cover
Article Per Year (5 Year)
All
Home Page
OAI Link
Editorial Team
Contact
Reviewer
Google Scholar
Contact Name
Indra Hadi
Contact Email
medikaprimainovasiutama@gmail.com
Phone
-
Journal Mail Official
pt.internationalmedicaljournal@gmail.com
Editorial Address
Equity Tower. 49th Floor. Sudirman Street. Special Region of Jakarta, Indonesia
Location
Kota adm. jakarta selatan,
Dki jakarta
INDONESIA
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 288 Documents
 25   26   27   28   29 
Management of Retained Placenta with Postpartum Hemorrhage in Vaginal Delivery: A Case Report Dewi Sunarti; Syauqi Kashira YA
The Indonesian Journal of General Medicine Vol. 43 No. 1 (2026): 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/bkrq9h66

Abstract

Background: Retained placenta is a condition in which the placenta is not delivered or fails to be expelled from the uterus more than 30 minutes after delivery during the third stage of labor, despite active management. This condition can result from inadequate uterine contractions or abnormal placental attachment to the uterine wall. It is a leading cause of postpartum hemorrhage. Postpartum hemorrhage is defined as a condition in which a patient experiences blood loss exceeding 500 mL following delivery, whether via spontaneous vaginal birth or cesarean section. Case Report: A 33-year-old pregnant woman (P3A0) presented with heavy bleeding following a vaginal delivery at the Warungpring Community Health Center (Puskesmas). The patient had undergone a spontaneous delivery at 40 weeks of gestation; the placenta had been delivered, and there appeared to be no retained placental tissue. Three hours after placental delivery, the patient experienced vaginal bleeding amounting to 500 mL, causing weakness and dizziness. Consequently, she was referred to the hospital for further management; dual-line intravenous fluids were initiated at the health center, and urinary catheterization yielded 100 cc of urine. Physical examination revealed vital signs as follows: blood pressure 100/70 mmHg, pulse 80 beats/minute, respiratory rate 21 breaths/minute, and temperature 36°C. Findings included the absence of lacerations, a positive exploration result (suggesting no retained tissue), and anemic conjunctivae. Examinations of the head, nose, ears, mouth, heart, lungs, abdomen, and extremities yielded normal results. Genital examination via inspection of the vulva and vagina revealed fresh red blood flowing from the birth canal. Ancillary testing included a complete blood count, which showed a hemoglobin level of 6.8 g/dL and a leukocyte count of 18,950. The patient received a transfusion of three units of packed red cells (PRC), resulting in post-transfusion hemoglobin and leukocyte levels of 9.6 g/dL and 18,740, respectively. Ultrasonography revealed retained placental tissue within the uterine cavity; consequently, the patient underwent curettage due to retained placenta. A follow-up hemoglobin check after the curettage showed a hemoglobin level of 9.2 g/dL and a leukocyte count of 15,070. Discussion: Retained placenta can occur due to a failure of uterine contractions or inadequate contractions, or because of abnormal placental attachment to the uterine wall. This condition is a cause of postpartum hemorrhage, requiring prompt and appropriate medical intervention to prevent severe complications. From a pathophysiological perspective, retained placenta results from the myometrium's failure to contract optimally at the placental implantation site. Consequently, the placental detachment process is incomplete, leaving blood vessels at the implantation site exposed and leading to hemorrhage. Additionally, abnormalities in placental attachment such as placenta accreta contribute to the risk of retained placenta in pregnant women. Physical examination of patients diagnosed with retained placenta typically reveals an enlarged, soft uterus accompanied by persistent bleeding. If the bleeding is not controlled, signs of hypovolemic shock may develop, such as an increased pulse rate, decreased blood pressure, and pale conjunctiva. These physical examination findings are crucial for determining the immediate course of action. Transabdominal ultrasonography (USG) can be performed to detect any remaining placental tissue within the uterine cavity. Furthermore, ancillary tests including laboratory assessments of hematocrit, hemoglobin, and coagulation parameters are necessary to evaluate blood loss and guide the planning of subsequent management.
EFFICACY OF GLP-1 RECEPTOR AGONISTS ON GLYCAEMIC CONTROL AND WEIGHT REDUCTION IN TYPE 2 DIABETES MELLITUS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS Nadhira Iriani Djatmiko; Muhamad Luthfi Asyhar; Rifqi Alridjal; Zia Faradila; Fitria Hazmi Sholihah; Brigitta Vania Santoso; Muhammad A'raaf Sirojan Kusuma; Charles Sanjaya
The Indonesian Journal of General Medicine Vol. 43 No. 1 (2026): 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/bbvjb653

