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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.

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Articles 529 Documents

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Silicone Intubation Versus No Intubation In Dacryocystorhinostomy For Nasolacrimal Duct Obstruction: A Systematic Review Ida Ayu Bintang Maui Putri; Anak Agung Avrella Shora Yuananda; Ni Made Ayu Trisnadewi Suyasa
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/f32v4d04

Introduction: Nasolacrimal duct obstruction (NLDO) is the most common cause of impaired tear drainage and typically presents with excessive tearing and/or recurrent infection. Although medical treatment, such as antibiotics may provide symptomatic relief, definitive management, typically external and endonasal dacryocystorhinostomy (DCR) is usually required. Several variations of DCR have been described, including procedures with silicone intubation. However, the role of silicone intubation in DCR remains controversial, with differing opinions regarding its clinical benefit. Methods: This study was conducted following PRISMA guidelines. A thorough literature search was performed across four electronic databases: PubMed, ScienceDirect, Semantic Scholar, and Google Scholar. The search strategy was designed to identify studies evaluating DCR performed with and without silicone tube insertion in patients with NLDO. The primary outcomes of interest included anatomical and functional patency and the presence of persistent epiphora. Result: Fourteen studies were included in the analysis. Symptom improvement occurred in patients with and without silicone intubation, typically within weeks and maintained through follow-up. Patency was assessed by various methods, and tube removal timing varied. Most studies found no statistically significant differences in functional or anatomical outcomes between the two groups. Conclusion: This review suggests that the role of silicone intubation is similar in both external and endonasal dacryocystorhinostomy. While some studies show a trend toward higher success with intubation, few report statistically significant improvements. Silicone tubes are associated with longer operative times, higher costs, and potential complications, yet high success rates are also achieved without them. Therefore, silicone intubation is recommended only for carefully selected patients, considering the surgical approach, anatomy, and risk of failure.

The Comprehensive Systematic Review of Association of Placenta Previa to the Incidence of Preeclampsia Made Krisna Wibawa Pramartha; I Made Sudarmayasa
The International Journal of Medical Science and Health Research Vol. 36 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: 10.70070/4xfcgv50

Introduction: Placenta previa and preeclampsia are major causes of maternal and perinatal morbidity worldwide. While both conditions originate from placental abnormalities, the direct association between placenta previa and preeclampsia incidence remains poorly understood. This systematic review aims to synthesize available evidence on the relationship between placenta previa and the subsequent development of preeclampsia. Methods: A comprehensive systematic review was conducted following standardized screening and data extraction protocols. We screened studies based on population (pregnant women with confirmed placenta previa), outcome (reported preeclampsia incidence), comparison groups, and study design. Eighty sources were retrieved and assessed for eligibility, with direct and indirect evidence analyzed separately. Results: The sole meta-analysis directly addressing this association (Y. Xa et al., 2015) pooled seven cohort studies and reported an overall inverse association between placenta previa and hypertensive disorders (pooled RR 0.55, 95% CI 0.32–0.97). However, this protective effect was specific to pregnancy-induced hypertension (RR 0.36, 95% CI 0.23–0.57), with no significant association for preeclampsia specifically (RR 0.94, 95% CI 0.44–2.00). Placental laterality studies demonstrated that lateral placental location strongly predicted preeclampsia (pooled OR 3.48, 95% CI 3.03–3.99), while central/fundal locations were protective against hypertension (RR 0.47, 95% CI 0.31–0.71). Endometriosis meta-analyses consistently showed strong associations with placenta previa (OR range 2.84–3.92) but only modest, inconsistent links with preeclampsia. Discussion: The available evidence suggests that placenta previa is not significantly associated with preeclampsia incidence. The apparent protective effect against hypertensive disorders is attributable to reduced gestational hypertension risk rather than preeclampsia. Distinct pathophysiological mechanisms may underlie different placental location abnormalities: lateral implantation may compromise uterine artery perfusion leading to preeclampsia, while low-lying implantation in placenta previa does not involve the same laterality-dependent hemodynamic deficit. Conclusion: Current evidence does not support an association between placenta previa and increased preeclampsia risk. Future research should distinguish between hypertensive disorder subtypes and employ standardized definitions to clarify these relationships.

