raises concerns about radiation exposure and healthcare costs. The STONE clinical prediction score was developed to stratify patients by risk of urolithiasis, potentially guiding more judicious imaging. This systematic review aims to synthesize evidence on the association between STONE score implementation and CT scan utilization reduction in the ED. Methods: A systematic review was conducted following a structured screening protocol. Studies were included if they were conducted in an ED setting, involved adult patients with suspected kidney stones, implemented or evaluated the STONE score, and reported CT utilization outcomes. Data were extracted on study design, STONE score implementation, CT usage metrics, clinical outcomes, and implementation barriers. Results: Of 80 screened sources, only four studies directly examined STONE score implementation. The score demonstrated high heterogeneity in performance across studies but was useful for risk stratification (low-risk: ~12% stone prevalence; high-risk: ~83%). Direct evidence linking STONE score use to reduced CT ordering is scant. One prospective study showed STONE-guided reduced-dose CT protocols achieved 88.2% radiation dose reduction while maintaining high sensitivity. Broader evidence supports alternative strategies for CT reduction, including ultrasound-first protocols (achieving 7.7% absolute reduction) and low-dose CT protocols (75-88% dose reduction). Multispecialty consensus suggests 45% of clinical scenarios may require no imaging. Discussion: The STONE score’s primary utility appears to be identifying low-risk patients who may avoid imaging, rather than reducing overall CT ordering. Successful CT reduction requires multifaceted interventions beyond prediction tools, including ultrasound-first pathways, low-dose protocols, and system-level changes like interdisciplinary collaboration and workflow integration. Significant barriers persist, including clinician comfort, radiologist acceptance of reduced-dose CT, and a gap between evidence and practice. Conclusion: While the STONE score is a valid risk-stratification tool, direct evidence of its effectiveness in reducing CT scan utilization is limited. Its value is likely as part of a comprehensive, multi-strategy approach that includes ultrasound-first algorithms and dose optimization protocols. Future implementation research should focus on integrating the STONE score into clinical decision support systems within broader diagnostic pathways.

The Efficacy of Secondary Prophylaxis in Reducing the Progression of Rheumatic Heart Disease in Children and Adolescents in Endemic Regions: A Systematic Review Rizky Handayani; Dita Ayu Dewi Laras Sati; Agustinus Mahardhika Sarayar
The International Journal of Medical Science and Health Research Vol. 25 No. 1 (2026): 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: 10.70070/2kkbhh45

Introduction: Rheumatic heart disease (RHD), a chronic and debilitating sequela of Group A Streptococcus infection, persists as a leading cause of cardiovascular morbidity and mortality among children and young adults in endemic regions. Secondary antibiotic prophylaxis is the cornerstone of management, aimed at preventing recurrent episodes of acute rheumatic fever (ARF) and halting the progression of cardiac valvular damage. This systematic review critically evaluates the body of evidence supporting the effectiveness of this vital intervention in pediatric and adolescent populations. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library databases were systematically searched for randomized controlled trials (RCTs) and observational studies published up to October 2024. Studies were included if they evaluated antibiotic prophylaxis compared to placebo, no treatment, or alternative prophylactic regimens in children and adolescents with a diagnosis of ARF or RHD in endemic settings. A comprehensive set of outcomes was assessed, including echocardiographic progression of disease, ARF recurrence, all-cause and cardiovascular mortality, major cardiac events, and adverse events. The methodological quality of included studies was rigorously assessed using the Cochrane Risk of Bias 2 tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Results: A total of 18 studies, comprising 3 pivotal RCTs and 15 observational cohort and registry studies, met the stringent inclusion criteria. High-certainty evidence from a recent, large-scale RCT conducted in Uganda (Beaton et al., 2021) demonstrated that intramuscular benzathine penicillin G (BPG) significantly reduces the risk of echocardiographic progression in children with latent RHD compared to no treatment (Risk Difference -7.5%; 95% CI, -10.2 to -4.7; p<0.001). A comprehensive 2024 Cochrane review (Bray et al., 2024), which included a meta-analysis of historical trials, confirmed that intramuscular BPG is substantially superior to oral antibiotic regimens for the prevention of ARF recurrence (Risk Ratio 0.07; 95% CI, 0.02 to 0.26). The body of evidence from observational studies consistently reveals a strong and significant correlation between poor adherence to secondary prophylaxis and increased rates of ARF recurrence, RHD progression, and adverse cardiac outcomes. Discussion: The collective evidence unequivocally supports the use of secondary prophylaxis with intramuscular BPG as a highly effective clinical intervention. The recent validation of its efficacy in the early, latent stage of RHD provides a compelling scientific and ethical rationale for the integration of echocardiographic screening into public health programs in high-risk settings. However, the profound gap between the proven efficacy of this therapy and its real-world effectiveness is a critical concern. This gap is driven almost entirely by poor patient adherence, which remains the single greatest barrier to the successful control and eventual elimination of RHD. Conclusion: Secondary antibiotic prophylaxis, particularly with long-acting intramuscular BPG, is unequivocally effective in reducing the progression of RHD and preventing its devastating sequelae in children and adolescents. The focus of future research and public health initiatives must pivot from confirming efficacy to addressing the complex challenges of implementation. Overcoming the profound and multifaceted barriers to treatment adherence is the most urgent priority to translate this proven intervention into tangible and equitable public health gains.

