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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 516 Documents

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The Comprehensive Systematic Review of Association of PSA Level to Clinical Stage of Carcinoma Prostat Brahm Setioesa; Bendy Dwi Irawan; Cita Pakarti Dharma Kusuma
The International Journal of Medical Science and Health Research Vol. 27 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/a0wvtz42

Introduction: Prostate-specific antigen (PSA) is a cornerstone biomarker in prostate cancer (PCa) management, used for screening, diagnosis, staging, and monitoring treatment response. However, the precise relationship between PSA levels and clinical stage is complex and influenced by numerous factors. This systematic review synthesizes the current evidence to elucidate the association between PSA and the clinical stage of prostate carcinoma. Methods: A comprehensive systematic review was conducted. We screened studies based on predefined criteria, including the involvement of prostate cancer patients, measurement of serum PSA levels, availability of clinical staging information, and analysis of the PSA-stage relationship. Studies were limited to human clinical studies with adequate sample sizes (≥10 patients) that examined pre-treatment PSA. Data were extracted on study design, patient characteristics, PSA measurement details, staging systems, statistical analyses, primary findings, outcomes, confounding variables, and study quality from 80 included sources. Results: The evidence demonstrates a significant but nuanced association between PSA levels and clinical stage. Established PSA thresholds correlate with disease severity: levels <10 ng/mL are typically linked to localized disease (T1-T2), while levels >20 ng/mL consistently predict advanced/high-risk or metastatic disease (Buzzoni et al., 2015; Tombal et al., 2010). However, paradoxical findings exist, such as worse survival in high-grade patients with very low PSA (<4.0 ng/mL), indicating aggressive tumor biology with reduced PSA secretion (Kang et al., 2020). PSA kinetics (doubling time, nadir) and density (PSAD) provide enhanced prognostic value beyond absolute PSA levels. For instance, a PSA nadir <0.2 ng/mL post-treatment is strongly associated with superior overall survival (Harshman et al., 2017; Tripathi et al., 2025). The relationship is modified by tumor grade, prostate volume, race, and treatment modality. Multi-kallikrein panels improve predictive accuracy over PSA alone (Vickers et al., 2010). Discussion: The PSA-stage relationship is context-dependent. PSA serves as a robust but imperfect predictor. Its utility is maximized when integrated with other parameters like Gleason score, imaging, and kinetics. The "PSA pyramid" concept allows for individualized screening intervals based on baseline PSA (Randazzo et al., 2015). Treatment decisions, such as radiation dose escalation or ADT duration, can be effectively guided by specific PSA thresholds and nadir values (Al-Mamgani et al., 2010; Ayoub et al., 2022). Conclusion: PSA levels are strongly associated with the clinical stage of prostate carcinoma, providing critical prognostic information. However, interpretation must account for modifying factors like tumor grade and prostate volume. Future management should emphasize a multiparametric approach, combining PSA with advanced biomarkers and imaging for precise risk stratification and personalized treatment planning.

The Comprehensive Systematic Review of Use of Prostaglandin Analogues in Glaucoma Treatment Irene Sekarjati
The International Journal of Medical Science and Health Research Vol. 28 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: 10.70070/477ja281