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic disorder with a rapidly escalating global burden and is closely linked to obesity and cardiovascular disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are an incretin-based therapeutic class that simultaneously targets hyperglycaemia and adiposity. This systematic review aimed to evaluate the efficacy of GLP-1 RAs on glycaemic control and weight reduction in T2DM on the basis of randomized controlled trial (RCT) evidence. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Eligible studies were RCTs in adults with T2DM comparing a GLP-1 RA with placebo or an active comparator and reporting HbA1c and/or body weight outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool and certainty of evidence using the GRADE approach. Because of substantial clinical heterogeneity, evidence was synthesised in a structured narrative format rather than pooled quantitatively. Results: Thirty-two RCTs comprising 29,958 participants met the eligibility criteria. Every placebo-controlled comparison demonstrated a statistically and clinically significant reduction in HbA1c, with estimated treatment differences (ETDs) ranging from -0.5% to -1.75% (all p<0.001). Subcutaneous semaglutide produced HbA1c ETDs of up to -1.53% and weight reductions of up to -5.06 kg versus placebo, and was superior to exenatide extended release (ETD -0.62%; -3.78 kg) and to dulaglutide (ETD -0.41%; -3.55 kg). Once-weekly semaglutide 7.2 mg reduced body weight by 13.2% (ETD -9.3%) with an HbA1c ETD of -1.5%. The proportion achieving >=5% weight loss reached 68.8% in STEP 2 (odds ratio 4.88) and yielded an odds ratio of 10.0 in STEP UP T2D. Benefit was consistent across 16 outcome domains, including fasting plasma glucose, waist circumference, systolic blood pressure (ETD up to -5.0 mmHg), insulin requirement (glargine titration difference -13 U/day), and major adverse cardiovascular (HR 0.88; 95% CI 0.79-0.99) and renal (HR 0.85; 95% CI 0.77-0.93) outcomes in REWIND. Hypoglycaemia risk remained low, whereas mild-to-moderate gastrointestinal events were the most frequent adverse events. Twenty-three studies were judged at low risk of bias and nine raised some concerns, chiefly owing to open-label designs. Discussion: The consistency of the direction and magnitude of effect across 32 RCTs spanning diverse background regimens (monotherapy, metformin, sulphonylurea, SGLT-2 inhibitor and basal insulin combinations) supports a robust and reproducible class effect. A clear dose-response relationship, the superiority of semaglutide in head-to-head comparisons, and the accompanying cardiorenal benefit reinforce the position of this class within T2DM treatment algorithms for patients with concomitant obesity. Gastrointestinal tolerability and cost remain the principal implementation considerations, particularly within the Indonesian health-care setting. Conclusion: GLP-1 receptor agonists consistently and significantly improve glycaemic control and reduce body weight in T2DM, with a low risk of hypoglycaemia and additional cardiorenal benefit in high-risk populations. The evidence supports positioning GLP-1 RAs as a preferred option in patients with T2DM and overweight or obesity and elevated cardiovascular risk.
Multimodal Analgesia Techniques within Enhanced Recovery After Cesarean Surgery (ERACS) and Their Effect on Early Mobilisation and Breastfeeding After Caesarean Section: A Systematic Review of Randomised Controlled Trials and Primary Studies Ilham Ghifari; Michael Yazid Raushan Dhamir; Sabran Jamil Pulubuhu; Rizki Syafira
The Indonesian Journal of General Medicine Vol. 43 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/3ct6qr89

