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The International Journal of Medical Science and Health Research

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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 Automated Insulin Delivery Systems to Time-in-Range Improvement in DM Pediatric Nadya Virana Putri; Selvia Rahayu; Ningrum Jayanti
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/k2ftdq16

Introduction: Automated insulin delivery (AID) systems represent a transformative advancement in the management of type 1 diabetes (T1D) in pediatric populations. These systems aim to improve glycemic control by automating insulin adjustments based on continuous glucose monitoring, thereby increasing time-in-range (TIR) and reducing hypoglycemia. However, comprehensive evidence on their efficacy across diverse pediatric age groups, baseline glycemic profiles, and prior therapy methods remains essential for clinical implementation. Methods: This systematic review synthesized evidence from 80 studies, including randomized controlled trials, meta-analyses, single-arm studies, and observational studies conducted between 2010 and 2025. Inclusion criteria focused on pediatric populations (0–18 years), AID interventions, TIR outcomes, and controlled study designs. Data extraction covered AID system details, population characteristics, study design, control comparisons, TIR outcomes, safety metrics, and key findings. Results: AID systems consistently improved TIR across pediatric populations, with meta-analyses reporting mean improvements of 8.70% to 11.38% (Baoqi Zeng et al., 2023; L. Hespanhol et al., 2023). Individual trials showed TIR gains of 6.7% to 19.1%, translating to 2.6 to 3.7 additional hours/day in target range. Greater improvements were observed in those with higher baseline HbA1c (Abraham et al., 2024) and in patients transitioning from multiple daily injections (MDI) to AID (G. Petrovski et al., 2022). Safety outcomes were favorable, with rare severe hypoglycemia or diabetic ketoacidosis events and reduced time below range. Discussion: The evidence supports AID systems as effective and safe across all pediatric age groups. Improvements were influenced by baseline glycemic control, prior therapy, age, system settings, and user engagement. AID also demonstrated potential to reduce healthcare disparities, with significant benefits in under-resourced populations. Virtual initiation and structured protocols further enhance accessibility and outcomes. Conclusion: AID systems significantly and safely improve TIR in pediatric T1D, with durable benefits over time. Implementation should be encouraged across all pediatric age groups, with particular attention to patients with suboptimal baseline control and those transitioning from MDI. Future research should focus on long-term outcomes, psychosocial impacts, and equitable access.

The Relationship Between Hba1c Levels and The Risk of Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients : A Systematic Review Fahmi Nur Suwandi; Devy Juniarti Iskandar; Charles Sanjaya
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: 10.70070/0kyg9c18

Introduction: Diabetic retinopathy (DR) remains a leading cause of visual impairment worldwide among patients with type 2 diabetes mellitus (T2DM). Glycated hemoglobin (HbA1c) serves as the primary marker of glycemic control, yet the precise nature of its relationship with DR risk requires comprehensive synthesis. This systematic review aimed to evaluate the association between HbA1c levels and DR risk in T2DM patients, examine dose-response relationships, identify effect modifiers, and determine optimal HbA1c thresholds for DR prevention. Methods: A systematic review was conducted following standardized screening criteria. Studies were included if they involved adult T2DM patients, measured quantitative HbA1c levels as an exposure variable, assessed DR as a clearly defined outcome, and examined the relationship between these parameters. Data extraction encompassed study characteristics, HbA1c measurement methods, DR assessment techniques, association measures, and risk factor analyses. Results: Two hundred studies comprising diverse populations across 30 countries were analyzed, with sample sizes ranging from 30 to 175,645 participants. The overwhelming majority demonstrated significant positive associations between elevated HbA1c and increased DR risk. Adjusted odds ratios ranged from 1.60 (95% CI 1.13-2.25) for HbA1c ≥7.5% to 4.23 (95% CI 3.90-4.58) for HbA1c >10%. Dose-response relationships revealed progressive risk increases across HbA1c categories, with optimal screening thresholds identified between 6.6% and 8.15%. HbA1c variability emerged as an independent risk factor beyond mean levels (RR=1.48, 95% CI 1.24-1.78). Significant effect modification was observed with blood pressure, lipid profiles, diabetes duration, nephropathy, and genetic factors. Discussion: The HbA1c-DR relationship demonstrates remarkable consistency across global populations, supporting glycemic control as a cornerstone of DR prevention. The identification of glycemic memory effects and variability as independent risk factors suggests that both achieving target levels and maintaining stable control are crucial. Combined risk factor control produces multiplicative benefits, emphasizing multifactorial management approaches. Conclusion: Elevated HbA1c levels are strongly and consistently associated with increased DR risk in T2DM patients, with evidence supporting target maintenance below 7%. Future research should focus on personalized threshold algorithms incorporating individual risk profiles and investigating interventions targeting HbA1c variability.

