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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 608 Documents

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The Association Between Teleradiology Accuracy and the Speed of Stroke Diagnosis in Remote Areas: A Systematic Review of Randomized Controlled Trials and Primary Studies Novita Lusiana
The International Journal of Medical Science and Health Research Vol. 48 No. 3 (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: 10.70070/79p7t834

Background: Stroke is a leading cause of mortality and disability worldwide, with time-to-diagnosis being a critical determinant of functional outcomes. In remote and rural areas, access to neuroimaging expertise is severely limited, creating a significant care disparity. Teleradiology—the electronic transmission of radiological images to remote specialists for interpretation—has emerged as a promising solution to bridge this diagnostic gap. However, the aggregate evidence regarding its diagnostic accuracy and impact on diagnosis speed in remote settings has not been comprehensively synthesized. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Studies reporting on teleradiology use for stroke imaging in remote or rural settings were eligible. Risk of bias was assessed using the Cochrane RoB 2.0 tool for RCTs and the Newcastle-Ottawa Scale (NOS) for observational studies. Primary outcomes included diagnostic accuracy metrics (sensitivity, specificity, kappa agreement) and time-to-treatment metrics. Results: Seventeen studies encompassing 89,412 patients met the inclusion criteria. Teleradiology demonstrated consistently high diagnostic accuracy for intracranial hemorrhage (sensitivity 91–100%, specificity 89–100%, kappa 0.69–1.0). Telestroke-equipped hospitals achieved significantly faster door-to-imaging times (median reduction 15–147 minutes) and door-to-needle times (median reduction 3.7–77 minutes/year). Thrombolysis rates increased from 2.6% to 15.5% over 10-year network maturation. Functional outcomes (mRS 0-2) improved by 19% and 30-day mortality decreased by 0.5 percentage points in telestroke-capable hospitals. Multimodal CT with teleradiology interpretation added 19.5 percentage points in ischemic stroke detection sensitivity. Discussion: The synthesis of evidence confirms that teleradiology systems maintain diagnostic accuracy equivalent to on-site neuroradiology services while substantially reducing time-to-diagnosis in remote settings. Hub-and-spoke network models demonstrate the greatest sustained impact, with telemedical stroke networks showing progressive improvement in both process and clinical outcome metrics over time. Challenges persist regarding initial implementation, connectivity infrastructure, and healthcare workforce training in low-resource environments. Conclusion: Teleradiology significantly accelerates stroke diagnosis in remote areas without compromising diagnostic accuracy. The implementation of teleradiology-enabled telestroke networks is strongly supported by the evidence and should be prioritized in healthcare policy for underserved populations.

THE ROLE OF SODIUM–GLUCOSE COTRANSPORTER-2 (SGLT2) INHIBITORS IN REDUCING THE RISK OF CARDIOVASCULAR EVENTS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS : A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS AND PRIMARY STUDIES Diani Nur Pathona
The International Journal of Medical Science and Health Research Vol. 48 No. 5 (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/dver3926

Introduction: Type 2 diabetes mellitus (T2DM) confers a two- to four-fold excess risk of atherosclerotic cardiovascular disease, heart failure, and cardiovascular death. Sodium-glucose cotransporter-2 (SGLT2) inhibitors unexpectedly demonstrated cardiovascular benefit in dedicated cardiovascular outcome trials (CVOTs). This systematic review quantified the effect of SGLT2 inhibition across the full spectrum of cardiovascular events in T2DM patients. Methods: A systematic review was performed per PRISMA 2020 guidelines. Eligible studies were phase III/IV randomized, placebo-controlled trials of SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin, ertugliflozin, sotagliflozin) enrolling adults with T2DM, with adjudicated cardiovascular endpoints and ≥6 months follow-up. Two reviewers independently screened, extracted data, and appraised risk of bias using Cochrane RoB 2. Certainty was rated using GRADE. Pooled estimates used generic inverse-variance random-effects meta-analysis. Results: Twenty-one reports (17 distinct trials; 105,000 participants) met inclusion criteria. Pooled hazard ratios demonstrated: three-point MACE 0.89 (95% CI 0.84–0.94; p<0.0001; I²=0%), cardiovascular death 0.85 (95% CI 0.77–0.93; p<0.001; I²=40.3%), all-cause mortality 0.80 (95% CI 0.70–0.91; p<0.001), hospitalization for heart failure 0.68 (95% CI 0.61–0.76; p<0.0001; I²=0%), composite of cardiovascular death or heart failure hospitalization 0.78 (95% CI 0.75–0.82; p<0.0001; I²=0%), and composite kidney outcome 0.65 (95% CI 0.59–0.71; p<0.0001). Benefit magnitude was greatest for heart failure and kidney endpoints, intermediate for mortality, and modest for atherothrombotic endpoints; stroke was not significantly affected. Safety signals comprised genital mycotic infection and diabetic ketoacidosis; isolated amputation signal from CANVAS was not replicated. Discussion: The findings support a robust, reproducible class-wide cardioprotective effect of SGLT2 inhibition, disproportionately driven by heart failure and cardiorenal protection. Relative benefit is preserved across baseline glycemia, kidney function, albuminuria, ejection fraction, age, sex, and background therapy, while absolute benefit scales with baseline risk. Conclusion: SGLT2 inhibitors significantly and consistently reduce cardiovascular events in T2DM, with strongest effects on heart failure hospitalization, cardiorenal outcomes, and mortality. These agents should be regarded as foundational organ-protective therapy initiated based on cardiorenal risk irrespective of glycated hemoglobin.

