Medicinus was established in 2007 as the official journal of the Faculty of Medicine at Universitas Pelita Harapan. It functions as a scholarly publication that undergoes peer-review and is easily accessible to readers. Its scope includes a wide range of topics, spanning from basic scientific research to clinical applications within the field of health and medical science. Authors are encouraged to submit original research articles, review papers, and compelling case reports for consideration. Medicinus is published three times per year in February, June, and October. 1978-3094 (print ISSN) | 2622-6995 (e-ISSN)
Fakultas Kedokteran Universitas Pelita Harapan
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Association Between Gender, Coronary Artery Dominance and Severity of Coronary Artery Stenosis on Computed Tomography Angiography
Background: Coronary artery disease (CAD) is one of the leading causes of death worldwide. Several preliminary studies suggest that certain dominance patterns may be associated with the distribution and severity of stenosis, influencing the risk of cardiac complications and interventional strategies. However, the relationship of gender specific between coronary artery dominance patterns and the severity of stenosis remains poorly understood. This study designed to evaluate the relationship between gender specific, coronary artery dominance, and severity of coronary artery stenosis, number of stenosis vessels, stenosis location, and calcium score on CCTA examination. Methods: A retrospective cross-sectional study with consecutive non-probability sampling was conducted over a one-year period with 1115 patients who underwent CCTA were analysed using the Chi-square test, Fisher’s exact test, and T-test according to the type of data. Result: The result showed a strong association was found between non-right dominant coronary artery (non-RDCA) in females and significant coronary stenosis (p=0.009), with the most strongly associated location being the LCX (p=0.017). Conclusions: These findings suggest the presence of gender- and dominance-specific patterns in coronary artery disease (CAD), warranting further investigation using prospective study designs and larger sample sizes.
Copyright (c) 2026 Yohanes Chandra Kurniawan, Rusli Muljadi, Koesbandono, Antonia Anna Lukito, Nata Pratama Hardjo Lugito, Mira Yuniarti http://creativecommons.org/licenses/by-sa/4.0
Accuracy of Mammography and Ultrasonography in Differentiating Benign and Malignant Breast Lesions Based on Histopathology at MRCCC Siloam Semanggi Hospital
Background: Breast cancer is the most common malignancy in women. Early detection improves survival. Mammography is the gold standard for women over 40, while ultrasonography is commonly used in younger women with dense breasts. To compare the diagnostic accuracy of mammography and ultrasonography in differentiating benign and malignant breast lesions using histopathology as the Gold standard. Methods: This cross-sectional analytic study included 91 patients who underwent mammography, ultrasonography, and histopathological confirmation at MRCCC Siloam Semanggi Hospital. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) were calculated. Statistical analysis used McNemar’s test and ROC curve analysis based on Hanley & McNeil’s method, with p < 0.05 considered significant. Result: Ultrasonography demonstrated higher sensitivity (98.4%) and NPV (92.3%) than mammography (96.7% and 88.9%), indicating better ability to rule out malignancy. Mammography showed higher specificity (53.3% vs. 40.0%) and PPV (80.8% vs. 76.9%), reflecting better performance in identifying benign lesions. Overall accuracy was slightly higher for mammography (82.4%) compared to USG (79.1%). The AUC for mammography was 0.750 (95% CI: 0.630–0.870), while USG had an AUC of 0.692 (95% CI: 0.565–0.819). Overlapping confidence intervals indicated no statistically significant difference in diagnostic accuracy between the two modalities (p > 0.05). Conclusions: Mammography and ultrasonography both demonstrated high diagnostic performance with complementary strengths. Mammography provided higher specificity and PPV, while USG offered superior sensitivity and NPV. Given the small difference in accuracy and overlapping AUC confidence intervals, no significant difference was found between the two modalities. Combined use of mammography and USG may improve diagnostic accuracy in clinical practice.
Copyright (c) 2026 Randi Eben Haezer, Nungky Kusumaningtyas, Mirna Muis, Denni Joko Purwanto, Nata Pratama Hardjo Lugito, Nina ISH Supit http://creativecommons.org/licenses/by-sa/4.0
Diagnostic Accuracy of Coronary Artery Calcium Scoring in Detecting Significant Coronary Artery Stenosis Compared with Invasive Coronary Angiography
Background: Coronary artery disease (CAD) remains a leading cause of mortality, emphasizing the importance of early non-invasive diagnostic strategies. This study evaluated the diagnostic accuracy of coronary artery calcium scoring (CACS) in detecting significant coronary stenosis, using invasive angiography as the reference standard. Methods: Sixty-three patients who underwent both CACS and quantitative coronary angiography were retrospectively analyzed. The mean total CACS was 684.1 ± 1030.8, and significant stenosis (≥70%) was most prevalent in the left anterior descending artery (92.1%). Result: Spearman’s analysis revealed positive correlations between CACS and angiographic stenosis in the right coronary artery (ρ = 0.338, p = 0.007), left anterior descending artery (ρ = 0.492, p = 0.001), and left circumflex artery (ρ = 0.314, p = 0.012). Receiver operating characteristic (ROC) analysis demonstrated moderate-to-good diagnostic performance, with area under the curve (AUC) values of 0.699 for RCA, 0.769 for LAD, and 0.690 for LCX. Conclusions: These findings indicate that CACS can serve as a reliable, low-cost, and non-invasive modality for preliminary screening and risk stratification of CAD, particularly in identifying patients who may benefit from invasive coronary angiography.