Abstract

Introduction: Caesarean section is the most frequently performed inpatient surgical procedure globally, generating moderate-to-severe somatic and visceral pain that impedes early mobilisation and lactation initiation. Enhanced Recovery After Cesarean Surgery (ERACS) positions opioid-sparing multimodal analgesia as the key pharmacological component. This systematic review aimed to synthesise randomised controlled trial evidence on the effect of multimodal analgesic techniques within an ERACS framework on early mobilisation and breastfeeding success after caesarean delivery. Methods: This systematic review adhered to PRISMA 2020 guidelines. Inclusion criteria: randomised controlled trials in women undergoing caesarean delivery comparing a multimodal/ERACS-embedded analgesic strategy with active or placebo comparator, reporting at least one of sixteen pre-specified outcome domains. Risk of bias was assessed using Cochrane RoB 2. Certainty of evidence was evaluated using GRADE. Synthesis was performed narratively-structurally with vote-counting of effect direction. Results: Twenty-eight randomised controlled trials (approximately 2,900 parturients) from 14 countries were included. Movement-evoked pain at 24 hours was significantly reduced by fascial plane blocks when neuraxial morphine was absent; opioid-sparing of 40-73% was achieved in morphine-free regimens. Early mobilisation improved significantly: full mobilisation on postoperative day 1 was achieved by 98% of women receiving multimodal regimens versus 83% receiving placebo and 58% receiving standard care. Breastfeeding at discharge increased from 48.3% to 67.2% under an ERACS pathway (p=0.046). Quality of recovery, satisfaction, pruritus, nausea and vomiting, bowel function, catheter removal, and length of stay all favoured optimised multimodal regimens. Adding fascial plane blocks to regimens already containing intrathecal morphine conferred no additional benefit beyond six hours. Discussion: An analgesic ceiling effect exists in which the contribution of any single modality is conditional on the background regimen. Intrathecal morphine remains the reference standard; when unavailable, fascial plane blocks deliver clinically important opioid-sparing translating into earlier ambulation. ERACS benefits on mobilisation and lactation appear to be mediated more by reduction of opioid-related adverse effects than by absolute pain score reduction. Conclusion: Multimodal, opioid-sparing analgesia delivered within an ERACS pathway produces statistically significant and clinically meaningful improvements in movement-evoked pain, opioid consumption, early mobilisation, quality of recovery, length of stay, and in-hospital breastfeeding after caesarean section. Regimen design should be stratified by whether long-acting neuraxial opioid is used. Future trials should adopt the ERACS core outcome set.
A Comprehensive Systematic Review Comparing Perioperative Outcomes of Robotic-Assisted versus Laparoscopic Resection of the Anterior Liver Segments Dita Oktaviani Ayuningtyas; Ika Fitriana Setyaningtias
The Indonesian Journal of General Medicine Vol. 43 No. 1 (2026): 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/tc7ev309

Abstract

Introduction: Minimally invasive liver surgery (MILS) is the contemporary standard for lesions in the anterior liver segments (II, III, IVb, V, VI), where the parenchymal transection plane is directly accessible. Robotic advantages in posterosuperior segments and major hepatectomy are established, yet its incremental value in the comparatively "easy" anterior segments remains contested. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines comparing robotic (RLR) versus laparoscopic (LLR) liver resection in anterior segments. Risk of bias assessed with ROBINS-I and RoB 2. Sixteen perioperative outcomes were synthesised narratively with direction-of-effect vote counting. Results: Twenty-three studies (>20,000 hepatectomies) were included. In the largest anterior-segment analysis (1,401 matched pairs), RLR had lower blood loss (75 vs 100 mL, P<0.001), lower transfusion (3.1% vs 5.4%, P=0.003), lower major morbidity (2.5% vs 4.6%, P=0.004), lower conversion (1.2% vs 4.5%, P<0.001), and shorter stay (4 vs 5 days, P<0.001), but higher 30-day readmission (3.5% vs 2.1%, P=0.042). A second international cohort (1,505 pairs) confirmed higher textbook outcome (78.3% vs 71.8%, P<0.001), lower blood loss, and lower morbidity. Direction-of-effect: robotic superior for conversion (16/18 studies) and blood loss (14/21), laparoscopic superior for operative time (13/21) and cost (7/7). Mortality, bile leak, liver failure, R0, and survival were equivalent. The single RCT found no quality-of-life difference. Discussion: In the anterior segments, robotics yields statistically significant but clinically modest gains, concentrated in haemostasis and conversion avoidance. Benefit magnitude is markedly attenuated relative to posterosuperior segments, consistent with a ceiling effect: laparoscopy in the anterolateral liver is already mature with low conversion and morbidity. The economic penalty of robotics is uniform and substantial. Conclusion: Robotic anterior-segment resection is safe and oncologically non-inferior, with advantages in blood loss, conversion, morbidity, and length of stay, but longer operative time and higher cost. Laparoscopy remains a highly cost-effective default; robotics is best justified in cirrhosis, reoperative surgery, and institutional MILS programme development.
A Comprehensive Systematic Review: Radiological Characteristics of Respiratory Distress Syndrome (RDS) Versus Transient Tachypnea of the Newborn (TTN) on Neonatal Chest Radiographs Ahmad Fauzi; Gani Michel; Nunung Nuripah; Zemmy Dison Bira
The Indonesian Journal of General Medicine Vol. 43 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/2s5mch46