The Comprehensive Systematic Review of Association of the HLA-B27 antigen to the development of ankylosing spondylitis Clareta Vero Patricia Widya; Devina Adelina Wijaya
The International Journal of Medical Science and Health Research Vol. 25 No. 1 (2026): 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/vnecfx77

Introduction: Ankylosing Spondylitis (AS) is a chronic inflammatory arthritis primarily affecting the axial skeleton, with a well-established but complex genetic association with the Human Leukocyte Antigen B27 (HLA-B27). Despite decades of research, the precise mechanisms, the differential roles of HLA-B27 subtypes, and the influence of geographic and genetic modifiers remain areas of active investigation (Reveille, 2006). Methods: This comprehensive systematic review synthesized evidence from 80 studies, including case-control studies, cohort studies, and meta-analyses. A stringent screening process was applied, focusing on studies with defined AS diagnostic criteria, confirmed HLA-B27 testing, comparison groups, and reported statistical measures of association. Data extraction covered study design, population characteristics, HLA-B27 testing methods, AS definitions, association results (odds ratios, relative risks), HLA-B27 prevalence, subtype analyses, epistatic interactions, and clinical phenotype correlations. Results: The analysis confirmed an exceptionally strong association between HLA-B27 and AS, with relative risks estimated between 50 and 100 for carriers. However, significant heterogeneity exists. HLA-B27 prevalence in AS patients varies geographically, from ~90% in Caucasian and Asian populations to as low as 26.2% in some Middle Eastern countries. Critical nuances emerged: specific subtypes confer differential risk (e.g., B2704 is a risk factor, while B2706 and B*2707 are protective), and powerful epistatic interactions were identified, particularly with HLA-B60 (RR up to 342) and ERAP1 polymorphisms. Clinically, HLA-B27 positivity is associated with earlier disease onset, better response to biologic therapies, and shorter diagnostic delays, but a lower-than-expected diagnostic likelihood ratio (LR+ 2.7) (A. D. Vieira Bento Silva et al., 2023). Discussion: The findings underscore that HLA-B27 is a necessary but insufficient factor for AS pathogenesis. The disease risk is modulated by a complex interplay of specific HLA-B27 subtypes, co-inherited genetic factors (epistasis), and population-specific genetic backgrounds. This complexity explains why only 1-5% of HLA-B27 carriers develop AS and accounts for the wide geographic variation in disease association strength. Conclusion: HLA-B27 remains the paramount genetic risk factor for AS, but its clinical and pathogenic interpretation must account for subtype variation, epistatic interactions, and ethnic background. Future research should prioritize elucidating the molecular mechanisms of protective subtypes and integrating polygenic risk scores with HLA status for improved diagnosis, prognosis, and personalized treatment strategies.

