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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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Identification of Risk Factors for Urinary Tract Stones in Rural Populations : A Systematic Review Vachroul Rauzi; Dinda Pebriani Simbolon; Heri Setiawan; Yuni Agnes Lubis; Nasribar
The International Journal of Medical Science and Health Research Vol. 45 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/kaw8nv91

Introduction: Urinary tract stones (UTS) are a growing global health concern, yet risk factors in rural populations remain poorly synthesized due to distinct environmental, occupational, and dietary exposures. This systematic review identifies significant risk factors for UTS specifically in rural settings. Methods: A systematic review of 80 studies (RCT, etc) from global databases was conducted. Studies were included if they reported on rural populations or provided separate rural subgroup analyses for UTS risk factors. Results: Key positive risk factors identified include: male sex (male-to-female ratio up to 10.5:1 in endemic pediatric bladder stone disease) (2,3); family history (OR=16.98, 95%CI:3.02-95.25) (9); low fluid intake (OR=2.64, 95%CI:2.00-3.48) (6); red meat consumption (OR=32.28, 95%CI:9.7-143.2) (9); high sodium (OR=1.88) (6); obesity (OR=2.36) (6); diabetes (OR=1.68) (4); hypertension (OR=2.04) (4); ambient temperature (10% increased risk per 5°C) (7); occupational heat exposure (ninefold risk) (8); cadmium exposure (RR=1.07 per 1.0 µg/L urinary cadmium) (12); and phthalate exposure (13). Hypocitraturia (91.3% prevalence) and hypercalciuria (68.5%) were the most common metabolic abnormalities in rural stone formers (5). Distinct rural stone types include ammonium urate (endemic bladder stones in South Asian children) (2) and struvite (infection-related). Discussion: Rural UTS risk operates via three distinct pathways: 1) poverty-driven endemic disease (protein deficiency, dehydration, infection) producing ammonium urate stones; 2) adult calcium oxalate disease driven by nutritional transition (metabolic syndrome, high animal protein, low fluid intake); and 3) environmental toxicant-related disease (cadmium, phthalates) from agricultural/industrial exposures. Healthcare access barriers delay diagnosis, increasing stone burden at presentation (14). Conclusion: Rural populations face unique, amplified UTS risk factors requiring context-specific interventions: ensuring potable water access at worksites, dietary protein supplementation in endemic bladder stone regions, metabolic syndrome management, and environmental remediation of heavy metals.

Diagnosis and Management of Eye Trauma in Primary Care Settings : A Systematic Review Dinda Pebriani Simbolon; Vachroul Rauzi; Yuni Agnes Lubis
The International Journal of Medical Science and Health Research Vol. 45 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/zkdmv147

Introduction: Eye trauma is a common presentation in primary care and emergency settings, yet guidance tailored to non-ophthalmologists remains fragmented. This review synthesises evidence on diagnosis, management, and triage of eye trauma to support primary care practitioners. Methods: A systematic review of 80 studies (2006–2026) including RCTs, etc. Populations included all ages with acute eye trauma. Outcomes focused on diagnostic accuracy, treatment efficacy, referral criteria, and visual outcomes. Results: Males predominate (62.8–99.3%) across all injury types. Corneal abrasions are the most common presentation (up to 80%). Topical NSAIDs reduce rescue analgesia (RR 0.46, p<0.01) but do not accelerate healing (1,2,3). Eye patching provides no benefit over no patching (4). Short-term topical tetracaine (24 hours) significantly reduces pain scores (NRS 1 vs 8, Δ7) without increased complications (5). Systemic tranexamic acid reduces secondary haemorrhage in traumatic hyphema (RR 0.31) (6). Point-of-care ultrasonography by non-ophthalmologists achieves 94% sensitivity and specificity for retinal detachment (7,8). Four independent predictors mandate urgent referral: visual acuity change, abnormal pupillary response, retrobulbar haemorrhage, and inability to open the eye (9,10,11). The Ocular Trauma Score correlates strongly with final vision (r=0.93) (12). Discussion: Primary care physicians demonstrate good inter-rater reliability versus ophthalmology when examinations are performed (sensitivity 60.6%, specificity 84.2%) (13). A substantial proportion of eye-related ED visits are non-urgent (39.5–53.5%) (14,15), indicating many cases are suitable for primary care. Cyanoacrylate tissue adhesive for periorbital lacerations in children achieves equivalent healing to sutures with shorter procedure time (184 vs 692 seconds) (16). Protective eyewear reduces firework injuries (OR 0.65) (17), and restrictive legislation reduces eye trauma by 87% (18). Conclusion: Most eye trauma can be managed safely in primary care using structured clinical assessment. Key positive findings include NSAIDs for pain, short-term topical anaesthetics for corneal abrasions, tranexamic acid for hyphema, and POCUS for posterior chamber evaluation. Four clinical predictors reliably identify patients needing urgent referral.