Evaluating The Role of Endometrial Receptivity in IVF Success : A Comprehensive Systematic Review Made Krisna Wibawa Pramartha; I Made Sudarmayasa
The International Journal of Medical Science and Health Research Vol. 36 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: 10.70070/9tmdjh80

Introduction: Endometrial receptivity is a critical determinant of successful embryo implantation in in vitro fertilization (IVF). Despite advances in assisted reproductive technology, implantation failure remains a significant barrier to successful pregnancy. This systematic review evaluates the role of various endometrial receptivity assessment methods in predicting and improving IVF outcomes. Methods: A comprehensive systematic review was conducted including 80 studies published to 2025. Studies were included if they assessed endometrial receptivity using validated methods (transcriptomic, ultrasound-based, histological, or molecular approaches) and reported IVF outcomes including implantation, clinical pregnancy, or live birth rates. Data were extracted on receptivity measures, IVF success outcomes, cycle types, patient populations, and statistical associations. Results: Endometrial receptivity was assessed using diverse methodologies including transcriptomic testing (ERA, rsERT), ultrasound parameters (thickness, pattern, vascularity, compaction), histological evaluation (pinopodes, chronic endometritis), and molecular biomarkers. Endometrial thickness demonstrated consistent threshold effects: thickness <7-8 mm was associated with significantly lower clinical pregnancy rates (OR 0.42, 95% CI 0.27-0.67) and live birth rates (OR 0.47, 95% CI 0.37-0.61). ERA-guided personalized transfer showed population-dependent efficacy, with significant benefits in recurrent implantation failure (RIF) patients (OR 2.50, 95% CI 1.42-4.40 for clinical pregnancy) but no benefit in good-prognosis populations (RR 0.95, 95% CI 0.79-1.13 for live birth). Chronic endometritis treatment restored normal IVF outcomes, with cured patients achieving comparable pregnancy rates to those without the condition. Endometrial scratching demonstrated variable results, with benefit primarily in RIF patients when performed in the luteal phase (clinical pregnancy RR 2.32, 95% CI 1.72-3.13). Discussion: The clinical utility of endometrial receptivity assessment depends critically on patient selection. In good-prognosis patients with euploid embryos, endometrial factors contribute minimally to success beyond achieving adequate thickness. Conversely, in RIF patients, advanced maternal age, or those with documented endometrial pathology, receptivity assessment and intervention provide meaningful improvements. The interaction between embryo quality and endometrial factors explains substantial heterogeneity in study findings. Conclusion: Endometrial receptivity assessment should be stratified based on patient characteristics. Routine ERA testing in unselected populations is not supported by evidence. Clinical recommendations include: ensuring endometrial thickness ≥8 mm before transfer, screening for chronic endometritis in RIF patients, and considering ERA or endometrial scratching specifically in RIF populations after excluding other causes. Future research should focus on developing integrated assessment approaches combining multiple receptivity parameters.

A Comprehensive Systematic Review of The Role of Ketamine-Propofol (Ketofol) in Interventional Radiology Oncology Nadya Larasati; Ashri Mirawati
The International Journal of Medical Science and Health Research Vol. 36 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/qz1m4473

