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The International Journal of Medical Science and Health Research

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Published by International Medical Journal Corp. Ltd.

ISSN : 30481376 EISSN : 30481368 DOI : -

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

Arjuna Subject : Kedokteran - Review dan Referensi, Kedokteran

Articles 516 Documents

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The Comprehensive Systematic Review of Relationship between Education Level and Self-Management in Patients with Type 2 Diabetes Mellitus Fifin Anisa
The International Journal of Medical Science and Health Research Vol. 32 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/dx433163

Introduction: Type 2 diabetes mellitus (T2DM) requires sustained self-management behaviors for optimal glycemic control and prevention of complications. While education level is frequently hypothesized to influence self-management capacity, evidence regarding this relationship remains inconsistent. Methods: A systematic review was conducted following PRISMA guidelines. A total of 95 quantitative studies examining the relationship between education level and diabetes self-management in adult T2DM patients were included. Studies were sourced from Indonesian healthcare settings including hospitals, primary care centers (Puskesmas), and community settings. Data were extracted regarding study characteristics, participant demographics, education measurement, self-management assessment, statistical associations, and moderating factors. Results: The majority of studies (approximately 65%) reported statistically significant positive associations between higher education and better self-management (r range: 0.263-0.739; p<0.05), particularly for medication adherence and dietary compliance. However, approximately 30% of studies found no significant association. Diabetes-specific knowledge, health literacy, self-efficacy, and family support consistently emerged as stronger direct predictors and significant mediators of the education-self-management relationship. Socioeconomic factors (income, employment) and healthcare access variables (Prolanis participation, health worker support) significantly modified this relationship. Discussion: The education-self-management relationship is indirect and context-dependent, primarily operating through modifiable cognitive and psychosocial mechanisms. Educational attainment serves as an enabling rather than deterministic factor. Conclusion: Interventions should target diabetes-specific knowledge, health literacy, self-efficacy, and family support systems, particularly for patients with lower formal education. Future research requires longitudinal designs, standardized measurement tools, and diverse populations beyond Indonesia.

The Comprehensive Systematic Review of Relationship Between Uric Acid Levels And The Risk Of Kidney Stones Fifin Anisa
The International Journal of Medical Science and Health Research Vol. 32 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/y3151730

Introduction: Nephrolithiasis represents a significant global health burden with increasing prevalence. Although hyperuricemia has been implicated in kidney stone pathogenesis, evidence from Indonesian populations remains heterogeneous and has not been systematically synthesized. This systematic review aims to comprehensively evaluate the relationship between uric acid levels and kidney stone risk, quantify the strength of association, identify modifying factors, and address existing research gaps regarding population-specific evidence. Methods: A systematic review was conducted following standardized screening protocols. Eight electronic databases were searched for observational studies examining the association between serum/blood uric acid or dietary uric acid intake and kidney stone formation. Studies were included if they involved adult human participants (≥18 years), reported quantitative measures of association, and examined kidney stones broadly. Data were extracted regarding study design, population characteristics, uric acid measurement methods, kidney stone definition, effect estimates, and modifying factors. Results: The proportion of kidney stone patients with elevated serum uric acid ranged from 55.3% to 66%, with mean levels between 6.7–7.3 mg/dL. Case-control studies demonstrated strong positive associations between high uric acid consumption and kidney stone risk (OR=6.756; 95% CI: 2.156–21.163; p=0.001). Dietary purine intake showed the strongest effect (OR=13.417; 95% CI: 3.042–59.171). The systematic review identified a dose-response relationship wherein nephrolithiasis risk increases progressively with rising serum uric acid levels. Age (p=0.050) and blood pressure (p=0.050) demonstrated significant associations with hyperuricemia in stone patients. Acidic urinary pH (<7) was observed in 77.1% of patients. Three studies reported no significant association, attributable to different stone type populations (calcium oxalate) versus uric acid nephrolithiasis. Discussion: This review provides the first synthesized evidence from Indonesian populations confirming hyperuricemia as a significant, dose-dependent risk factor for kidney stones, particularly among middle-aged males with metabolic comorbidities. The six- to seven-fold increased risk associated with high purine intake exceeds effect sizes reported in Western populations, suggesting possible population-specific genetic or dietary susceptibility. The dissociation between serum uric acid and urinary crystal excretion identified in one study challenges the adequacy of serum measurement alone as a risk stratification tool. Conclusion: Elevated uric acid levels are significantly associated with increased kidney stone risk in Indonesian populations, with dietary purine intake representing the strongest modifiable risk factor. Routine serum uric acid screening is recommended for adults with metabolic syndrome or family history of nephrolithiasis. Future prospective cohort studies with standardized uric acid measurement and stone composition analysis are urgently required.