Risk Factors for Surgical Site Infection in Abdominal Surgery : A Systematic Review Fauzi Alhuda; Afina Kamilia; Vivi Yovita
The International Journal of Medical Science and Health Research Vol. 46 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/y2jxnh75

Introduction: Surgical site infection (SSI) remains the most common postoperative complication in abdominal surgery, associated with increased morbidity, mortality, and healthcare costs. Identifying modifiable and non-modifiable risk factors is essential for targeted prevention. Methods: This systematic review synthesized data from 80 studies including RCT, etc across colorectal, gastric, cesarean, bariatric, hysterectomy, ventral hernia, appendectomy, and emergency laparotomy populations. Outcome measures were odds ratios (OR), relative risks (RR), and 95% confidence intervals (CI) for SSI. Results: Patient-related significant positive risk factors included obesity (BMI>30 kg/m², RR=1.60, 95%CI:1.47-1.74) (1), diabetes mellitus (RR=1.65, 95%CI:1.24-2.20) (1), hypoalbuminemia (OR=3.05,95%CI:2.08-4.49) (2), and ASA score ≥3 (RR=1.34,95%CI:1.19-1.51) (1). Perioperative factors with largest effect sizes included operative duration ≥3 hours (OR=8.33,95%CI:3.81-18.20) (2), blood transfusion (RR=2.03,95%CI:1.34-3.06) (1), open versus laparoscopic approach (RR=1.81,95%CI:1.57-2.10) (1), emergency versus elective surgery (RR=1.36,95%CI:1.19-1.55) (1), stoma formation (RR=1.89,95%CI:1.28-2.78) (1), and contaminated/dirty wound class (OR=4.5,95%CI:1.8-11.5) (4). Protective interventions included oral+IV antibiotics (RR=0.47,95%CI:0.40-0.56) (6), wound edge protectors in contaminated cases (RR=0.44,95%CI:0.28-0.67) (15), glove/instrument change before closure (aRR=0.87,95%CI:0.79-0.95,p=0.0032) (70), and triclosan-coated sutures (OR=0.84,95%CI:0.75-0.93) (50). High FiO₂ showed benefit only when mean BMI<30 and diabetic prevalence<20% (19). Discussion: Operative duration is the single most potent risk factor, possibly aggregating multiple mechanisms. Obesity-diabetes interactions attenuate supplemental oxygen benefits. Bundle RCTs paradoxically showed harm or no benefit, contrasting with observational data. Conclusion: SSI risk in abdominal surgery is driven by obesity, diabetes, prolonged operation, open approach, emergency status, and contamination. Prevention should prioritize antibiotic optimization, minimally invasive techniques, and contamination-reducing intraoperative maneuvers.

The Relationship between Radiotherapy and Cognitive Impairment in Brain Tumor Patients : A Systematic Review Ahmad Dalma Haidar; Arda Fatkhul Khoiriyah
The International Journal of Medical Science and Health Research Vol. 46 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/nazfmm24

