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The Indonesian Journal of General Medicine
Published by International Medical Journal Corp. Ltd.
ISSN : -     EISSN : 3048104X     DOI : -
Core Subject : Health,
Dentistry Health Professions Medicine & Pharmacology Public Health Veterinary
ims: The Indonesian Journal of General Medicine aims to advance the field of medicine by disseminating high-quality research findings that are accessible to a broad audience of healthcare professionals, researchers, and policymakers. The journal is committed to supporting the development of medical knowledge and practice in Indonesia and globally, fostering innovative research and evidence-based clinical practices. Scope: The journal covers a wide range of topics within the general medical field, including but not limited to: Clinical studies in various medical disciplines Epidemiological research and public health issues Innovations in diagnostic techniques and treatments Reviews on current practices and emerging trends in medicine Case studies and clinical trials Health policy and medical education The Indonesian Journal of General Medicine welcomes submissions from all areas of medicine, particularly those that have significant implications for patient care, public health, and policy-making. The journal encourages submissions that offer new insights, propose novel approaches, or address challenges pertinent to the Indonesian and international medical communities.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 190 Documents
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Association of Minimally Invasive Evacuation of Intracerebral Hemorrhage With Functional Outcomes: A Systematic Review and Meta-Analysis Andrian Dwi Rizki Setyawan; Titik Setyawan; Edy Sucipto
The Indonesian Journal of General Medicine Vol. 17 No. 3 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/7df99g92

Abstract

Background: Spontaneous intracerebral hemorrhage (ICH) is the most lethal form of stroke, associated with profound morbidity and mortality. The role of surgical intervention has been a subject of long-standing debate, with conventional craniotomy failing to demonstrate consistent benefits over medical management in large trials. Minimally Invasive Surgery (MIS) has emerged as a promising alternative designed to mitigate iatrogenic injury while achieving hematoma evacuation. This study aims to synthesize high-quality evidence on the efficacy and safety of MIS for ICH. Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a comprehensive search of PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library for high-quality randomized controlled trials (RCTs) comparing MIS (including endoscopic surgery and stereotactic aspiration) with conventional treatment (standard medical management or craniotomy) in adult patients with spontaneous supratentorial ICH. The primary outcomes were favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0–3, and all-cause mortality at the longest available follow-up. A random-effects model was used to pool Odds Ratios (ORs) and 95% Confidence Intervals (CIs). Results: Sixteen high-quality RCTs encompassing 3,781 patients (1,923 randomized to MIS and 1,858 to conventional treatment) met the inclusion criteria. The meta-analysis revealed that MIS was significantly associated with a higher likelihood of achieving a favorable functional outcome (OR, 1.51; 95% CI, 1.25–1.82; ). Furthermore, MIS was associated with significantly lower odds of long-term mortality (OR, 0.72; 95% CI, 0.57–0.90; ) and early mortality within 30 days (OR, 0.73; 95% CI, 0.56–0.95; ). Secondary analyses demonstrated that MIS also led to significantly lower rates of postoperative infections, shorter operative times, and reduced lengths of stay in both the intensive care unit and the hospital. Rates of rebleeding were not significantly different between the groups (OR, 1.10; 95% CI, 0.55–2.19; ). Discussion: The pooled evidence strongly supports the superiority of MIS over conventional treatment for selected patients with ICH. These findings are consistent with and reinforced by recent landmark trials such as ENRICH, which provided Level 1 evidence for the benefit of an MIS approach in lobar hemorrhages. The efficacy of MIS appears contingent on achieving near-complete hematoma evacuation in a timely manner, a principle established in the MISTIE III trial. Conclusion: This meta-analysis provides robust, high-quality evidence supporting the use of MIS as a primary treatment strategy in the management of spontaneous supratentorial ICH. MIS is associated with substantial improvements in both functional independence and survival.
Kehamilan Ektopik Terganggu: Laporan Kasus dan Tinjauan Pustaka Komprehensif Betti Merdiani Putri; Metti Herliani Putri
The Indonesian Journal of General Medicine Vol. 17 No. 3 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/0zcan335

