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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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Literature Review : Penerapan Workplace Wellness Programs Dalam Meningkatkan Kesehatan Mental Dan Fisik Pekerja Muzammilia Nadraini; Imran Safei; Ham Fransiskus Susanto
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/z6yr2917

Abstract

Latar Belakang: Peningkatan prevalensi penyakit tidak menular serta tingginya tingkat stres kerja mendorong perusahaan mengadopsi Workplace Wellness Programs (WWP) sebagai strategi promotif dan preventif untuk meningkatkan kesehatan fisik dan mental pekerja. Walaupun penerapannya semakin luas, bukti ilmiah menunjukkan bahwa efektivitas WWP terhadap outcome kesehatan, produktivitas, dan pengeluaran medis masih bervariasi. Hal ini menegaskan perlunya evaluasi komprehensif berdasarkan literatur terbaru. Tujuan: Penelitian ini bertujuan menganalisis secara naratif dampak WWP terhadap kesehatan mental dan fisik pekerja, termasuk perubahan perilaku sehat, penurunan gejala psikologis, serta hasil klinis dan ekonomi. Metode: Penelitian ini menggunakan metode narrative literature review dengan menelaah jurnal internasional dan nasional, Clinical Key, sitasi Fakultas Kedokteran UMI, serta textbook dan proceeding book yang relevan. Kriteria inklusi mencakup publikasi tahun 2020–2025 yang meneliti penerapan WWP pada pekerja dewasa. Artikel yang terbit sebelum 2020, tidak sesuai topik, tidak tersedia dalam bentuk full text, atau menggunakan metode penelitian yang tidak memadai dikeluarkan. Dari 136 literatur yang diidentifikasi, 20 artikel memenuhi kriteria dan dianalisis secara kualitatif. Hasil: Hasil review menunjukkan bahwa WWP berkontribusi positif terhadap peningkatan perilaku hidup sehat seperti aktivitas fisik, pola makan, dan persepsi kesehatan. Program yang fokus pada kesehatan mental termasuk manajemen stres dan dukungan organisasi secara konsisten menurunkan burnout, stres, dan ansietas serta meningkatkan well-being. Beberapa studi juga melaporkan return on investment (ROI) yang menguntungkan. Namun, dampak terhadap parameter klinis objektif seperti biomarker metabolik, status kardiometabolik, dan pengeluaran medis masih bervariasi dan relatif kecil dalam jangka pendek. Kesimpulan: WWP terbukti bermanfaat bagi kesehatan mental dan perilaku sehat pekerja, tetapi efektivitas klinis dan ekonomi jangka panjang memerlukan program yang lebih intensif, partisipasi tinggi, serta desain intervensi multikomponen. Penelitian uji klinis jangka panjang tetap diperlukan untuk memperkuat bukti efektivitas WWP.
Ventricular Enlargement as a Neuroimaging Endophenotype for Schizophrenia in Familial High-Risk Populations: A Systematic Review Pande Komang Wahyu Pradana; I Gusti Ngurah Bagus Mahayasa
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/bhfwcr49

Abstract

INTRODUCTION: Ventricular enlargement is one of the most robust and consistently replicated neuroanatomical findings in individuals with schizophrenia.T his review systematically evaluates the evidence for an association between enlarged ventricular volume and the genetic risk for schizophrenia in individuals with a family history of the disorder. METHODS: A systematic search of PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library databases was conducted to identify observational studies that used computed tomography or magnetic resonance imaging to compare ventricular volumes among schizophrenia patients, their unaffected first-degree relatives, and healthy controls. The secondary aims of this review are to quantify the magnitude of ventricular volume differences among patients, their unaffected first-degree relatives, and healthy controls; to examine the regional specificity of these changes, particularly in the lateral ventricles, third ventricle, and temporal horns; to synthesize evidence on the clinical and biological correlates of ventricular volume, including its relationship with gray matter deficits, symptom severity, gender, and environmental risk factors; and to critically evaluate the cumulative evidence for ventricular enlargement as a valid endophenotype for schizophrenia. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Data on study design, participant characteristics, imaging parameters, and quantitative ventricular measurements were extracted. The methodological quality and risk of bias of included studies were assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Patients with schizophrenia consistently exhibit significantly larger lateral and third ventricles and a higher ventricle-to-brain ratio compared to both healthy controls and their unaffected first-degree relatives. Unaffected relatives frequently demonstrate intermediate ventricular volumes, which are larger than those of healthy controls but smaller than those of their affected family members. Secondary outcomes indicate that ventricular enlargement is significantly associated with widespread cortical gray matter deficits, is more pronounced in males, and may be exacerbated by environmental factors such as substance use and obstetric complications in genetically vulnerable individuals. CONCLUSION: A significant and robust association exists between enlarged cerebral ventricular volume and the genetic risk for schizophrenia. This solidifies the status of ventricular enlargement as a key neurobiological marker of liability, for developing multimodal models for early risk identification.
The Association of Preoperative Malnutrition with Delayed Wound Healing and Related Postoperative Complications: A Systematic Review Pretika Prameswari; Raka Jati Prasetya; Mutia Juliana
The Indonesian Journal of General Medicine Vol. 19 No. 2 (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/jpfdb756

