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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.

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Articles 577 Documents

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What is The Effect of Early Enteral Nutrition on Mortality in Critically Ill Patients Receiving Vasopressor Support? : A Systematic Review Landong Sijabat; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 40 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: 10.70070/8e740g61

Background: The effect of early enteral nutrition (EEN) on mortality in critically ill patients requiring vasopressor support remains debated due to conflicting trial results. Methods: This systematic review synthesized data from 80 studies (2003-2025), including landmark RCTs (NUTRIREA-2, NUTRIREA-3) and large observational cohorts, focusing on mortality, vasopressor dose-response, enteral tolerance, and safety. Results: EEN did not reduce 28-day or 90-day mortality in patients with severe shock (norepinephrine ≥0.3 µg/kg/min) in major RCTs [1,2]. However, a clear dose-response relationship was identified: EEN significantly reduced mortality at low (<0.1 µg/kg/min) and medium (0.1-0.3 µg/kg/min) norepinephrine doses but not at high doses (≥0.3 µg/kg/min) [3]. Benefits were seen in transient shock (resolving <24h) but not persistent shock [4]. High-calorie EEN increased gastrointestinal complications, including vomiting (HR 1.89) and bowel ischemia (HR 3.84) [1], while low-calorie feeding (6 kcal/kg/day) reduced these risks [2]. Discussion: The effect of EEN on mortality is highly context-dependent. The lack of benefit in trials like NUTRIREA-2/3 is explained by enrollment of patients on high-dose vasopressors and use of immediate full-dose feeding—a strategy now considered harmful. Observational benefits likely reflect hemodynamic stability at feeding initiation. A safe approach includes starting trophic EEN (6-15 kcal/kg/day) after initial resuscitation when vasopressor doses are stable and ≤0.3 µg/kg/min, with gradual advancement. Conclusion: EEN does not reduce mortality in patients on high-dose vasopressors (≥0.3 µg/kg/min norepinephrine) but may improve survival in those on low-to-moderate doses with transient shock. Clinical practice should shift from rigid timing to hemodynamic-guided, gradual feeding.

What is The Effect of Early Surgical Stabilization of Rib Fractures Compared to Conservative Management on Pain Control and Pulmonary Function in ICU Patients? : A Systematic Review Landong Sijabat; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 40 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/zb5qvt71

Introduction: Rib fractures, especially flail chest and multiple displaced fractures, cause severe pain and respiratory dysfunction, often requiring ICU admission. The optimal management—early surgical stabilization (SSRF) versus conservative treatment—remains debated. Methods: This systematic review synthesized 80 studies (RCTs, etc) comparing early SSRF (≤72 hours) to conservative management in adult ICU patients with rib fractures. Outcomes focused on pain control, pulmonary function, and clinical endpoints. Results: Early SSRF significantly reduced pain scores at 2 weeks (NPS 2.9 vs. 4.5, p<0.01) [1] and lowered opioid requirements (155 vs. 246 morphine milliequivalents, p<0.001) [3]. Pulmonary benefits included shorter mechanical ventilation (mean difference -4.52 days) [4], reduced pneumonia (RR 0.57) [11], and fewer tracheostomies (OR 0.25) [4]. ICU stay decreased by ~4 days [8], and mortality improved (OR 0.3) [8]. Early intervention (≤72h) was superior to delayed surgery [21,25]. Benefits were most pronounced in flail chest, elderly, and mechanically ventilated patients [13,14,43]. Discussion: SSRF provides rapid pain relief, improves respiratory mechanics, and reduces complications, but outcomes depend on timing, patient selection, and injury pattern. Heterogeneity exists, with non-flail fractures showing less consistent benefit [19]. Conclusion: Early SSRF (within 72 hours) significantly improves pain, pulmonary function, and survival in high-risk ICU patients with severe rib fractures. Delayed surgery loses advantage. Future RCTs should standardize timing and subgroups.