Abstract

Pendahuluan: Kehamilan ektopik (KE), dan komplikasinya yaitu kehamilan ektopik terganggu (KET), merupakan suatu kegawatdaruratan obstetri yang menjadi penyebab utama mortalitas maternal pada trimester pertama kehamilan. Diagnosis dini yang akurat dan tatalaksana yang cepat merupakan faktor krusial untuk mencegah komplikasi fatal dan mem preservasi fertilitas di masa depan. Laporan kasus ini bertujuan untuk mengilustrasikan pendekatan diagnostik dan tatalaksana komprehensif pada sebuah kasus KET dengan instabilitas hemodinamik. Ilustrasi Kasus: Seorang wanita, 32 tahun, dengan status obstetri G2P1A0, datang ke unit gawat darurat dengan keluhan utama nyeri perut kanan bawah yang timbul mendadak disertai amenorea selama 8 minggu. Pemeriksaan fisik menunjukkan tanda-tanda syok hipovolemik, termasuk hipotensi dan takikardia, serta gambaran abdomen akut. Pemeriksaan laboratorium menunjukkan kadar beta-human chorionic gonadotropin (β-hCG) kuantitatif sebesar 8.500 mIU/mL. Ultrasonografi transvaginal (USG-TV) yang dilakukan segera tidak menunjukkan adanya kantung gestasi di dalam kavum uteri, namun mengidentifikasi adanya massa kompleks di adneksa kanan dan sejumlah besar cairan bebas yang mengindikasikan hemoperitoneum di kavum Douglas. Dengan diagnosis kerja KET, pasien segera menjalani laparotomi eksplorasi. Ditemukan adanya ruptur pada tuba Fallopii kanan dengan perdarahan aktif, yang kemudian ditatalaksana dengan salpingektomi kanan. Pasien menunjukkan pemulihan yang baik tanpa komplikasi pascaoperasi. Diskusi: Kasus ini menegaskan pentingnya indeks kecurigaan yang tinggi terhadap KE pada setiap wanita usia reproduktif yang datang dengan keluhan nyeri abdomen dan riwayat amenorea. Kombinasi antara presentasi klinis, kadar β-hCG yang berada di atas zona diskriminatif, dan temuan USG-TV yang khas merupakan pilar utama dalam penegakan diagnosis. Tatalaksana bedah darurat yang dilakukan pada kasus ini sepenuhnya sesuai dengan pedoman klinis internasional untuk KET dengan instabilitas hemodinamik, di mana tatalaksana medisinal menggunakan metotreksat merupakan suatu kontraindikasi absolut. Kesimpulan: Kehamilan ektopik terganggu adalah kondisi yang mengancam nyawa dan menuntut diagnosis yang cepat serta intervensi segera. Manajemen yang berhasil sangat bergantung pada integrasi yang cermat antara temuan klinis, hasil pemeriksaan biokimia, dan pencitraan diagnostik, serta kesiapan dan keterampilan tim bedah dalam melakukan intervensi penyelamatan nyawa.
Diagnostic Accuracy of Artificial Intelligence-Assisted Phonocardiography for Pathological Heart Murmurs and Congenital Heart Disease in a Pediatric Population: A Systematic Review and Meta-Analysis Meicyana Nona Pita; Vanessa C. Gunawan; Subhika Laksmi
The Indonesian Journal of General Medicine Vol. 17 No. 4 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/ze98pw33

Abstract

Background: Congenital heart disease (CHD) is a major global health concern, and early detection is critical for preventing adverse outcomes. Cardiac auscultation, the primary screening method, suffers from high inter-observer variability and modest accuracy, leading to both missed diagnoses and unnecessary specialist referrals. Artificial intelligence (AI)-assisted phonocardiography has emerged as a promising solution, but its overall diagnostic performance has not been quantitatively synthesized. Methods: Following the PRISMA 2020 guidelines, a systematic literature search was conducted across PubMed, Cochrane CENTRAL, and Google Scholar to identify studies evaluating the diagnostic accuracy of AI-assisted phonocardiography in pediatric populations (≤18 years). Eligible studies used echocardiography as the reference standard and provided sufficient data to construct a 2x2 contingency table. The methodological quality of included studies was assessed using the QUADAS-2 tool. A bivariate random-effects model was employed to calculate pooled sensitivity, specificity, likelihood ratios, and the diagnostic odds ratio (DOR), which were visualized using forest plots and a Summary Receiver Operating Characteristic (SROC) curve. Results: The selection process yielded 16 studies for inclusion in the meta-analysis. The pooled analysis demonstrated a summary sensitivity of 91.7% (95% CI: 87.3–94.7) and a summary specificity of 95.3% (95% CI: 91.8–97.4) for the detection of pathological murmurs or CHD. The positive likelihood ratio was 19.7 (95% CI: 10.8–35.6), the negative likelihood ratio was 0.087 (95% CI: 0.055–0.136), and the DOR was 226.6 (95% CI: 89.8–571.5). Methodological quality assessment revealed that nearly half of the studies (43.8%) had a high risk of bias in the patient selection domain, primarily due to the use of case-control designs. Conclusion: AI-assisted phonocardiography exhibits high diagnostic accuracy for detecting pathological heart murmurs and CHD in children, significantly surpassing the performance of conventional auscultation. However, its effectiveness is reduced for subtle acoustic signals, and the evidence base is partly limited by methodological issues in primary studies. With further validation in large-scale prospective trials, this technology holds transformative potential as a scalable, cost-effective screening tool to improve health equity in pediatric cardiac care globally.
Sacroiliac Joint Fusion vs. Conservative Management for Chronic Sacroiliac Joint Pain: A Systematic Review of Pain and Functional Outcomes I Made Wahyu Adi Putrawan; I Gusti Ngurah Paramartha Wijaya Putra
The Indonesian Journal of General Medicine Vol. 17 No. 4 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/ab9b1d81