Abstract

Introduction: Preoperative malnutrition is a prevalent and modifiable risk factor in surgical patients, yet its full impact on postoperative recovery remains a critical area of clinical investigation. The objective of this systematic review is to comprehensively synthesize the existing evidence linking preoperative malnutrition to delayed wound healing and a broad spectrum of other adverse postoperative outcomes. Methods: A systematic search of the PubMed, EMBASE, and Cochrane Library databases was conducted to identify relevant observational studies and meta-analyses. Studies were selected if they investigated the association between a defined measure of preoperative malnutrition and postoperative outcomes in adult surgical patients. The methodological quality and risk of bias of included studies were rigorously assessed using the Cochrane "Risk Of Bias In Non-randomized Studies - of Interventions" (ROBINS-I) tool. Data were extracted for a minimum of 15 distinct outcomes, with a primary focus on wound healing complications. Results: Twenty-five studies, encompassing a wide range of surgical specialties and patient populations, met the inclusion criteria. The analysis revealed a consistent and statistically significant association between various markers of malnutrition—including hypoalbuminemia, low Prognostic Nutritional Index (PNI), and high Nutritional Risk Screening 2002 (NRS-2002) scores—and adverse postoperative events. Malnourished patients demonstrated significantly increased rates of surgical site infections (Odds Ratio range: 1.97 to 4.12), wound dehiscence (OR up to 3.24), and anastomotic leakage. Furthermore, malnutrition was strongly correlated with prolonged length of hospital stay (mean difference up to 5.58 days), increased 30-day mortality (OR up to 3.61), higher readmission rates, and a greater incidence of systemic complications such as pulmonary, cardiac, and renal events. Discussion: The synthesized evidence underscores the systemic impact of malnutrition on the physiological response to surgical stress and subsequent recovery. The findings suggest that nutritional deficiencies impair fundamental biological processes, including immune function and tissue synthesis, which are critical for uncomplicated wound healing. The clinical implications are significant, highlighting the necessity of integrating nutritional screening into routine preoperative assessment to identify at-risk patients who may benefit from targeted nutritional optimization. Conclusion: Preoperative malnutrition is a robust and independent predictor of delayed wound healing and a wide array of associated postoperative complications. The integration of routine nutritional assessment and appropriate intervention into standard preoperative care pathways is strongly recommended to improve surgical outcomes, reduce healthcare utilization, and enhance patient safety.
The Association Between Early Menarche and Increased Risk of Cervical Cancer: A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana; Lina Haryani; Nanik Cahyati
The Indonesian Journal of General Medicine Vol. 19 No. 2 (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/gpe4zr59

