Journal Of The Indonesian Medical Association

Precision Diagnosis and Therapy in Trigeminal Neuralgia: From Pharmacotherapy to Minimally Invasive Interventional Procedures

2026-10-26T16:09:29+07:00

Trigeminal Neuralgia (TN) is one of the severe forms of cranial neuropathic pain in the field of neurology.¹ This condition is characterized by sudden, sharp pain attacks resembling an electric shock, stabbing, or burning sensation restricted to one or more distribution branches of the trigeminal nerve.^1,2This pain is generally paroxysmal, unilateral, and can be triggered by very mild non-painful tactile stimulation (innocuous stimuli) on a trigger zone area, such as during chewing, talking, brushing teeth, and exposure to wind.²Trigeminal neuralgia, also known as tic douloureux, is one of the causes of severe chronic pain and is common worldwide, with an incidence of 4 to 13 people per 100,000 per year.³ The incidence of trigeminal neuralgia is higher in women than in men, with a ratio of 1.74 : 1, and it predominantly affects individuals over the age of 40, peaking between the ages of 60 and 70.³

Is VIA Still Relevant for Mass Cervical Cancer Screening? A Systematic Review and Meta-Analysis

2026-10-26T16:09:02+07:00

Introduction: Visual inspection with acetic acid (VIA) remains in use in cervical cancer screening programmes in several resource-limited settings. However, the expansion of high-risk HPV testing as the preferred primary screening method and the continuing role of cervical cytology (Pap smear) require a reassessment of VIA. This study aimed to estimate the sensitivity and specificity of VIA based on available diagnostic-accuracy studies.
Methods: This systematic review followed PRISMA 2020 and the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Studies evaluating VIA as a screening method against an adequate reference standard were eligible. Multiple electronic databases and additional sources were searched without language or publication-year restrictions. Data were analysed using Meta-DiSc 1.4 and RevMan 5.4. The review was registered in PROSPERO (CRD42025645024).
Results: Fourteen articles with 17 study arms were included in the systematic review. Thirteen articles comprising 16 study arms and 65,359 participants provided adequate 2 × 2 data for quantitative synthesis. Recalculation yielded a pooled sensitivity of 75.5% (95% CI 73.7–77.2%) and a pooled specificity of 82.9% (95% CI 82.6–83.2%). Heterogeneity was very high, reflecting differences in populations, reference standards, target-disease thresholds, and verification procedures.
Discussion: VIA shows moderate diagnostic accuracy, but substantial heterogeneity and risk of bias limit generalisability and do not support its designation as the preferred primary method for mass screening on the basis of this analysis alone. In health systems undergoing transition, VIA may remain a contextual option or triage test where HPV testing is not yet uniformly available. High-risk HPV testing remains the preferred primary screening method, while Pap smear cytology retains a role in quality-assured cytology programmes and in triage algorithms. Screening strategies should be selected according to health-system capacity, quality assurance, follow-up, and access to treatment.

Short-Term QuickDASH Outcomes Following ERAS-Based Rehabilitation After Modified Radical Mastectomy: A Nonrandomized Controlled Study

2026-10-26T16:08:39+07:00

Introduction: Modified Radical Mastectomy (MRM) may cause postoperative upper-limb dysfunction in breast cancer patients. Enhanced Recovery After Surgery (ERAS) combined with upper-limb-specific exercise may improve shoulder functional recovery. This study aimed to evaluate the effect of ERAS combined with upper-limb-specific exercise on shoulder functional ability after MRM.
Methods: This experimental pretest–posttest controlled study included 24 breast cancer patients undergoing MRM, equally divided into ERAS and Non-ERAS groups. Shoulder functional ability was assessed using the Quick-DASH Score at one and four weeks postoperatively. Data were analyzed using paired and independent t-tests.
Results: The Quick-DASH Score decreased significantly in both groups. The Non-ERAS group improved from 67.08 ± 2.68 to 35.67 ± 4.98, while the ERAS group improved from 48.08 ± 6.80 to 12.50 ± 6.74, both p less than 0.001. The reduction was significantly greater in the ERAS group than in the Non-ERAS group, 35.58 ± 3.26 vs. 31.42 ± 3.18, p = 0.002.
Conclusion: ERAS combined with upper-limb-specific exercise significantly improves shoulder functional ability after MRM and may be considered a perioperative rehabilitation approach for breast cancer patients.

Diagnostic Accuracy of Bronchoalveolar Lavage and Bronchial Brushing Cytology, Alone and in Combination, in Patients with Histologically Confirmed Lung Adenocarcinoma and Squamous Cell Carcinoma