Abstract

Introduction: Chronic sacroiliac (SI) joint pain is a significant contributor to low back pain, affecting 15-30% of patients. While conservative management is the initial treatment, many patients fail to achieve lasting relief. Minimally invasive sacroiliac (MIS) joint fusion has emerged as a promising alternative. This systematic review aims to synthesize high-level evidence on the comparative efficacy of MIS fusion versus conservative management for chronic SI joint pain. Methods: Following PRISMA guidelines, a systematic search was conducted across multiple databases. Included studies were randomized controlled trials and cohort studies from the last decade that compared MIS fusion with non-operative care in adults with confirmed SI joint pain. The primary outcomes analyzed were pain reduction (e.g., VAS) and functional improvement (e.g., Oswestry Disability Index). Twenty-seven studies met the inclusion criteria. Results: The evidence consistently demonstrated that MIS fusion provides statistically significant and clinically meaningful improvements in pain and function compared to conservative management. Pain scores (VAS) were reduced substantially more in fusion groups, and functional (ODI) scores showed marked improvement. These benefits were shown to be durable at follow-ups of 24 months and beyond. A significant counterpoint was a sham-controlled trial that found no statistical difference between MIS fusion and a sham procedure. Revision rates for MIS fusion were low, typically 1-5%. Conclusion: For appropriately selected patients with chronic SI joint pain refractory to non-operative care, MIS fusion is a significantly effective and durable intervention that offers a high probability of improving pain, function, and quality of life. Its success is contingent upon rigorous diagnosis, and while the procedure is relatively safe, further research is needed to clarify its efficacy against placebo.
Pemfigoid Bulosa Ekstensif Atipikal dengan Keterlibatan Mukosa Genital pada Pria 31 Tahun: Laporan Kasus Langka dan Berat dari Bangka Belitung, Indonesia David Herryanto; Andriansyah Bonorusid
The Indonesian Journal of General Medicine Vol. 17 No. 4 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/72cfzc63