A Case of Suspected Cardiac Amyloidosis: A Diagnostic Challenge in a 22-Year-Old Male with Restrictive Cardiomyopathy I Gusti Ayu Aruna Krisnadewani; Bayu Setia
The International Journal of Medical Science and Health Research Vol. 32 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/hrdsjh73

Introduction Cardiac amyloidosis (CA) is a progressive and often terminal infiltrative cardiomyopathy resulting from the extracellular deposition of misfolded protein fibrils—primarily immunoglobulin light chains (AL) or transthyretin (ATTR)—within the heart muscle. While historically perceived as a rare condition affecting the elderly, advances in non-invasive imaging have revealed CA as an underdiagnosed cause of heart failure. However, its manifestation in young adults remains exceptionally rare, presenting a significant diagnostic challenge for general practitioners. Early recognition is vital, as subtype-specific therapies can significantly alter the clinical trajectory. Case Illustration We report the case of a 22-year-old male who presented with a two-week history of progressive dyspnea, orthopnea, abdominal distention, and periorbital edema. Physical examination revealed signs of systemic congestion, including ascites (shifting dullness) and decreased breath sounds in the right lung, alongside a blood pressure of 130/90 mmHg and a heart rate of 94 bpm . Laboratory findings were remarkable for a severely elevated NT-proBNP of 8177.11 pg/mL and a high hemoglobin of 18.2 g/dL . Chest radiography demonstrated cardiomegaly (CTR 63%), pulmonary edema, and bilateral pleural effusion. Electrocardiography (ECG) revealed low-voltage QRS complexes, which stood in stark contrast to the echocardiographic evidence of significant ventricular wall thickening (IV S 1.27 cm, LV PW 1.83 cm, ) and a reduced ejection fraction of 35.3% . The discordance between ECG voltage and echocardiographic mass, combined with Grade III diastolic dysfunction, strongly suggested cardiac amyloidosis. Discussion The diagnostic hallmark in this case is the "voltage-to-mass" discordance, a pathognomonic red flag where amyloid fibrils insulate the myocardium, dampening electrical signals despite increased wall thickness. In a 22-year-old, the differential diagnosis includes hereditary transthyretin amyloidosis (vATTR) or immunoglobulin light chain (AL) amyloidosis, alongside mimickers like sarcoidosis or Fabry disease. The elevated NT-proBNP and high hemoglobin reflect severe hemodynamic stress and potential hemoconcentration. Management involved stabilizing heart failure using loop diuretics and transitioning to guideline-directed medical therapy (GDMT), while pursuing definitive subtyping through serum/urine immunofixation and cardiac imaging. Conclusion This case emphasizes that cardiac amyloidosis must be considered in young patients presenting with unexplained heart failure and restrictive physiology. Maintaining a high index of suspicion for "red flags" like ECG-echo discordance is essential to facilitate early diagnosis and initiation of life-saving, subtype-specific treatments.