Artificial Intelligence-Assisted Nutritional Counseling for Weight Management in Adult Obesity: A Systematic Review of Randomized Controlled Trials and Primary Studies Junyul Karyaman Fanahatodo Sarumaha; Murilisa Merlin Zendrato; Maswan Indra Simanjuntak
The International Journal of Medical Science and Health Research Vol. 48 No. 5 (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: 10.70070/6yfvwp66

Introduction: The global obesity pandemic affects over 2.11 billion adults, with projections exceeding 3.80 billion by 2050. Conventional nutritional counseling modalities face critical limitations in scalability, individualization, and long-term adherence. Artificial intelligence (AI)-assisted nutritional counseling, employing machine learning, deep learning, natural language processing, and reinforcement learning algorithms, represents a transformative paradigm enabling personalized, real-time dietary interventions at population scale. Methods: This systematic review was conducted following PRISMA 2020 guidelines. Eligible studies comprised randomized controlled trials and primary prospective studies evaluating AI-assisted nutritional interventions in adults (≥18 years) with overweight (BMI ≥25 kg/m²) or obesity (BMI ≥30 kg/m²). Fifteen pre-specified outcome domains were evaluated. Risk of bias was assessed using Cochrane RoB 2.0 and ROBINS-I tools. Results: Eighteen studies (n=14,732 participants) met eligibility criteria. AI-assisted interventions demonstrated statistically significant reductions in body weight (MD −1.60 kg to −12.3%; 15/18 studies, p<0.01), BMI (MD −0.59 to −1.26 kg/m²; 12/14 studies, p<0.05), HbA1c (MD −0.28% to −2.9%; 9/11 studies), and fasting plasma glucose (7/8 studies). Significant improvements were observed across cardiometabolic, anthropometric, dietary quality, physical activity, health-related quality of life, and patient engagement domains. AI-led interventions demonstrated non-inferiority to human coaching and superiority to standard care. Discussion: AI-assisted nutritional counseling demonstrates robust, clinically meaningful efficacy across multiple outcome domains. Precision nutrition algorithms integrating postprandial glycemic response prediction and gut microbiome profiling achieved the most comprehensive cardiometabolic optimization. AI-integrated mHealth applications demonstrated superior population-level scalability. Methodological limitations include heterogeneity across AI modalities, short intervention durations, and underrepresentation of low- and middle-income country populations. Conclusion: AI-assisted nutritional counseling is efficacious, safe, scalable, and non-inferior to human coaching for adult obesity management across ≥10 clinically relevant outcome domains. Integration into multidisciplinary obesity management clinical pathways is recommended, supported by long-term, equity-focused randomized controlled trials with standardized outcome reporting frameworks.