Introduction: Radiotherapy (RT) is a cornerstone in treating brain tumors but is associated with potential cognitive decline. The relationship between RT and cognitive impairment is complex, influenced by tumor type, RT modality, and patient-specific factors. Methods: This systematic review synthesized data from 80 included studies encompassing a broad range of designs, from randomized controlled trials, etc. We extracted data on patient populations, RT details (whole-brain radiotherapy [WBRT], stereotactic radiosurgery [SRS], proton therapy), cognitive assessment methods, outcomes, dose-response relationships, underlying mechanisms, risk factors, and prevention strategies. Results: WBRT produced the most severe cognitive decline, with 91.7% of patients experiencing deterioration at 3 months compared to 63.5% with SRS alone (P. Brown et al., 2016). SRS-based approaches resulted in substantially less cognitive morbidity. Hippocampal-avoidance (HA)-WBRT significantly reduced cognitive failure (adjusted HR=0.74, p=0.016) (Crockett & Simões, 2023). Mean brain dose inversely predicted cognitive trajectories in IDH-mutant glioma (Jaspers et al., 2024). Key mechanisms include vascular injury, white matter damage, neuroinflammation, and oxidative stress. Risk factors include older age, low cognitive reserve, and pre-existing leukoencephalopathy. Discussion: The findings reveal a consistent hierarchy of cognitive toxicity: WBRT > SRS > focal/partial brain RT. A central tension exists between maximizing tumor control (achieved by WBRT) and preserving cognition (achieved by SRS and hippocampal sparing). Distinguishing tumor-related from treatment-related cognitive effects remains a key challenge, as baseline impairment is highly prevalent. Dose-response relationships are structure-specific, implicating the hippocampus, entorhinal cortex, thalamus, and white matter tracts. Neuroprotective strategies, including memantine and HA-WBRT, show benefit, while donepezil offers modest improvements. Conclusion: Modern RT protocols should prioritize cognitive preservation through appropriate modality selection (SRS alone for 1-3 metastases), hippocampal avoidance, and minimizing mean brain dose. Future research should focus on integrating cognitive endpoints into clinical trial design and validating dosimetric constraints for distributed brain structures.

Recurrent Ureteral Obstruction Revealing Malignant Lymphoma in a Young Adult : A Case Report Faathira Amalika Dewinadira Yusna; Abdul Malik Yusuf
The International Journal of Medical Science and Health Research Vol. 46 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: 10.70070/9dqk1120

Introduction Extranodal presentations of malignant lymphoma represent a significant diagnostic challenge for clinicians, as they frequently mimic more common organ-specific pathologies. While the lymphatic system is the primary origin of these neoplasms, approximately 25% to 40% of Non-Hodgkin Lymphoma (NHL) cases originate in extranodal sites.1 Genitourinary (GU) tract involvement is particularly rare, accounting for less than 5% of all primary extranodal lymphomas.4 Among GU involvements, prostatic and ureteral infiltrations are exceedingly uncommon, often manifesting as non-specific lower urinary tract symptoms (LUTS) or acute renal failure due to obstructive uropathy.6 In young adults, the diagnosis of malignant ureteral obstruction (MUO) is often delayed because medical attention initially focuses on metabolic urolithiasis or congenital anatomical anomalies.9 Case Illustration A 27-year-old male presented with a history of a neck tumor excision in 2022, which initially suggested Hodgkin Lymphoma (HL) or a Giant Cell Soft Tissue Tumor. Due to the patient’s refusal of systemic chemotherapy, the disease progressed over three years. In June 2025, he presented with acute-on-chronic kidney injury (AKI/CKD) and bilateral hydronephrosis. Endoscopic evaluation through ureterorenoscopy (URS) revealed no lithiasis but identified significant bilateral ureteral stiffness and strictures. Despite temporary stabilization with double-J (DJ) stents, the patient experienced recurrent obstruction within two months. Subsequent transurethral resection of the prostate (TURP) and ureteral evaluation revealed widespread mural infiltration. Histopathology and immunohistochemistry (IHC) confirmed a malignant tumor suggestive of lymphoma, with leukocyte common antigen (LCA) and CD20 positivity. Further staging identified systemic lymphadenopathy, chylothorax, and sclerotic/lytic spinal metastases at the C1, C4, and TH3 levels. The patient eventually succumbed to complications of uremic encephalopathy and disseminated disease. Discussion The diagnostic hallmark of this case was the "stiff ureter" sign observed during endoscopy, indicating direct mural infiltration of neoplastic cells rather than simple extrinsic compression by lymph nodes.8 The clinical progression highlights the deceptive nature of prostatic lymphoma, which often presents with normal prostate-specific antigen (PSA) levels, thus evading traditional screening protocols.7 The case further explores the "gray zone" between Hodgkin Lymphoma and high-grade B-cell Non-Hodgkin Lymphoma, emphasizing the biological continuum and the potential for transformation in inadequately treated patients.16 The role of aggressive surgical biopsy and multidisciplinary management in young adults with idiopathic urological obstruction is critical to prevent the transition from a potentially curable local disease to terminal systemic dissemination.19 Conclusion Heightened clinical suspicion for lymphoma must be maintained in young adults presenting with recurrent, rigid ureteral obstruction of unknown etiology. Early tissue sampling via TURP or URS is mandatory to differentiate rare secondary lymphomas from primary urothelial carcinomas. Comprehensive management requires a synergy between urology, nephrology for renal replacement therapy, and hematology-oncology for tailored chemotherapy protocols.19