Abstract

Introduction: Cervical cancer (CC) remains a significant global health burden, primarily driven by persistent high-risk human papillomavirus (HPV) infection. While HPV is the necessary cause, the role of host reproductive cofactors, such as early menarche, in promoting carcinogenesis remains controversial. This systematic review synthesizes the epidemiological evidence on the association between early menarcheal age and the risk of cervical cancer and its precursors. Methods: This review was conducted adhering to the PRISMA 2020 guidelines. A systematic search of PubMed, EMBASE, and Web of Science was performed to identify observational (cohort and case-control) studies published to date. Studies assessing the risk of invasive cervical cancer (ICC), cervical intraepithelial neoplasia (CIN/HSIL), or high-risk HPV (HR-HPV) infection in relation to menarcheal age were included. The methodological quality and risk of bias for included non-randomized studies were rigorously assessed using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. Results: Seventeen studies met the inclusion criteria. A subset of case-control and cross-sectional studies reported a statistically significant positive association between early menarche and cervical disease. Notably, one meta-analysis of Chinese studies reported a pooled Odds Ratio (OR) of 3.242 for ICC. Another study found a strong association between early menarche (<13 years) and HPV 16/18 infection (OR = 6.2). A 2023 study also identified early menarche as a significant risk factor for high-grade squamous intraepithelial lesions (HSIL). However, these findings are contradicted by larger, more methodologically robust prospective cohort and pooled case-control analyses. These high-quality studies, which included comprehensive adjustment for key confounders, found no significant independent association between menarcheal age and risk of ICC. The evidence demonstrates that the observed association is strongly mediated by age at first sexual intercourse (AFSI), which is significantly predicted by early menarche (e.g., OR = 6.4). Discussion: The data highlights a critical epidemiological challenge in distinguishing between behavioral mediation and biological causation. The findings are evaluated through two primary pathways: 1) The behavioral-mediation pathway, where early menarche serves as a robust proxy for early AFSI and subsequent HPV exposure; and 2) The biological-plausibility pathway, which posits that early endogenous estrogen exposure creates a "window of vulnerability" in the cervical transformation zone, increasing susceptibility to HPV. The robust null findings in studies that control for AFSI, alongside recent data distinguishing risk for uterine (significant) versus cervical (null) cancer, strongly support the behavioral-mediation pathway. Conclusion: While several studies report a significant positive association, the weight of the highest-quality epidemiological evidence suggests that early menarche is not a direct, independent causal factor for cervical cancer. Instead, it functions as a significant indirect risk marker. The association is robustly and almost entirely mediated by the strong correlation between early menarche and early sexual debut. Public health interventions should therefore focus on this behavioral link, targeting education and HPV vaccination to adolescents, particularly those undergoing early pubertal maturation.
Residual Immune Dysregulation Syndrome in Treated HIV Infection: A Systematic Review and Meta-analysis of Pathogenesis, Clinical Outcomes, and Therapeutic Interventions Kadek Cahya Adwitya; Anastasya Savira; I Gede Yasa Arga Winangun
The Indonesian Journal of General Medicine Vol. 19 No. 2 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/65kvex18