Copyright (c) 2026 Adelbertus Erico, Rusli Muljadi, Mira Yuniarti, Ingrid Maria Pardede, Andree Kurniawan, Patricia Jorizal http://creativecommons.org/licenses/by-sa/4.0
Quantitative CT Attenuation Cut-off Values for Lesion Characterization: Enostoses in Patients Without Malignancy Versus Osteoblastic Metastases in Breast Cancer
Background: Incidental osteoblastic bone lesions detected on CT scans, such as enostoses and osteoblastic metastases, often pose diagnostic challenges, especially in patients with or without a history of breast cancer. Hounsfield unit (HU) attenuation values have been proposed to differentiate these lesions non-invasively, however, variability in cut-off values exists in prior studies. Methods: This observational analytic case-control study included adult patients who underwent CT and FDG PET-CT at MRCCC Siloam Semanggi Hospital, Jakarta from 2020 to 2025. Controls were patients with enostoses and no history of malignancy, while cases were breast cancer patients with PET/CT-confirmed osteoblastic metastases. Mean and maximum HU values were measured and analyzed to determine optimal cut-offs. Result: Mean and maximum HU values were significantly higher in enostoses than in osteoblastic metastases (mean: 1025 ± 123.66 vs. 449.65 ± 106.93; maximum: 1167.77 ± 106.20 vs. 599.34 ± 134.78; p < 0.001). A mean HU cut-off of 692 achieved 100% sensitivity, 98.36% specificity, and an AUC of 0.992. A maximum HU cut-off of 860 showed 79.61% sensitivity, 100% specificity, and an AUC of 0.898. Conclusions: Mean and maximum HU values on CT are highly effective for differentiating enostoses from osteoblastic metastases in breast cancer patients.
Copyright (c) 2026 Novita Pitri, Mathelda Diah Wulandari, Dario Agustino Nelwan, Patricia Jorisal, Ivana Dewi Mulyanto, Ratna Sari Wijaya http://creativecommons.org/licenses/by-sa/4.0
Association Between Ultrasound-Derived Fat Fraction (UDFF) Values and Metabolic Syndrome Laboratory Parameters in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD), is highly prevalent worldwide and is strongly associated with metabolic syndrome and its related conditions such as diabetes mellitus and hypertension. Without early detection and intervention, hepatic steatosis can progress to hepatic inflammation, fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC). This study aims to evaluate the relationship between ultrasound-derived fat fraction (UDFF) values and laboratory parameters of metabolic syndrome in MASLD, particularly liver enzymes, lipid profile, and glycemic profile, as well as to determine the optimal UDFF cut-off value for detecting metabolic syndrome risk in Indonesian patients. Methods: A cross-sectional study was conducted on 96 patients who underwent UDFF and laboratory assessments including liver enzymes (SGOT/AST, SGPT/ALT), lipid profile (total cholesterol, HDL, LDL, triglycerides), and glycemic profile (HbA1c, fasting blood glucose). Data analysis included bivariate-multivariate correlation and ROC analysis. Result: The distribution of UDFF (%) was as follows: normal ≤6% (27.1%; n=26), mild >6–15% (37.5%; n=36), moderate >15–25% (21.9%; n=21), and severe >25% (13.5%; n=13). UDFF showed a moderate positive correlation with SGPT (ρ=0.370; p<0.01) and triglycerides (ρ=0.380; p<0.01), and a weak negative correlation with HDL (ρ=−0.221; p<0.05). A UDFF threshold of 14% was able to predict abnormal SGPT levels and elevated triglycerides. Conclusions: UDFF shows a significant correlation with laboratory parameters of metabolic syndrome in MASLD, confirming its potential as an accessible, effective, efficient, non-radiative, and non-invasive imaging modality. These findings support the central role of radiology in the early detection and therapeutic monitoring of MASLD and metabolic syndrome, as well as in preventing disease progression from hepatic steatosis to inflammation, fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Large-scale multicenter validation is required to optimize these findings.