The Comprehensive Systematic Review of Association of Non-Nutritive Sweetener Consumption to Potential Effects of Glucose Intolerance Devina Adelina Wijaya; Clareta Vero Patricia Widya
The International Journal of Medical Science and Health Research Vol. 25 No. 1 (2026): 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/z329kc27

Introduction: Non-nutritive sweeteners (NNS) are widely used as sugar substitutes to reduce caloric intake and manage body weight, yet their long-term metabolic effects, particularly on glucose tolerance, remain controversial. While acute studies often report neutral effects, emerging evidence suggests that chronic consumption, especially of certain NNS types, may adversely affect insulin sensitivity and glucose homeostasis in specific populations (Romo-Romo et al., 2018; Suez et al., 2022). Methods: A comprehensive systematic review was conducted, screening studies based on predefined inclusion criteria: human participants, NNS exposure assessment, glucose metabolism outcomes, appropriate study designs (RCTs, cohort studies, systematic reviews), and methodological quality. Data extraction covered NNS type, dosage, study population, glucose outcomes, study design, key findings, and proposed mechanisms. A total of 80 studies were included and critically synthesized. Results: The evidence reveals significant heterogeneity in NNS effects. Acute NNS exposure generally has minimal impact on postprandial glucose and insulin (Greyling et al., 2020), but chronic consumption (≥2 weeks), particularly of sucralose, is associated with decreased insulin sensitivity in healthy, lean, non-habitual users (Romo-Romo et al., 2018, 2024, 2025). Effects vary by sweetener type: stevia shows neutral to beneficial effects on fasting glucose (Bai et al., 2024; Zare et al., 2024), aspartame largely exhibits neutral metabolic impact (Santos et al., 2018; Higgins et al., 2018), while saccharin and sucralose demonstrate more variable, often microbiome-dependent outcomes (Suez et al., 2022; Méndez-García et al., 2022). Population characteristics, including baseline metabolic health and habitual NNS use, significantly moderate these effects. Discussion: The divergence in findings can be explained by population-specific responses, sweetener-specific mechanisms (e.g., gut microbiota modulation by sucralose), study duration, methodological quality, and comparator substances. When NNS replace sugar-sweetened beverages, they generally offer a net metabolic benefit, supporting their role in dietary strategies for sugar reduction (McGlynn et al., 2020; Lee et al., 2022). Conclusion: The impact of NNS on glucose metabolism is not uniform but is influenced by sweetener type, consumption duration, and individual host factors such as metabolic health and gut microbiome composition. While certain NNS may pose risks to insulin sensitivity in metabolically naive individuals, they remain a preferable alternative to caloric sweeteners for weight and glycemic management in broader populations. Future research should focus on personalized nutrition approaches and long-term outcomes.

Surgical Reconstruction and Multimodal Management of Traumatic Corneoscleral Rupture with Iris Prolapse Following Blunt High-Velocity Impact: A Comprehensive Case Analysis and Clinical Review Dewi Dwipayanti Giri; I Putu Rustama Putra
The International Journal of Medical Science and Health Research Vol. 25 No. 2 (2026): 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/r3zcpw50

Introduction Ocular trauma remains a significant contributor to global monocular blindness, particularly among the young and economically productive demographic. Open globe injuries (OGI), specifically those characterized by corneoscleral rupture and uveal tissue incarceration, represent a critical ophthalmic emergency that demands immediate surgical intervention to restore anatomical integrity. This report explores the management of a Zone II rupture following a motorcycle accident, emphasizing the integration of surgical repair with systemic stabilization and advanced postoperative care. Case Illustration A 21-year-old female patient presented to the emergency department thirty minutes after a high-velocity blunt impact to the right eye during a motor vehicle accident. Clinical evaluation revealed a visual acuity of 1/300 in the affected eye, a 5 mm corneoscleral rupture involving the 9 o’clock limbal meridian, and significant iris prolapse. Preoperative laboratory findings were notable for significant elevations in hepatic transaminases, suggesting subclinical blunt trauma or skeletal muscle injury. The patient underwent urgent corneoscleral suturing, iris repositioning, and bandage contact lens application. Within seven days, the visual acuity improved to 1/60, with successful restoration of the anterior chamber. Discussion The discussion evaluates the mechanical forces involved in blunt-force globe rupture, utilizing Arlt’s theory of equatorial expansion. It further analyzes the clinical decision-making process regarding iris repositioning versus excision, the importance of prompt surgical closure within 24–48 hours to mitigate endophthalmitis risk, and the utility of the Ocular Trauma Score (OTS) as a prognostic predictor. The significance of systemic laboratory markers in the context of ocular polytrauma is also examined, alongside the pharmacological rationale for combined antimicrobial and anti-inflammatory therapy. Conclusion Timely anatomical restoration through meticulous surgical technique and aggressive prophylaxis against secondary complications are fundamental to preserving visual potential in complex OGI cases. Long-term rehabilitation remains dependent on managing secondary astigmatism and monitoring for late-onset glaucoma.