The Association between Early Enteral Nutrition and Patient Mortality in the ICU : A Systematic Review Mohamad Fadli; Hendandy Driya Pamungkas
The International Journal of Medical Science and Health Research Vol. 41 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: 10.70070/5nqxbh37

Introduction: Early enteral nutrition (EEN) is recommended in critical care, yet its association with mortality remains debated due to heterogeneous evidence across populations and comparators. This systematic review aims to evaluate the association between EEN and mortality in adult ICU patients, identify condition-specific effects, and determine factors modifying this relationship. Methods: A systematic review was conducted on 80 studies including randomized controlled trials, etc examining EEN (initiation within 24-48 hours of ICU admission) compared with delayed EN, parenteral nutrition (PN), or standard care in adult ICU patients. Mortality outcomes were extracted alongside population characteristics, comparators, and effect modifiers. Results: In general ICU populations, large RCTs (CALORIES, n=2400; NUTRIREA-2, n=2410) found no mortality difference between early EN and early PN (RR 0.97, p=0.57; 37% vs 35%, p=0.33). However, meta-analyses comparing EEN specifically against delayed EN demonstrated significant mortality reduction (OR 0.45, 95% CI 0.21-0.95, p=0.038). Condition-specific benefits emerged: sepsis (OR 0.59, 95% CI 0.37-0.94, p=0.03), burns (OR 0.36, 95% CI 0.18-0.72, p=0.003), traumatic brain injury (RR 0.35, 95% CI 0.24-0.50), and severe acute pancreatitis (aOR 0.44, 95% CI 0.20-0.96). Hemodynamic status significantly modified effects: EEN benefited patients with transient or low-to-moderate vasopressor requirements but not those with persistent severe shock (OR 1.28, p=0.485). Methodological quality assessment revealed that positive findings were predominantly from smaller, higher-bias trials. Discussion: The mortality association with EEN is comparator-dependent and population-specific. When compared with early PN, EEN shows no survival advantage, indicating the route of early nutrition is less critical than timely nutritional delivery. Conversely, EEN reduces mortality compared with delayed EN, supporting early initiation over delayed strategies. Biological plausibility is supported by immune modulation (Th17/Treg regulation), reduced infectious complications, and gut barrier preservation. Hemodynamic stability represents a critical treatment effect modifier, with benefits confined to resolving or moderate shock. Conclusion: EEN is associated with reduced mortality compared to delayed EN in specific ICU populations including sepsis, burns, traumatic brain injury, and severe acute pancreatitis, but not when compared with early PN in general ICU populations. Hemodynamic status should guide clinical decision-making. Future research should prioritize large, low-bias trials in stratified populations.

A Comprehensive Systematic Review of The Association between High-Protein Diet and Body Composition in Obese Patients Mohamad Fadli; Hendandy Driya Pamungkas
The International Journal of Medical Science and Health Research Vol. 41 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/ps95av64

Introduction: Obesity is a global health concern associated with adverse metabolic outcomes. High-protein diets (HPD) are increasingly utilized for weight management, but their specific effects on body composition in obese populations require comprehensive evaluation. This systematic review aims to synthesize evidence from randomized controlled trials examining the association between HPD and body composition changes in obese adults. Methods: A systematic review of randomized controlled trials, etc published up to 2024 was conducted. Studies included obese adults (BMI ≥30 kg/m²) comparing HPD (≥1.2 g/kg body weight/day or >20% total energy from protein) with standard-protein diets. Primary outcomes included changes in total body weight, fat mass, lean body mass, and regional adiposity. Data were extracted on protein intervention details, comparison groups, population characteristics, and outcome measurements. Results: Eighty studies comprising over 4,300 participants were included. HPD produced significantly greater weight loss (additional 0.67 kg; 95% CI: -0.23, -0.03) and fat mass reduction (additional 0.57 kg; 95% CI: -0.24, -0.04) compared to standard-protein diets (1,64). Lean mass preservation favored HPD (0.43 kg; 95% CI: 0.09-0.78) (2). Visceral and trunk fat reductions were consistently greater with HPD, particularly in individuals with elevated triglycerides (5,8). Protein intake exceeding 1.3 g/kg/day was associated with muscle mass preservation, while intakes below 1.0 g/kg/day increased muscle loss risk (9). Combining HPD with resistance exercise produced superior outcomes (6,7). Sex-specific responses were observed, with men losing more trunk fat and women more subcutaneous fat (20,27). Genetic variants (FTO, TFAP2B) modulated individual responses (3,73). Discussion: HPD confer modest but clinically meaningful benefits for body composition during energy restriction, primarily through enhanced fat loss and preferential visceral adipose tissue reduction. Lean mass preservation depends on achieving adequate protein thresholds (>1.3 g/kg/day), even protein distribution across meals (≥30 g/meal), and concurrent resistance exercise. Metabolic status, age, and genetic factors influence individual responses. Long-term adherence remains challenging, with protein intakes converging between groups over 12-24 months. Conclusion: High-protein diets (1.2-1.6 g/kg/day or 25-35% total energy) are effective for improving body composition in obese adults, particularly when combined with resistance exercise and structured meal plans. Future research should focus on personalized approaches based on genetic and metabolic phenotypes.