Copyright (c) 2026 Rheza Maulana Syahputra, Patricia Jorisal, Vera Nevyta Tarigan, Brian Lucas, Hardianto Setiawan, Andree Kurniawan http://creativecommons.org/licenses/by-sa/4.0
Diagnostic Performance of PI-RADS v2.1 for Clinically Significant Prostate Cancer in Indonesian Patients Undergoing MRI Fusion Prostate Biopsy
Background: Prostate cancer is the second most common malignancy among men and one of the leading causes of cancer-related death. MRI evaluation using prostate imaging and data system (PI-RADS) v2.1 is widely applied to detect clinically significant prostate cancer (csPCa). However, data on its diagnostic performance in Indonesian population remain limited. Methods: An analytical observational study with retrospective cross-sectional design was conducted on patients with PI-RADS category 3-5 who underwent MRI fusion prostate biopsy at Siloam Hospitals Kebon Jeruk between 2021 and 2025. Sensitivity, specificity, predictive values, and accuracy of PI-RADS v2.1 were evaluated against histopathological findings. Statistical analyses include Chi-Square and Mann-Whitney U test. Result: A total of 75 patients were included, with a median age of 71 years (range: 49-84). The csPCa detection rates for each PI-RADS category were 14.29% for PI-RADS 3, 48.28% for PI-RADS 4 and 89.74% for PI-RADS 5. Histopathology confirmed csPCa in 50 patients (66.67%) and non-csPCa or benign lesions in 25 patients. The sensitivity of PI-RADS v2.1 at a cutoff ≥4 was 98% (95% CI 89.35–99.95), specificity 24% (95% CI 9.36–45.13), positive predictive value (PPV) 72.06%, negative predictive value (NPV) 85.71%, and overall accuracy 73.33% (95% CI 61.86–82.89). Bivariate analysis showed that older age, higher PSA, larger lesion size, PSA density ≥0.15 ng/ml2, and PIRADS 4/5 category were significantly associated with csPCa. Conclusions: PI-RADS v2.1 demonstrates very high sensitivity and good NPV for excluding csPCa but has low specificity, resulting in moderate overall accuracy (73.33%).
Copyright (c) 2026 Nyoman Aditya Sindunata, Vera Nevyta Tarigan, Patricia Jorisal, Bachtiar Murtala, Marto Sugiono, Veli Sungono http://creativecommons.org/licenses/by-sa/4.0
Relationship Between Electronic Device Usage with Asthenopia in Workers at Pelita Harapan University Lippo Karawaci
Background: Breast cancer is the most common malignancy among women and a leading cause of cancer-related mortality. Early detection is crucial to improve survival outcomes. Mammography is considered the gold standard for screening women over 40 years, while ultrasonography (USG) is frequently used in younger women with dense breasts. However, diagnostic accuracy varies, and comparative studies in Indonesia remain limited. To compare the diagnostic accuracy of mammography and ultrasonography in differentiating benign and malignant breast lesions using histopathology as the Gold standard. Methods: This cross-sectional analytic study included 91 patients who underwent mammography, ultrasonography, and histopathological confirmation at MRCCC Siloam Semanggi Hospital. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) were calculated. Statistical analysis used McNemar’s test and ROC curve analysis based on Hanley & McNeil’s method, with p < 0.05 considered significant. Result: Ultrasonography demonstrated higher sensitivity (98.4%) and NPV (92.3%) than mammography (96.7% and 88.9%), indicating better ability to rule out malignancy. Mammography showed higher specificity (53.3% vs. 40.0%) and PPV (80.8% vs. 76.9%), reflecting better performance in identifying benign lesions. Overall accuracy was slightly higher for mammography (82.4%) compared to USG (79.1%). The AUC for mammography was 0.750 (95% CI: 0.630–0.870), while USG had an AUC of 0.692 (95% CI: 0.565–0.819). Overlapping confidence intervals indicated no statistically significant difference in diagnostic accuracy between the two modalities (p > 0.05). Conclusions: Mammography and ultrasonography both demonstrated high diagnostic performance with complementary strengths. Mammography provided higher specificity and PPV, while USG offered superior sensitivity and NPV. Given the small difference in accuracy and overlapping AUC confidence intervals, no significant difference was found between the two modalities. Combined use of mammography and USG may improve diagnostic accuracy in clinical practice.