Introduction: Glaucoma is a leading cause of irreversible blindness worldwide, characterized by progressive optic neuropathy, with elevated intraocular pressure (IOP) being the primary modifiable risk factor. Prostaglandin analogues (PGAs) have emerged as a cornerstone of pharmacological therapy due to their potent IOP-lowering efficacy and once-daily dosing (Aptel, Cucherat & Denis, 2008). This systematic review synthesizes evidence on the efficacy, safety, and clinical utility of PGAs in glaucoma management. Methods: A systematic literature review was conducted. We screened studies based on predefined criteria, including human studies on adult glaucoma patients, evaluation of PGA interventions, reporting of clinical outcomes (IOP reduction, visual field, adverse events), and acceptable study designs (RCTs, cohort studies, systematic reviews, etc.). Data from 80 included sources were extracted concerning study design, patient population, interventions, IOP efficacy, safety profiles, and key conclusions. Results: PGAs consistently demonstrated substantial IOP reduction, with bimatoprost often showing numerically superior efficacy (mean reduction up to 9.16 mmHg, 35.2%) compared to latanoprost (7.7 mmHg, 31%) and travoprost (8.0-8.9 mmHg) (Brandt et al., 2001; Hedman & Alm, 2000). The United Kingdom Glaucoma Treatment Study (UKGTS) provided pivotal evidence that latanoprost significantly reduces the risk of visual field deterioration compared to placebo (Hazard Ratio 0.44) (Garway-Heath et al., 2015). Safety profiles varied, with bimatoprost associated with the highest incidence of conjunctival hyperemia, while latanoprost was generally better tolerated (Aptel, Cucherat & Denis, 2008). Novel formulations like latanoprostene bunod and preservative-free PGAs offered enhanced efficacy or improved tolerability (Weinreb et al., 2017; Hommer et al., 2010). Discussion: The analysis reveals a critical trade-off between the maximal IOP-lowering potential of bimatoprost and the superior tolerability of latanoprost. Long-term efficacy is maintained, and PGAs are effective in special populations like normal-tension and angle-closure glaucoma. Preservative-free formulations address ocular surface disease concerns, potentially improving adherence. Conclusion: Prostaglandin analogues remain the first-line pharmacological treatment for glaucoma, offering effective and sustained IOP reduction. Clinical choice should individualize therapy based on the required IOP target, patient tolerance, and ocular surface health. Future research should focus on long-term comparative outcomes, personalized medicine approaches, and novel drug delivery systems.

THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND MENTAL HEALTH AMONG ADOLESCENTS IN SENIOR HIGH SCHOOLS IN BANDA ACEH CITY Imelda; Misbahul Muna
The International Journal of Medical Science and Health Research Vol. 28 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/mgyemt97

Adolescence is a period that is particularly vulnerable to mental health issues due to hormonal, physical, and psychosocial changes. If not properly managed, these changes and challenges may trigger emotional and mental health disorders among adolescents. One strategy to prevent or reduce the risk of mental health problems is engaging in regular physical activity. This study aimed to examine the relationship between physical activity and mental health among adolescents in senior high schools in Banda Aceh. This research employed a descriptive correlational method with a cross-sectional study design. The population consisted of all tenth-grade students at Senior High School 9 Banda Aceh, with a total sample of 154 students. Data were collected using the Physical Activity Questionnaire for Adolescents (PAQ-A) and the Mental Health Continuum-Short Form (MHC-SF). Data were analyzed using the Chi-Square test. The results showed a significant relationship between physical activity and adolescent mental health, with a p-value = 0.000. It is recommended that adolescents engage more actively in physical activities to maintain their mental well-being. In addition, support from parents and schools in providing environments that encourage physical activity is essential to promote adolescent mental health.

A Comprehensive Systematic Review of The Relationship Between Serum Progesterone Levels and the Success of Maintaining Pregnancy in Threatened Miscarriage Made Ega Krisna Prananda; Ketut Ananda Wiratama; Irwin Lamtota Lumbanraja; Igam Aditya Prasada
The International Journal of Medical Science and Health Research Vol. 28 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/fvjjeg52

