Universa Medicina
type: channel
description: Universa Medicina (UnivMed) is an official scientific publication of the Faculty of Medicine Universitas Trisakti and is a peer-reviewed open-access journal. Universa Medicina is a four-monthly medical journal that publishes new research findings on a wide variety of topics of importance to biomedical science and clinical practice. Universa Medicina is a general medical journal that focuses on all aspects of human health. Accredited journal based on Ministerial Decree of the Minister of Research and Technology / Head of National Research and Innovation Agency of the Republic of Indonesia with First Grade (Peringkat 1, Sinta 1, Garuda) No. 148/M/KPT/2020 Volume 38 Number 3, 2019 to Volume 43 Number 2, 2024. The Univ Med journal has been indexed and abstracted and displayed in Clarivate Analytics Web of Science Core Collection Database (Emerging Source Citation Index) (Q4 JCR) 2023, 2024, 2025, Dimensions-Digital Science, CABI, ASEAN Citation Index, DOAJ, Chemical Abstract Services (CAS), ROAD, National Library of Medicine, ICMJE, ICI, and SINTA. Imprint information Author Guidelines Make a Submission
publisher: Faculty of Medicine, Universitas Trisakti
language: en
publication name: Universa Medicina
issn: 1907-3062
copyright: The journal allows the authors to hold the copyright without restrictions and allow the authors to retain publishing rights without restrictions.
items: Targeting tumor associated macrophages to alternate cancer stem cells and tumor microenvironment milieu
items: The Effect of Nanoliposomal Curcumin (Cur-NLPs) Proliferation Rate with Cell Counting Kit 8 (CCK-8) and PI3K expression in cervical cancer HeLa cells
items: Strengthening clinical microbiology laboratories and prevention programs: a call to action for better infection control
items: Transforming intracranial hemorrhage detection with artificial intelligence: advances in neuroimaging
items: Maternal Trichomonas vaginalis as a risk factor of spontaneous preterm labour in Southwest Nigeria: a case-control study
items: Knowledge of people with visual impairment about contraceptives: an exploratory study
items: Attitude towards telemedicine and e-health literacy among health sciences faculty students
items: Molecular progression of chronic rhinosinusitis: a pseudotime reconstruction of a transcriptomic dataset
items: Female university students’ attitude toward fertility and childbearing in Vietnam
items: Clinical utility of artificial intelligence in prehospital emergency medical services : a systematic review and meta-analysis
items: Clinico-epidemiological profile of disorders of sex development at a tertiary referral hospital in South Kalimantan, Indonesia
items: Effect of using normal saline, alcohol and acetone on pain during removal of polyacrylate adhesive dressings in children aged 10–15 years: a pilot randomized controlled trial
items: Dendrophthoe pentandra (Mango Mistletoe) leaves modulate steroidogenic acute regulatory protein, aromatase, and estrogen receptor expression in aged mice
items: Prevalence and risk factors of Entamoeba histolytica and Giardia lamblia infection among patients with gastrointestinal complaints
items: Trends of early-onset colorectal cancer biomarkers from 1985 to 2024 : a bibliometric analysis
items: Effect of brain endurance training on fatigue and physical endurance among stroke survivors: a non-blinded randomized controlled trial
items: The effect of war on displaced hemodialysis patients in Sudan
items: Microbiota as a reservoir of antibiotic resistance genes: relevance and urgency
items: Gamma-oryzanol as a potential intervention for normalizing insulin secretion and pancreatic β-cell function
items: Machine learning models for predicting 48-hour mortality in acute intracerebral hemorrhagic stroke
items: Role of global deoxyribonucleic acid methylation and molecular hypoxia changes in male infertility