Copyright (c) 2026 Sachio Harlendo, Josiah Irma, Saraswati Anindita Rizki, Ruth Syeela Widianty http://creativecommons.org/licenses/by-sa/4.0
Association between Frailty and Dialysis Symptom Index among Chronic Hemodialysis Patients in Indonesia
Background: Chronic kidney disease (CKD) is one of the causes of global death with 79% of them being stage G3-G5, so it is not uncommon for people to require hemodialysis. However, on the other hand, hemodialysis patients have a high risk of experiencing side effects, especially frailty. It is also known that frailty can worsen the side effects of hemodialysis, even death. Therefore, this study aimed to investigate the relationship between frailty and the dialysis symptom index in chronic hemodialysis patients. Methods: This research uses a cross-sectional method with an unpaired numerical comparative analytical study design. Data was obtained using the Dialysis Symptom Index questionnaire and the RAPUH questionnaire. This research targets patients undergoing chronic hemodialysis aged 18 years and over. The statistical test for this research uses the T Test or Mann-Whitney Test method. Result: There were 35 patients (24.8%) undergoing hemodialysis who experienced frailty and 106 patients (75.2%) who did not experience frailty. Significant symptoms in frailty patients undergoing hemodialysis are lack of appetite (p < 0.001), shortness of breath (p = 0,039), feeling lightheaded or dizzy (p = 0,022), feeling tired or lacking energy (p < 0.001), dry mouth (p = 0,004), bone or joint pain (p = 0,001), difficulty sleeping (p = 0,014), waking up easily (p = 0,007), decreased sexual desire (p < 0.001), and difficulty becoming aroused sexually (p < 0.001). Conclusions: In this study, there was a significant relationship between frailty and the side effects of hemodialysis. The most common symptoms are feeling tired or lacking energy, decreased sexual desire, difficulty becoming sexually aroused, waking up easily, muscle cramps, and difficulty sleeping.
Copyright (c) 2026 Hosea Glory, Jeremia Immanuel Siregar http://creativecommons.org/licenses/by-sa/4.0
Environmental and Geographical Determinants of Nephrolithiasis: An Ecological Study in Kabupaten Kebumen
Background: Nephrolithiasis is a significant public health concern influenced by environmental, metabolic, and lifestyle factors. This study aimed to investigate the incidence of nephrolithiasis and its associated risk factors in karst and non-karst zones, focusing on demographic characteristics, water sources, comorbidities, and geographic variability. Understanding these determinants is crucial for developing targeted prevention strategies. Methods: A cross-sectional study was conducted from January 2025 to February 2025, involving 98 participants (35 from a karst zone and 63 from a non-karst zone). Data were collected through structured interviews, medical record reviews, and laboratory assessments, following the STROBE guidelines. Variables included age, gender, water source, daily water consumption, urinary habits, comorbidities, and occupational environment. Statistical analyses were performed using RStudio, with Mann-Whitney U tests for continuous variables and logistic regression for categorical variables. Nephrolithiasis incidence rates were calculated per 100,000 population and visualized using a heatmap. Result: District-specific incidence ranged from 10,989.0 (Ayah, karst; Karanganyar, non-karst) to 1,098.9 (Prembun, non-karst) per 100,000 population. Unadjusted risk-ratio (RR) estimates (95 % CI) included: female sex RR 1.52 (0.52–4.42); groundwater vs distilled water RR 1.65 (0.43–6.35); municipal vs distilled water RR 0.26 (0.03–2.12); fluid intake < 2,500 mL vs ≥ 2,500 mL RR 0.96 (0.32–2.81); urine retention RR 1.07 (0.38–3.03); outdoor vs indoor work RR 1.52 (0.52–4.42); scale present on boiling water RR 3.27 (0.88–12.24). None of the adjusted models reached statistical significance. Conclusions: This study underscores the multifactorial etiology of nephrolithiasis, emphasizing the role of geological, metabolic, and lifestyle factors. Targeted interventions, including community screening, dietary modifications, and improved water quality, are essential for reducing disease burden. Future research should explore causal relationships and refine preventive strategies through longitudinal studies and larger cohorts. These findings contribute to a deeper understanding of nephrolithiasis and inform region-specific public health measures.
Copyright (c) 2026 Eka Asmara Juhan Putra, Muhammad Irbabul Lubab http://creativecommons.org/licenses/by-sa/4.0
The Association Between Preoperative Anxiety and Pain Severity, Opioid Requirement, Neutrophil-to-Lymphocyte Ratio, and Postoperative Blood Glucose After Gynecologic Laparotomy at Ngoerah Hospital
Background: We assessed whether preoperative anxiety is associated with postoperative pain severity, opioid requirement, neutrophil-to-lymphocyte ratio (NLR), and blood glucose after gynecologic laparotomy. Methods: Prospective cohort at Ngoerah Hospital (May to June 2025). Anxiety was measured preoperatively with APAIS and categorized as non-anxious, mild, moderate, or severe. Outcomes were NRS pain at 6, 12, and 24 hours, total fentanyl in the first 24 hours, and NLR and blood glucose at 6 hours postoperatively. Multivariable analysis used MANCOVA (99% confidence intervals). Result: Fifty-four patients were included (mean age 41.78 ± 10.58 years). Anxiety distribution was 46.3% non-anxious, 25.9% mild, 24.1% moderate, and 3.7% severe. Higher anxiety was associated with higher NRS at 6 hours (B 0.842; 99% CI 0.475 to 1.209; p < 0.001), 12 hours (B 0.381; 0.247 to 0.515; p < 0.001), and 24 hours (B 0.158; 0.048 to 0.269; p = 0.048). Anxiety was associated with higher 24-hour fentanyl requirement (B 147.8 microg; 99% CI 124.062 to 171.651; p < 0.001), higher postoperative NLR (B 4.31; 99% CI 0.609 to 8.027; p = 0.024), and higher postoperative blood glucose (B 19.4 mg/dL; 99% CI 7.912 to 30.912; p = 0.001). Conclusions: Higher preoperative anxiety was independently associated with worse pain, greater opioid requirement, and higher postoperative NLR and blood glucose after gynecologic laparotomy.