Medial Tibial Bone Defect with Severe Varus Deformity in Osteoarthritis Kellgren Lawrence grade IV Using Primary Total Knee Arthroplasty Combined with screwing and Autologous Bone Graft: A Case Report and Technical Notes Luthfi Lazuardi; Dicky Mulyadi; Albert Riantho
The International Journal of Medical Science and Health Research Vol. 34 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/abkdss91

Medial tibial bone defects in varus knee osteoarthritis pose challenges during total knee arthroplasty (TKA) due to bone loss and soft-tissue imbalance, which complicate restoration of alignment and stability. While constrained implants are an option, primary TKA with screw fixation and autologous bone grafting offers a bone-preserving, cost-effective alternative in patients with intact collateral ligaments. A 64-year-old male presented with progressive right knee pain, deformity, and inability to bear weight for nine years despite conservative treatment. Radiographs revealed tricompartmental osteoarthritis, varus deformity exceeding 15°, and a contained medial tibial defect measuring 10–12 mm. The patient underwent primary TKA via a medial parapatellar approach using a stabilized implant. The defect was reconstructed with an autologous cancellous graft harvested from the distal femoral cut and secured with two cortical screws. Cemented femoral, tibial, and polyethylene components were implanted after achieving soft-tissue balance. Postoperatively, he remained non–weight-bearing for three months, then progressed to full weight bearing. Early follow-up showed a 0°–110° range of motion, stable fixation, and early graft incorporation on radiographs. Autologous bone graft reconstruction provides a biological, economical method to restore the joint line and mechanical axis in primary TKA. Studies by Kharbanda, Sugita, and Dewidar have reported durable outcomes with stable graft incorporation. Careful preoperative planning, rigid fixation, and structured rehabilitation are essential for success. This technique offers a reliable, bone-preserving solution that achieves alignment correction and functional recovery without the need for constrained implants.

Conservative Management of Non-Traumatic Spontaneous Bilateral Deep Intracerebral Hemorrhage: Neurological Perspectives from Two Cases Indah Nurul Maghfiroh
The International Journal of Medical Science and Health Research Vol. 34 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: 10.70070/4zjqf123

Introduction: Non-traumatic spontaneous bilateral intracerebral hemorrhage (PISBNT) is a rare subtype of hemorrhagic stroke and is often perceived as having a poor prognosis. Accurate etiological assessment and appropriate management are critical to guide clinical decision-making. Case Illustration: We report two cases of PISBNT. The first involved a 34-year-old man presenting with acute right-sided hemiparesis and dysarthria, found to have bilateral lentiform nucleus hemorrhages. The second was a 65-year-old woman with left-sided hemiparesis and dysarthria, with bilateral thalamic hemorrhages. Both patients presented with elevated blood pressure. Non-contrast CT confirmed bilateral deep intracerebral hemorrhage, while CT angiography excluded secondary vascular causes. No mass effect or intraventricular extension was observed. Discussion: Both patients were managed conservatively with strict blood pressure control and comprehensive stroke unit care. Structured etiological reasoning supported hypertension as the primary cause. Despite bilateral involvement, neurological status improved progressively during hospitalization. Follow-up imaging at six months demonstrated complete hematoma resorption, and both patients achieved favorable functional outcomes (mRS 1). Conclusion: PISBNT does not inevitably predict poor outcome. When guided by systematic neurological assessment and conservative management, selected patients can achieve excellent recovery. These cases highlight the importance of individualized clinical reasoning in managing rare bilateral intracerebral hemorrhage.