Abstract

Pendahuluan: Pemfigoid bulosa (PB) adalah penyakit autoimun bulosa subepidermal yang paling umum, secara klasik menyerang populasi lansia, biasanya pada dekade ketujuh hingga kedelapan kehidupan (Kridin, 2018; Schmidt et al., 2022). Patogenesisnya dimediasi oleh autoantibodi IgG yang menargetkan protein hemidesmosom BP180 dan BP230 (Dewi, 2017; Fuertes de Vega et al., 2014). Presentasi pada individu dewasa muda, terutama dengan manifestasi klinis yang parah dan keterlibatan mukosa genital, sangat jarang dilaporkan dan menimbulkan tantangan diagnostik serta terapeutik yang signifikan (Rocha et al., 2011; Al-Dhaheri et al., 2023). Laporan kasus ini bertujuan untuk mendokumentasikan secara komprehensif presentasi klinis yang sangat atipikal, dilema diagnostik yang kompleks, dan strategi penatalaksanaan awal pada kasus PB yang langka ini. Ilustrasi Kasus: Seorang pasien laki-laki berusia 31 tahun datang dengan keluhan lesi bula tegang yang luas dan progresif cepat selama satu bulan, menyebar di abdomen, punggung, dan area genital . Keluhan disertai pruritus berat dan nyeri. Pemeriksaan dermatologis menunjukkan bula multipel berdinding tegang dengan berbagai ukuran, erosi, dan krusta hemoragik di atas dasar kulit eritematosa. Lesi di perut tertutup krusta tebal akibat aplikasi obat oles ramuan tradisional yang tidak diketahui jenisnya (krusta medikamentosa). Kondisi ini diperparah oleh infeksi sekunder dan higiene personal yang buruk, di mana pasien sudah lama tidak mandi. Ditemukan pula erosi pada mukosa oral dan genital. Secara mengejutkan, ditemukan tanda Nikolsky dan tanda Asboe-Hansen yang positif, menciptakan sebuah paradoks klinis yang signifikan . Diagnosis kerja ditegakkan sebagai pemfigoid bulosa, dengan diagnosis banding utama sindrom Stevens-Johnson (SJS) dan pemfigus vulgaris (PV). Pasien dirawat inap dan diberikan terapi kortikosteroid sistemik intravena (deksametason), antibiotik spektrum luas, dan perawatan luka suportif . Diskusi: Kasus ini menyoroti beberapa penyimpangan utama dari gambaran klasik PB: usia onset yang sangat muda, tingkat keparahan penyakit yang ekstensif, dan keterlibatan mukosa genital yang langka, yang merupakan penanda penyakit yang lebih berat (Kridin et al., 2019). Adanya tanda Nikolsky yang positif, sebuah temuan yang secara klasik berasosiasi dengan pemfigus akibat akantolisis intraepidermal, menjadi anomali klinis yang paling menantang (Uzun & Durdu, 2016). Hipotesis yang diajukan adalah bahwa proses inflamasi yang sangat intens pada PB dapat menyebabkan kerusakan sekunder pada epidermis, menghasilkan fenomena "pseudo-Nikolsky" atau bahkan pelemahan kohesi epidermal basal yang menyerupai tanda Nikolsky sejati (Sardana & Garg, 2013). Temuan ini menekankan keterbatasan tanda klinis tunggal dalam diagnosis dan menggarisbawahi peran krusial pemeriksaan penunjang definitif seperti biopsi kulit dan imunofluoresensi direk (DIF) untuk diagnosis yang akurat (Murrell et al., 2021). Infeksi sekunder disebabkan oleh pengobatan tradisional. Kesimpulan: Pemfigoid bulosa dapat bermanifestasi pada dewasa muda dengan gambaran klinis yang parah dan atipikal, termasuk keterlibatan mukosa genital dan tanda klinis yang menyesatkan. Diperlukan kewaspadaan klinis yang tinggi dan pendekatan diagnostik yang sistematis, termasuk konfirmasi melalui pemeriksaan histopatologi dan imunopatologi, untuk memastikan penatalaksanaan yang tepat dan akurat pada kasus-kasus yang kompleks.
What Is The Comparative Effectiveness Of Radical Prostatectomy, Radiation Therapy, And Androgen Deprivation Therapy In Patients With Biochemically Recurrent Prostate Cancer After Initial Treatment? : A Systematic Review and Metaanalysist Studies Tegar Pamungkas; John M.Sangkai
The Indonesian Journal of General Medicine Vol. 14 No. 3 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/q303zb82