Is there a relationship between anti-Mullerian hormone (AMH) levels and the prediction of ovarian reserve in reproductive-age women undergoing fertility evaluation? : A Systematic Review Rizky Febriansyah; Bangar Parlinggoman Tua; Mutia Juliana; Aditya Rifandi Zaenudin
The International Journal of Medical Science and Health Research Vol. 41 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/n2fhkv25

Introduction: Accurate assessment of ovarian reserve is crucial for counseling women undergoing fertility evaluation. Anti-Müllerian hormone (AMH) has emerged as a promising biomarker, yet its predictive value for ovarian reserve in reproductive-age women requires systematic evaluation. This systematic review aims to determine the relationship between AMH levels and ovarian reserve prediction in reproductive-age women undergoing fertility assessment. Methods: A systematic review of 80 studies involving reproductive-age women (18-45 years) undergoing fertility evaluation was conducted. Studies were included if they measured serum AMH levels, assessed ovarian reserve through validated markers (antral follicle count [AFC], ovarian volume, response to stimulation), and examined their correlation. Data extraction encompassed AMH measurement protocols, ovarian reserve assessment methods, statistical relationships, and confounding factors. Results: AMH demonstrated consistently strong correlations with AFC across studies (r=0.48-0.89), with the strongest correlations observed with histological primordial follicle count (ρ=0.75). For predicting poor ovarian response, AMH showed excellent discriminatory ability (AUC 0.75-0.93), with cutoff values ranging from 0.7-1.37 ng/mL across different assays. AMH outperformed traditional markers including basal FSH and demonstrated superior reproducibility (ICC=0.89) compared to AFC (ICC=0.73). Age-stratified analyses revealed that in women >35 years, AMH (AUC=0.858) significantly outperformed AFC (AUC=0.675) in predicting suboptimal response. For high response prediction, AMH achieved AUC values of 0.81-0.91. However, AMH's predictive ability for pregnancy outcomes was more modest (AUC 0.56-0.63), operating primarily through oocyte quantity rather than quality. Discordance between AMH and AFC occurred in approximately 20% of women, increasing with age. Discussion: AMH consistently demonstrates strong correlation with ovarian reserve markers, particularly AFC, and shows excellent predictive accuracy for extremes of ovarian response in assisted reproduction. Its superior reproducibility and age-dependent performance—especially superior to AFC in women over 35 years—support its role as a primary ovarian reserve marker. However, significant heterogeneity exists due to assay platforms, population characteristics, and outcome definitions. The biological variability and assay-specific differences necessitate platform-specific reference ranges. Conclusion: AMH is a reliable predictor of ovarian reserve in reproductive-age women undergoing fertility evaluation, with strongest performance for quantitative outcomes and extremes of response. Clinical implementation requires standardized assays, age-specific interpretation, and recognition that AMH predicts oocyte quantity rather than quality. Future research should focus on assay standardization, population-specific thresholds, and integration with other clinical parameters.

How does maternal occupation (specifically exposure to work stress and long working hours) affect the risk of low birth weight infants? : A Systematic Review Rizky Febriansyah; Bangar Parlinggoman Tua; Mutia Juliana; Aditya Rifandi Zaenudin
The International Journal of Medical Science and Health Research Vol. 41 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/achsm516