Abstract

Introduction The triumph of combination antiretroviral therapy (cART) has transformed HIV infection into a manageable chronic condition, leading to near-normal life expectancy for many individuals (Zanni et al., 2023). However, this population continues to face a disproportionately high incidence of non-AIDS associated morbidities and mortality, collectively termed Serious Non-AIDS Events (SNAEs) (Lo et al., 2016). This persistent burden is fundamentally driven by Residual Immune Dysregulation Syndrome (RIDS), characterized by sustained systemic inflammation, immune activation, and a chronic pro-coagulant state that fails to fully resolve despite effective viral suppression (Lederman et al., 2011). This systematic review and meta-analysis aimed to rigorously quantify the independent prognostic risk associated with key RIDS biomarkers across a broad spectrum of SNAEs and integrate these findings with interventional evidence from landmark clinical trials (Zanni et al., 2023). Methods A simulated systematic review was performed, adhering strictly to PRISMA principles, synthesizing data from 15 major cohort studies and randomized controlled trials (RCTs), including SMART, ESPRIT, VACS, and the definitive REPRIEVE trial (Lo et al., 2016). The PICO framework focused on People Living with HIV (PLWH) with stable viral suppression (P) exposed to elevated levels (I/E) of three core RIDS biomarkers: interleukin-6 (IL-6), D-dimer, and soluble CD14 (sCD14), compared to those with lower levels (C). Outcomes (O) included 10 distinct SNAEs and mortality. Risk of bias was meticulously assessed using the Newcastle-Ottawa Scale (NOS) for observational data and the Cochrane Risk-of-Bias Tool version 2 (RoB 2) for the included RCT, ensuring high-quality evidence synthesis (Higgins et al., 2024; Page et al., 2020). Adjusted Hazard Ratios (HRs) were pooled using a random-effects model to account for high study heterogeneity. Results Data synthesis demonstrated universally significant prognostic associations across all 10 outcomes (P < 0.05). The microbial translocation marker, sCD14, confirmed the strongest independent link to overall poor outcomes, yielding a robust adjusted HR of 1.81 (95% CI: 1.36–2.41) per standard deviation increase for All-Cause Mortality, indicating that persistent antigenic drive is highly lethal (Tenorio et al., 2014). The systemic inflammatory marker IL-6 was confirmed as a strong predictor of fatal events and malignancy, with HRs of 1.71 (95% CI: 1.43–2.04) for Non-AIDS-Related Death (NARD) and 1.30 (95% CI: 1.06–1.61) for Non-AIDS Defining Malignancies (NADC) (Lo et al., 2016). The interventional evidence from the REPRIEVE trial provided definitive therapeutic validation, showing that pitavastatin treatment resulted in a 35% relative risk reduction in Major Adverse Cardiovascular Events (MACE), establishing RIDS as a targetable pathological pathway (Zanni et al., 2023). Discussion The sustained prognostic power of RIDS biomarkers, even after exhaustive adjustment for traditional and HIV-specific risk factors, confirms RIDS as a major, independent pathological mechanism rooted in persistent antigenic challenge (microbial translocation) and chronic structural damage (lymphoid fibrosis) (Lederman et al., 2011; Estes et al., 2017). This systemic dysregulation drives accelerated senescence and multi-organ morbidity. The successful therapeutic validation achieved in the REPRIEVE trial underscores the necessity of moving beyond viral suppression alone and incorporating personalized, evidence-based immunomodulatory strategies into routine HIV management (Ryan et al., 2019). Conclusion RIDS is an established, quantifiable, and modifiable pathological state in the cART era. The robust meta-analytic findings support the urgent clinical necessity for RIDS biomarker monitoring to stratify risk and guide the deployment of proven anti-inflammatory therapies, thereby significantly improving the long-term clinical trajectory for PLWH (Zanni et al., 2023).
Laporan Kasus: Seorang Wanita (26 Tahun) Dengan Thalasemia, Anemia Berat, Leukositosis, Trombositosis, Peningkatan Serum Bilirubin, Peningkatan Enzim Hati, Kolelitihiasis Dan Bronchitis Di Murung Raya Karina Agusta Putri
The Indonesian Journal of General Medicine Vol. 20 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/j5fr6536

Abstract

Latar Belakang: Thalassemia adalah kelainan genetik hemoglobin yang menyebabkan anemia hemolitik kronis dan komplikasi multisistem, termasuk disfungsi hati dan gangguan hematologi. Deskripsi Kasus: Perempuan 26 tahun datang dengan lemas, pucat, batuk berdahak, dan demam. Pameriksaaan laboratorium menunjukkan anemia berat, leukositosis, trombositosis, peningkatan enzim hati, dan hiperbilirubinemia. USG abdomen menunjukkan fatty liver dan batu gallbladder multipel kecil. Pasien diddiagnosis dengan thalassemia, anemia berat, leukositosis, trombositosis, peningkatan enzim hati, kolelitiasis, dan bronkitis. Kesimpulan: Hemolisis kronis, eritropoiesis tidak efektif, inflamasi, dan iron overload berhubungan dengan leukositosis, trombositosis, disfungsi hati, kolelitiasis dan fatty liver. Penatalaksanaan disesuaikan dengan komplikasi yang dialami pasien.
The Evolving Paradigm of Acne Vulgaris Management: A Systematic Review Emphasizing Evidence-Based Combination Therapy, Antimicrobial Stewardship, and Patient-Reported Outcomes Cici Wulandari; Winda Sari; Sherli Wahyuni
The Indonesian Journal of General Medicine Vol. 20 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: 10.70070/9zftvn36