items: Clinical significance of pre-operative prognostic nutritional index in predicting survival in patients with renal cell carcinoma
items: Association of toxoplasmosis with risk factors among adults in Duhok Province, Kurdistan Region, Iraq
items: Umbilical cord mesenchymal stem cells and their secretome: a new frontier in orthopedic medicine
items: Validity of core needle biopsy in diagnosing primary thyroid lymphoma: a systematic-review and meta-analysis
items: Effect of Muay Thai training frequency on VO2 max and muscle endurance in non-athletic adults: a randomized clinical trial
items: Hypoxic mesenchymal stem cell-derived secretome and alkaline water synergistically reduce apoptosis and insulin resistance in type 2 diabetes mellitus rat model
items: Association between homicide and myocardial infarction mortality: a population-level analysis in Mexico from 2000 to 2019
items: Bench to bedside and beyond: evolving trends in translational research
items: Application of international classification of functioning, disability and health in salat: a scoping review

Targeting tumor associated macrophages to alternate cancer stem cells and tumor microenvironment milieu
type: item
description: Macrophages in the tumor microenvironment are involved in promoting cancer growth and enabling it to evade therapies. By acting as something like a tumor's "underground," these cells dampen down the "calls for help" that chemotherapy or radiotherapy might otherwise trigger. They also appear to enable some cells in the cancers to reset themselves into cancer stem cells (CSCs), allowing them to divide and differentiate. Cancer stem cells are compelled to initiate tumors and maintain their growth. In part, the tumor-associated macrophages (TAMs) effect this by secreting cytokines with well-established roles in regulating stemness, as well as proteins that govern cell migration and are known to help keep CSCs in the niche where the tumor formed and maintain the tumor. Prognostic studies have found that TAMs are associated with worse patient outcomes. This article reviews the existing knowledge on TAMs in supporting the survival and maintenance of CSCs, increasing tumor resilience and resistance to therapy. We did a systematic review using the keywords CSC, TAM, tumor microenvironment (TME), and extracellular matrix remodeling from the following databases: ScienceDirect, PubMed, NCBI, Nature, Google Scholar, and Oxford Academic for articles published between 2010 to 2026. The underlying premise of the current investigation is that macrophages facilitate the maintenance of the "stemness" characteristics of CSCs. The TAM-CSC alliance must be interrupted to improve therapeutic outcomes and reduce tumor recurrence. Our review focuses on addressing the difficulties presented by CSCs and TME through advanced research techniques and specific combination treatments. This alternative method offers a less harsh and more effective therapy that will improve the patient’s outcomes by effectively eradicating tumor cells and modifying the tumor microenvironment to enhance the immune system's capability to combat the tumor.
subject: Review Article
  topic: section
subject: immune cell
  topic: keywords
subject: tumor microenvironment
  topic: keywords
subject: epithelial-mesenchymal transition
  topic: keywords
subject: infiltration
  topic: keywords
subject: extracellular matrix remodeling
  topic: keywords
subject: Tumor-associated macrophages
  topic: subjects
subject: Cancer stem cells
  topic: subjects
subject: Tumor microenvironment
  topic: subjects
subject: Cancer immunology
  topic: subjects
subject: Tumor plasticity
  topic: subjects
subject: Immune modulation
  topic: subjects
subject: Oncology
  topic: disciplines
subject: Immunology
  topic: disciplines
subject: Cancer Biology
  topic: disciplines
subject: Translational Medicine
  topic: disciplines