Effectiveness of Probiotim and Mecobalamin Supplementation as an Adjuvant Therapy for Acute Stroke: A Quasi-Experimental Study ST Nur Indah Sari HS; Nurhikmah; Anita Amir
The International Journal of Medical Science and Health Research Vol. 46 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: 10.70070/8c7sx652

Introduction: Acute stroke is a leading cause of mortality and long-term disability worldwide. Beyond standard reperfusion and pharmacological therapies, adjuvant strategies targeting neuroinflammation and neural regeneration are crucial. This study aimed to evaluate the effectiveness of combining Probiotim (a probiotic immunomodulator) and Mecobalamin (an active form of vitamin B12) compared to Mecobalamin alone as an adjuvant therapy for acute stroke patients. Methods: A quasi-experimental study with a pre-test and post-test control group design was conducted at the Stroke Unit of Latemmamala Hospital, Soppeng, from October to December 2025. Ten acute ischemic stroke patients (<72 hours onset) were recruited using consecutive sampling and divided into two groups (n=5 each): an intervention group (Probiotim + Mecobalamin + standard therapy) and a control group (Mecobalamin + standard therapy). Neurological improvement and functional outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS) and Barthel Index at baseline and after 7-14 days of intervention. Data were analyzed using descriptive statistics and the Mann-Whitney U test due to non-normal distribution. Results: Both groups showed clinical improvement. In the intervention group, 40% of patients achieved mild dependence (Barthel Index) and 30% had moderate stroke (NIHSS-out), while in the control group, 30% achieved mild dependence and 20% had mild stroke (NIHSS-out). However, the Mann-Whitney U test revealed no statistically significant differences between the two groups for the Barthel Index (p = 0.439), NIHSS admission scores (p = 0.811), or NIHSS discharge scores (p = 0.729). No adverse events were reported in either group. Discussion: The lack of significant difference suggests that adding Probiotim to Mecobalamin did not provide superior short-term neurological recovery compared to Mecobalamin alone. This may be attributed to the small sample size (n=10), short intervention duration insufficient for probiotic gut colonization, the dominant and rapid neuroregenerative effect of Mecobalamin received by both groups, and the relatively mild baseline stroke severity. While Mecobalamin's neuroprotective role is supported by theory, the synergistic effect of probiotics through the gut-brain axis was not captured within the study's limitations. Conclusion: Both Probiotim+Mecobalamin and Mecobalamin alone are safe and associated with neurological improvement in acute stroke patients. However, the combination did not demonstrate statistically significant additional benefits over Mecobalamin alone for short-term outcomes. Larger, longer-term studies with a placebo-only control group and microbiome analysis are needed.

Analysis of Lipid Profile as a Risk Factor for Ischemic Stroke Incidence : A Systematic Review Febriana Intan Diatri
The International Journal of Medical Science and Health Research Vol. 46 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: 10.70070/3q6z2w63