Abstract

Introduction: Biochemically recurrent prostate cancer (BCRPC) after initial treatment poses a significant clinical challenge. This systematic review and meta-analysis aimed to evaluate the comparative effectiveness of radical prostatectomy, radiation therapy, and androgen deprivation therapy (ADT), including novel antiandrogens, in patients with BCRPC without metastatic disease. Methods: Following PRISMA 2020 guidelines, 40 studies published within the last 10 years were included, comprising mostly randomized controlled trials and prospective cohorts. Eligible studies compared at least two interventions among radical prostatectomy, radiation therapy, and ADT in adult patients with biochemical recurrence after primary treatment. Primary outcomes included progression-free survival, metastasis-free survival (MFS), overall survival (OS), and treatment-related complications. Data extraction and quality assessment were performed independently by multiple reviewers. Results: The addition of ADT to salvage radiotherapy (SRT) significantly improved PSA progression-free survival (HR 0.63; 95% CI 0.53–0.74) and metastasis-free survival (HR 0.67; 95% CI 0.55–0.82). Longer ADT duration (24 months) was superior to shorter duration (6 months) in improving MFS (HR 0.77; 95% CI 0.61–0.97). Novel hormonal agents combined with ADT, such as apalutamide, abiraterone, and enzalutamide, further enhanced biochemical control (HRs ranging 0.48–0.72). No consistent overall survival benefit was observed across studies (HR 0.85; 95% CI 0.42–1.69). PSMA PET/CT-guided SRT improved biochemical progression-free survival compared to conventional imaging. Treatment-related toxicities increased with dose-intensified radiotherapy and intensified hormonal therapies but were generally manageable. Discussion: Combining ADT with SRT improves biochemical and metastasis-free outcomes in BCRPC patients. Extended ADT duration and novel antiandrogen additions show further benefit, though optimal timing and duration remain uncertain. Advanced imaging enhances treatment precision. Balancing efficacy with toxicity and quality of life is essential. Conclusion: Multimodal treatment involving salvage radiotherapy and ADT, especially with novel hormonal agents, improves disease control in biochemically recurrent prostate cancer. Personalized treatment decisions based on patient risk and PSA kinetics are crucial. Further research is needed to clarify overall survival benefits and optimize therapy duration.
Non-Sterile Clean Gloves versus Sterile Gloves for Uncomplicated Wound and Laceration Repair: A Systematic Review of Clinical, Economic, and Patient-Reported Outcomes Regenio Akira Handoyo; John M. Sangkai
The Indonesian Journal of General Medicine Vol. 18 No. 1 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/y0krv256

Abstract

Introduction The use of sterile gloves is a deeply entrenched standard of care for surgical procedures, including the repair of cutaneous wounds and lacerations, to prevent surgical site infections (SSIs). However, this practice is resource-intensive and its necessity for minor, non-operating room procedures is increasingly questioned. This review evaluates the clinical and economic rationale for using clean, non-sterile gloves as an evidence-based alternative in outpatient and emergency settings (Hamam et al., 2024; Brewer et al., 2016). Methods A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Major electronic databases (PubMed, Embase, Cochrane CENTRAL, and CINAHL) were searched through May 2024 for randomized controlled trials (RCTs) and comparative observational studies comparing sterile versus non-sterile gloves for wound repair (Hamam et al., 2024). The primary outcome was the incidence of SSI. Secondary outcomes (16 total) included cost-effectiveness, procedure duration, and adverse events. Methodological quality was rigorously assessed using the Cochrane Risk of Bias 2 (RoB 2) and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools (Mahraoui et al., 2024; Hamam et al., 2024). Results Ten primary studies (6 RCTs, 4 observational) and three systematic reviews, encompassing over 21,000 patients, met the inclusion criteria. The quantitative meta-analysis of RCTs found no statistically significant difference in the incidence of SSI between the non-sterile glove group and the sterile glove group. Pooled data from recent meta-analyses confirm this finding (Risk Ratio 1.17, 95% Confidence Interval [CI] 0.88–1.55, P=.62) (Hamam et al., 2024). This result was highly robust, with no statistical heterogeneity (I² = 0%) (Hamam et al., 2024; Brewer et al., 2016). Evidence from multiple primary studies confirmed that non-sterile gloves are a highly cost-effective option, with sterile gloves costing up to seven times more per pair (Perelman et al., 2004; Mehta et al., 2014). Discussion The aggregated evidence demonstrates high-confidence non-inferiority for the use of clean, non-sterile gloves in uncomplicated, superficial wound repairs in immunocompetent patients (Heal et al., 2015; Zwaans et al., 2022). This is clinically plausible as traumatic lacerations are already contaminated, and a "clean" technique (including sterile instruments) is sufficient to prevent iatrogenic infection. However, the evidence clearly does not support non-sterile glove use for high-risk scenarios, such as in immunocompromised patients (Zwaans et al., 2022) or for complex, deep-tissue reconstructions (Rogues et al., 2007). A significant gap exists in the literature regarding patient-reported outcomes, particularly long-term cosmetic results. Conclusion Clean, non-sterile gloves are a safe, cost-effective, and evidence-based standard of care for the vast majority of uncomplicated laceration and wound repairs performed outside a formal operating room in immunocompetent patients. Clinical guidelines and institutional policies should be updated to reflect this evidence, promoting high-value care and reducing medical waste.
The Relationship Between Ki-67 Expression and Post-Surgical Breast Cancer Recurrence Rates: A Systematic Review Fiya Natilda; Miya Elmira; Desty Triyanti
The Indonesian Journal of General Medicine Vol. 18 No. 1 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/9sw42374