Prevalence , Diagnosis and Management of Hemorage Post Partum in Early Young Woman Under 20 Years Old and Over 35 Years Old : A Systematic Review Triasih Amalya
The International Journal of Medical Science and Health Research Vol. 34 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: 10.70070/7e1nrh05

Introduction: Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality globally, with maternal age extremes representing potentially vulnerable populations. This systematic review aimed to evaluate the prevalence, diagnosis, and management of PPH in women under 20 years and over 35 years of age. Methods: A systematic review was conducted following PRISMA guidelines. We screened studies based on predefined criteria including target age groups (<20 or ≥35 years), relevant outcomes (prevalence, diagnosis, management), recognized PPH definitions, and acceptable study designs. Data extraction encompassed study characteristics, age-specific prevalence, risk factors, diagnostic methods, management approaches, prevention strategies, and outcomes by age. Results: From 105 included studies, global PPH prevalence was estimated at 9.97% (95% CI: 6.90%-13.04%). Both maternal age extremes demonstrated elevated risk in a U-shaped pattern. Women ≥35 years had significantly higher PPH incidence (OR range: 1.73-4.61), with rates reaching 23-30.7% compared to 4.3-16.0% in younger women. Women <20 years showed comparable elevated risk (OR=1.73, p=0.005). Risk factors concentrated in older mothers included grand multiparity (92.5%), pre-existing diabetes (26%), and hypertensive disorders (38.6%). Diagnostic methods lacked age-specific approaches. Management strategies included uterotonics (oxytocin, misoprostol), tranexamic acid (1g IV within 3 hours), mechanical interventions (balloon tamponade success 81.3-87.9%), and surgical procedures (uterine compression sutures, artery ligation). Fertility-preserving interventions were prioritized in younger women. Multi-faceted interventions reduced PPH incidence from 14.01% to 4.90% and maternal mortality from 1,104/100,000 to 279/100,000. Discussion: The elevated PPH risk at both age extremes suggests shared pathways through uterine dysfunction and comorbidities, though mechanisms likely differ—biological immaturity and primiparity in young mothers versus accumulated comorbidities and grand multiparity in older mothers. The absence of age-specific diagnostic protocols represents a critical gap, as physiological responses to hemorrhage may vary by age. Context-dependent effectiveness of interventions (tranexamic acid, misoprostol) underscores the need for resource-stratified guidelines. Conclusion: Both young (<20) and older (≥35) mothers face significantly elevated PPH risk, warranting enhanced surveillance and targeted prevention strategies. Future research should prioritize direct age-group comparisons, mechanistic studies, and resource-stratified clinical guidelines.

A Comprehensive Systematic Review of Relationship between Coffee Consumption and The Risk of Calcium Oxalate Stone Formation Wily Danis Pratama; Shavira Putri Pratama
The International Journal of Medical Science and Health Research Vol. 35 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/jbvrsq56