2026-10-26T16:08:15+07:00

Introduction: Bronchoalveolar lavage (BAL) and bronchial brushing (BB) are minimally invasive cytology techniques used during the diagnostic work-up of lung cancer. They sample different anatomic compartments. Their performance for lung adenocarcinoma (ADC) and squamous cell carcinoma (SCC) may differ. This study evaluated their subtype-specific diagnostic performance, alone and in combination, using histopathology as the reference standard.
Method: This retrospective paired diagnostic-accuracy study included 38 patients at Prof. dr. Chairuddin Panusunan Lubis Teaching Hospital, Medan, from January 2023 to June 2024. All underwent BAL, BB, and lung biopsy. Cytology was evaluated on Giemsa-stained preparations and histopathology on hematoxylin and eosin-stained sections. Sensitivity and subtype-specific specificity, with exact 95% confidence intervals (CIs), were calculated for concordant cytologic subtype assignment.
Results: Histopathology showed ADC in 21 patients and SCC in 17. BAL sensitivity for ADC was 95.2% (95% CI: 76.2–99.9), compared with 76.2% (95% CI: 52.8–91.8) for BB. For SCC, BAL sensitivity was 47.1% (95% CI: 23.0–72.2) and BB sensitivity was 94.1% (95% CI: 71.3–99.9). The combined strategy matched the more sensitive individual test for each subtype. No cross-subtype cytologic assignments occurred; subtype-specific specificity was 100%, with wide CIs due to the small non-target groups.
Conclusion: BAL demonstrated higher sensitivity for ADC, whereas BB demonstrated higher sensitivity for SCC; together, the techniques can provide complementary preliminary cytologic information, although histopathological confirmation remains necessary.

Differences in Survival of Chronic Kidney Disease Patients Based on Initial Glomerular Filtration Rate (eGFR)

2026-10-26T16:07:51+07:00

Introduction: One of the leading causes of death in the world today is chronic kidney disease (CKD). In 2021, the death rate for CKD patients receiving hemodialysis rose by 0.6%. This study aims to determine the relationship between the initial Glomerular Filtration Rate (eGFR) value and the survival of stage V CKD patients undergoing regular hemodialysis.
Method: This cohort-retrospective analytical study was carried out at Prof. Dr. Chairuddin’s P. Lubis Hospital in Medan between July and September of 2024. Patients with stage V CKD who were registered in their medical records and began receiving regular hemodialysis in 2021–2023 met the inclusion criteria for the study sample, while patients with incomplete medical record data met the exclusion criteria. The Kaplan Meier survival curve and the log-rank test were used to evaluate the data.
Result: The age group of 45–59 years old (40%), males (64.6%), beginning hemodialysis with an initial eGFR value of less than 5.0 ml/minute/1.73 m2 (44.6%), and receiving regular hemodialysis for less than 12 months (56.9%) included the biggest distribution of the 65 research samples. The average initial eGFR value was 5.74 ml/minute/1.73 m2. The findings of the log-rank test were not significant (p greater than 0.05).
Conclusion: There is no significant difference in survival based on the initial eGFR value at the time of hemodialysis initiation.

Effectiveness of Preoperative Reconditioning Exercise in Grade IV Knee Osteoarthritis Patients Undergoing Total Knee Arthroplasty: An Evidence-Based Case Report

2026-10-26T16:07:27+07:00

Knee osteoarthritis (OA) is the most common degenerative joint disease and a leading cause of disability among older adults, frequently requiring total knee arthroplasty (TKA) as a definitive treatment. Preoperative reconditioning exercise (prehabilitation) is thought to enhance preoperative functional status and accelerate postoperative recovery, although clinical evidence remains varied. This evidence- based case report aims to evaluate the effectiveness of preoperative reconditioning exercise in a patient with grade IV knee OA scheduled for TKA. A literature search was conducted in December 2024 across PubMed, Scopus, Cochrane, and ScienceDirect databases to address the clinical question. Across the five selected systematic reviews, preoperative exercise programs consisting of lower-extremity strengthening, flexibility, mobility, and balance training delivered over 3-12 weeks were shown to shorten hospital stay, reduce postoperative pain in the short term (up to 3 months), and improve muscle strength, functional mobility, and overall knee function. Despite heterogeneity across studies, implementing preoperative exercise for 4-12 weeks focusing on lower-extremity strengthening, flexibility, mobility, and balance training is an effective strategy to optimize preoperative functional status and accelerate postoperative recovery following TKA.

Neisseria gonorrhoeae in Gynecological Practice: A Systematic Review from Clinical Microbiology and Obstetrics-Gynecology Perspectives

2026-10-26T16:07:09+07:00

This systematic review summarizes evidence on Neisseria gonorrhoeae in gynecological practice from clinical microbiology and obstetrics-gynecology perspectives, covering mucopurulent cervicitis, pelvic inflammatory disease (PID), tubo-ovarian abscess, infertility, the relevance of IVF, IUD use, diagnosis, presumptive therapy, and antimicrobial resistance. Literature searches followed PRISMA 2020 and included PubMed, Embase, and Cochrane Library publications from 2020 to 2025. Of 1,247 records, seven publications met the eligibility criteria, comprising five primary studies and two systematic reviews/meta-analyses; the five primary studies were appraised using MMAT. Gonorrhea in women is often asymptomatic or resembles nonspecific vaginal discharge, but may cause mucopurulent cervicitis through cervical inflammation and neutrophil recruitment. Ascending infection may progress to endometritis, salpingitis, PID, and tubo-ovarian abscess, with ciliary damage, fibrosis, and tubal adhesions contributing to tubal-factor infertility and ectopic pregnancy. Evidence indicates an epidemiological association between GC/ CT infection and female infertility, but the included publications do not establish an independent effect of gonorrhea on IVF outcomes or improved pregnancy rates after screening and treatment. IVF therefore remains an evidence gap requiring prospective research. POC-NAAT may reduce antibiotic overtreatment, while sampling should reflect clinical presentation and sexual practices. Integration between obstetrics-gynecology and clinical microbiology supports accurate diagnosis, stewardship, and prevention of reproductive complications.