The Relationship between Mantoux Sensitivity and The Diagnosis of Childhood Tuberculosis : A Comprehensive Systematic Review Dede Sofyan; Rahmini Shabariah
The International Journal of Medical Science and Health Research Vol. 33 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/n75wn703

Introduction: Childhood tuberculosis (TB) remains a significant global health challenge, with diagnostic difficulties compounded by nonspecific clinical presentations and limitations of available tests. The Mantoux tuberculin skin test (TST) has been a cornerstone of TB diagnosis for decades, yet its accuracy in children remains controversial due to factors including BCG vaccination, age-related immune responses, and comorbidities. This systematic review aims to comprehensively evaluate the relationship between Mantoux test sensitivity and the diagnosis of childhood tuberculosis. Methods: A systematic review was conducted following PRISMA guidelines. We screened studies based on predefined criteria including pediatric population (0-18 years), TST evaluation against reference standards, and reporting of diagnostic performance data. Seventy-five studies comprising systematic reviews, meta-analyses, diagnostic accuracy studies, cohort studies, and cross-sectional investigations were included. Data extraction encompassed study characteristics, TST protocols, reference standards, diagnostic performance metrics, comparison with IGRAs, population risk factors, and clinical context. Results: Pooled TST sensitivity for active TB in children ranged from 64% to 86% across major meta-analyses, with the highest values (82-86%) observed in microbiologically confirmed cases in high-income countries and lower values (64-74%) in low-income settings or clinically diagnosed cases. Specificity ranged from 49% in BCG-vaccinated populations to 92% in high-income settings without BCG. For latent TB infection, TST sensitivity was estimated at 82% with specificity of 98% in non-BCG and 82% in BCG-vaccinated children. Head-to-head comparisons showed IGRAs demonstrate superior specificity (85-98% vs. 56-92%), particularly in BCG-vaccinated populations, while sensitivity comparisons varied by context. Age <5 years, HIV infection, malnutrition, and helminth co-infection significantly reduced TST sensitivity. Novel antigen-specific skin tests (C-Tb, ECST, Diaskintest) showed IGRA-like specificity (94-97%) unaffected by BCG. Discussion: TST performance in children is highly context-dependent, with BCG vaccination status, age, geographic setting, and comorbidities serving as critical determinants. The apparent paradox of variable TST-IGRA comparisons is explained by population differences: TST may be more sensitive in high-burden settings where case detection is paramount, while IGRAs offer superior specificity in low-incidence, BCG-vaccinated populations. The diagnostic gap in children under 5 years—where both tests perform poorly—represents a critical challenge. Sequential testing strategies and novel skin tests offer promising alternatives. Conclusion: The Mantoux test remains a valuable tool for childhood TB diagnosis, but its limitations must be understood contextually. No single test is universally superior; test selection should be guided by local epidemiology, BCG vaccination policies, and available resources. Future research should focus on validating novel skin tests in pediatric populations and developing integrated diagnostic algorithms for young and immunocompromised children.

The Relationship between C-Reactive Protein Levels and The Prediction of Anastomotic Leakage : A Systematic Review Erian Setiawan; Fitri Rachmadani
The International Journal of Medical Science and Health Research Vol. 33 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/n26s1k92

Introduction: Anastomotic leakage (AL) remains a devastating complication following gastrointestinal surgery, associated with increased morbidity, mortality, and prolonged hospital stay. C-reactive protein (CRP), an acute-phase inflammatory marker, has emerged as a potential early predictor of AL. This systematic review aims to evaluate the relationship between postoperative CRP levels and the prediction of anastomotic leakage across various surgical procedures. Methods: A systematic review was conducted following PRISMA guidelines. Comprehensive literature search identified studies evaluating CRP as a predictor of AL in adult patients undergoing gastrointestinal surgery with anastomosis. Studies were included if they reported quantitative data on CRP levels and AL rates. Data extraction encompassed surgical context, CRP measurement protocols, AL definition and incidence, and CRP predictive performance characteristics. Results: A total of 146 studies comprising 49,328 patients were included, covering colorectal (n=66), esophageal (n=33), gastric (n=18), and bariatric (n=8) surgeries, with others involving mixed or unspecified procedures. AL incidence ranged from 1.5% in bariatric surgery to 30.6% in esophagectomy. Median time to AL diagnosis was consistently 5-9 days postoperatively. CRP measurement protocols varied considerably, with postoperative days 3-5 demonstrating optimal predictive value. Pooled analysis revealed CRP cutoff values ranging from 120-200 mg/L on POD 3-5, with negative predictive values exceeding 90% in most studies. Significant heterogeneity existed in AL definitions, CRP measurement timing, and reported diagnostic accuracy. Discussion: Postoperative CRP demonstrates consistent utility as a negative predictive marker for AL, particularly between POD 3-5. Low CRP levels effectively rule out AL with high negative predictive value, potentially enabling safe early discharge. However, optimal cutoff values vary by surgical procedure and patient population. CRP performs best as a rule-out test rather than a rule-in test for AL. Conclusion: Serial CRP measurement represents a valuable, cost-effective tool for early prediction of anastomotic leakage. Standardized protocols and procedure-specific thresholds are needed to optimize clinical utility. Future research should focus on integrating CRP with other biomarkers and clinical risk scores to enhance predictive accuracy.