Copyright (c) 2026 Fivilia Anjelina Bora, Dewa Ayu Mas Shintya Dewi, I Putu Kurniyanta, Tjokorda Gde Agung Senapathi, I Made Gede Widnyana, Putu Pramana Suarjaya, I Gusti Ngurah Mahaalit Aribawa, Tjahya Aryasa EM, Pontisomaya Parami, Otniel Andrians Labobar http://creativecommons.org/licenses/by-sa/4.0
Indirect Right Inguinal Hernia in a Six-Year-Old Girl: A Case Report and Literature Review
Background: Pediatric inguinal hernia is a common surgical problem, yet direct hernias in girls account for fewer than 1.5% of childhood groin defects. Although often painless and reducible, the cumulative risk of incarceration approaches 6%, warranting early repair. Case Description: A healthy six-year-old girl presented with a two-month history of an intermittent, painless right-groin bulge that appeared with crying or coughing. Physical examination revealed a 2.5 × 2 cm fully reducible mass; ultrasonography confirmed a fat-containing herniation medial to the inferior epigastric vessels, consistent with a reducible direct inguinal hernia. After optimization, she underwent an open high ligation herniotomy. The hernia sac was dissected to the internal ring and securely ligated without mesh. Operative time was 25 minutes and blood loss were negligible. The patient was discharged the same day, resumed unrestricted activity within one week, and remained asymptomatic at six-month follow-up with no evidence of recurrence. Conclusions: This case illustrates that open high ligation provides safe, durable closure for the exceedingly rare direct inguinal hernia in pediatric females, mirroring success rates above 98% reported for indirect defects. Early elective repair eliminates the risk of incarceration, avoids mesh-related morbidity, and allows rapid return to normal activity.
Copyright (c) 2026 Gusti Putu Agung Pratama P http://creativecommons.org/licenses/by-sa/4.0
The Hidden Clot: A Case of Recurrent Atypical Venous Thrombosis Highlighting the Need for Vigilant Diagnostic Evaluation
Background: Venous thromboembolism (VTE) is the third most common cardiovascular disorder worldwide. While lower-extremity deep vein thrombosis and pulmonary embolism are typical presentations, thrombosis in atypical sites remains challenging to recognize and diagnose. Case Description: A 27-year-old female flight attendant with history inflammatory bowel disease (IBD), tuberculosis and combined oral contraceptive (COC) use presented with an acute abdominal pain. Initial contrast-enhanced CT revealed thrombosis of the left renal and ovarian veins. Laboratory tests showed elevated hs-CRP and D-dimer, with positive ANA but negative antiphospholipid antibodies. She was treated with intravenous heparin followed by oral rivaroxaban, though adherence was inconsistent due to episodes of heavy vaginal bleeding. Repeat CT imaging eight months later demonstrated resolution of the initial thrombi but revealed a new thrombus in the inferior vena cava extending into the right common iliac vein, accompanied by recurrent elevation of D-dimer. This case illustrates the interplay of multiple risk factors for VTE, including IBD, prolonged immobility during long-haul travel, COC use, tuberculosis, and rifampicin therapy. These overlapping chronic and transient triggers likely contributed to recurrent thrombosis despite ongoing treatment. Conclusions: Recurrent VTE in unusual venous sites can occur particularly in patients with multiple risk factors. Early recognition, appropriate imaging, and anticoagulant therapy adherence are essential to preventing progression and recurrence
Copyright (c) 2026 Gladys Mangkuliguna, Ratna Sutanto, Olivia Violetta, Andree Kurniawan http://creativecommons.org/licenses/by-sa/4.0
Isolated Hypoglossal Nerve Palsy Associated with Tuberculosis of the Atlantoaxial Joint: A Rare Case Report
Background: Venous thromboembolism (VTE) is the third most common cardiovascular disorder worldwide. While lower-extremity deep vein thrombosis and pulmonary embolism are typical presentations, thrombosis in atypical sites remains challenging to recognize and diagnose. Case Description: A 27-year-old female flight attendant with history inflammatory bowel disease (IBD), tuberculosis and combined oral contraceptive (COC) use presented with an acute abdominal pain. Initial contrast-enhanced CT revealed thrombosis of the left renal and ovarian veins. Laboratory tests showed elevated hs-CRP and D-dimer, with positive ANA but negative antiphospholipid antibodies. She was treated with intravenous heparin followed by oral rivaroxaban, though adherence was inconsistent due to episodes of heavy vaginal bleeding. Repeat CT imaging eight months later demonstrated resolution of the initial thrombi but revealed a new thrombus in the inferior vena cava extending into the right common iliac vein, accompanied by recurrent elevation of D-dimer. This case illustrates the interplay of multiple risk factors for VTE, including IBD, prolonged immobility during long-haul travel, COC use, tuberculosis, and rifampicin therapy. These overlapping chronic and transient triggers likely contributed to recurrent thrombosis despite ongoing treatment. Conclusions: Recurrent VTE in unusual venous sites can occur particularly in patients with multiple risk factors. Early recognition, appropriate imaging, and anticoagulant therapy adherence are essential to preventing progression and recurrence.