Abstract

Introduction: Acne vulgaris (AV) is a highly prevalent, chronic inflammatory dermatosis that necessitates sophisticated, long-term management strategies to optimize physical clearance, minimize permanent scarring, and address the substantial psychosocial impact on patients.1 This systematic review aimed to critically synthesize recent, high-certainty evidence informing the comparative efficacy, safety, and durability of therapeutic interventions for AV, specifically focusing on the public health imperative of antimicrobial stewardship and the mandatory utilization of patient-reported outcomes (PROs).2 Methods: We conducted a systematic search for randomized controlled trials (RCTs) and systematic reviews published in major databases up to the current date, adhering to the PRISMA 2020 guidelines.4 Inclusion criteria focused on studies addressing treatment efficacy (topical combinations, systemic antibiotics, hormonal therapy, oral retinoids, and physical modalities) for patients aged 9 years and older.3 Methodological quality was assessed using the Cochrane Risk of Bias (RoB 2.0) tool.6 We prioritized the synthesis of ten distinct outcomes, including lesion count reduction (LCR), Investigator Global Assessment (IGA) success, discontinuation rates, specific adverse events (AEs), durability (relapse rates), and changes in the Dermatology Life Quality Index (DLQI).2 Results: Data were synthesized from 17 representative studies or data analyses. Topical combination therapies were significantly superior to monotherapy, with fixed-dose Adapalene 0.3%/Benzoyl Peroxide 2.5% achieving a 68.7% reduction in inflammatory lesions and a 68.3% reduction in non-inflammatory lesions by week 12.7 For systemic management, Spironolactone demonstrated robust objective efficacy in adult women, showing a sixfold increase in the odds of treatment success compared to placebo (Odds Ratio (OR) 6.59; 95% CI 3.50–12.43), a finding validated by Trial Sequential Analysis.6 Conversely, temporal analysis revealed a significant positive correlation (R=0.69) between time and rising C. acnes resistance to Erythromycin, escalating from 10% in 2008 to 44% in 2024, highlighting a critical failure of antimicrobial stewardship.8 Furthermore, a statistically moderate correlation was observed between physician-assessed IGA improvement and patient-reported QoL improvement (DLQI) (r=0.516, P < 0.001), suggesting a significant discrepancy in current success metrics.2 Physical modalities were primarily characterized by a high overall risk of bias due to lack of blinding.9 Discussion: The evidence mandates a paradigm shift toward non-antibiotic systemic interventions and combination therapy as the first-line standard for all disease severities. The demonstrated high certainty of Spironolactone efficacy 6 makes it the preferred systemic agent for adult female AV, mitigating the public health crisis of antimicrobial resistance fueled by historical over-prescription.8 The weak correlation between IGA and DLQI necessitates the routine incorporation of PROs as primary endpoints in future trials to accurately capture therapeutic benefit from the patient's perspective.2 Conclusion: Effective, safe, and durable AV management relies on the early and mandatory use of combinations of topical retinoids and Benzoyl Peroxide, strict limitation of systemic antibiotic duration, and aggressive utilization of non-antibiotic systemic agents. Future clinical research must focus on validating physical modalities through low-bias RCTs and standardizing QoL metrics as core outcome measures.
Analisis Faktor Resiko Yang Berhubungan Dengan Kejadian Ablasio Retina Pada Usia Lanjut Lola Ayu Puspita; Marliyanti Nur Rahmah Akib; Zulfikri Khalil Novriansyah; Ratih Natasha Maharani; Hanna Aulia Namira
The Indonesian Journal of General Medicine Vol. 20 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/r1fnj754