Introduction: Maternal employment during pregnancy is increasingly common, yet the impact of work-related stress and long working hours on low birth weight (LBW) remains inconclusive. This systematic review synthesizes evidence from observational studies examining associations between maternal occupational exposures—specifically psychosocial work stress, job strain, and long working hours—and the risk of LBW infants. Methods: A systematic review of 17 sources published to 2025 was conducted. Studies were included if they examined employed pregnant women, assessed work-related stress or working hours, reported LBW (<2500g) as an outcome, and provided quantitative data. Data extraction covered work exposures, population characteristics, LBW outcomes, related pregnancy outcomes, study design, confounders, and dose-response evidence. Results: Long working hours (>40 h/week) were associated with significantly increased odds of LBW in the largest meta-analysis (OR 1.43, 95% CI 1.11–1.84), though other reviews found no significant association. Psychosocial work stress showed non-significant association with dichotomous LBW (OR 2.30, 95% CI 0.70–7.60) but significantly reduced mean birthweight by 77 grams (95% CI −121.18 to −33.01). Physically demanding work demonstrated consistent association with small-for-gestational-age infants (OR 1.37, 95% CI 1.30–1.44). Preterm delivery showed modest associations with long hours (OR 1.16–1.21) and shift work (OR 1.13–1.21). Dose-response evidence was limited, though declining effort-reward imbalance across pregnancy was associated with 408 g higher birthweight. Discussion: The evidence is heterogeneous, with effect estimates moderated by exposure specificity, study quality, and outcome measurement. Psychosocial stress affects continuous birthweight more consistently than dichotomous LBW, suggesting mechanistic pathways through neuroendocrine disruption of placental perfusion. Long working hours operate primarily through preterm delivery rather than fetal growth restriction. Higher-quality studies yield smaller estimates, and confounding control remains inadequate. Conclusion: Maternal work stress and long hours are associated with modest but significant reductions in birthweight and increased preterm delivery risk. However, certainty is low due to observational designs and heterogeneity. Future research requires prospective designs with repeated exposure measures, adequate confounding control, and standardized outcomes.

Does the use of hormonal contraception increase the risk of breast cancer in women of reproductive age (15-49 years)? : A Systematic Review Rizky Febriansyah; Bangar Parlinggoman Tua; Mutia Juliana; Aditya Rifandi Zaenudin
The International Journal of Medical Science and Health Research Vol. 41 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/j9g4dc43

Introduction: Hormonal contraception is widely used by women of reproductive age worldwide, yet concerns persist regarding its potential association with breast cancer risk. Despite numerous studies, heterogeneity in findings across populations and contraceptive types has created uncertainty for clinicians and users. This systematic review aims to evaluate the relationship between hormonal contraceptive use and breast cancer risk in women aged 15-49 years, examining variations by contraceptive type, duration, formulation, and population characteristics. Methods: A systematic review was conducted of 80 studies examining hormonal contraception and breast cancer risk in reproductive-age women. Included studies comprised cohort studies, etc. Data were extracted on study design, population characteristics, contraceptive type and duration, breast cancer outcomes, risk measures, and effect modifiers. Studies were assessed for methodological quality and risk of bias. Results: Large prospective cohort studies demonstrated consistently increased breast cancer risk with current or recent hormonal contraceptive use (relative risks 1.20-1.33) (1,3,5). Risk varied by formulation: triphasic levonorgestrel (RR=3.05) (3), high-dose estrogen (OR=2.7) (8), and ethynodiol diacetate (OR=2.6) (8) showed strongest associations, while low-dose formulations showed minimal risk (OR=1.0) (7). Duration-response relationships were evident, with risk increasing from 1.09 for <1 year to 1.38 for >10 years use (1). Progestogen-only methods showed comparable risks: oral (OR=1.26), injectable (OR=1.25), and levonorgestrel-IUD (OR=1.32) (10). Risk dissipated within 5-15 years after cessation (12,13). Absolute excess risks were age-dependent: 8 per 100,000 women-years for ages 16-20 versus 265 per 100,000 for ages 35-39 (2). Southeast Asian studies reported higher odds ratios (2.66-9.06) (17-19), likely reflecting methodological differences rather than true population variation. Discussion: The evidence supports a modest, transient increase in breast cancer risk with hormonal contraceptive use that varies substantially by formulation, duration, and age. Contemporary low-dose formulations confer minimal risk. The rapid risk dissipation after cessation suggests a promotional rather than initiating mechanism. Absolute risks remain small, particularly for women under 35 years, and must be balanced against the established benefits of pregnancy prevention and non-contraceptive health benefits. Conclusion: Hormonal contraception is associated with a small increased risk of breast cancer during use that declines after cessation. Formulation-specific differences exist, with contemporary low-dose preparations demonstrating the most favorable risk profile. Clinicians should provide individualized counseling considering age, contraceptive needs, and risk factors, emphasizing that absolute risks are minimal for most reproductive-age women.