Abstract

Introduction: Post-surgical recurrence remains the primary driver of mortality in breast cancer. While the proliferation biomarker Ki-67 is recognized as a potent prognostic tool, its clinical implementation is debated due to significant methodological inconsistencies. This systematic review aims to synthesize the extensive body of evidence to confirm the significant, independent association between high Ki-67 expression and post-surgical breast cancer recurrence. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library was performed for studies from January 2007 to October 2024. The PICO (Population, Intervention, Comparator, Outcome) framework was used to select high-quality cohort studies and meta-analyses. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) for prognostic studies. Results: A total of 17 high-impact studies were included, comprising 12 primary cohort studies and 5 major meta-analyses, which collectively represent over 85,000 patients. The synthesis of this data demonstrates a highly significant and robust association between high Ki-67 expression and worse post-surgical outcomes. Major meta-analyses report that high Ki-67 confers a pooled Hazard Ratio (HR) for relapse of 1.93 (95% CI: 1.74–2.14, p < 0.001) and a pooled HR for mortality of 2.05 (95% CI: 1.66–2.53, p < 0.00001). High-impact cohort studies reinforce this, reporting HRs for recurrence risk as high as 7.14, 12.90, and even 30.47 in specific patient groups. This association remains significant across all major breast cancer subtypes, including ER+/HER2- and triple-negative breast cancer. Discussion: The prognostic signal of Ki-67 is exceptionally robust, remaining statistically significant despite wide heterogeneity in study cutoffs, ranging from 13% to 40%). This confirms its fundamental biological importance. Ki-67 is clinically essential for differentiating low-risk Luminal A from high-risk Luminal B subtypes and is now a critical biomarker for guiding adjuvant therapy decisions, including the use of CDK4/6 inhibitors. Conclusion: High Ki-67 expression is one of the most significant and clinically relevant independent predictors of post-surgical breast cancer recurrence. The urgent, collective adoption of international standardization guidelines for Ki-67 assessment, as proposed by groups like the International Ki-67 in Breast Cancer Working Group (IKWG), is the final and necessary step to unlock its full clinical utility in routine oncological practice.
The Diagnostic Accuracy of Automated Immature Granulocyte Percentage (IG%) for Early Sepsis and Serious Bacterial Infection Detection in Emergency Department Patients: A Systematic Review of Diagnostic Test Accuracy Studies Hendra Dwitanto; Nina Amelinda Panggabean
The Indonesian Journal of General Medicine Vol. 18 No. 1 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/mr93ks21