Copyright (c) 2026 Dr. dr. Rocksy FV Situmeang, Sp.N, dr. Nadia Gabriella, dr. Koesbandono, Sp.Rad http://creativecommons.org/licenses/by-sa/4.0
Impact of Socioeconomic Inequalities on the Incidence of Type 2 Diabetes Mellitus: A Systematic Review
ckground: Type 2 diabetes mellitus (T2DM) is a rising global burden, and socioeconomic inequalities may shape risk through differential resources, environments, and access to prevention and care. We synthesised evidence on the association between socioeconomic position (SEP) and incident T2DM. Methods: We conducted a PRISMA 2020–guided systematic review of PubMed, EMBASE, and Scopus (inception to 18 January 2026). Observational studies of adults without diabetes at baseline that measured SEP (education, income, occupation and/or area deprivation) prior to diagnosis and reported incident T2DM were eligible. Random-effects meta-analyses pooled relative risks (RRs), treating hazard ratios as approximations. Risk of bias was assessed (NOS). Result: From 1,580 records, 25 studies met inclusion criteria and 23 contributed to quantitative synthesis. Studies were mainly prospective cohorts or nested case–control designs, largely from high-income countries, with follow-up from 3 to 34 years and participants aged 18–86 years. Lower education was associated with higher T2DM incidence (least vs most educated: RR 1.55, 95% CI 1.37–1.75). Lower occupational position was also associated with increased risk (lowest vs highest: RR 1.60, 95% CI 1.25–2.05). Income was not statistically conclusive (lowest vs highest: RR 1.37, 95% CI 0.94–2.01). Conclusions: Socioeconomic disadvantage, particularly lower education and occupational status, is consistently associated with higher risk of incident T2DM. Prevention and screening should incorporate SEP to better target upstream determinants.
Copyright (c) 2026 Calvin Sasongko, Jessica Adrya, Srigita Varsha, Sony A. Fatchurrahman, Galih Muchlis Hermawan, Veriantara Satya Dhika, Teddy Tjahyanto http://creativecommons.org/licenses/by-sa/4.0
Prognostic Significance of Hypoalbuminemia in Transcatheter Aortic Valve Implantation Patients: A Systematic Review and Meta Analysis of Diagnostic Test Accuracy
ckground: Calcific aortic stenosis is common in older adults, and TAVR has expanded treatment to patients with high comorbidity and frailty. Serum albumin is an inexpensive marker that reflects inflammation, nutrition, and physiologic reserve, but its prognostic performance in TAVR needs clearer quantification. Methods: We performed a PRISMA/PRISMA-DTA–guided systematic review and diagnostic test accuracy meta-analysis of studies evaluating pre-procedural hypoalbuminemia in adults undergoing TAVR/TAVI. PubMed, Embase, and Scopus were searched from inception to 18 January 2026. Hierarchical models were used to pool sensitivity and specificity for 30-day mortality, and a random-effects model pooled hazard ratios for time-to-event mortality. Risk of bias was assessed using PROBAST. Result: Ten studies met inclusion criteria. Definitions of hypoalbuminemia varied (most commonly <3.3–3.5 g/dL). For predicting 30-day mortality, pooled sensitivity was 47.7% (95% CI 35.5–59.9) and pooled specificity was 76.0% (95% CI 62.9–89.2), indicating better rule-in than rule-out performance. Across studies reporting time-to-event outcomes, hypoalbuminemia was associated with higher mortality (pooled HR 1.15, 95% CI 1.03–1.29). PROBAST ratings were generally low risk for participants, predictors, and outcomes, with some concerns in the analysis domain. Conclusions: Pre-procedural hypoalbuminemia is a practical risk marker in TAVR patients, showing moderate specificity for early mortality and a consistent association with worse survival, supporting its use in peri-procedural risk stratification.