subject: Biomedical Sciences
  topic: disciplines
creator: Mahdaleny Mahdaleny
creator: Septelia Inawati Wanandi
creator: Noorwati Sutandyo
creator: Febriana Catur Iswanti
rights: Copyright (c) 2026 Mahdaleny Mahdaleny, Septelia Inawati Wanandi, Noorwati Sutandyo, Febriana Catur Iswanti https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-08-22
publication date: 2026-08-22
starting page: 310
ending page: 321
doi: 10.18051/UnivMed.2026.v45.310-321

The Effect of Nanoliposomal Curcumin (Cur-NLPs) Proliferation Rate with Cell Counting Kit 8 (CCK-8) and PI3K expression in cervical cancer HeLa cells
type: item
description: INTRODUCTION Cervical cancer is a major health problem in developing countries. Cisplatin therapy has limitations related to toxicity and drug resistance associated with activation of the PI3K/AKT/mTOR pathway. Curcumin has anticancer activity, but its bioavailability is low; therefore, it has been developed in a nanoliposomal formulation. This study aimed to evaluate the effects of curcumin nanoliposomes (Cur-NLPs) on proliferation and PI3K expression of HeLa cells. METHODS An experimental study was conducted using HeLa cells, divided into seven groups: negative control, cisplatin 5 µg/mL, and Cur-NLPs groups at 50, 100, 150, 200, and 250 µg/mL. Cell viability was measured using the cell counting kit-8 (CCK-8). Measurements were performed at 24 and 48 hours at a wavelength of 450 nm. Based on viability results, PI3K expression was analyzed at 48 hours using flow cytometry in five groups: negative control, cisplatin, and Cur-NLPs at 100, 150, and 200 µg/mL. Data were analyzed using one-way ANOVA followed by Games-Howell test. RESULTS Cur-NLPs significantly reduced HeLa cell viability at 24 and 48 hours (p<0.001). The 200 µg/mL dose showed the most optimal antiproliferative effect, with viability of 38.3% at 24 hours and 18.0% at 48 hours. PI3K expression in the Cur-NLPs group (42.49–45.03%) was lower than that in the cisplatin group (66.78%), but the difference was not statistically significant (p=0.063). CONCLUSION Cur-NLPs inhibited HeLa cell viability in a dose- and time-dependent manner and showed a trend toward reduced PI3K expression. Further replication and analysis of downstream PI3K markers are needed to confirm these findings.
subject: Original Articles
  topic: section
subject: Nanoliposomal curcumin
  topic: keywords
subject: HeLa cells
  topic: keywords
subject: cervical cancer
  topic: keywords
subject: cell proliferation
  topic: keywords
subject: PI3K
  topic: keywords
subject: flow cytometry
  topic: keywords
creator: Subandi Subandi
creator: Ferry Suciati
creator: Maya Devi Arifiandi
creator: I Wayan Agung Indrawan
rights: Copyright (c) 2026 Subandi Subandi, Ferry Suciati, Maya Devi Arifiandi, I Wayan Agung Indrawan https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-21
publication date: 2026-07-21
starting page: 249
ending page: 258
doi: 10.18051/UnivMed.2026.v45.249-258

Strengthening clinical microbiology laboratories and prevention programs: a call to action for better infection control
type: item
description: The coronavirus disease 2019 (COVID-19) pandemic has revealed severe vulnerabilities in the global clinical laboratory systems, especially in low- and middle-income countries, where diagnostic capacity is still poor. As the world emerges from the acute phase of the pandemic, antimicrobial resistance (AMR) has re-emerged as the silent pandemic demanding urgent attention. Clinical microbiology laboratories are not just support services, they are the first line of defense against the disease outbreaks, healthcare-associated infections, and the increased risk of the drug-resistant pathogens. However, in most environments these laboratories are poorly funded, staffed and equipped. Enhancement of clinical microbiology laboratories should, therefore, be considered as one of the health priorities in the world.