Introduction: Threatened miscarriage is a common obstetric complication, and serum progesterone levels are frequently measured to assess pregnancy viability. However, the prognostic accuracy of a single progesterone measurement and the therapeutic efficacy of progesterone supplementation remain areas of clinical debate and heterogeneous evidence. Methods: This comprehensive systematic review synthesized evidence from 57 studies (including meta-analyses, randomized controlled trials, and observational studies) to evaluate the relationship between serum progesterone levels and pregnancy maintenance success in women with threatened miscarriage up to 20 weeks' gestation. Data extraction focused on study population, progesterone measurement methodology, defined pregnancy outcomes, statistical associations, identified thresholds, and confounding factors. Results: The analysis demonstrated a strong inverse relationship between serum progesterone and miscarriage risk. Diagnostic accuracy was high, with a synthesized Area Under the Curve (AUC) of 0.85 (95% CI 0.81–0.88) for predicting viability (Yi Gong et al., 2024). Threshold-dependent performance was evident; levels <6.3 ng/mL showed exceptional specificity (97.3–99.2%) for non-viable pregnancy, while levels ≥20–25 ng/mL strongly predicted viability (B. Ghaedi et al., 2022). The therapeutic benefit of progesterone supplementation was not uniform but significantly modified by patient history and treatment type. Women with recurrent miscarriage, particularly those with three or more losses, derived clear benefit (RR 1.28 for live birth) (A. Coomarasamy et al., 2020). Oral dydrogesterone showed more consistent efficacy (OR 0.43 for reducing miscarriage) compared to vaginal progesterone (Hee-Joong Lee et al., 2017). Discussion: The evidence confirms serum progesterone as a valuable prognostic biomarker. The apparent contradiction in therapeutic trial outcomes is largely explained by population heterogeneity—specifically, previous miscarriage history, route of administration, and baseline progesterone status. Progesterone's mechanism extends beyond hormonal support to include immunomodulation (shifting cytokine balance towards Th2 dominance) and improvement in uteroplacental hemodynamics (Hudic et al., 2011; Czajkowski et al., 2007). Conclusion: A single serum progesterone measurement provides valuable prognostic information in threatened miscarriage, with very low levels being highly predictive of pregnancy failure. Progesterone supplementation is most beneficial for a defined subgroup: women with a history of recurrent miscarriage and early pregnancy bleeding. Clinical implementation should be tailored, moving away from universal supplementation towards a stratified approach based on individual risk factors and biomarker status.

A Comprehensive Systematic Review of The Relationship between Breathing Exercises (Yoga / Pranayama) and Lung Function in Asthma Patients Harlina Hi M Konoras; Muhammad Irsan; Brian Enrique Fritzgerald
The International Journal of Medical Science and Health Research Vol. 28 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/af09gs20

Introduction: Asthma is a chronic inflammatory airway disease characterized by variable airflow obstruction, affecting millions worldwide. Despite pharmacological advances, many patients experience suboptimal control and seek complementary therapies. Breathing exercises, including yoga and pranayama, have been widely advocated as adjunctive interventions to improve respiratory mechanics and lung function in asthma (Santino et al., 2020). This systematic review comprehensively examines the relationship between structured breathing exercises and objective lung function parameters in asthma patients. Methods: A systematic review was conducted following a detailed screening protocol. Studies were included if they involved ≥80% asthma patients or provided subgroup analysis, examined yoga/pranayama/structured breathing techniques, measured objective lung function (e.g., FEV1, FVC, PEFR), employed controlled study designs (RCTs, quasi-experimental, cohort, case-control, systematic reviews), included a comparison group, and had an intervention duration of at least one week. Data extraction covered intervention details, lung function assessments, study design, population characteristics, outcomes, and contextual factors from 80 included sources. Results: The evidence reveals heterogeneous findings. Meta-analyses showed conflicting results; for example, Yang et al. (2016) found no significant effect on FEV1 (MD 0.04 L, 95% CI -0.10 to 0.19), while Rathore et al. (2025) reported a significant improvement (WMD 0.47 L, p<0.00001). PEFR demonstrated the most consistent improvements across studies (e.g., Cramer et al., 2014: SMD 0.49, p<0.001). Pranayama and Buteyko techniques showed comparable efficacy, with some evidence favoring Buteyko for certain spirometric parameters (Swathi et al., 2021; Elsaid et al., 2023). Improvements were more pronounced with supervised, frequent (daily), and longer-duration (≥8 weeks) interventions, particularly in adult mild-to-moderate asthma populations. Discussion: The heterogeneity in outcomes can be attributed to variations in study quality, intervention type, duration, intensity, population characteristics, and cultural context. High-quality RCTs often reported more modest lung function benefits alongside significant improvements in symptoms and quality of life. The primary mechanism likely involves enhanced respiratory muscle efficiency, improved breathing pattern control, and potential modulation of autonomic and inflammatory pathways, rather than fundamental reversal of airway obstruction. Conclusion: Breathing exercises, particularly yoga and pranayama, can serve as beneficial adjunctive therapy for asthma, primarily improving PEFR and potentially FEV1 with sustained practice. They are most effective for adults with mild-to-moderate asthma when practiced regularly under guidance. Future research should prioritize high-quality, large-scale RCTs with standardized protocols, longer follow-up, and exploration of mechanisms and cost-effectiveness to solidify clinical recommendations.