Peripheral Neuropathy Associated with Linezolid Dosage in MDR-TB: A Systematic Review Muhammad Akbar Ramadhan Munandar; Abdurrachman Machfudz; Hendra Priatna Munandar; Liana Herlina
The International Journal of Medical Science and Health Research Vol. 25 No. 2 (2026): 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: 10.70070/8fm3z016

Introduction: Linezolid is a critical component of modern regimens for multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). However, its use is limited by significant adverse effects, particularly peripheral neuropathy (PN). The precise relationship between linezolid dosage, treatment duration, and the incidence of PN remains inadequately characterized, posing challenges for optimizing the risk-benefit balance in clinical practice (G. Maartens and C. Benson, 2015). Methods: This comprehensive systematic review analyzed 80 studies, including randomized controlled trials, prospective and retrospective cohorts, systematic reviews with meta-analyses, and case series. Studies were screened and included based on criteria focusing on MDR-TB populations, linezolid use for TB treatment, assessment of PN, provision of dosing details, human subjects, and appropriate study designs. Data were extracted on study characteristics, linezolid dosing regimens, PN incidence and characteristics, other neurological and non-neurological adverse effects, dose-response relationships, patient risk factors, and treatment outcomes (C. Padmapriyadarsini et al., 2022; N. Ahmad et al., 2018). Results: The evidence revealed substantial heterogeneity in linezolid dosing, ranging from 300 mg to 1200 mg daily for durations from weeks to over two years. A clear dose- and duration-dependent relationship with PN was observed. The highest incidence (81%) was reported with 1200 mg/day for 26 weeks, while shorter durations and lower doses (e.g., 600 mg/9 weeks) showed significantly lower rates (13-24%) (F. Conradie et al., 2020; F. Conradie et al., 2022). Structured dose-reduction strategies (e.g., 600 mg to 300 mg) achieved comparable treatment success rates (88-94%) with reduced PN incidence. Other dose-dependent toxicities included myelosuppression and optic neuropathy. Patient risk factors such as diabetes, malnutrition, and alcohol use appeared to modify PN risk (C. Padmapriyadarsini et al., 2024; Yanjun Li et al., 2025). Discussion: The findings underscore that PN risk is influenced by both daily dose and cumulative exposure. The delayed onset (typically after 3 months) suggests a mechanism of cumulative mitochondrial toxicity. While 600 mg daily for 26 weeks offers a favorable balance of efficacy (91% success) and manageable toxicity (24% PN), protocolized dose reduction after an initial intensive phase presents a viable strategy to minimize neurotoxicity while preserving therapeutic effectiveness. The variability in reported PN rates highlights the impact of population-specific risk factors and differences in adverse event monitoring intensity (Xin Zhang et al., 2015; N. Kwak et al., 2025). Conclusion: Peripheral neuropathy is a major, dose- and duration-dependent toxicity of linezolid in MDR-TB treatment. An initial dose of 600 mg daily, with consideration for structured reduction to 300 mg after 9-16 weeks, is supported by evidence as an optimal strategy to maximize efficacy while mitigating neurotoxicity. Active monitoring for PN, especially in patients with underlying risk factors, is essential from 8 weeks of treatment onwards. Future research should focus on therapeutic drug monitoring and personalized dosing strategies to further individualize therapy.