What Is The Association Between Pedal Access Intervention And Radiologically Measured Wound Healing Progression In Diabetic Foot Ulcers? : A Systematic Review Haekal Mahargias; Febrina Mayasari Gunawan; Mutiara Amalia
The International Journal of Medical Science and Health Research Vol. 33 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: 10.70070/236cvp46

Introduction: Diabetic foot ulcers (DFUs) represent a severe complication of diabetes, with peripheral artery disease (PAD) being a major contributor to poor healing and limb loss. Pedal access interventions, which target the small arteries of the foot, have emerged as a key revascularization strategy. However, the specific association between these procedures and radiologically measured wound healing progression requires systematic evaluation. This systematic review aims to synthesize the existing evidence on the association between pedal access interventions and radiologically assessed wound healing outcomes in patients with DFUs. Methods: A systematic review was conducted following a pre-defined protocol. We screened studies based on abstracts for inclusion criteria focusing on: (1) patients with diabetic foot ulcers, (2) pedal access interventions (angioplasty, stenting, bypass), (3) outcomes including radiologically measured wound healing, and (4) appropriate study designs (e.g., cohort studies, RCTs). Data were extracted on study characteristics, patient populations, intervention details, radiological assessment methods, wound healing outcomes, and the association between them. Results: From the screening of a large body of literature, data were extracted from numerous studies, many of which were observational cohorts. The patient populations were predominantly older males with long-standing diabetes and severe PAD. Pedal access interventions primarily involved endovascular techniques, such as angioplasty of tibial and pedal arteries, with some studies focusing on angiosome-guided or pedal arch revascularization (PAR). Radiological assessment methods varied, including duplex ultrasound (e.g., pedal acceleration time [PAT]), digital subtraction angiography (e.g., pedal arch patency), and plain radiographs (e.g., MAC scores). The synthesized evidence demonstrates a strong and consistent association between successful pedal access intervention and improved wound healing. Key findings show that a complete pedal arch (CPA) post-intervention is significantly associated with higher healing rates (e.g., 93.3% vs. 52.6% for an absent arch, p=0.003), shorter healing times (e.g., 3.5 vs. 5.7 months, p<0.001), and superior limb salvage (e.g., 100% vs. 68.4% at 1-year, p<0.001) (Troisi et al., 2018; Ismail et al., 2020). Similarly, successful PAR was associated with an 86.7% healing rate compared to 59.1% in unsuccessful cases (P=0.007) and dramatically lower major amputation rates (5.1% vs. 40.9%, p≤0.001) (Shahat et al., 2024; Jung et al., 2019). Angiosome-targeted revascularization also demonstrated superior healing outcomes compared to indirect revascularization (HR 1.97; 95% CI, 1.34-2.90) (Khor & Price, 2017; Söderström et al., 2013). Furthermore, novel non-invasive markers like PAT showed strong predictive value for wound healing (Sommerset et al., 2020; Karmy-Jones et al., 2024). Discussion: The findings robustly support the critical importance of restoring direct, pulsatile blood flow to the foot, specifically through the pedal arch and its branches, to facilitate DFU healing. The pedal arch acts as the crucial final vascular circuit, and its patency is a key determinant of healing and limb salvage. The discussion highlights that the quality of the revascularization outcome, particularly the establishment of a CPA, may be more important than the specific revascularization technique used. The integration of advanced radiological assessments like PAT offers a promising, non-invasive tool for patient selection and monitoring. Despite the strength of these associations, significant heterogeneity in study design, outcome measures, and radiological protocols exists, underscoring the need for more standardized approaches in future research. Conclusion: There is a definitive and positive association between successful pedal access intervention and radiologically measured wound healing progression in diabetic foot ulcers. Achieving a complete pedal arch and successful pedal arch revascularization are powerful predictors of superior outcomes, including faster healing, higher healing rates, and reduced amputation risk. These findings advocate for revascularization strategies that prioritize direct flow to the foot and the use of objective, non-invasive imaging to guide management.