A Comprehensive Systematic Review of The Relationship Between Onset-to-Needle Time and Recanalization Success in Ischemic Stroke Rosi Rahmadarti; Dino Adijaya
The International Journal of Medical Science and Health Research Vol. 28 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/b7qmgt15

Introduction: The effectiveness of reperfusion therapies in acute ischemic stroke is highly time-dependent, with earlier treatment generally associated with better outcomes. However, the precise relationship between onset-to-needle time (ONT) and recanalization success, and how this relationship varies across treatment modalities and patient subgroups, requires systematic synthesis of the extensive and sometimes heterogeneous evidence. Methods: A systematic review was conducted, screening sources based on strict criteria including adult acute ischemic stroke patients receiving intravenous thrombolysis (IVT), clear reporting of ONT, and assessment of recanalization via validated imaging. Data were extracted from 80 eligible studies, encompassing randomized controlled trials, cohort studies, and meta-analyses, with sample sizes ranging from 24 to 12,529 patients. Extraction focused on time metrics, treatment modalities, recanalization rates, functional outcomes, safety data, and statistical relationships. Results: A strong inverse relationship exists between ONT and recanalization success. Ultra-early treatment within the "golden hour" (≤60 minutes) achieved a 44% recanalization rate compared to 12% when treated after one hour (Bernatowicz et al., 2016). A clear dose-response effect was evident, with the odds of favorable outcome declining from 2.8 for treatment within 90 minutes to 1.2 for 271-360 minutes (Hacke et al., 2004). For patients with large vessel occlusion (LVO) receiving bridging IVT before thrombectomy, the benefit becomes non-significant beyond approximately 2 hours 20 minutes (Kaesmacher et al., 2024). Each 15-minute delay in door-to-needle time was associated with 20.3 fewer excellent outcomes per 1000 patients (Goyal et al., 2019). Safety outcomes, including symptomatic intracranial hemorrhage rates, did not show a significant increase with earlier treatment. Discussion: The synthesized evidence underscores "time is brain" as a fundamental principle. Heterogeneity in effect sizes is explained by differences in patient populations (e.g., LVO vs. non-LVO), treatment contexts (IVT alone vs. bridging therapy), and study methodologies. The benefit of IVT extends to extended time windows (4.5-24 hours) when guided by advanced imaging selection (Campbell et al., 2020; Rahmati et al., 2025). Workflow innovations, such as mobile stroke units and protocols favoring tenecteplase, significantly reduce critical time intervals and improve outcomes (Czap et al., 2021; Henderson et al., 2024). Conclusion: Earlier onset-to-needle time is consistently and powerfully associated with higher rates of successful recanalization and improved functional independence in acute ischemic stroke. This relationship is quantifiable and should drive clinical protocols and public health initiatives aimed at minimizing all pre- and in-hospital delays. Treatment decisions in extended windows must be individualized using advanced neuroimaging.