Abstract

Introduction: RDS and TTN are the two most frequent causes of early neonatal respiratory failure, traditionally differentiated by chest radiography (CXR). RDS results from surfactant deficiency with alveolar collapse, while TTN results from delayed fetal lung fluid clearance. Both differ in prognosis and surfactant need, yet their radiographic signs overlap substantially in the first hours of life. Methods: A systematic review was conducted in accordance with PRISMA 2020. Eligible designs were RCTs, cohort, case-control, cross-sectional, and observational studies. Risk of bias was appraised with QUADAS-2, Newcastle-Ottawa Scale and RoB 2. A structured narrative synthesis with descriptive quantitative pooling across fourteen outcome domains was undertaken. Results: Twenty-nine studies (>350,000 neonates, >43,000 CXRs) included. Ground-glass/reticulogranular in 83.6%, air bronchograms 70.9%, reduced lung volume 66.4% in RDS; consolidation with air bronchograms exclusive to RDS (sensitivity & specificity ~100%). TTN characterised by interstitial fluid without consolidation (99.5% on serial exams). CXR alone performed lower: sensitivity 38.9%, specificity 77.8% for predicting NIV failure, AUC 0.80 for surfactant need (vs LUS 88.9%/100% and AUC 0.94). Each 1-point CXR score increase raised BPD odds by 77.7% (OR 1.777; p=0.001). Deep-learning F1 score 90.30% for RDS vs 70.84% for TTN. Discussion: The radiographic distinction between RDS and TTN rests on a small number of high-value discriminators—consolidation with air bronchograms and homogeneous granular hypoaeration for RDS, versus interstitial/perihilar fluid patterns with preserved or increased lung volume for TTN—but the plain radiograph is limited by low interobserver reliability, delayed acquisition, radiation exposure and a systematic tendency to misclassify early or mild disease. The evidence is consistent that CXR retains an irreplaceable confirmatory and complication-detection role, particularly in low-resource settings, while surrendering its position as the sole first-line arbiter of surfactant decisions. Conclusion: Chest radiography discriminates RDS from TTN with high specificity when consolidation and air bronchograms are present, but with insufficient sensitivity in the first hours of life to serve alone as the basis for surfactant decisions. Radiographic severity is a genuinely graded prognostic marker. A hybrid pathway—radiographic confirmation combined with quantitative bedside lung ultrasound and structured severity grading—is recommended, together with prospective studies using explicit, blinded, radiograph-only feature extraction.
A COMPREHENSIVE SYSTEMATIC REVIEW OF THE ASSOCIATION BETWEEN THALASSAEMIA MAJOR, ENDOCRINE COMPLICATIONS AND QUALITY OF LIFE Jeffy Marta
The Indonesian Journal of General Medicine Vol. 43 No. 1 (2026): 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/yrf06a50