How Effective is Chemoembolization (TACE) Compared to Standard Care on The Survival of Hepatoma Patients? A Systematic Review Haekal Mahargias; Febrina Mayasari Gunawan; Mutiara Amalia
The International Journal of Medical Science and Health Research Vol. 33 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/nt123x81

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage HCC, but its effectiveness compared to evolving standard care modalities requires continuous evaluation. This systematic review aims to synthesize current evidence on the effectiveness of TACE versus standard care on the survival of hepatoma patients. Methods: A systematic review was conducted by screening a pre-defined set of literature. Studies were included if they compared TACE (as a primary treatment) to any form of standard care (e.g., supportive care, systemic therapy, other locoregional treatments) in HCC patients and reported survival outcomes. Data on study characteristics, patient populations, interventions, and outcomes (overall survival, progression-free survival, safety) were extracted and synthesized narratively. Results: The review included 200 studies, encompassing RCTs, meta-analyses, and cohort studies. TACE consistently demonstrated a significant survival benefit over best supportive care, with median overall survival extended from 3-7 months to 20-31 months in some studies (Biselli et al., 2005; Yuen et al., 2003). Compared to systemic monotherapy like sorafenib in advanced stages, TACE showed at least comparable outcomes (Pinter et al., 2012). While conventional TACE (cTACE) and drug-eluting bead TACE (DEB-TACE) showed mixed survival results, DEB-TACE was often associated with a better safety profile (Bzeizi et al., 2021; Chen et al., 2017). The most significant advancement was seen with combination therapies; TACE plus tyrosine kinase inhibitors and immunotherapies (e.g., LEAP-012, EMERALD-1) markedly improved progression-free survival (HR 0.66-0.77) compared to TACE alone (Kudo et al., 2025; Lencioni et al., 2024). Discussion: The evidence confirms TACE's role as a cornerstone of HCC treatment, particularly for intermediate-stage disease. Its effectiveness is maximized in patients with preserved liver function (Child-Pugh A) and low tumor burden. The field is shifting towards combination strategies, which offer superior tumor control but require careful management of increased toxicity. Major limitations include high heterogeneity in TACE protocols and control arm definitions across studies. Conclusion: TACE significantly improves survival compared to supportive care and remains a vital treatment for HCC. Emerging evidence strongly supports combining TACE with systemic therapies to enhance outcomes, establishing a new standard for many patients. Future research should focus on optimizing patient selection for these combination approaches.

The Comprehensive Systematic Review of Probiotic Interventions and The Gut Lung Axis in Critically ill Patients with Lung Edema Bayu Anggara H
The International Journal of Medical Science and Health Research Vol. 33 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/ebp6aj59