A Comprehensive Systematic Review of The Relationship between Body Mass Index and The Risk of Implant Failure in Total Knee Arthroplasty Satya Agung Nugroho; Nazalla Gwen Vaganesha; Agus Saribudaya
The International Journal of Medical Science and Health Research Vol. 1 No. 1 (2022): 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/g4c26064

Introduction: Total knee arthroplasty (TKA) is a highly successful procedure for end-stage knee osteoarthritis. However, the global rise in obesity presents a significant challenge, as elevated body mass index (BMI) is a suspected risk factor for postoperative complications, particularly implant failure. This systematic review aims to synthesize the existing evidence on the relationship between BMI and the risk of implant failure following primary TKA. Methods: A systematic review of the literature was conducted following established guidelines. Eighty studies meeting predefined inclusion criteria were selected from 118 screened sources. Inclusion criteria focused on adult primary TKA patients, availability of BMI data, reported implant failure outcomes, and a minimum follow-up of 6 months. Data extraction covered study design, BMI categories, population characteristics, definitions of implant failure, follow-up duration, effect measures, and confounding factors. Results: The evidence demonstrates a clear dose-response relationship between increasing BMI, particularly at levels ≥40 kg/m², and elevated risk of all-cause revision and infection-related failure. Meta-analyses indicate risk ratios (RR) for all-cause revision rise from 1.19 for severe obesity (BMI ≥35) to 4.75 for super-obesity (BMI ≥50) (Chaudhry et al., 2019). Septic revision risk shows an even stronger association, with RR reaching 3.69 for morbid obesity (BMI ≥40) (Chaudhry et al., 2019). In contrast, the association between BMI and aseptic loosening is inconsistent and generally non-significant. Some studies employing specific implant designs or surgical techniques reported no significant survival differences across BMI groups (Gaillard et al., 2017; Kanna et al., 2021). Discussion: The relationship between BMI and TKA failure is nuanced, primarily driven by a markedly increased risk of periprosthetic joint infection (PJI) rather than mechanical failure. Reconciling heterogeneous findings requires consideration of BMI threshold effects, failure type specificity, implant/technique considerations, and follow-up duration. The risk appears most clinically significant at BMI ≥40 kg/m². While obesity elevates complication risks, patients across all BMI categories achieve meaningful functional improvements post-TKA. Conclusion: Elevated BMI, especially morbid and super-obesity, is a significant risk factor for implant failure, predominantly through infectious complications. This should inform preoperative counselling and risk stratification. However, obesity should not be an absolute contraindication for TKA. Future strategies should emphasize optimized surgical techniques, targeted infection prophylaxis, and structured preoperative weight management programs for high-risk patients to improve long-term outcomes.

A Comprehensive Systematic Review of The Relationship Between Intra-Articular Corticosteroid Use and Cartilage Damage Satya Agung Nugroho; Nazalla Gwen Vaganesha; Agus Saribudaya
The International Journal of Medical Science and Health Research Vol. 8 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/g9ry3s82