Abstract

Introduction: Thalassaemia major (TM) is the most severe transfusion-dependent form of β-globin chain synthesis failure, transformed from a fatal paediatric disease into a chronic multisystem disorder of adulthood. The price of survival gain is cumulative transfusional iron overload targeting the anterior pituitary, pancreatic islets, thyroid, parathyroids, gonads and skeleton. Endocrine complications constitute the dominant morbidity of adult TM, intersecting directly with health-related quality of life (HRQoL). This review quantified endocrine morbidity in TM and its relationship to HRQoL. 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. Systematic reviews were excluded from primary tabulation but retained for corroboration. Two reviewers independently screened, extracted data and appraised risk of bias using Newcastle-Ottawa Scale, JBI checklist and RoB 2; certainty was graded with GRADE. Sixteen prespecified outcomes were synthesised narratively with structured tabulation. Results: Forty-seven primary studies encompassing >10,000 patients across 20 countries met eligibility. Multiple endocrinopathy affected 56% of TM patients versus 13% of transfused sickle-cell controls (p<0.001), adjusted odds ratio 9.4 (p<0.001). Hypogonadism was most frequent (40-56.7%), followed by growth failure (24-50.5%), glucose disorders (6.4-34%), thyroid dysfunction (6.5-19.9%), hypoparathyroidism (2.2-12.8%) and osteoporosis (21.6-89%). In a population-based English cohort, 76% had ≥1 comorbidity, 54% ≥2 and 37% ≥3; 10-year mortality 6.2% versus 1.2% in general population (p<0.001). Ferritin ≥1000 ng/mL predicted heart failure (HR 3.35) and death (HR 2.45). Pancreatic T2* <13.07 ms predicted abnormal glucose tolerance; normal pancreatic T2* carried 100% negative predictive value for dysglycaemia. HRQoL was significantly impaired relative to population norms: five of eight SF-36 subscales and both component summaries reduced (p<0.05); EQ-VAS 67.1 versus 80.4, FACT-G 70.1 versus 77.0, FACIT-Fatigue 27.9 versus 43.6 (all p<0.001). Female sex, older age, higher ferritin and greater complication number were independent determinants of poorer HRQoL. Gene editing exceeded minimal clinically important difference thresholds across all instruments; luspatercept responders achieved clinically meaningful SF-36 physical component improvement more often than placebo (31.1% vs 16.5%, p=0.024). GRADE certainty was moderate for six outcomes, low for eight, very low for two. Discussion: The evidence describes a coherent chain: transfusional iron loading produces organ-specific siderosis; endocrinopathies accumulate with age and iron exposure; this burden independently impairs HRQoL. Critically, the relationship is modifiable. Intensive chelation normalised glucose metabolism in 44%, permitted thyroxine discontinuation in 10/18 and testosterone in 7/14, while long-term deferasirox significantly improved lumbar bone mineral density (p<0.001) and reduced osteoporosis (p=0.022). Contemporary optimally managed cohorts show attenuated endocrine phenotype, whereas resource-constrained cohorts show the opposite. The dominant determinant is therefore not genotype but adequacy of iron control. Conclusion: Thalassaemia major is associated with high, statistically significant, multi-axis endocrine complication burden that accumulates with age and iron exposure and translates into significant HRQoL impairment across physical, psychological and social domains. Because the relationship between iron burden, endocrinopathy and quality of life is modifiable, structured age-stratified endocrine surveillance, aggressive organ-specific iron control guided by magnetic resonance relaxometry rather than ferritin alone, and routine longitudinal patient-reported outcome measurement should be core, non-optional components of comprehensive thalassaemia care.
A COMPREHENSIVE SYSTEMATIC REVIEW OF THE ASSOCIATION BETWEEN VISCERAL OBESITY AND INCREASED CARDIOMETABOLIC DISEASE RISK: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS AND PRIMARY STUDIES Jeffy Marta
The Indonesian Journal of General Medicine Vol. 43 No. 1 (2026): 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/r23xkg06