Copyright (c) 2026 Destino Huvi, Jessica Adrya, Nihal Sofyan, Daffa Rizqi Fauzi, Alan Dharmasaputra, Srigita Varsha, Putri Dhiya Prameswari Wiyono http://creativecommons.org/licenses/by-sa/4.0
Platelet-Rich Plasma as a Novel Treatment for Hair Loss: A Systematic Review of Safety, Efficacy, and Patient Outcomes
Background: Hair loss is common and clinically heterogeneous, and platelet-rich plasma (PRP) has emerged as a minimally invasive autologous therapy with potential effects on follicular cycling and the scalp microenvironment. This review evaluated PRP safety, efficacy, and patient outcomes across hair-loss conditions. Methods: PRISMA-guided systematic review and meta-analysis was conducted using PubMed, Embase, and Scopus (inception to 10 February 2026). Human clinical studies with extractable quantitative data on PRP for hair loss were included. Primary outcomes were hair density, hair thickness, hair count, and pulled hair number; safety and patient-reported outcomes were summarized. Risk of bias was assessed using ROBINS-I, and random-effects models were applied for pooling. Result: Eight studies met inclusion criteria. PRP was generally well tolerated, with mostly mild, transient procedure-related adverse events (e.g., injection-site pain, erythema/edema, pruritus, bruising) and no consistent signal of serious complications, although safety reporting was variable. Meta-analysis showed PRP increased hair density (pooled SMD = 3.39, 95% CI 2.27–4.52) and hair thickness (pooled SMD = 2.78, 95% CI 1.91–3.65) versus control, and reduced pulled hair number (pooled SMD = −3.75, 95% CI −5.59 to −1.92). Hair count was not clearly different from control (pooled SMD = −0.95, 95% CI −17.87 to 15.96). Most studies were at low-to-moderate risk of bias, with one at serious risk. Conclusions: PRP may improve hair density and thickness and reduce shedding-related measures in selected patients, but effects on hair count remain uncertain and outcomes are sensitive to protocol variability. Larger standardized randomized trials with longer follow-up are needed.
Copyright (c) 2026 Claudia Felicia Limanda, Ericko Hartanto, Jeanny Megawati Soewardy, Alya Ihsani Harahap http://creativecommons.org/licenses/by-sa/4.0
The Evolution of Biologic Therapies for Psoriasis and Atopic Dermatitis: A Systematic Review of Randomized Controlled Trial
ground: Psoriasis and atopic dermatitis are chronic, immune-mediated inflammatory skin diseases that cause a substantial, lifelong burden on patients globally. Over the past two decades, the therapeutic paradigm has shifted dramatically from broad immunosuppression to highly targeted biologic therapies designed to interrupt key cytokine pathways driving clinical disease activity. Methods: To comprehensively evaluate this transition, we conducted a systematic review of randomized controlled trials assessing the efficacy and safety of biologic treatments for moderate-to-severe psoriasis and atopic dermatitis. We systematically searched major electronic databases for peer-reviewed published trials, extracting data on targeted mechanisms, clinical efficacy outcomes, and safety profiles. Result: The evolution in psoriasis treatment progressed sequentially from early tumor necrosis factor inhibitors to highly specific interleukin (IL)-12/23, IL-17, and selective IL-23 blockades. These newer agents consistently demonstrate unprecedented rates of complete skin clearance and durable responses. Similarly, the atopic dermatitis landscape has been revolutionized by biologics targeting type 2 inflammation, particularly the IL-4 and IL-13 pathways. These interventions provide profound relief from intractable pruritus and persistent lesions in patients refractory to conventional therapies, while largely avoiding the off-target toxicities of older systemic agents. Conclusions: The advent and evolution of biologic therapies represent a watershed moment in dermatology. By enabling precision immunology, these targeted treatments have fundamentally transformed disease management, offering patients realistic expectations for sustained remission and significantly enhanced quality of life.