Introduction: Interventional radiology oncology procedures require optimal sedation that ensures hemodynamic stability, respiratory safety, and adequate analgesia. Ketamine-propofol (ketofol) combines the sympathomimetic properties of ketamine with the sedative effects of propofol, offering potential advantages in this vulnerable population. This systematic review evaluates the role of ketofol in interventional radiology oncology procedures. Methods: A systematic review of 58 sources identified through screening based on predefined criteria including ketofol intervention, adult oncology patients undergoing interventional procedures, and appropriate study designs. Data were extracted on procedure context, patient characteristics, ketofol administration, comparator regimens, sedation effectiveness, safety outcomes, recovery parameters, and clinical recommendations. Results: Meta-analyses demonstrated that ketofol significantly reduces hypotension (RR 0.11-0.40), bradycardia (RR 0.34-0.47), and respiratory adverse events (RR 0.48-0.55) compared to propofol alone. Ketofol reduces propofol consumption by 30-65% and provides superior analgesia. However, ketofol increases neurological adverse events compared to propofol (RR 1.95-3.68) and may prolong recovery by 2-7 minutes. The 1:2 to 1:4 ketamine-to-propofol ratio appears optimal. Discussion: Ketofol demonstrates pharmacological synergy that addresses the specific needs of interventional radiology oncology patients, who often present with compromised cardiovascular status. The hemodynamic and respiratory advantages are well-established across diverse clinical contexts. However, direct evidence in interventional radiology oncology remains limited, with most studies excluding high-risk patients (ASA III-IV) typical of oncology practice. The trade-off between improved cardiorespiratory stability and increased neuropsychiatric effects requires individualized patient selection. Conclusion: Ketofol at 1:2-1:4 ratios represents a reasonable sedation strategy for interventional radiology oncology procedures where hemodynamic stability and respiratory safety are priorities. Future research should focus on high-risk oncology patients, optimal dosing for prolonged procedures, and head-to-head comparisons with dexmedetomidine-based regimens.

A Comprehensive Systematic Review of Blood Pressure Variability during Mechanical Thrombectomy under Anesthesia Nadya Larasati; Ashri Mirawati
The International Journal of Medical Science and Health Research Vol. 36 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/ytnzh498

Introduction: Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke due to large vessel occlusion. However, optimal blood pressure (BP) management during MT under anesthesia remains uncertain, particularly regarding blood pressure variability (BPV) and its impact on clinical outcomes. This systematic review comprehensively synthesizes evidence on BPV during MT under anesthesia. Methods: We systematically screened studies from multiple databases including adult patients (≥18 years) undergoing MT under any form of anesthesia, reporting intra-procedural BPV metrics with continuous BP monitoring. Study designs included randomized controlled trials, cohort studies, case-control studies, systematic reviews, and meta-analyses with sample sizes ≥5 patients in appropriate clinical settings. Data extraction encompassed study characteristics, patient populations, anesthesia management, BP measurement methods, BPV patterns, clinical outcomes, statistical associations, and predictive factors. Results: From 104 included sources, consistent patterns emerged despite substantial methodological heterogeneity. Observational studies demonstrate associations between intraoperative BP drops and worse functional outcomes (1,2), particularly when mean arterial pressure decreases exceed 20-40% from baseline (3). Randomized trials comparing general anesthesia with procedural sedation show mixed results, with three single-center trials demonstrating equivalence or modest benefit for general anesthesia when strict protocols are applied (6,7,19). Intensive BP lowering post-thrombectomy consistently demonstrates harm (9,10), with the ENCHANTED2/MT trial showing intensive targets <120 mmHg worsened outcomes (9). BPV metrics including standard deviation, coefficient of variation, and successive variation are associated with functional outcomes, though definitions vary widely (11,12). Critical gaps include underrepresentation of posterior circulation strokes, large core infarcts, and patients with extended time windows. Discussion: The evidence converges on avoiding profound hypotension during MT, with thresholds of MAP <70 mmHg for >10 minutes associated with poor outcomes (4). However, optimal absolute thresholds remain contested. The interaction between anesthesia technique and BP management introduces complexity, with dedicated neuroanesthesia teams and protocol-mandated targets potentially more important than anesthesia modality per se. Current BPV metrics fail to capture temporal dynamics and clinical context of pressure changes. Conclusion: BPV during MT under anesthesia is critically associated with clinical outcomes. Future research requires adequately powered multicenter trials with standardized BPV metrics, comparative effectiveness studies of vasoactive agents, and prospective registries including underrepresented populations. Individualized BP management strategies accounting for patient-specific factors remain inadequately tested.