Abstract

Introduction Sepsis, defined as a life-threatening organ dysfunction resulting from a dysregulated host response to infection (Singer et al., 2016), demands rapid diagnostic tools in the Emergency Department (ED). The automated Immature Granulocyte percentage (IG%), derived from routine Complete Blood Count (CBC), represents a real-time, cost-effective marker of acute hematopoietic stress, historically recognized as the 'left shift' (Ayres et al., 2019). The timely quantification of IG% offers a potentially superior advantage over traditional inflammatory markers with slower kinetic profiles (Bhansaly et al., 2022). Methods A systematic review of diagnostic test accuracy (DTA) studies was performed following the methodological standards of the PRISMA-DTA guidelines. Studies evaluating IG% in acute care settings (ED, ICU) with sufficient data for 2x2 contingency tables were included. Methodological quality and risk of bias were meticulously assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool (Whiting et al., 2011). Pooled estimates for diagnostic metrics, including Sensitivity, Specificity, and the Diagnostic Odds Ratio (DOR), were calculated using a robust bivariate random effects model to account for study heterogeneity. Results A total of 15 high-quality diagnostic accuracy studies were included in the quantitative synthesis, encompassing diverse patient spectrums and rigorous sepsis/Serious Bacterial Infection (SBI) definitions. The meta-analysis demonstrated highly significant diagnostic performance for IG%. The pooled diagnostic accuracy yielded an Area Under the Curve (AUC) of 0.86 (95% CI: 0.83–0.89). The pooled Sensitivity was calculated at 83.1% (95% CI: 78.5%–87.1%), and pooled Specificity at 85.5% (95% CI: 82.1%–88.6%). Furthermore, IG% demonstrated a robust pooled DOR of 31.2 (95% CI: 22.5–43.1), significantly surpassing most traditional ED biomarkers like Lactate (DOR 4.78) (Bhansaly et al., 2022; Wong et al., 2017). Importantly, Immature Granulocyte Count (IG%) and IG% showed discriminatory value (AUC \sim 0.82) as early as 24 hours prior to clinical diagnosis, demonstrating a crucial temporal advantage over Procalcitonin (PCT) (Bhansaly et al., 2022). Discussion The high pooled DOR confirms IG% as an essential ancillary biomarker for rapid sepsis triage. Its strength lies in its immediate availability, which circumvents the turnaround delays associated with specialized inflammatory assays. Observed heterogeneity in optimal cutoff values, ranging from 0.2\% to 3.0\%, reflects the dependency on patient age (adult versus pediatric) and clinical objective (screening versus exclusion) (Buoro et al., 2015; Zhong et al., 2021; Ayres et al., 2019). The integration of IG% into multivariate prediction models, particularly alongside C-Reactive Protein (CRP) and White Blood Cell (WBC) count, achieved the highest reported sensitivity of 93.0\% for SBI detection (Kwon et al., 2017). Conclusion Automated IG% is a rapid, inexpensive, and highly effective biomarker for the early detection and risk stratification of sepsis and SBI in the ED. Its combination of high diagnostic accuracy, cost-effectiveness, and critical temporal superiority provides clinicians with a powerful tool for initiating timely, goal-directed therapy and improving outcomes in acute emergency settings.
Narrative Review : Hubungan Lama Pemberian ASI, MPASI, Riwayat Penyakit Ibu Dan Anak, Imunisasi Dasar Terhadap Kejadian Stunting Dafa Rizki; Shofiyah Latief; Marzelina Karim; Sidrah Darma; Abdi Dwiyanto
The Indonesian Journal of General Medicine Vol. 19 No. 1 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/dkytzv05

Abstract

Latar Belakang:Stunting merupakan gangguan pertumbuhan kronis pada anak yang disebabkan oleh kekurangan gizi jangka panjang, tingginya paparan penyakit infeksi, serta praktik pemberian makan yang tidak optimal. Indonesia masih menghadapi beban stunting yang cukup besar, termasuk di Kota Makassar, sehingga diperlukan pemahaman komprehensif mengenai faktor-faktor yang berkontribusi terhadap kejadian stunting, terutama pada periode kritis 1000 HPK. Tujuan: Penelitian ini bertujuan untuk menganalisis secara naratif berbagai faktor yang berhubungan dengan kejadian stunting, meliputi pemberian ASI, kualitas dan waktu pemberian MP-ASI, riwayat penyakit ibu dan anak, serta status imunisasi dasar. Metode: Penelitian menggunakan metode narrative review dengan telaah literatur dari Google Scholar, PubMed, Elsevier, dan NCBI. Pemilihan literatur mengikuti kriteria inklusi tahun publikasi 2019–2025 (textbook 2015–2025) dan menghasilkan 41 artikel yang dianalisis secara kualitatif. Data diringkas dalam tabel deskriptif dan disintesis untuk menghasilkan kesimpulan tematik. Hasil: Hasil review menunjukkan bahwa ASI eksklusif berperan protektif terhadap stunting, dengan beberapa studi menemukan hubungan signifikan (p < 0,05). MP-ASI yang bergizi dan tepat waktu juga berkaitan dengan risiko stunting yang lebih rendah. Riwayat penyakit infeksi—seperti diare dan ISPA—dalam banyak studi menunjukkan hubungan signifikan dengan stunting, meskipun tidak konsisten di semua lokasi. Faktor maternal, termasuk status gizi ibu dan usia kehamilan berisiko, turut meningkatkan kemungkinan terjadinya stunting. Status imunisasi dasar menunjukkan hasil bervariasi: beberapa studi tidak menemukan hubungan langsung, tetapi ada bukti efek tidak langsung melalui pencegahan infeksi. Kesimpulan: Pemberian ASI eksklusif, kualitas MP-ASI, pencegahan infeksi, serta kesehatan ibu selama kehamilan merupakan faktor kunci dalam pencegahan stunting. Intervensi integratif berbasis data lokal sangat diperlukan untuk menurunkan prevalensi stunting secara efektif.

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