Abstract

Introduction: Visceral adipose tissue (VAT) is a metabolically active, pro-inflammatory fat depot distinct from subcutaneous fat. Body mass index (BMI) and waist circumference (WC) cannot discriminate VAT from subcutaneous fat, misclassifying patients with normal-weight central adiposity. This review synthesised primary evidence linking visceral obesity to cardiometabolic disease across sixteen outcome domains. 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, cohort, case-control and observational studies quantifying VAT by imaging (CT, MRI, DXA) or validated surrogates (METS-VF, VAI, CVAI). Systematic reviews were excluded from primary tabulation. Two reviewers independently screened, extracted data and appraised risk of bias using Newcastle-Ottawa Scale and RoB 2; certainty was graded with GRADE. Synthesis was narrative and tabular. Results: Fifty-two primary studies (36 observational, 16 RCTs) encompassing >400,000 participants were included. Incident CVD adjusted HRs ranged from 1.62 to 2.78. VAT predicted coronary heart disease independently of WC (HR 1.15 per SD), recurrent MACE (aHR 2.71), cardiovascular mortality (aHR 1.23 per SD; C-statistic 0.73), and all-cause mortality (HR 4.90 highest quartile). T2DM associations were markedly sex-divergent: adjusted ORs 2.62 in men and 32.49 in women. VAT predicted hypertension (OR 5.07) and metabolic syndrome (OR per SD 4.7 women, 4.2 men), persisting after BMI, WC and SAT adjustment. In normal-weight individuals, highest VAT quartile conferred 9-fold increased metabolic syndrome risk (OR 9.3). Randomized evidence demonstrated VAT modifiability: liraglutide 3.0 mg reduced VAT by 12.49% versus 1.63% with placebo (p<0.0001); combined exercise plus GLP-1 RA reduced metabolic syndrome severity z-score by -0.48 and hsCRP by 43%. Risk of bias was low to moderate. GRADE certainty was moderate for T2DM, hypertension, metabolic syndrome and VAT modifiability; low for cerebrovascular events. Discussion: VAT consistently outperforms SAT in predicting outcomes; associations persist after anthropometric adjustment; dose-response and cumulative-exposure gradients are demonstrated; effects are stronger in women; risk exists in normal-weight individuals; VAT is reversible under randomized intervention. Visceral and hepatic fat are related but distinct. Incremental predictive value beyond established risk scores is modest; VAT assessment is best as reclassification tool for intermediate-risk individuals. Conclusion: Visceral obesity is an independent, dose-dependent, sex-modified and therapeutically modifiable determinant of cardiometabolic disease, exerting effects not captured by BMI or WC alone. Clinical practice should move towards phenotype-centric assessment using imaging where available and validated surrogates where not, prioritising interventions with demonstrated VAT efficacy. Future research should establish population-specific VAT thresholds and test whether VAT-guided treatment improves hard outcomes.
CONTEMPORARY CHEST RADIOGRAPHIC MANIFESTATIONS OF PULMONARY TUBERCULOSIS INFECTION WITH HIV/AIDS COINFECTION : A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS AND PRIMARY STUDIES Rahma Adinda; Nindi Elis; Hikmatul Lailiyah
The Indonesian Journal of General Medicine Vol. 44 No. 1 (2026): 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/msqq9n43

Abstract

Introduction: Tuberculosis (TB) remains the leading infectious cause of death among people living with HIV (PLHIV), with chest radiography (CXR) as the primary imaging modality in high-burden settings. Progressive CD4+ T-lymphocyte depletion disrupts granulomatous containment, producing "atypical" radiographic patterns including lymphadenopathy, lower-zone consolidation, miliary dissemination, and normal radiographs. This systematic review synthesises CXR manifestations of pulmonary TB in HIV/AIDS coinfection across fourteen outcome domains. Methods: Systematic review per PRISMA 2020 guidelines. Eligible designs included RCTs, cohort, case-control, cross-sectional, and observational primary studies. Risk of bias assessed with RoB 2, Newcastle-Ottawa Scale, JBI checklist, and QUADAS-2. Narrative synthesis with tabulated effect estimates performed. Results: Thirty-four primary studies (>55,000 participants) met inclusion criteria: 5 randomised/cluster-randomised trials and 29 observational studies. Cavitation was significantly less frequent with advanced immunosuppression: 32% vs 68% in CD4 <200 vs ≥200 cells/µL (P=.008); HIV independently reduced adjusted odds of cavities (aOR 0.34, 95% CI 0.13-0.85; P=.02). Consolidation: 47% vs 63% (P=.002; aOR 0.30 for any opacity). Lymphadenopathy more frequent at low CD4: 30% vs 7% (P=.01). Miliary pattern increased with immunosuppression: 64% vs 36% (P=.04). Normal/non-suggestive CXR occurred in 14-32% of bacteriologically confirmed cases. HIV was sole independent predictor of atypical radiographic appearance (OR 0.20 for typical pattern, 95% CI 0.13-0.31). Computer-aided detection sensitivity fell by 13.4 absolute percentage points in PLHIV for two of three algorithms (95% CI -21.1 to -6.9). Radiographic deterioration occurred in 53.4% of paradoxical TB-IRIS events; corticosteroids significantly improved CXR at weeks 2 (P=.002) and 4 (P=.02). Discussion: Radiographic phenotype in HIV/TB coinfection reflects quantitative immunological deficit. Cavitation requires intact granulomatous response; as CD4+ declines, adenopathic, disseminated, and radiographically silent phenotypes predominate. Molecular evidence confirms altered host immunity, not recent infection, drives this shift. Normal CXR does not exclude active TB in PLHIV; radiographic gatekeeping is unsafe. Computer-aided detection requires HIV-stratified calibration. CXR retains value for severity, monitoring, and prognosis but must be abandoned as rule-out test. Conclusion: CXR in HIV/TB coinfection shifts predictably away from cavitary post-primary disease toward adenopathic, miliary, and silent phenotypes with CD4 depletion, degrading diagnostic sensitivity. Every PLHIV investigated for TB should undergo molecular testing irrespective of CXR appearance. Radiological reports should state CD4 stratum and avoid "no evidence of active TB"; CAD thresholds require local HIV-stratified calibration.