Introduction: Intra-articular corticosteroid (IACS) injections are a cornerstone treatment for symptomatic osteoarthritis and inflammatory arthropathies. However, significant controversy persists regarding their long-term effects on articular cartilage, with studies reporting outcomes ranging from chondroprotective to chondrodestructive. This systematic review synthesizes the current evidence on the relationship between IACS use and structural cartilage damage. Methods: A comprehensive systematic review was conducted following predefined screening criteria. Eligible studies examined IACS effects on cartilage using validated structural assessment methods (e.g., MRI, histology, radiography) with follow-up ≥3 months. Data from 80 included studies—including RCTs, cohort studies, animal studies, and systematic reviews—were extracted regarding study design, corticosteroid protocol, patient characteristics, assessment methods, and cartilage outcomes. A qualitative synthesis was performed, focusing on reconciling conflicting findings through analysis of dose-response relationships, temporal patterns, and joint-specific effects. Results: The evidence demonstrates substantial heterogeneity. High-quality RCTs, such as McAlindon et al. (2017), found that repeated triamcinolone injections every 3 months for 2 years caused significantly greater cartilage volume loss compared to saline. Similarly, studies by Saif-ur-Rehman et al. (2022) and Haddad et al. (2000) reported increased disease progression and histological cartilage damage. Conversely, multiple studies, including Raynauld et al. (2003) and Şahin et al. (2023), found no significant cartilage damage with single or infrequent injections. A clear dose-response relationship was identified, with low doses (≤3 mg/dose) potentially beneficial and high cumulative doses (>18-24 mg) associated with damage. The hip and temporomandibular joints appeared more vulnerable than the knee. Baseline disease severity, obesity, and injection frequency were significant effect modifiers. Discussion: The apparent conflict in the literature is largely explained by differences in treatment protocols (dose, frequency, duration), joint-specific vulnerability, and patient characteristics. The balance between the potent anti-inflammatory benefits of IACS and their potential catabolic effects on cartilage matrix is delicate and context-dependent. The findings underscore that IACS are not uniformly "good" or "bad" for cartilage; their impact is modulated by clinical context. Conclusion: IACS injections present a dualistic effect on articular cartilage. Single or infrequent injections in the knee, particularly at low doses, appear to carry minimal structural risk and can be chondroprotective in inflammatory settings. However, repeated, high-dose injections, especially in vulnerable joints like the hip and TMJ, are associated with accelerated cartilage damage. Clinical practice should adhere to the principle of using the lowest effective dose with adequate intervals between injections, tailored to the specific joint and patient profile.

A Comprehensive Systematic Review of Management of Normal Tension Glaucoma Michelthelia Sulijaya Suyono; Benso Sulijaya Suyono
The International Journal of Medical Science and Health Research Vol. 28 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/wy5vxc77

Introduction: Normal tension glaucoma (NTG) represents a significant diagnostic and therapeutic challenge within the spectrum of open-angle glaucomas. Characterized by progressive optic neuropathy and visual field loss despite intraocular pressure (IOP) measurements consistently within the statistically normal range, its management remains complex and debated. The central question persists: is IOP reduction beneficial in NTG, and if so, what is the optimal therapeutic strategy? (Anderson et al., 2003). Methods: This comprehensive systematic review was conducted in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A thorough literature search and screening process identified 80 eligible studies, including randomized controlled trials, cohort studies, and meta-analyses. Inclusion criteria focused on studies evaluating therapeutic interventions (medical, laser, surgical) for NTG with a minimum follow-up of 6 months. Data extraction encompassed management approaches, clinical outcomes (IOP, visual fields, optic disc), patient characteristics, and adverse effects. Results: The synthesis of evidence reveals that IOP reduction, even from normal baseline levels, is beneficial in slowing NTG progression. Medical therapy, particularly prostaglandin analogues (PGAs) like latanoprost, provides an average IOP reduction of 16-24% (Cheng et al., 2009; Ang et al., 2004). Selective laser trabeculoplasty (SLT) achieves comparable efficacy, with first-line use showing superior outcomes (Nitta et al., 2024; Naito et al., 2025). Surgical interventions, including trabeculectomy and minimally invasive glaucoma surgery (MIGS), offer greater and more sustained IOP lowering (30-40%) and reduce medication burden (Chin Lai et al., 2022; Hnin P Oo et al., 2024). Critically, a ≥25% IOP reduction from baseline is associated with significant suppression of visual field progression (Yoshikawa et al., 2018). Evidence also supports pressure-independent neuroprotective effects, notably with brimonidine (Sena & Lindsley, 2017; Krupin et al., 2005) and nilvadipine (Koseki et al., 2008). Discussion: The findings advocate for a stratified, patient-centric management paradigm. Treatment efficacy is strongly influenced by baseline IOP; patients with higher baseline IOP (>15 mmHg) respond better to conventional IOP-lowering therapies. In contrast, patients with lower baseline IOP require consideration of adjunctive neuroprotective strategies and management of vascular risk factors like disc hemorrhage and nocturnal blood pressure dipping (Lee et al., 2014; Bowe et al., 2015). Long-term safety considerations, such as prostaglandin-induced central corneal thinning (Kim & Cho, 2011; Hyungwoo Lee & Cho, 2015) and surgical complication profiles (Andrea Gabai et al., 2019), must be balanced against therapeutic benefits. Conclusion: Effective management of NTG necessitates a multifaceted approach centered on achieving substantial IOP reduction, with a target of ≥25% being clinically meaningful. Treatment selection should be individualized based on baseline IOP, risk factor profile, disease severity, and patient tolerance. Future research should prioritize long-term outcomes of novel interventions, refined patient stratification biomarkers, and the integration of neuroprotection into standard care protocols.