What is The Effectiveness of Early Versus Delayed Surgical Fixation of Orthopaedic Injuries on Mortality and Functional Outcomes in Multiply Injured Patients? : A Systematic Review Kenny Yose Timisela
The International Journal of Medical Science and Health Research Vol. 36 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/qq4vk533

Introduction: The optimal timing for surgical fixation of orthopedic injuries in multiply injured patients remains controversial, with conflicting evidence regarding early versus delayed intervention. This review synthesizes current evidence on the effectiveness of early compared to delayed surgical fixation on mortality and functional outcomes in polytrauma patients. Methods: A comprehensive review of 80 studies examining timing of surgical fixation in multiply injured patients was conducted. Studies included randomized controlled trials, cohort studies, systematic reviews, and meta-analyses. Early fixation was variably defined as within 24-72 hours, delayed beyond these cutoffs. Outcomes assessed included mortality, complications (ARDS, pneumonia, multiple organ failure), healthcare utilization, and functional outcomes. Results: Early definitive fixation was not associated with increased mortality in adequately resuscitated patients (1.4% vs 1.6%, p=0.78) (1). However, early surgery in specific high-risk populations—particularly thoracic spine fractures with hemoglobin <10 mg/dL—showed significantly increased mortality (p<0.01) (14). Early fixation consistently reduced ARDS (1.7% vs 5.3%, p=0.048) (1), pneumonia (8.6% vs 15.2%, p=0.07), hospital length of stay (10.5 vs 14.3 days, p=0.001), and ICU days (5.1 vs 8.4 days, p=0.006). Damage control orthopedics offered no survival advantage over early total care (OR 0.92) and increased complications (39). Functional outcome data were limited, though early spinal decompression improved neurological recovery (log OR 0.82, p<0.001) (18). Discussion: Benefits of early fixation depend on adequate resuscitation, with subclinical hypoperfusion (lactate ≥2.5 mmol/L) predicting poor outcomes (13). Injury pattern significantly influences optimal timing, with thoracic spine injuries requiring caution while lumbar and extremity fractures benefit from early intervention. Conclusion: Early fixation within 24-48 hours is safe and beneficial in adequately resuscitated polytrauma patients but should be avoided in those with subclinical hypoperfusion or specific high-risk injury combinations. A physiology-driven, injury pattern-specific approach optimizes outcomes.

Three Consecutive Complete Hydatidiform Moles: A Rare and Challenging Pattern of Gestational Trophoblastic Disease Tiffany Sudirman; Ummu Fatihah
The International Journal of Medical Science and Health Research Vol. 36 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/rzq8k425

Introduction Recurrent hydatidiform mole is an uncommon gestational trophoblastic disease but is clinically important. Although a single molar pregnancy is generally well understood, consecutive recurrences remain rare and raise concerns regarding the underlying genetic predisposition, with implications for malignant progression and future reproductive outcomes. Case Illustration A 26-year-old woman presented with one month of vaginal bleeding with clots, lower abdominal pain, severe nausea, dizziness, and weakness. She had undergone three prior curettages (one miscarriage and two molar pregnancies). Inspection detected anemia, uterine enlargement, lower abdominal tenderness and visible tissue on the cervix. Ultrasound revealed a classic “snowstorm” pattern. Transfusion stabilized the patient, who had evacuation curretage. The patient was then referred to a tertiary care center for genetic identification and serial β-hCG surveillance. Discussion The risk of hydatidiform mole in subsequent pregnancies is known to increase in cases of previous hydatidiform mole. Recurrences occur in 1.3%-2% of women who have had hydatidiform mole and rise to 15% in women who have had two consecutive hydatidiform mole. It is more common in those of reproductive age (15-45 years) and in multiparous. Approximately 10% of all cases are prone to malignant transformation. Conclusion This case underscores the importance of considering recurrent cases of hydatidiform mole in woman with early pregnancy bleeding and prior molar history. Early ultrasonographic evaluation, histopathological confirmation, and prompt evacuation are essential to reduce morbidity. Careful postevacuation surveillance is critical to detect persistent trophoblastic disease and prevent malignant progression.