A Comprehensive Systematic Review of The Relationship between Epstein-Barr Virus (EBV) Exposure and the Development of Non-Keratinizing Nasopharyngeal Carcinoma Muhammad Rifki Kholis Putra; Muhammad Abduh Firdaus
The International Journal of Medical Science and Health Research Vol. 25 No. 2 (2026): 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/bdks4d72

Introduction: Nasopharyngeal carcinoma (NPC) is a malignancy with a distinct geographical distribution, showing high prevalence in endemic regions like Southern China and Southeast Asia. The Epstein-Barr virus (EBV) is a well-established oncogenic driver, particularly for non-keratinizing NPC subtypes (WHO Types II/III). Understanding the precise relationship between EBV exposure, its biomarkers, and NPC development is critical for improving early detection, prognosis, and treatment strategies (Banko et al., 2021; Chan et al., 2004). Methods: This report synthesizes evidence from a systematic review of 80 sources, including meta-analyses, cohort studies, randomized controlled trials, and case-control studies. Data extraction focused on study design, population characteristics, EBV exposure definition (serological markers, plasma EBV DNA, genetic variants), NPC histological classification, measures of association, confounders, and study quality. Quantitative synthesis was performed on diagnostic accuracy, prognostic value, and screening effectiveness. Results: The evidence demonstrates a near-universal association between EBV and non-keratinizing NPC in endemic regions, with EBV positivity rates reaching 100%. Serological markers like VCA-IgA show high diagnostic accuracy (pooled sensitivity 0.91, specificity 0.92), with multi-marker panels (e.g., VCA-IgA + EA-IgA + Rta-IgG) providing superior performance. Plasma EBV DNA detection offers excellent diagnostic (sensitivity 89.1%, specificity 85.0%) and superior prognostic utility. High-risk EBV genetic variants (e.g., BALF2 I613V, OR=7.9) are strongly linked to NPC risk. Pre-treatment and, more powerfully, post-treatment plasma EBV DNA levels are significant independent prognostic factors for overall, progression-free, and distant metastasis-free survival (e.g., HR up to 129.07 for post-treatment DNA). EBV-based screening programs in endemic areas have demonstrated a significant 30% reduction in NPC mortality (Chen et al., 2024). Discussion: The robust association underscores EBV's central role in non-keratinizing NPC carcinogenesis. The diagnostic and prognostic hierarchy favors plasma EBV DNA and multi-parameter serology. Geographic, methodological, and histological heterogeneity explain variations in reported associations. EBV biomarkers are pivotal for risk stratification, screening, treatment monitoring, and prognostication. Conclusion: EBV is a fundamental etiological agent for non-keratinizing NPC. Integrating EBV serology and plasma EBV DNA into public health screening programs in endemic regions and into clinical management protocols for diagnosis, prognostic stratification, and treatment monitoring is strongly supported by evidence. Future research should focus on standardizing assays, elucidating molecular mechanisms, and validating findings in non-endemic populations.

The Role of Stem Cell Therapy in Stroke: A Narrative Review of Scientific Evolution, Clinical Evidence, and Implementation Challenges in Neurology Michael Aditya Marjoto
The International Journal of Medical Science and Health Research Vol. 26 No. 1 (2026): 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/j9dj6746

Stroke represents a paramount challenge to global public health, standing as a primary cause of mortality and long-term adult disability. In Indonesia, the epidemiological shift toward younger populations and the escalating socioeconomic burden necessitate a transition from traditional neuroprotection to advanced neurorestoration. This narrative literature review provides an exhaustive analysis of the role of stem cell therapy in stroke management, synthesizing four decades of scientific evolution. The report delineates the biological foundations of neurorestoration—including neurogenesis, angiogenesis, synaptogenesis, and immunomodulation—while characterizing various stem cell sources such as mesenchymal stem cells (MSCs), neural stem cells (NSCs), and bone marrow mononuclear cells (BMMNCs). A rigorous methodological assessment using the Cochrane Risk of Bias tool is applied to major clinical trials, including the MASTERS and TREASURE programs. Results indicate that while stem cell therapy demonstrates a robust safety profile and significant improvements in functional activities of daily living (measured by the Barthel Index and NIHSS), consistent global disability reduction (measured by mRS) remains elusive due to a translational disconnect involving dosage, timing, and delivery modalities. Furthermore, this review explores the multifaceted challenges of implementation within neurology practice, particularly in Indonesia, addressing ethical concerns regarding unproven therapies and the critical need for enhanced specialized education for neurologists. The synthesis concludes with strategic recommendations for integrating regenerative medicine into clinical pathways to bridge the current therapeutic gap.

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Indra Hadi

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profesionaljournalmedicine@gmail.com

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

Location
Kota adm. jakarta selatan,

Dki jakarta

INDONESIA