Copyright (c) 2026 Claudia Felicia Limanda, Ericko Hartanto, Elisa Putri, Nurzanah Primadani, Multiyus Hasnah http://creativecommons.org/licenses/by-sa/4.0
Evaluating the Effectiveness and Safety of a Shortened Rifapentine-Moxifloxacin Regimen in Treating Drug-Sensitive Pulmonary Tuberculosis: A Systematic Review
Background: Prolonged treatment duration remains a key challenge in managing drug-sensitive pulmonary tuberculosis (DS-TB), contributing to poor adherence and treatment failure. Recent evidence suggests that regimens incorporating rifapentine and moxifloxacin (RPT+MOX) may allow for effective 4-month treatment courses. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines to evaluate the effectiveness and safety of shortened RPT+MOX regimens. PubMed, EMBASE, and Scopus were searched up to May 2025. Eligible studies included randomized trials or observational cohorts comparing shortened RPT+MOX regimens with standard 6-month therapies in patients with DS-TB. Outcomes included culture conversion at 8 weeks, relapse or treatment failure, and serious adverse events. Risk of bias was assessed using the ROBINS-I tool. Result: Five studies (three RCTs, two observational) met inclusion criteria. Pooled analysis showed no significant difference in risk for relapse or treatment failure (RR 0.79, 95% CI: 0.37–1.67), culture conversion (RR 1.16, 95% CI: 0.80–1.69), or serious adverse events (RR 0.92, 95% CI: 0.65–1.29) between RPT+MOX and standard regimens. Risk of bias ranged from minimal to moderate. The GRADE assessment supported high certainty of evidence. Conclusions: Shortened RPT+MOX regimens demonstrate comparable effectiveness and safety to standard 6-month treatment for DS-TB, supporting their use in appropriate settings. Further studies are warranted to assess long-term outcomes, real-world adherence, and feasibility across diverse populations.
Copyright (c) 2026 Luthfia Ayu Wicaksana, Endy Amos Todo Hasudungan Sirait http://creativecommons.org/licenses/by-sa/4.0
Incidence and Risk Factors of Hernia Mesh-Related Infections: A Systematic Review and Meta-Analysis
Background: Prosthetic mesh lowers hernia‑recurrence rates but can precipitate infection; reported incidence and risk factors remain inconsistent. The objective of this systematic review and meta-analysis is to estimate the pooled incidence of hernia mesh infections and to identify the key risk factors associated with their development. Methods: A PRISMA 2020 search of PubMed, EMBASE and Scopus identified randomised, cohort and case‑control studies that reported mesh‑related infection incidence or risk factors ≥ 3 months after adult hernia repair. Two reviewers independently screened records, appraised bias (ROBINS‑I) and graded certainty (GRADE). Random‑effects meta‑analyses generated pooled proportions and risk ratio (RR). Result: Seven studies encompassing 57,653 repairs qualified. Infection incidence ranged 1.3 – 10.2 %; the pooled proportion was 4.9 % (95 % CI 2.6 – 7.4, I² = 87 %). Diabetes (RR 1.49, 95 % CI 1.13 – 1.97) and smoking (RR 1.43, 95 % CI 1.34 – 1.52) were consistent patient‑level risks, whereas obesity (RR 1.48, 95 % CI 0.68 – 3.22) and female sex (RR 1.08, 95 % CI 1.04 – 1.11) exerted smaller effects. Operative time > 2 h, emergency repair, large/PTFE or composite intraperitoneal meshes, and repeat surgery each roughly doubled infection odds. Certainty was low‑to‑moderate overall but high for diabetes and smoking; no publication bias was detected. Conclusions: Roughly one in twenty mesh repairs is complicated by infection. Optimising glycaemic control, enforcing smoking cessation, shortening operations and selecting macroporous meshes may meaningfully lower risk.
Copyright (c) 2026 Qanita Izza Kemala, Ghina Nabila Aisyah, Nusaibah Hanina Najah http://creativecommons.org/licenses/by-sa/4.0
VEGF as a Marker of Wound Healing: Better High or Better Low?
Background: Vascular Endothelial Growth Factor (VEGF) is a key regulator of angiogenesis and tissue regeneration in wound healing. However, the prognostic significance of VEGF expression remains controversial, with both high and low levels variably associated with good or impaired wound healing. This review aimed to clarify the prognostic implications of VEGF expression in wound healing, focusing on whether high or low levels better pred ict favorable outcomes. Methods: A systematic search was conducted in PubMed, EBSCOHost, Embase, and Google Scholar using PRISMA guidelines. Studies involving VEGF measurements in human or animal models of acute and chronic wounds were included. VEGF levels were correlated with healing parameters such as angiogenesis, re-epithelialization, inflammation, and overall wound resolution. Risk of bias was assessed using Cochrane RoB 2.0 and the Newcastle-Ottawa Scale. Result: 15 studies met inclusion criteria. High VEGF levels were oftenly associated with improved outcomes in early wound phases by enhancing angiogenesis. However, sustained high levels in chronic wounds often correlated with unresolved inflammation and fibrosis. In contrast, low VEGF expression indicates impaired angiogenesis. Conclusions: VEGF expression is related to the ongoing phase of wound healing. High levels are beneficial during the acute phase, but if sustained, it may exert negative effects. Clinical interpretation should consider wound type, timing, and VEGF source, rather than relying on absolute expression levels alone.
Copyright (c) 2026 Kenny Wijaya Sutanto, Endang Sri Lestari, Sigit Adi Prasetyo http://creativecommons.org/licenses/by-sa/4.0