The Association Between Venous Ulcer Area and Time to Healing Following Venous Ablation : A Comprehensive Systematic Review Muchamad Zubaid; Kun Sriwibowo; Muhammad Zulbani
The International Journal of Medical Science and Health Research Vol. 37 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/pqzmz027

Introduction: Venous leg ulcers (VLUs) affect millions worldwide with significant morbidity. While endovenous ablation addresses underlying venous reflux, the prognostic role of baseline ulcer size on healing time remains inadequately characterized. This systematic review synthesized evidence on the relationship between baseline venous ulcer area and time to healing following venous ablation. Methods: Seventy sources were systematically reviewed using predefined criteria: adult patients with venous ulcers undergoing ablation, reporting baseline ulcer size and healing time. Data extraction encompassed ulcer size parameters, healing time metrics, size-healing relationship analyses, and study characteristics. Results: Twenty-four studies reported baseline ulcer size, and 48 reported healing time. Measurement methods were heterogeneous: area (cm²) reported by Weber et al. (7.7±10.7 cm²), Sermsathanasawadi et al. (2.8±2.0 cm²), and Ivanova et al. (391.3±100.42 cm²); diameter categories used by Uttaray et al. (<2, 2-4, >4 cm) and Gohel et al. (<2, 2-6, >6 cm). Healing times ranged from 22 days for small ulcers (Savolyuk et al.) to median 56-82 days (EVRA trial). Savolyuk et al. demonstrated size-dependent healing: 7-21 cm² ulcers healed in 22.3±0.9 days versus 29.1±0.7 days for larger ulcers. Uttaray et al. observed non-healing associated with ulcers >5 cm. Tenbrook et al. identified diameter >2 cm as a non-healing risk factor. Discussion: Larger ulcers require greater tissue regeneration and are associated with longer disease duration and more severe dermal damage. Despite biological plausibility and recognition of size as a prognostic variable (stratification in VUERT and AAVTIRS trials), direct evidence remains limited. Studies primarily compared ablation modalities rather than examining size as a predictor. Heterogeneity in measurement methods and insufficient statistical power constrain definitive conclusions. Conclusion: Current evidence suggests larger venous ulcers heal more slowly following ablation, but the association lacks robust quantification. Future research requires standardized size measurement and adequate sample sizes for size-stratified analyses.

The Comprehensive Systematic Review of Low Back Pain and its Association with Physical Activity Levels Maulida Hayati; Kus Ageriyawan
The International Journal of Medical Science and Health Research Vol. 37 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/hmtqvr92

Introduction: Low back pain (LBP) is a leading cause of disability worldwide. While physical activity (PA) is a cornerstone of LBP management, the precise nature of the dose-response relationship remains debated, with studies reporting protective, harmful, and null effects. This comprehensive systematic review synthesizes evidence from observational studies to clarify the association between PA levels and LBP, exploring how this relationship is modified by activity domain, intensity, population characteristics, and pain chronicity. Methods: A systematic review was conducted, screening studies based on pre-defined criteria: adult populations (≥18 years) with non-specific LBP; assessment of PA as a primary exposure; and reporting of LBP outcomes (e.g., incidence, severity, disability). Eligible designs included observational studies (cross-sectional, cohort, case-control), systematic reviews, and meta-analyses that used validated measurement tools. Data were extracted on study characteristics, PA and LBP assessment methods, primary association results, moderating factors, and study quality. Results: Eighty studies were included, comprising 56 cross-sectional and 16 prospective cohort designs, with sample sizes ranging from 30 to 365,307 participants. The findings reveal a context-dependent relationship. Moderate-to-vigorous leisure-time PA was consistently associated with a protective effect against chronic LBP (RR range 0.84-0.90) (1,2). Optimal doses were identified at approximately 400-670 minutes of MVPA per week or 1800-2400 MET-min/week (3,4). In contrast, occupational PA (18,20), heavy domestic labor (17), and sedentary behavior (9,12,23) were associated with increased LBP risk. The relationship was often U-shaped, with both very low and very high activity levels conferring greater risk (1,4,10,25). Protective effects were more pronounced in older adults (≥50 years) (10,11), women (12,13), and obese individuals (14-16). Physical activity was more strongly associated with reduced disability (33,36) and the prevention of chronicity (2,6) than with acute pain episodes. Discussion: The heterogeneity in findings is explained not by contradiction but by the context-specificity of the PA-LBP relationship. The domain of activity (leisure vs. occupation) and its intensity are critical determinants of effect. While moderate leisure activity is protective, obligatory and high-intensity occupational demands can be harmful. PA's benefits appear to accumulate over time, primarily preventing the transition to chronic pain and reducing disability rather than eliminating acute episodes. The association is further modified by individual factors like age, sex, and BMI, and is mediated by psychological factors such as fear-avoidance beliefs. Conclusion: This review concludes that the relationship between physical activity and low back pain is non-linear and highly context-dependent. Recommendations should promote moderate-to-vigorous leisure-time physical activity for the prevention and management of chronic LBP, particularly in at-risk populations. However, they must be personalized, considering an individual's age, occupation, BMI, and psychological state. Future research should prioritize the use of objective activity measures and longitudinal designs to further delineate causal pathways and domain-specific dose-response relationships.