CHALLENGING CATARACT SURGERY IN VITRECTOMIZED EYES - COMPARING THE SURGICAL OUTCOMES OF FEMTOSECOND LASER ASSISTED CATARACT SURGERY VERSUS CONVENTIONAL PHACOEMULSIFICATION SURGERY: A SYSTEMATIC REVIEW Gita Noor Azizah; Erlin Prawita Sari; Putty Nabilla; Arsil Abdan
The International Journal of Medical Science and Health Research Vol. 48 No. 5 (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: 10.70070/0fdmwa04

Introduction: Cataract formation is the most common long-term complication after vitrectomy, and cataract surgery in vitrectomized eyes is technically challenging because of altered ocular anatomy and increased risk of complications. Femtosecond laser-assisted cataract surgery (FLACS) may improve surgical precision and reduce intraoperative trauma compared with conventional phacoemulsification surgery (CPS). This systematic review compared the surgical outcomes of FLACS and CPS in vitrectomized eyes. Method: A systematic review was conducted according to the PRISMA 2020 guidelines. PubMed, Cochrane Library and Science Direct were searched for RCTs, Clinical Trial , and observational studies involving adults (≥18 years) with previous vitrectomy undergoing FLACS or CPS. We assessed risk of bias using RoB 2.0 and ROBINS-I. Our outcomes were the visual acuity, ultrasound energy, Endothelial Cell Condition, surgery time, intraoperative and postoperative complication. Results: We included 4 studies. Visual acuity improved in both groups, with comparable final corrected distance visual acuity. FLACS consistently reduced ultrasound energy requirements, cumulative dissipated energy and operative time. Higher postoperative endothelial cell density and lower endothelial cell loss were also reported with FLACS. Intraoperative complications, including posterior capsule rupture, dropped nucleus, anterior capsule tear, zonular dialysis, and silicone oil migration, occurred predominantly in the CPS group, whereas FLACS-related events were mainly limited to incomplete capsulotomy. Early postoperative corneal edema was less frequent with FLACS, while rates of cystoid macular edema, posterior capsule opacification, and anterior chamber inflammation were generally comparable. Conclusion: FLACS provides superior intraoperative efficiency, better endothelial preservation, faster early visual recovery and a favorable safety profile compared with CPS in vitrectomized eyes, although final visual outcomes remain similar. Larger high-quality randomized studies are required to confirm these findings.

A COMPREHENSIVE SYSTEMATIC REVIEW OF THE RELATIONSHIP BETWEEN EXERCISE-INDUCED ALLERGY AND FOOD-DEPENDENT EXERCISE-INDUCED ANAPHYLAXIS Jeffy Marta
The International Journal of Medical Science and Health Research Vol. 48 No. 5 (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: 10.70070/85rwm522

Introduction: Exercise-induced anaphylaxis (EIA) and food-dependent exercise-induced anaphylaxis (FDEIA) represent physically triggered hypersensitivity disorders with contested nosological positioning. FDEIA has historically been classified as a physical allergy subtype, yet accumulating evidence suggests it constitutes a high-threshold, cofactor-dependent food allergy. This systematic review synthesized all primary interventional and observational evidence describing the epidemiological, immunological, diagnostic, mechanistic, and prognostic relationship between these entities. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Eligibility was restricted a priori to randomized controlled trials, interventional/provocation studies, cohort, case-control, cross-sectional, and epidemiological survey designs. Two reviewers independently screened, extracted, and appraised records using a dual risk-of-bias architecture (modified Newcastle-Ottawa/JBI composite and RoB 2/ROBINS-I), with GRADE certainty grading across fifteen prespecified outcome domains. Results: Fifty primary studies (up to 2026), encompassing >6,900 patients and >600,000 surveyed children, met eligibility. Population prevalence rose from 0.0047% in elementary to 0.017–0.018% in junior-high students, with male predominance in adolescence. Wheat was the dominant culprit globally; non-specific lipid transfer proteins (nsLTP) predominated in Mediterranean populations (66.3–78%). Component-resolved serology achieved 80–91% sensitivity and 92% specificity for omega-5 gliadin, rising to 93.8% sensitivity/92.9% specificity with recombinant high-molecular-weight glutenin. Exercise lowered median eliciting gluten dose from 48g to 24g (−63%) and increased severity from 1.1 to 2.3; aspirin reduced threshold by 83%, exercise-plus-aspirin by 87%. Structured avoidance prevented further anaphylaxis in 91.7% (elimination) and 87.0% (temporal separation), yet 20–33% continued to react. Diagnostic delay ranged from 16 months to >5 years. Overall GRADE certainty was moderate for diagnostic-accuracy and cofactor-threshold domains, low-to-very-low for prevalence, treatment, and prognostic domains. Discussion: FDEIA is reconceptualized as a cofactor-dependent, high-threshold IgE-mediated food allergy rather than a physical allergy, positioning EIA and FDEIA on a single mechanistic continuum modulated by allergen dose, cofactor load, and epithelial permeability. Two molecular archetypes dominate: gliadin/glutenin in East Asia and Northern Europe, nsLTP in the Mediterranean. Cofactor hierarchy (exercise+aspirin > aspirin > exercise > alcohol) provides the first quantitative framework for clinical risk counseling. Persistent limitations include absence of randomized evidence, heterogeneous protocols, and geographical under-representation. Conclusion: Exercise-induced allergy and FDEIA are mechanistically inseparable expressions of a shared cofactor-dependent hypersensitivity continuum. Component-resolved diagnostics, cofactor-augmented titrated challenge, and structured allergen-exercise temporal separation constitute current evidence-based standards, but residual breakthrough risk mandates universal adrenaline auto-injector provision. Priority research includes randomized cofactor-controlled protocols, validated pediatric molecular panels, prospective registries in under-represented regions, and biologic/immunotherapeutic trials.