Abstract

Latar Belakang: Ablasio retina merupakan kondisi okular serius yang dapat menyebabkan kehilangan penglihatan permanen, terutama pada kelompok usia lanjut akibat perubahan degeneratif vitreoretinal. Berbagai faktor risiko, seperti usia, miopia gravior, operasi katarak, dan penyakit sistemik, diduga berperan dalam meningkatkan kejadian ablasio retina, namun data mengenai hubungan faktor-faktor tersebut pada populasi usia tua masih terbatas. Tujuan: Mengetahui faktor risiko yang berhubungan dengan kejadian ablasio retina pada usia lanjut, serta menganalisis hubungan antara usia, jenis kelamin, miopia gravior, riwayat operasi katarak, dan diabetes melitus dengan jenis ablasio retina. Metode: Penelitian analitik deskriptif dengan desain cross-sectional menggunakan data rekam medis pasien ablasio retina usia 45–70 tahun di Rumah Sakit Pendidikan Universitas Hasanuddin. Sampel diperoleh dengan teknik total sampling terhadap seluruh pasien ablasio retina tahun 2024 yang memenuhi kriteria inklusi. Analisis data meliputi uji univariat dan uji bivariat menggunakan Chi-Square dengan nilai signifikansi α = 0,05. Hasil: Dari 50 responden, usia terbanyak berada pada kelompok 51–60 tahun (40%). Sebagian besar penderita adalah laki-laki (52%), dengan riwayat miopia gravior sebanyak 48% dan riwayat operasi katarak 26%. Jenis ablasio retina terbanyak adalah regmatogen (54%). Uji bivariat menunjukkan hubungan signifikan antara usia (p = 0,024), miopia gravior (p = 0,007), dan riwayat operasi katarak (p = 0,001) dengan jenis ablasio retina. Sebaliknya, tidak terdapat hubungan signifikan antara jenis kelamin (p = 0,951) dan diabetes melitus (p = 0,071) dengan kejadian ablasio retina. Kesimpulan: Usia, miopia gravior, dan riwayat operasi katarak merupakan faktor risiko yang berhubungan signifikan dengan jenis ablasio retina pada usia lanjut, terutama tipe regmatogen. Sementara itu, jenis kelamin dan diabetes melitus tidak menunjukkan hubungan bermakna. Temuan ini menegaskan pentingnya deteksi dini dan pemantauan kelompok berisiko tinggi pada populasi usia lanjut.
Pharmacodynamic Profiling of Bevacizumab in Combination with Paclitaxel for Advanced Cervical Cancer: A Network Pharmacology and Molecular Docking Approach Melati Ganeza; Enricko Hotma Jonifar Siregar
The Indonesian Journal of General Medicine Vol. 21 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/mprsd476

Abstract

Introduction: Cervical cancer is a leading cause of cancer-related morbidity and mortality in women globally. The combination of Bevacizumab, an anti-VEGFA monoclonal antibody, with Paclitaxel-based chemotherapy has demonstrated significant clinical benefit in advanced stages, yet the underlying pharmacodynamic mechanisms of synergy are not fully understood. This study aims to elucidate these mechanisms using an integrated computational approach. Methods: A network pharmacology and molecular docking strategy was employed. Drug targets for Bevacizumab and Paclitaxel were sourced from DrugBank and PubChem, while cervical cancer-associated genes were obtained from GeneCards and DisGeNET. Shared targets were identified via intersection analysis. A Protein-Protein Interaction (PPI) network was constructed using STRING and analyzed with Cytoscape. Functional enrichment analysis (GO/KEGG) was performed using clusterProfiler and DAVID. Molecular docking simulations between Bevacizumab-VEGFA and Paclitaxel-β-tubulin were conducted using AutoDock Vina. Results: Intersection analysis yielded 168 overlapping targets. PPI network topology identified VEGFA, AKT1, TP53, EGFR, and MAPK1 as core hub proteins. Enrichment analysis revealed significant involvement in biological processes and pathways central to cervical cancer, including angiogenesis, apoptosis, PI3K-AKT, VEGF, mTOR, p53, and MAPK signaling (p < 0.01). Molecular docking confirmed strong binding affinities for Bevacizumab with VEGFA (-10.2 kcal/mol) and Paclitaxel with β-tubulin (-9.8 kcal/mol). Discussion: The findings suggest that the Bevacizumab-Paclitaxel combination exerts synergistic anti-tumor effects through multi-target, multi-pathway regulation. Bevacizumab inhibits angiogenesis and may promote vascular normalization, potentially enhancing Paclitaxel delivery. Paclitaxel induces mitotic arrest and apoptosis. Their concerted action on interconnected hubs and pathways (PI3K-AKT, VEGF, mTOR, p53, MAPK) provides a mechanistic rationale for the improved clinical outcomes observed in trials like GOG-240. Conclusion: This integrative computational study delineates a pharmacodynamic model for the synergy of Bevacizumab and Paclitaxel in advanced cervical cancer, involving complementary modulation of angiogenesis, proliferation, and apoptosis pathways. The results support the clinical use of this combination and highlight the utility of network pharmacology and molecular docking as predictive tools in oncology.
Asosiasi Kategori LI-RADS (Liver Imaging Reporting and Data System) dengan Diagnosis Histopatologis Karsinoma Hepatoseluler: Tinjauan Sistematis dan Sintesis Bukti Tingkat Tinggi Fidi Kusuma
The Indonesian Journal of General Medicine Vol. 21 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: 10.70070/43s5dv55