Page 29 of 29 | Total Record : 288

 25   26   27   28   29 

Filter by Year

2024 2026


Reset
Filter By Issues
All Issue Vol. 44 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 43 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 42 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 41 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 40 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 39 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 38 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 37 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 36 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 35 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 34 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 33 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 32 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 31 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 30 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 29 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 28 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 27 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 26 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 25 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 24 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 23 No. 1 (2026): The Indonesian Journal of General Medicine Vol. 22 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 21 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 20 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 19 No. 2 (2025): The Indonesian Journal of General Medicine Vol. 19 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 18 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 17 No. 4 (2025): The Indonesian Journal of General Medicine Vol. 17 No. 3 (2025): The Indonesian Journal of General Medicine Vol. 17 No. 2 (2025): The Indonesian Journal of General Medicine Vol. 17 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 16 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 15 No. 2 (2025): The Indonesian Journal of General Medicine Vol. 15 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 14 No. 3 (2025): The Indonesian Journal of General Medicine Vol. 14 No. 2 (2025): The Indonesian Journal of General Medicine Vol. 14 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 13 No. 5 (2025): The Indonesian Journal of General Medicine Vol. 13 No. 4 (2025): The Indonesian Journal of General Medicine Vol. 13 No. 3 (2025): The Indonesian Journal of General Medicine Vol. 13 No. 2 (2025): The Indonesian Journal of General Medicine Vol. 13 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 12 No. 3 (2025): The Indonesian Journal of General Medicine Vol. 12 No. 2 (2025): The Indonesian Journal of General Medicine Vol. 12 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 11 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 10 No. 2 (2025): The Indonesian Journal of General Medicine Vol. 10 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 9 No. 2 (2025): The Indonesian Journal of General Medicine Vol. 9 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 8 No. 2 (2025): The Indonesian Journal of General Medicine Vol. 8 No. 1 (2025): The Indonesian Journal of General Medicine Vol. 7 No. 4 (2024): The Indonesian Journal of General Medicine Vol. 7 No. 3 (2024): The Indonesian Journal of General Medicine Vol. 7 No. 2 (2024): The Indonesian Journal of General Medicine Vol. 7 No. 1 (2024): The Indonesian Journal of General Medicine Vol. 6 No. 1 (2024): The Indonesian Journal of General Medicine Vol. 5 No. 2 (2024): The Indonesian Journal of General Medicine Vol. 5 No. 1 (2024): The Indonesian Journal of General Medicine Vol. 4 No. 1 (2024): The Indonesian Journal of General Medicine Vol. 3 No. 1 (2024): The Indonesian Journal of General Medicine Vol. 2 No. 8 (2024): The Indonesian Journal of General Medicine Vol. 2 No. 7 (2024): The Indonesian Journal of General Medicine Vol. 2 No. 6 (2024): The Indonesian Journal of General Medicine Vol. 2 No. 5 (2024): The Indonesian Journal of General Medicine Vol. 2 No. 4 (2024): The Indonesian Journal of General Medicine Vol. 2 No. 3 (2024): The Indonesian Journal of General Medicine Vol. 2 No. 2 (2024): The Indonesian Journal of General Medicine Vol. 2 No. 1 (2024): The Indonesian Journal of General Medicine Vol. 1 No. 8 (2024): The Indonesian Journal of General Medicine Vol. 1 No. 7 (2024): The Indonesian Journal of General Medicine Vol. 1 No. 6 (2024): The Indonesian Journal of General Medicine Vol. 1 No. 5 (2024): The Indonesian Journal of General Medicine Vol. 1 No. 4 (2024): The Indonesian Journal of General Medicine Vol. 1 No. 3 (2024): The Indonesian Journal of General Medicine Vol. 1 No. 2 (2024): The Indonesian Journal of General Medicine Vol. 1 No. 1 (2024) More Issue