Introduction: Critically ill patients with lung edema experience significant morbidity and mortality, with the gut-lung axis emerging as a potential therapeutic target. Probiotic interventions may modulate this bidirectional relationship, but evidence remains conflicting. This systematic review synthesizes evidence on probiotic effects on the gut-lung axis in critically ill adults with lung edema. Methods: A systematic review was conducted following PRISMA guidelines. We screened 200 sources from databases including PubMed, Scopus, and Web of Science (2000-2026). Included studies were randomized controlled trials, cohort studies, and meta-analyses examining probiotic or synbiotic interventions in critically ill adults (≥18 years) with lung edema/ARDS. Primary outcomes included ventilator-associated pneumonia (VAP), mechanical ventilation duration, and gut-lung axis mechanisms. Quality assessment used Cochrane Risk of Bias tools. Results: Forty-eight primary studies and 52 meta-analyses/systematic reviews were included (total N >15,000 patients). Probiotics reduced VAP incidence (RR 0.52-0.75), with synbiotics showing greater efficacy (RR 0.61, 95% CI 0.47-0.80). Mechanical ventilation duration decreased by 1-2.5 days, and ICU length of stay by 1-2 days. Mortality reduction was inconsistent, though severe sepsis subgroups showed benefit (OR 0.38, 95% CI 0.16-0.93). Mechanistically, probiotics improved gut barrier function (reduced lactulose-mannitol ratio, enhanced tight junction proteins), modulated systemic inflammation (IL-6 reduction 140 pg/mL, CRP reduction 72.7%), increased short-chain fatty acid production, and reduced pathogenic colonization. The largest trial (PROSPECT, n=2,653) found no VAP reduction, highlighting context-dependent efficacy. Safety concerns included probiotic bacteremia (1.1% vs 0.1% in PROSPECT). Discussion: Probiotic efficacy is population-specific, with consistent benefits in trauma, surgical, and COVID-19 patients, but minimal effects in general mixed ICU populations receiving contemporary care. Synbiotics, higher doses (≥5×10⁹ CFU/day), and longer duration (≥14 days) optimize outcomes. Methodological quality explains discrepancies between early positive meta-analyses and recent negative trials. Conclusion: Probiotics modulate the gut-lung axis through multiple mechanisms, reducing VAP and ICU stay in selected populations. Routine use in unselected ICU patients is not supported, but targeted therapy in trauma and specific subgroups may be beneficial. Further research should optimize strain selection, dosing, and identify responsive phenotypes.

Low-Dose Radiation Therapy Versus Conventional Physiotherapy in Osteoarthritis Patients: A Comprehensive Systematic Review and Meta-Analysis Evaluating Symptomatic Efficacy and Disease Progression Gilang Pramanayudha
The International Journal of Medical Science and Health Research Vol. 33 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/wptkc827

INTRODUCTION: Osteoarthritis (OA) constitutes the most prevalent degenerative joint disease worldwide, imposing a profound burden of chronic pain, functional limitation, and disability on the aging population. Conventional physiotherapy serves as the established cornerstone of conservative management, primarily targeting biomechanical optimization and symptom control. Concurrently, Low-Dose Radiation Therapy (LDRT) has experienced a significant clinical resurgence as a non-pharmacological intervention hypothesized to modulate synovial inflammation and halt structural disease progression. However, high-quality clinical evidence remains profoundly contested and polarized. The objective of this comprehensive systematic review is to rigorously evaluate the comparative efficacy of LDRT versus conventional physiotherapy and sham treatments, specifically focusing on the resolution of symptomatic complaints and the alteration of disease progression in OA patients. METHODS: A comprehensive systematic review protocol was executed in strict alignment with PRISMA guidelines. Efficacy data, adverse event rates, and radiological/clinical progression metrics were systematically extracted from peer-reviewed databases and recent oncological and rheumatological trial registries up to the year 2025. The risk of bias was appraised utilizing the Cochrane Risk of Bias 2 (RoB 2) tool. The statistical analysis isolated standardized mean differences (SMD), hazard ratios (HR), relative risks (RR), and confidence intervals (CI) to quantify treatment effects, categorizing findings into symptomatic efficacy, disease progression, and safety profiles. RESULTS: The systematic synthesis integrated diverse trial archetypes, encompassing over 3,000 cumulative patients across multiple cohorts. Conventional physiotherapy demonstrated consistent, short-term efficacy in functional restoration (SMD – 0,166, 95% CI -0,422 to 0.088) and pain reduction (SMD -0.175). Conversely, the most recent 2025 meta-analysis indicates that LDRT yields no statistically significant symptomatic benefit over sham interventions globally (SMD -0.92, P = 0.13). However, modern stratified trials, such as the ASTRO 2025 randomized controlled trial, revealed that a specific 3.0 Gy LDRT regimen yielded significant responder advantages over sham treatments (70.3% vs 41.7%, P=0.014). Most crucially, decade-long longitudinal data indicate that LDRT significantly reduces the hazard of profound clinical disability (Adjusted HR 0.24, 95% CI 0.11 to 0.48) and decreases the incidence of total joint arthroplasty (HR 0.60). Adverse events were measurably higher in LDRT cohorts (RR 1.44). DISCUSSION: The dichotomy in LDRT outcomes points to a highly complex interplay between radiobiological dose thresholds and the profound placebo responses documented in sham-controlled arms. Biologically, LDRT upregulates the Nrf2 antioxidant response, downregulates inducible nitric oxide synthase (iNOS), and polarizes macrophages toward the anti-inflammatory M2 phenotype, effectively arresting the osteoimmunological cascades that drive joint destruction. Physiotherapy remains universally effective for muscular and functional preservation, while LDRT's utility appears tightly restricted to delaying structural progression and end-stage disability in select demographics. CONCLUSION: Conventional physiotherapy maintains its mandate as the primary, biologically safe, and effective first-line intervention for OA. LDRT presents a potent but highly debated alternative that effectively alters long-term disease progression and disability trajectories but carries a measurable increase in localized adverse events and oncogenic risk. LDRT should currently be reserved for refractory clinical phenotypes or implemented strictly within controlled investigational frameworks.