Background: Ischemic stroke (IS) is a leading cause of death and disability worldwide, with a complex and incompletely understood relationship with lipid parameters. Unlike coronary heart disease, the association between lipids and IS shows heterogeneity across subtypes and populations. Methods: This systematic review synthesized evidence from 80 sources, including RCT, etc. We focused on studies reporting quantitative associations between lipid profile components and IS incidence, emphasizing statistically significant positive risk factors. Results: Genetically determined LDL-C showed a modest causal effect on IS (OR 1.09, 95% CI 1.07-1.12) (1), but this was driven entirely by the large artery atherosclerosis (LAA) subtype (OR 0.75 for lower LDL-C) with null effects on cardioembolic and small vessel stroke (3). Observational data confirmed increased IS risk with elevated LDL-C (HR up to 1.74) (20) and non-HDL-C (HR 2.45) (20). HDL-C demonstrated a U-shaped relationship, with both low (HR 1.29) and very high levels (HR 1.84) increasing risk (4). Lipoprotein(a) [Lp(a)] was a significant observational risk factor (RR 1.29 per 1SD) (7) and for stroke recurrence (OR 1.69) (47), though MR evidence was weaker (1). The triglyceride-glucose (TyG) index (HR up to 2.21) (11) and atherogenic index of plasma (AIP) (HR 1.12) (10) showed strong, significant positive associations. Lp-PLA2 activity was causally linked specifically to LAA stroke (OR 3.25) (15), while oxidized LDL increased both stroke (HR 1.39) and hemorrhagic events (HR 3.61) (14). Omega-3 fatty acids DHA and DPA were protective (HR 0.80 and 0.74, respectively) (12). Discussion: The LDL-C-IS association is real but weaker than for coronary disease due to subtype heterogeneity. HDL-C is a complex marker where particle functionality supersedes total cholesterol. The discordance between observational and MR evidence for Lp(a) suggests conditional causality dependent on inflammatory and lipid milieu. Conclusion: Significant positive risk markers for IS include LDL-C, non-HDL-C, Lp(a), TyG index, AIP, Lp-PLA2 (for LAA), and oxidized LDL. Lipid management for stroke prevention must be subtype-specific and move beyond traditional LDL-C targeting.

Effectiveness of Tele-ophthalmology for Diabetic Retinopathy Screening in Rural Settings : A Systematic Review Arihta Johana Wulandari Ginting; Tria Pertiwi; Fasya Radilia; Theresia Fitri Hakna Sihombing; Indah Purnama
The International Journal of Medical Science and Health Research Vol. 46 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/c97b9262

Introduction: Diabetic retinopathy (DR) is a leading cause of preventable blindness, yet screening rates remain critically low in rural and underserved settings due to limited access to ophthalmologists and logistical barriers. Tele-ophthalmology and artificial intelligence (AI)-based retinal imaging have emerged as potential solutions, but their effectiveness in rural contexts requires systematic evaluation. Methods: This systematic review synthesized evidence from 38 studies, including randomized controlled trials, etc. Studies were included if they evaluated tele-ophthalmology or AI-based DR screening in rural, remote, or underserved populations and reported outcomes related to diagnostic accuracy, screening completion, referral adherence, cost-effectiveness, or implementation factors. Results: Tele-ophthalmology significantly improved screening completion rates, with RCT demonstrating 94% completion in the telemedicine arm versus 56% in traditional surveillance (p<0.001). Referral adherence varied substantially from 13-52% depending on financial and logistical support. Pooled diagnostic sensitivity for referable DR ranged from 0.90-0.95 across tele-ophthalmology and AI modalities, with specificity of 0.81-0.91. Cost-effectiveness analyses consistently favored tele-ophthalmology, with ICERs ranging from cost-saving to $3,328 per QALY in rural settings. Discussion: Tele-ophthalmology effectively addresses the access gap in rural DR screening. AI-based systems offer comparable diagnostic accuracy to human graders with added advantages in speed and immediate feedback, which can improve referral adherence when combined with patient support. However, long-term screening participation tends to decline without sustained engagement strategies. Implementation success depends on reliable infrastructure, task-shifting to non-ophthalmologist staff, and integration with functional referral pathways. Conclusion: Tele-ophthalmology and AI-based screening are effective, accurate, and cost-effective for DR screening in rural settings. Successful programs require concurrent investment in referral infrastructure, patient navigation support, and quality assurance mechanisms. Future implementations should prioritize context-specific validation and sustainable engagement strategies.