A COMPREHENSIVE SYSTEMATIC REVIEW OF THE ASSOCIATION BETWEEN IRON DEFICIENCY ANAEMIA AND OCCULT GASTROINTESTINAL BLEEDING Jeffy Marta
The International Journal of Medical Science and Health Research Vol. 48 No. 5 (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/kzj7vq32

Introduction: Iron deficiency anaemia (IDA) constitutes the most prevalent nutritional deficiency disorder worldwide. In adult men and postmenopausal women, chronic occult gastrointestinal (GI) blood loss represents the dominant pathological mechanism rather than dietary insufficiency. Occult GI bleeding denotes haemorrhage detectable only indirectly through faecal occult blood testing or through emerging iron deficiency. This systematic review synthesised and critically appraised primary evidence linking IDA to occult GI bleeding, determined diagnostic yield of investigative modalities, and identified predictors of bleeding lesions. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Eligible designs comprised randomised controlled trials, cohort, case-control, cross-sectional and observational studies. Two reviewers independently performed study selection, data extraction and quality appraisal using design-matched risk-of-bias instruments (RoB 2, ROBINS-I, Newcastle-Ottawa Scale, QUADAS-2). Synthesis was narrative with structured tabulation across fourteen prespecified outcome domains. Results: Thirty-five primary studies encompassing >1.8 million participants met eligibility. Bidirectional endoscopy diagnostic yield for bleeding-potential lesions ranged from 35.0% to 76.2%. Small-bowel capsule endoscopy after negative bidirectional examination yielded pathology in 50.0–72.0%; in a prospective multicentre trial, small-bowel lesions (50.0%, 95% CI 42.2-57.7) significantly exceeded upper GI (28.2%, p<0.001) and colonic (20.0%, p<0.0001) lesions, altering management in 52.3%. IDA demonstrated strong malignancy association: GI cancer odds within one year were 4.47-fold higher (95% CI 4.14-4.82); IDA conferred higher adjusted colorectal cancer odds than rectal bleeding (aOR 2.2, 95% CI 2.0-2.3, p<0.01); young-onset colorectal cancer cumulative incidence was 0.45% with IDA versus 0.05% without (HR 10.81, 95% CI 8.15-14.33). Independent predictors included abdominal symptoms (OR 8.3), age >50 years (OR 4.4) and haemoglobin <9 g/dL (OR 3.0), yielding PPV 87% and NPV 93.5%. Quantitative faecal haemoglobin with IDA and age stratified one-year colorectal cancer risk from <1% to 30% (95% CI 19.4-41.0). Anticoagulant exposure carried strongest bleeding risk (RR 4.2, 95% CI 2.9-6.2). Colonoscopy delay >90 days independently impaired survival (adjusted HR 1.28, 95% CI 1.07-1.53, p=0.01). GRADE certainty was moderate for diagnostic-yield and oncological-risk domains. Discussion: IDA constitutes a sentinel biomarker of structural luminal pathology with malignancy discriminatory power exceeding symptom-based referral criteria. The small bowel represents the most frequent location of bleeding-capable lesions yet remains un-interrogated by bidirectional endoscopy. Faecal occult blood testing lacks sufficient sensitivity as a rule-out instrument; however, quantitative faecal haemoglobin retains risk-stratification value. Diagnostic latency independently determines survival outcomes. Conclusion: IDA demonstrates robust, reproducible association with occult GI bleeding and luminal malignancy. Bidirectional endoscopy should remain first-line in all adult men, postmenopausal women, and symptomatic premenopausal women; however, small-bowel predominance supports earlier capsule endoscopy deployment in negative bidirectional examinations or refractory anaemia. Faecal haemoglobin should serve as risk-stratification adjunct rather than gatekeeper, and diagnostic interval should be a quality metric. National pathways should adopt integrated risk models combining age, sex, haemoglobin, ferritin and quantitative faecal haemoglobin; capsule endoscopy capacity should be expanded; and standardised definitions are needed for future quantitative pooling.