Is there an association between ultra-processed food consumption and ovarian cancer risk in women? : A Systematic Review Amanda Ezra Natasya Napitupulu; Jenary Immanuel Surbakti
The International Journal of Medical Science and Health Research Vol. 41 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/p2g9ps32

Introduction: Ultra-processed foods (UPF) have been implicated in chronic disease development, but their association with ovarian cancer—a leading cause of gynecologic cancer mortality—requires systematic evaluation. This review examines evidence linking UPF consumption to ovarian cancer risk. Methods: We systematically reviewed observational studies assessing UPF consumption (using NOVA classification or quantitative methods) and ovarian cancer incidence or mortality in adult women. Nine studies met inclusion criteria. Results: The UK Biobank prospective cohort (197,426 participants; 143 ovarian cancer cases; 9.8 years follow-up) demonstrated significant positive associations between UPF consumption and ovarian cancer incidence (HR 1.19 per 10% increment; 95% CI: 1.08–1.30; p<0.001) and mortality (HR 1.30; 95% CI: 1.13–1.50). Supporting evidence from case-control studies showed preserved foods consumption (>13.5 g/day) was associated with 78% increased odds of epithelial ovarian cancer (OR 1.78; 95% CI: 1.35–2.34), while a "meat and fat" dietary pattern was associated with 2.5-fold increased risk (OR 2.49; 95% CI: 1.75–3.55). Brazilian cross-sectional studies identified UPF consumption among ovarian cancer survivors, particularly those under 40 years. Discussion: The positive association observed in the UK Biobank persisted after adjustment for multiple confounders including age, BMI, reproductive factors, and socioeconomic status. The consistency across different dietary exposures—UPF, preserved foods, and high-fat dietary patterns—suggests that processed and energy-dense foods may contribute to ovarian carcinogenesis through multiple pathways, potentially including inflammation, insulin resistance, and endocrine disruption. BMI adjustment in the Kolahdooz study strengthened the observed association, indicating mechanisms independent of adiposity. Conclusion: Evidence supports a positive association between consumption of ultra-processed and processed foods and increased ovarian cancer risk. Further research should identify specific UPF subgroups and vulnerable populations.

How does primary debulking surgery compared to neoadjuvant chemotherapy followed by interval debulking surgery affect overall survival in women with advanced ovarian cancer? : A Systematic Review Amanda Ezra Natasya Napitupulu; Jenary Immanuel Surbakti
The International Journal of Medical Science and Health Research Vol. 42 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/zrxd4092

Introduction: Advanced epithelial ovarian cancer (stage III-IV) remains a leading cause of gynecologic cancer mortality worldwide. The optimal initial treatment approach—primary debulking surgery (PDS) versus neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS)—continues to generate substantial clinical debate despite multiple randomized trials. This systematic review aims to compare overall survival outcomes between PDS and NACT-IDS in women with advanced ovarian cancer. Methods: A systematic review was conducted following PRISMA guidelines. We screened studies based on predefined criteria: inclusion of women ≥18 years with FIGO stage III-IV epithelial ovarian cancer, direct comparison of PDS versus NACT-IDS, reporting of overall survival outcomes, and study designs including randomized controlled trials, cohort studies, systematic reviews, and meta-analyses. Data extraction encompassed study characteristics, patient selection criteria, treatment details, survival outcomes, surgical outcomes, and subgroup analyses. Results: Eighty studies were included, comprising five major RCTs (EORTC 55971, CHORUS, SCORPION, JCOG0602, TRUST) and numerous meta-analyses and observational studies. Meta-analyses demonstrated no significant difference in overall survival between PDS and NACT-IDS (HR 0.96, 95% CI 0.86-1.08) [1-3]. Individual RCTs confirmed similar findings: EORTC 55971 (HR 0.98, 90% CI 0.84-1.13) [4], CHORUS (HR 0.87, 95% CI 0.72-1.05) [5], and TRUST (HR 0.89, 95% CI 0.74-1.08) [6]. However, NACT-IDS achieved superior complete cytoreduction rates (RR 2.34, 95% CI 1.48-3.71) [2] with significantly lower perioperative mortality (RR 0.16, 95% CI 0.06-0.46) and major complications (RR 0.22, 95% CI 0.13-0.38) [1]. Observational studies consistently favored PDS, reflecting selection bias [7,8]. Stage-specific analysis revealed NACT-IDS benefited stage IV disease (HR 0.76, 95% CI 0.58-1.00) [9], while PDS showed advantage in stage III with limited metastatic burden [6,8]. Discussion: The apparent contradiction between RCT and observational evidence reflects fundamental differences in patient selection, surgical quality, and study design. Complete cytoreduction at PDS identifies a biologically favorable subset with superior outcomes, whereas achieving complete resection after NACT may indicate chemotherapy responsiveness without equivalent survival benefit. NACT-IDS offers clear perioperative safety advantages, making it preferable for unresectable disease, poor performance status, and extensive stage IV disease. Optimal treatment selection requires accurate preoperative assessment of resectability, patient fitness, and surgical expertise. Conclusion: PDS and NACT-IDS provide comparable overall survival in advanced ovarian cancer when patients are appropriately selected. PDS remains preferred when complete cytoreduction is achievable by experienced surgeons in fit patients with stage IIIC disease. NACT-IDS is a safe, effective alternative for patients with unresectable disease, poor fitness, or extensive stage IV disease. Future research should focus on validated prediction models incorporating clinical, imaging, and molecular markers to optimize individualized treatment selection.