Introduction: Kidney stones, particularly calcium oxalate stones, are a prevalent and painful urological condition with significant healthcare burdens. Dietary factors play a crucial role in their pathogenesis. Coffee, one of the world's most consumed beverages, contains various bioactive compounds, but its specific relationship with calcium oxalate stone risk remains a topic of scientific inquiry, with conflicting public perception. Methods: A systematic review methodology was employed. Thirteen sources, including cohort studies, meta-analyses, and a Mendelian randomization study, were identified through a structured screening process focusing on human adults, quantifiable coffee exposure, and calcium oxalate stone outcomes. Data were extracted on coffee consumption patterns, stone outcomes, risk associations, study populations, confounding adjustments, and proposed biological mechanisms. Results: The synthesized evidence consistently demonstrates a protective association between coffee consumption and kidney stone risk. Meta-analyses reported a significant risk reduction, with odds ratios (OR) of 0.70 (95% CI 0.60-0.82) for highest vs. lowest coffee intake and a relative risk (RR) of 0.68 (95% CI 0.61-0.75) for highest vs. lowest caffeine intake (Wang et al., 2014; Zhao et al., 2022). A Mendelian randomization study provided strong causal evidence, showing a 40% lower risk (OR=0.60, 95% CI 0.46-0.79) per 50% genetically predicted increase in coffee consumption (Yuan and Larsson, 2021). Proposed mechanisms include caffeine-induced diuresis increasing urine volume, increased excretion of citrate and magnesium, and direct inhibition of calcium oxalate crystal adhesion to renal cells (Barghouthy et al., 2020; Peerapen and Thongboonkerd, 2018). Discussion: The findings robustly indicate that moderate coffee consumption (typically 3-4 cups daily) is associated with a reduced risk of kidney stone formation. This effect is biologically plausible through multiple pathways involving both caffeine and other coffee compounds like chlorogenic acid and trigonelline. The consistency across diverse study designs, including genetically informed methods, strengthens causal inference. Limitations include the general focus on kidney stones overall rather than exclusively on calcium oxalate composition and the predominance of Western populations in the studies. Conclusion: Current evidence supports that coffee consumption is associated with a lower risk of kidney stone formation, including calcium oxalate stones. The protective effect is likely mediated through a combination of increased urine output, favorable changes in urinary composition, and direct anti-lithogenic actions. For most healthy adults, moderate coffee intake can be considered part of a dietary pattern that may mitigate stone risk. Future research should focus on stone-type-specific analyses and diverse populations.

A Comprehensive Systematic Review of The Relationship between Uncontrolled Hypertension and the Incidence of Vascular Dementia Andi Riska Gunawati; Tika W. Rahajaan
The International Journal of Medical Science and Health Research Vol. 35 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/jkxb7q71

Introduction: Hypertension is a highly prevalent modifiable risk factor for dementia, yet the specific relationship between uncontrolled hypertension and vascular dementia remains incompletely characterized. This systematic review aims to synthesize current evidence on the association between uncontrolled hypertension and vascular dementia incidence, examining the effects of blood pressure control, treatment duration, and age-dependent factors. Methods: A systematic literature search was conducted following PRISMA guidelines. Studies were included if they examined adult patients (≥18 years) with diagnosed hypertension, clearly defined uncontrolled hypertension as an exposure variable, assessed vascular dementia as a primary or secondary outcome, and provided analyzable data. Observational studies (cohort, case-control, cross-sectional), systematic reviews, and meta-analyses were eligible. Data extraction encompassed study characteristics, hypertension definitions, dementia outcomes, association findings, confounders, and quality indicators. Results: One hundred twenty-five studies met inclusion criteria, encompassing over 2.6 million participants across diverse geographic settings. Uncontrolled hypertension was consistently associated with increased vascular dementia risk, with incidence rates of 8.1 versus 4.9 per 1,000 person-years in uncontrolled versus controlled groups (p<0.001). Antihypertensive treatment reduced dementia risk by 7-13% (OR 0.87-0.93), with each additional treatment year conferring 5-6% risk reduction. Midlife hypertension (ages 40-65) increased dementia risk by 63% (HR 1.63, 95% CI 1.37-1.89), whereas associations in late life were heterogeneous. Blood pressure variability independently predicted dementia (HR 1.69, 95% CI 1.25-2.28). Vascular markers including white matter hyperintensities, cerebral microbleeds, and microinfarcts mediated these relationships. Discussion: The hypertension-dementia relationship exhibits pronounced age dependence, with midlife exposure showing strongest associations through cumulative cerebrovascular damage. Blood pressure control effectiveness varies by dementia subtype, with stronger effects for vascular than Alzheimer's dementia. Treatment duration, blood pressure variability, and multifactorial risk factor control represent critical modifiers of cognitive outcomes. Conclusion: Uncontrolled hypertension significantly increases vascular dementia risk, with optimal blood pressure control in midlife offering substantial cognitive protection. Future research should address ethnic diversity, optimize late-life blood pressure targets, and evaluate combination risk factor interventions.