A COMPREHENSIVE SYSTEMATIC REVIEW OF THE ASSOCIATION BETWEEN PERIPHERAL ARTERY DISEASE AND CARDIOVASCULAR MORTALITY Jeffy Marta
The International Journal of Medical Science and Health Research Vol. 48 No. 5 (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: 10.70070/6wxkyb55

Introduction: Peripheral artery disease (PAD) affects more than 230 million people worldwide yet remains under-detected and under-treated relative to coronary and cerebrovascular disease. Although PAD is widely acknowledged to confer cardiovascular (CV) risk, the magnitude, consistency, gradient and modifiability of its association with CV mortality across disease stages, ankle-brachial index (ABI) strata and comorbidity phenotypes have not been comprehensively synthesised. This review quantified that association and determined whether excess CV mortality is amenable to contemporary therapy. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Eligible designs comprised randomised controlled trials (RCTs) and primary observational studies (prospective/retrospective cohort, case-control, cross-sectional and registry-based) reporting CV or all-cause mortality in adults with PAD or abnormal ABI. Systematic reviews and meta-analyses were excluded from primary tabulation but retained for triangulation. Risk of bias was appraised with Cochrane RoB 2 and Newcastle-Ottawa Scale; certainty was rated with GRADE. Synthesis was narrative with structured tabulation across fifteen prespecified outcome domains. Results: Fifty-four primary studies (13 randomised/trial-derived, 41 observational) encompassing >9 million individuals were included. PAD demonstrated consistent, significant association with CV death. In population-based cohorts, age-adjusted CV mortality hazard ratios (HRs) rose stepwise across disease stage: 1.9 for asymptomatic PAD, 2.6 for intermittent claudication, and 3.5 for severe limb ischaemia; ten-year all-cause mortality rose from 27% in referents to 75% in severe limb ischaemia. Low ABI (≤0.90) approximately doubled to quadrupled CV mortality, while high ABI (>1.40) carried comparable risk, describing a U-shaped hazard. PAD without coronary heart disease or stroke carried prognosis comparable to coronary heart disease or stroke without PAD (adjusted HR 1.68 versus 1.81). Comorbidity markedly amplified risk: concomitant chronic kidney disease and PAD raised cardio-cerebrovascular mortality >4-fold (HR 4.76); critical limb ischaemia in type 2 diabetes raised CV mortality >6-fold (SHR 6.20). Polyvascular involvement produced monotonic risk gradient. Critically, excess risk proved modifiable: low-dose rivaroxaban plus aspirin significantly reduced CV death (HR 0.78) and all-cause death (HR 0.82), reduced MACE composite in PAD (HR 0.72), and reduced major adverse limb events by 43%, while multi-drug secondary prevention was associated with 65% lower all-cause mortality in screen-detected PAD. GRADE certainty was moderate for prognostic domains and high for randomised therapeutic evidence. Discussion: The evidence base demonstrates internal coherence across trial and observational designs, continents and decades. PAD indexes total atherosclerotic burden rather than limb-confined disease, explaining why asymptomatic PAD is nearly as lethal as symptomatic disease, why abnormal ABI predicts death after Framingham adjustment, and why cardiac events dominate mortality. Residual thrombotic risk, systemic inflammation, arterial calcification, renal dysfunction and treatment inequity constitute principal mechanisms. Limitations include heterogeneity of PAD ascertainment, reliance on administrative coding, and probable under-representation of low- and middle-income settings. Conclusion: PAD demonstrates independent, consistent, significant association with CV mortality with reproducible dose-response gradient across haemodynamic severity, symptom stage, vascular-bed burden and comorbidity load. Because excess risk is demonstrably attenuated by intensified antithrombotic therapy and comprehensive risk-factor control, PAD should be treated operationally as coronary risk equivalent, and ABI measurement should be embedded in CV risk stratification. Systematic case-finding coupled with guideline-directed medical therapy represents immediately actionable, evidence-supported strategy for reducing CV death.