A Comprehensive Systematic Review of The Relationship Between Sunscreen Use and Prevention of Photoaging Betti Merdiani Putri; Metti Herliani Putri
The International Journal of Medical Science and Health Research Vol. 29 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/dmhdf292

Introduction: Photoaging, the premature aging of skin induced by chronic ultraviolet (UV) radiation exposure, manifests as wrinkles, dyspigmentation, and loss of elasticity. While sunscreen is a cornerstone of photoprotection, the comprehensive evidence linking its use specifically to the prevention of photoaging requires systematic synthesis. This review aims to consolidate the relationship between various photoprotection strategies—including topical sunscreens, oral supplements, antioxidants, and behavioral interventions—and the prevention or amelioration of photoaging. Methods: A systematic review was conducted following predefined screening criteria. Databases were searched for studies involving human participants that investigated sunscreen or photoprotection interventions and reported quantitative outcomes on clinical photoaging measures. Included studies encompassed randomized controlled trials, cohort studies, case-control studies, cross-sectional studies, systematic reviews, and meta-analyses. Data on intervention details, population characteristics, photoaging assessment methods, and outcomes were extracted and analyzed. Results: Sixty-three studies were included. The landmark Nambour trial demonstrated a 24% reduction in skin aging with daily versus discretionary sunscreen use over 4.5 years (Hughes et al., 2013). Shorter-term studies consistently showed significant improvements in wrinkles, pigmentation, and skin texture with regular sunscreen use, with effects evident from 8 to 52 weeks (Randhawa et al., 2016; Sarkar et al., 2019; Du et al., 2020). Enhanced formulations combining UV filters with antioxidants (e.g., vitamin C, bakuchiol), anti-inflammatory agents, or DNA repair enzymes offered superior benefits (Shirata & Maia Campos, 2021; Draelos et al., 2022; Luze et al., 2020). Appearance-based behavioral interventions, such as UV photography and mobile apps, effectively increased sun protection intentions and behaviors, with medium effect sizes (Persson et al., 2018; Brinker et al., 2020). Oral multi-component antioxidant supplements showed promise in increasing minimal erythema dose and improving skin appearance, whereas single-agent β-carotene was ineffective (Stephens et al., 2016; Zhang et al., 2023; Darlington et al., 2003). Discussion: The evidence robustly supports that consistent sunscreen use prevents and can partially reverse signs of photoaging. Efficacy is influenced by formulation, compliance, skin type, and environmental factors. Synergistic effects are observed when UV filtration is combined with agents targeting oxidative stress and inflammation. Behavioral strategies are crucial for fostering long-term adherence. Conclusion: Daily use of broad-spectrum sunscreen, preferably SPF 30 or higher, is a proven, effective strategy for preventing photoaging. Formulations with added antioxidants or anti-inflammatory components provide enhanced protection. Public health initiatives should incorporate appearance-based education to improve sunscreen adherence. Oral antioxidant supplements may serve as adjuncts but not replacements for topical sunscreens.

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Indra Hadi

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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