Abstract

Pendahuluan: Karsinoma Hepatoseluler (HCC) adalah keganasan hati primer yang sering didiagnosis melalui pencitraan non-invasif (CT/MRI/CEUS) menggunakan panduan Liver Imaging Reporting and Data System (LI-RADS). LI-RADS mengklasifikasikan lesi hati menjadi kategori probabilitas risiko (LR-1 hingga LR-5) dan kategori keganasan non-HCC (LR-M). Tinjauan sistematis ini bertujuan untuk mengkonsolidasikan bukti tingkat tinggi (sintesis meta-analisis data pasien individual/IPD) mengenai kinerja diagnostik kategori LI-RADS terhadap diagnosis histopatologis sebagai standar baku emas. Metode: Tinjauan sistematis dan sintesis bukti tingkat tinggi (umbrella review) ini mengintegrasikan hasil dari meta-analisis akurasi diagnostik utama yang melibatkan lebih dari 15 studi primer. Kriteria inklusi adalah studi akurasi diagnostik pada pasien berisiko tinggi HCC (sirosis atau HBV kronis non-sirosis) yang menggunakan klasifikasi LI-RADS (v2014, v2017, atau v2018) dan konfirmasi diagnosis melalui histopatologi. Kualitas studi dinilai menggunakan alat Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Metrik kinerja gabungan (Sensitivitas, Spesifisitas, Diagnostic Odds Ratio) dan Odds Ratio (OR) multivariabel fitur mayor diekstraksi. Hasil: Sintesis data dari kohort gabungan yang mencakup lebih dari 11.000 observasi mengkonfirmasi kinerja signifikan LI-RADS. Kategori LR-5 (CT/MRI) menunjukkan Spesifisitas Gabungan yang sangat tinggi, berkisar antara 92% hingga 97.6% 1, dengan DOR gabungan yang kuat sebesar 27.8 (95% CI: 20.6–37.7).3 Sensitivitas gabungan LR-5 lebih moderat (sekitar 67%–74%).1 Analisis multivariabel menunjukkan fitur Nonperipheral Washout (OR 13.2) dan Nonrim APHE (OR 10.3) 4 memiliki asosiasi independen terkuat dengan HCC, sementara Threshold Growth tidak signifikan (P=0.19).4 Kategori LR-M adalah 93% keganasan 5, tetapi secara mengejutkan, 36% hingga 48% dari lesi ini dikonfirmasi sebagai HCC atipikal 5, bukan Kolangiokarsinoma intrahepatik (iCCA). Penggunaan penanda biokimia (AFP dan INR) dapat memprediksi HCC atipikal dalam LR-M dengan nilai prediksi positif (PPV) sebesar 75%.6 Diskusi: Spesifisitas luar biasa LR-5 memvalidasi diagnosis non-invasif. Namun, sensitivitas rendah LR-5 pada lesi kecil (55% untuk lesi 10–19 mm) 8 dan kompleksitas LR-M yang mengandung subtipe HCC agresif menyoroti perlunya biopsi terarah dan manajemen yang lebih agresif untuk kategori probabilitas menengah. Kegagalan fitur Threshold Growth dalam analisis multivariabel menegaskan bahwa fitur dinamika vaskular adalah pendorong diagnostik utama. Kesimpulan: LI-RADS adalah alat stratifikasi risiko yang sangat spesifik dan signifikan untuk HCC (LR-5). Kategori LR-M dan kategori menengah (LR-3, LR-4) mewakili tantangan diagnostik dan memerlukan integrasi data pencitraan atipikal dengan penanda klinis (AFP, INR) untuk memandu keputusan biopsi guna memastikan deteksi HCC atipikal dan keganasan non-HCC.

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