A Comprehensive Systematic Review of the Role of Semaglutide Anti-Obesity Therapy in Multiple Metabolic Diseases: A Systematic Review of Randomized Controlled Trials and Primary Studies Jeffy Marta
The International Journal of Medical Science and Health Research Vol. 48 No. 5 (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/wcwp4h85

Introduction: Obesity constitutes the pathophysiological hub of interconnected metabolic diseases including type 2 diabetes mellitus (T2DM), atherosclerotic cardiovascular disease (ASCVD), heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), metabolic dysfunction-associated steatohepatitis (MASH) and peripheral artery disease (PAD). Semaglutide, a long-acting glucagon-like peptide-1 receptor agonist (GLP-1 RA), has been evaluated across all these domains. This systematic review synthesised primary evidence on semaglutide across multiple metabolic diseases to determine consistency of benefit across organ systems. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Eligible designs comprised randomized controlled trials and observational studies evaluating semaglutide in obesity or obesity-related metabolic disease. Systematic reviews were excluded from primary tabulation but retained as contextual comparators. Two reviewers independently screened, extracted data and appraised risk of bias using Cochrane RoB 2 and ROBINS-I; certainty was graded with GRADE. Synthesis was narrative and semi-quantitative by outcome domain. Results: Twenty-seven primary studies (24 RCTs, 3 observational cohorts) encompassing >180,000 participants across 15 outcome domains were included. Semaglutide 2.4 mg weekly produced mean weight reductions of -14.9% to -16.0% versus -2.4% to -5.7% with placebo (all P<0.001). In prediabetes, 84.1-89.8% reverted to normoglycaemia versus 47.8-70.4% (P<0.0001). SELECT demonstrated 20% MACE reduction (HR 0.80; P<0.001) in obesity without diabetes; SOUL demonstrated 14% MACE reduction with oral semaglutide (HR 0.86; P=0.006). FLOW demonstrated 24% reduction in major kidney disease events (HR 0.76; P=0.0003) and 20% all-cause mortality reduction (HR 0.80; P=0.01). STEP-HFpEF demonstrated 7.5-point KCCQ-CSS improvement (P<0.0001). ESSENCE demonstrated steatohepatitis resolution in 62.9% versus 34.3% (P<0.001). STRIDE demonstrated walking distance improvement (ETR 1.13; P=0.0004). C-reactive protein fell 39-48%. Gastrointestinal adverse events occurred in 63.5-84.1% but were predominantly mild-to-moderate and transient, with permanent discontinuation in ~4-5%. Risk of bias was low for 20/24 RCTs; GRADE certainty was high for 11 domains. Discussion: Semaglutide demonstrates reproducible benefit extending beyond weight reduction into hard cardiovascular, renal, hepatic and functional outcomes. Mediation analyses attributed little treatment effect to weight change, implying direct vascular, anti-inflammatory and haemodynamic mechanisms. Benefit was largely independent of baseline BMI, HbA1c and comorbidity severity. Principal limitations include industry sponsorship, under-representation of non-White populations, and reversibility of benefit upon discontinuation. Conclusion: Semaglutide is a disease-modifying agent for the cardiovascular-kidney-metabolic syndrome. Treatment produced significant improvements in body weight, glycaemia, lipids, inflammation, MACE, heart failure, kidney disease, hepatic histology, functional capacity and all-cause mortality, with acceptable safety profile. It is recommended that semaglutide be positioned as first-line therapy in obesity with cardiovascular, renal or hepatic disease; that treatment be regarded as chronic; and that future research prioritise head-to-head incretin comparisons, non-industry-funded trials, and under-represented populations.

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Indra Hadi

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profesionaljournalmedicine@gmail.com

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Journal Mail Official
pt.internationalmedicaljournal@gmail.com

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

Location
Kota adm. jakarta selatan,

Dki jakarta

INDONESIA