Is Allergic Rhinitis Associated with Increased Severity Of Coexisting Asthma In Children And Adults? : A Comprehensive Systematic Review Nydia Ayu Ulima; Dhimas Reyhan Putra; Rajmil Shafira Salsabila
The International Journal of Medical Science and Health Research Vol. 37 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/hqdmmy88

Introduction: Allergic rhinitis (AR) and asthma frequently coexist as manifestations of the unified allergic airway disease, yet the precise relationship between AR and asthma severity remains incompletely characterized across different age groups. This systematic review aimed to synthesize current evidence on whether AR is associated with increased severity of coexisting asthma in children and adults. Methods: A systematic review was conducted following PRISMA guidelines. Studies were screened based on predefined criteria including diagnosed asthma population, AR assessment using validated methods, measurement of asthma severity through clinical parameters, differentiation between allergic and non-allergic rhinitis, and appropriate observational or interventional study designs. Data extraction encompassed study characteristics, population demographics, AR diagnostic criteria, asthma severity measures, association results, age group effects, and effect modifiers. Results: Eighty studies published between 2002-2025 met inclusion criteria, comprising cross-sectional studies (n=62), cohort studies (n=12), systematic reviews (n=2), randomized controlled trials (n=2), and case-control studies (n=2). AR prevalence in asthmatic populations ranged from 29.2% to 97.5% across studies. The majority of studies (72/80, 90%) demonstrated a positive association between AR and increased asthma severity, manifested through poorer asthma control (OR range 1.21-2.74), more frequent exacerbations (incidence rate ratio 1.12), increased healthcare utilization (OR 2.64-2.98 for emergency visits), and impaired lung function (lower FEV₁, FEF₂₅–₇₅). AR severity correlated positively with asthma severity (correlation coefficients 0.365-0.689), with persistent and moderate-to-severe AR phenotypes consistently associated with difficult-to-control asthma. Treatment of AR, particularly with intranasal corticosteroids, was associated with improved asthma outcomes. Age-specific effects included stronger associations in school-age children compared to younger children (<6 years), and attenuation of prevalence in older adults. Discussion: The consistent positive association between AR and asthma severity across diverse populations supports the unified airway concept and has important clinical implications. The dose-response relationship between AR severity and asthma severity, coupled with improved asthma outcomes following AR treatment, suggests potential causal mechanisms including naso-bronchial reflex, systemic eosinophilic inflammation, and shared type-2 inflammatory pathways. However, heterogeneity in AR assessment methods and asthma severity definitions across studies limits direct comparability. Conclusion: Compelling evidence demonstrates that AR is associated with increased severity of coexisting asthma in both children and adults, with AR severity, persistence, and specific phenotypes serving as important determinants. Systematic assessment and optimal management of AR should be integrated into asthma care to potentially improve asthma outcomes.

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Contact Name
Indra Hadi

Contact Email
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