What is the diagnostic accuracy of different clinical diagnostic criteria (Rotterdam, NIH, and Androgen Excess Society) for identifying polycystic ovary syndrome in women of reproductive age? : A Systematic Review Amanda Ezra Natasya Napitupulu; Jenary Immanuel Surbakti
The International Journal of Medical Science and Health Research Vol. 42 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/ehpn3k33

Introduction: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting women of reproductive age, with multiple diagnostic criteria currently in use including Rotterdam, NIH, and AES criteria. However, the diagnostic accuracy of these criteria remains variable across populations. This systematic review aimed to evaluate and compare the diagnostic accuracy of different clinical diagnostic criteria for identifying PCOS in reproductive-age women. Methods: A systematic review of diagnostic accuracy studies was conducted. Studies were included if they evaluated at least one of the three specified diagnostic criteria (Rotterdam, NIH, or AES) against a reference standard in women of reproductive age (15-45 years). Diagnostic accuracy measures including sensitivity, specificity, and area under the ROC curve (AUC) were extracted. The quality of included studies was assessed using appropriate diagnostic accuracy assessment tools. Results: Eighty studies encompassing diverse populations across North America, Europe, Asia, Africa, and the Middle East were included. The Rotterdam criteria demonstrated strong diagnostic utility with follicle number per ovary showing the highest accuracy (sensitivity 84%, specificity 91%, AUC 0.905). NIH criteria identified fewer women (27.1% prevalence) compared to Rotterdam (40%) and showed an AUC of 0.80 for AMH as a diagnostic marker. AES criteria yielded intermediate prevalence (29.3%) with AMH sensitivity of 84.4% and specificity of 72% (AUC 0.857). Anti-Müllerian hormone emerged as a promising biomarker with age-specific thresholds ranging from 5.7 ng/mL (20-27 years) to 3.72 ng/mL (35-40 years). Replacing PCOM with AMH in Rotterdam criteria improved diagnostic accuracy (AUC 0.934-0.97). Significant geographic and ethnic variations in optimal thresholds were observed. Discussion: The Rotterdam criteria demonstrate superior sensitivity but may overdiagnose milder phenotypes, while NIH criteria identify metabolically high-risk women with greater specificity. AES criteria provide an intermediate approach emphasizing androgen excess. Age-stratified and population-specific thresholds are essential for optimal diagnostic accuracy. AMH shows promise as an objective alternative to ultrasound assessment of PCOM. Conclusion: No single diagnostic criterion is universally optimal; the choice of criteria should be guided by clinical context, population characteristics, and available resources. Age-stratified and population-specific thresholds, particularly for AMH and ultrasound parameters, are recommended to improve diagnostic accuracy.

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Indra Hadi

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profesionaljournalmedicine@gmail.com

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

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Kota adm. jakarta selatan,

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INDONESIA