Effect of Intravenous Magnesium Sulfate on Postoperative Opioid Consumption : An Update Systematic Review of Randomized Controlled Trial I Gede Agus Rastika; I Komang Adi Kusuma Jaya; I Komang Budi Lastiawan
The International Journal of Medical Science and Health Research Vol. 47 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: 10.70070/4tkc6e58

Introduction: Postoperative pain management frequently relies on opioids, which are associated with significant adverse effects including nausea, vomiting, respiratory depression, and potential for dependence. Intravenous magnesium sulfate, an N-methyl-D-aspartate (NMDA) receptor antagonist, has emerged as a potential non-opioid analgesic adjuvant. This systematic review synthesizes evidence from the last five years on the effect of perioperative intravenous magnesium sulfate on postoperative opioid consumption. Methods: A systematic review of randomized controlled trials (RCTs) published between 2021 and 2025 was conducted. Databases were screened for studies involving adult patients (≥18 years) undergoing surgical procedures, where intravenous magnesium sulfate was administered perioperatively compared to placebo, standard care, or active comparators. The primary outcome was total postoperative opioid consumption. Secondary outcomes included pain scores, postoperative nausea and vomiting (PONV), and adverse effects. Results: Forty-four RCTs encompassing diverse surgical procedures (spinal, gynecological, bariatric, orthopedic, laparoscopic) were included. The vast majority (over 90%) demonstrated that intravenous magnesium sulfate significantly reduced postoperative opioid consumption by approximately 20-50% within the first 24 hours. The most effective regimen was a loading dose of 30-50 mg/kg followed by a maintenance infusion of 10-15 mg/kg/h. Pain scores were significantly reduced primarily in the early postoperative period (0-12 hours). The opioid-sparing effect was most pronounced in procedures with moderate-to-severe baseline pain. One study reported paradoxical increased rescue analgesia using a fixed 3g dose without maintenance infusion. The highest maintenance dose (20 mg/kg/h) caused unacceptable hypotension and bradycardia, establishing 15 mg/kg/h as the upper safe limit. No respiratory depression attributable to magnesium was reported. Discussion: The opioid-sparing effect of magnesium is mechanistically explained by NMDA receptor antagonism, preventing central sensitization and opioid tolerance. The effect size varies with surgical context, baseline multimodal analgesia, and dosing regimen. Weight-based dosing with continuous infusion appears superior to fixed single boluses. The benefit attenuates by 48 hours, suggesting prolonged infusion may extend analgesia. The safety profile is favorable at standard doses. Conclusion: Intravenous magnesium sulfate at doses of 30-50 mg/kg loading and 10-15 mg/kg/h maintenance consistently reduces postoperative opioid consumption by 20-50% with a favorable safety profile. It is most beneficial in surgeries with expected moderate-to-severe pain and should be considered part of multimodal analgesia, particularly when minimizing opioid exposure is desirable.

A Preventable Cascade: Severe Acute Malnutrition and Bilateral Pneumonia in a Young Infant with Unrecognized Feeding Dysfunction due to Labiopalatoschizis Aulia Dyanaputri; Cempaka Kesumaningtyas
The International Journal of Medical Science and Health Research Vol. 47 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/enp6pg91

Introduction: Severe acute malnutrition and pneumonia remain leading contributors to infant morbidity and mortality, particularly in resource-limited settings. Infants with cleft lip and palate are at risk of feeding dysfunction, which may precipitate nutritional decline if not promptly recognized. Case Illustration: A 1-month-26-day-old male infant with complete unilateral labiopalatoschizis presented with progressive shortness of breath and hypoxemia. Anthropometry revealed weight-for-age, length-for-age, and weight-for-length below –3 SD, consistent with severe acute malnutrition of the marasmic type. Feeding history demonstrated inadequate intake and frequent choking without structured feeding modification. Laboratory findings showed anemia and leukocytosis, and chest radiography confirmed bilateral pneumonia. Management included oxygen therapy, intravenous antibiotics, and phased nutritional rehabilitation via orogastric feeding. Discussion: This case illustrates a preventable cascade in which structural feeding impairment led to chronic caloric insufficiency, immune compromise, and severe respiratory infection. The interaction between malnutrition and pneumonia amplified clinical severity. Early feeding counseling and routine growth monitoring might have prevented progression to severe wasting and infection. Conclusion: Infants with labiopalatoschizis require early structured feeding support and close nutritional surveillance to prevent severe acute malnutrition and life-threatening complications such as pneumonia.

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

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