The Comprehensive Systematic Review of Platelet Count and Hematocrit as Predictors of Plasma Leakage in Dengue Hemorrhagic Fever Hairanty sinaga; Cici Nurhalimah
The International Journal of Medical Science and Health Research Vol. 35 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/scx3k161

Introduction: Dengue hemorrhagic fever (DHF) remains a major public health concern in endemic regions, with plasma leakage being the pathognomonic feature determining disease severity. Despite widespread clinical use of platelet count and hematocrit as monitoring parameters, their predictive value for plasma leakage remains debated. This systematic review aims to comprehensively evaluate the evidence for platelet count and hematocrit as predictors of plasma leakage in DHF patients. Methods: A systematic review of 34 sources including primary observational studies, systematic reviews, meta-analyses, and randomized controlled trials was conducted. Studies were screened based on predefined criteria including DHF population according to WHO criteria, plasma leakage assessment through clinical signs or imaging, reporting of platelet count and/or hematocrit as predictors, and adequate statistical information. Data extraction encompassed study characteristics, platelet and hematocrit measurements, statistical findings, and confounding factors. Results: Low platelet count demonstrated consistent association with plasma leakage across multiple meta-analyses, with pooled odds ratios ranging from 2.01 (95% CI: 1.70-2.38) to 3.21 (95% CI: 1.81-5.69). A dose-response relationship showed 33% increase in logOR per 10,000-cell decrement. Platelet count below 50,000/mm³ was identified as a significant threshold for dengue shock syndrome (OR=2.85; 95% CI: 1.25-6.47). Hematocrit showed variable predictive utility depending on measurement timing; significant during critical phase (days 4-7) but not during early febrile phase. Combined assessment of rising hematocrit with declining platelet count yielded the strongest predictive signal (OR range: 5.13-43.17). Discussion: The apparent contradiction regarding hematocrit's predictive value is explained by temporal discordance in measurement timing. Platelet count emerges as a more reliable early predictor, with reductions detectable during febrile phase before hemoconcentration manifests. Population-specific factors, particularly age, significantly modulate predictive accuracy. The combined parameter approach captures mechanistically linked processes of capillary permeability and platelet consumption. Conclusion: Platelet count below 50,000/mm³ and rising hematocrit (particularly >20% above baseline) are consistent predictors of plasma leakage, with combined assessment providing optimal predictive utility. Serial monitoring rather than single-point measurements is essential. Future research should focus on developing integrated predictive models incorporating clinical, laboratory, and sonographic parameters.

Long-Term Tobacco Use and COPD Outcomes: A Systematic Review of Disease Progression, Smoking Cessation Benefits, and Treatment Modification Shopia Mabella; Bayu Irianto
The International Journal of Medical Science and Health Research Vol. 35 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/wkw5dy64

Introduction: Smoking is the primary risk factor for chronic obstructive pulmonary disease (COPD), yet the quantitative impact of long-term smoking exposure on disease progression and the magnitude of benefit from cessation remain incompletely characterized. This systematic review synthesizes evidence from longitudinal studies to quantify the effects of smoking on COPD progression and evaluate how smoking status modifies treatment responses. Methods: We systematically screened longitudinal studies with ≥12 months follow-up examining smoking exposure in adults with established COPD. Studies were included if they reported quantitative measures of progression including FEV1 decline, exacerbation frequency, hospitalization, mortality, or quality of life. Data extraction encompassed smoking history, progression measures, long-term outcomes, study design, baseline characteristics, and effect modifiers. Results: Eighty studies with follow-up ranging from 6 months to 32.5 years were included. Current smokers exhibited accelerated FEV1 decline compared with former smokers, with excess decline ranging from 7-10 mL/year in general populations to >100 mL/year in genetically susceptible subgroups (p<0.001) (1,2). Smoking cessation produced immediate FEV1 improvement (121.8 mL at week 12, p=0.0069) that partially attenuated over time (20), with sustained symptom benefits (20,55). The half-life of excess COPD risk after quitting was 13.3 years (95% CI 11.86-14.96) (8). Smoking status significantly modified pharmacotherapy responses: current smokers showed blunted responses to inhaled corticosteroids (9,10,57), reduced benefit from azithromycin (interaction p=0.03) (11), but enhanced responses to CXCR2 antagonists (23). Exacerbations accelerated FEV1 decline by an additional 23 mL/year in GOLD stage 1, with smoking amplifying this effect (14). Mortality was significantly reduced with cessation in multiple studies (RR 0.75, 95% CI 0.56-1.00, p=0.05) (4). Discussion: This review demonstrates that continued smoking accelerates COPD progression through multiple mechanistic pathways including sustained neutrophilic inflammation, bacterial colonization, and corticosteroid resistance. Cessation benefits accumulate gradually over decades, with baseline severity and age at cessation as critical determinants of outcomes. The paradoxical early fall in CT lung density post-cessation reflects inflammatory resolution rather than emphysema worsening. Conclusion: Smoking cessation remains the cornerstone intervention for modifying COPD progression, with effects on lung function, exacerbations, and mortality that accumulate over years. Treatment selection must account for ongoing smoking exposure due to substantially altered pharmacotherapy efficacy.