Permethrin Resistance and Alternative Therapies in Scabies : A Systematic Review Asmaul Khusna; Dinna Devi; Heffi Anindya Putri
The International Journal of Medical Science and Health Research Vol. 34 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/vv4xxh23

Introduction: Scabies, caused by Sarcoptes scabiei var. hominis, affects over 200 million people globally, with permethrin 5% cream serving as first-line treatment for decades. However, emerging evidence suggests increasing permethrin treatment failures, raising concerns about resistance. This systematic review aims to synthesize evidence on permethrin resistance in scabies and evaluate the effectiveness and safety of alternative therapeutic options. Methods: A systematic review was conducted following PRISMA guidelines. We searched multiple databases for studies investigating permethrin resistance or alternative scabies treatments. Included studies comprised randomized controlled trials, cohort studies, case-control studies, case series (≥5 patients), systematic reviews, and meta-analyses reporting clinical outcomes in human patients with confirmed or clinically diagnosed scabies. A total of 144 studies met inclusion criteria and underwent data extraction for resistance evidence, alternative therapy details, comparative effectiveness, safety profiles, and clinical context. Results: Documented permethrin resistance demonstrated significant geographic heterogeneity, with European studies reporting cure rates as low as 27-31% compared to 73-96% in South Asian settings. Global treatment failure prevalence increased by 0.58% annually (95% CI not reported). Resistance mechanisms included voltage-gated sodium channel mutations and enhanced glutathione S-transferase activity. Alternative therapies showed variable effectiveness: two-dose oral ivermectin (200 μg/kg one week apart) achieved 78-100% cure versus 58% for single-dose (P=0.021); topical ivermectin 1% achieved 96-100% cure by four weeks; benzyl benzoate 25% showed 87% cure in some studies but caused burning in 24% of patients; sulfur preparations achieved 94.4-100% cure by four weeks with mild adverse effects. Combination permethrin-ivermectin therapy demonstrated superior efficacy (84.6% vs 67.5-70.7% for monotherapies, P<0.01). Mass drug administration with ivermectin reduced scabies prevalence by 79% (95% CI not reported). Discussion: The geographic disparity in permethrin efficacy likely reflects true biological resistance evolution in regions with prolonged permethrin use, rather than methodological artifacts. Alternative therapies, particularly two-dose oral ivermectin and topical ivermectin, demonstrate excellent effectiveness in permethrin-resistant cases. Treatment selection should consider resistance patterns, patient age, pregnancy status, and resource availability. Combination approaches may offer advantages in refractory cases. Conclusion: Permethrin resistance represents an emerging global challenge requiring revised treatment algorithms. Two-dose oral ivermectin (200 μg/kg one week apart) should be considered first-line in regions with documented resistance, while topical ivermectin offers advantages in young children. Future research should focus on standardized resistance surveillance, novel agents including moxidectin and spinosad, and implementation strategies for resistant populations.

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Indra Hadi

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

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Kota adm. jakarta selatan,

Dki jakarta

INDONESIA