Predicting Pulmonary Arterial Hypertension in Patients with Connective Tissue Disease: A Systematic Review of Risk Factors and Screening Strategies Yeni Oktasari; Yessica Fianita
The International Journal of Medical Science and Health Research Vol. 35 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/c882a920

Introduction: Pulmonary arterial hypertension (PAH) is a severe and life-threatening complication of connective tissue diseases (CTD), associated with significant morbidity and mortality. Early detection through effective screening strategies and identification of robust risk factors is crucial for improving patient outcomes. This systematic review aims to synthesize and evaluate the current evidence on risk factors, predictors, and screening strategies for PAH in patients with CTD. Methods: A systematic literature search was conducted to identify studies investigating risk factors, biomarkers, screening strategies, and predictive models for PAH in CTD patients. Studies were included if they enrolled patients with systemic sclerosis (SSc), systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), or other CTDs, and reported quantitative measures of association or screening performance. Data were extracted on CTD populations, PAH definitions, risk factors, screening modalities, and predictive performance metrics. Results: Fifty-four studies met inclusion criteria, encompassing prospective and retrospective cohorts, systematic reviews, and meta-analyses. The majority focused on SSc (n=38), followed by SLE (n=8) and MCTD (n=1). Composite screening algorithms (DETECT and ASIG) demonstrated superior performance (sensitivity 94-100%, NPV 87-100%) compared to single modalities. Echocardiography showed moderate sensitivity (49-95%) with threshold-dependent specificity (43-100%). NT-proBNP exhibited pooled sensitivity of 67% (95% CI 52-79%) and specificity of 84% (95% CI 75-91%). In SSc, key risk factors included low DLCO (45-70% predicted), anti-centromere antibodies, telangiectasias, and nailfold capillaropathy (OR 7.3, 95% CI 3.0-18.0). In SLE, anti-RNP antibody (OR 3.68, 95% CI 2.04-6.63), antiphospholipid antibodies (OR 2.28, 95% CI 1.65-3.15), Raynaud's phenomenon (RR 1.83, 95% CI 1.41-2.37), and interstitial lung disease (RR 4.36, 95% CI 2.42-7.85) were significant predictors. Survival was worse in SSc-PAH (67% at 3 years) compared to SLE-PAH (87% at 3 years). Screening programs improved survival outcomes compared to clinical diagnosis. Discussion: This systematic review demonstrates that multi-modal screening algorithms significantly outperform single-modality approaches for CTD-PAH detection. Risk factor profiles differ substantially between CTD subtypes, reflecting distinct underlying pathophysiological mechanisms. The predominance of SSc-focused evidence highlights a critical research gap for non-scleroderma CTDs. The integration of emerging modalities including exercise testing, nailfold capillaroscopy, and genetic risk scores may further refine risk stratification. Conclusion: Current evidence supports annual multi-modal screening in SSc patients using composite algorithms incorporating echocardiography, pulmonary function tests, and biomarkers. For SLE and other CTDs, targeted screening based on identified risk factor profiles is recommended. Future research should focus on validating prediction models in diverse CTD populations and investigating early intervention strategies in high-risk patients.

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Indra Hadi

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profesionaljournalmedicine@gmail.com

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Journal Mail Official
pt.internationalmedicaljournal@gmail.com

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

Location
Kota adm. jakarta selatan,

Dki jakarta

INDONESIA