subject: Editorial
  topic: section
creator: Abayeneh Girma
rights: Copyright (c) 2026 Abayeneh Girma https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-23
publication date: 2026-05-23
starting page: 166
ending page: 168
doi: 10.18051/UnivMed.2026.v45.166-168

Transforming intracranial hemorrhage detection with artificial intelligence: advances in neuroimaging
type: item
description: Intracranial hemorrhage (ICH) represents a challenging neurological emergency, characterized by bleeding within the cranial vault. Timely intervention in this case is directly linked to reduced mortality and prevention of permanent sequelae. The interpretation of radiological examination for ICH is full of challenges, including anatomical variations, imaging artifacts, and small hemorrhages. Artificial Intelligence (AI), particularly through the application of deep learning (DL) models such as Convolutional Neural Networks (CNNs), has emerged as a transformative adjunctive technology for radiological interpretation. This study reviews the growing field of AI for ICH detection on non-contrast head CT scans. A literature search was conducted in major databases (PubMed, ScienceDirect, SpringerLink, Google Scholar) for English articles from 2016 - 2026 using keywords related to artificial intelligence, deep learning, intracranial hemorrhage, and its variations. The analysis synthesizes performance metrics reported in recent studies, such as sensitivity, specificity, and area under the receiver operating characteristic curve (AUC-ROC). This study explores the potential of AI in quantifying hemorrhage volume, precise localization, classification of hemorrhage subtypes, and integration into clinical workflows for triage and decision support. Challenges and considerations that accompany the clinical translation of AI are also defined, including the need for external validation, the nature of complex algorithms, ethical and legal standings, data security, and integration into existing radiology information systems. The integration of AI into ICH care signifies a paradigm shift from standardized treatment protocols toward dynamic, precision medicine. This review explores the role of AI in augmenting the diagnosis and management of intracranial hemorrhage, emphasizing its role as a powerful tool to enhance the clinical acumen of radiologists.
subject: Review Article
  topic: section
subject: Artificial Intelligence (Ai)
  topic: keywords
subject: Deep Learning
  topic: keywords
subject: Intracranial Hemorrhage
  topic: keywords
subject: Non-contrast Computed Tomography
  topic: keywords
subject: radiology
  topic: subjects
subject: artifical intelligence
  topic: subjects
subject: Neurology
  topic: subjects
subject: radiology
  topic: disciplines
creator: Finidya Septiani
creator: Vininta Fazharyasti
creator: Terawan Agus Putranto
creator: Nataliandra N. Maarifat
creator: Samuel Tandionugroho
creator: Muhammad Irvanie Rama Harahap
rights: Copyright (c) 2026 Finidya Septiani, Irvanie Rama Harahap Muhammad , Tandionugroho Samuel , N. Maarifat Nataliandra , Fazharyasti Vininta, Agus Putranto Terawan https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-08-23
publication date: 2026-08-23
starting page: 322
ending page: 331
doi: 10.18051/UnivMed.2026.v45.322-331

Maternal Trichomonas vaginalis as a risk factor of spontaneous preterm labour in Southwest Nigeria: a case-control study
type: item
description: Background Trichomonas vaginalis is a sexually transmitted protozoan infection associated with adverse pregnancy outcomes, including spontaneous preterm labour. The proposed mechanism involves genital tract inflammation, which may trigger cervical changes and uterine contractions. This study assessed whether T. vaginalis infection was associated with spontaneous preterm labour among pregnant women at Lagos Island Maternity Hospital, Lagos, Nigeria. Methods This case-control study recruited 520 pregnant women, comprising 260 women with spontaneous preterm labour and 260 women who delivered at term. Vaginal swabs were collected using sterile swab sticks. Wet mount microscopy and culture were performed to detect T. vaginalis. The association between T. vaginalis infection and spontaneous preterm labour was assessed using the Chi-square test, while binary logistic regression was used to adjust for potential confounders. Statistical significance was set at p<0.05. Results The mean age of participants was comparable between the preterm and term labour groups: 30.1 ± 5.3 years versus 29.8 ± 6.2 years, respectively (p=0.625). T. vaginalis infection was more prevalent among women with spontaneous preterm labour than controls, 16.9% versus 10.2%. On unadjusted analysis, infection was significantly associated with spontaneous preterm labour (OR 1.78, p=0.028). However, after adjustment for confounders, the association was no longer statistically significant (aOR 1.34, 95% CI 0.72–2.51, p=0.351). Conclusion T. vaginalis infection was more common among women with spontaneous preterm labour, but the association was not independently significant after adjustment. Comprehensive antenatal risk assessment remains essential.
subject: Original Articles
  topic: section
subject: Trichomonas vaginalis
  topic: keywords
subject: preterm labour
  topic: keywords
subject: maternal infection
  topic: keywords
subject: Nigeria
  topic: keywords
creator: Adetokunbo Agbolade Oyeleye
creator: Muisi Alli Adenekan
creator: Akeem Abayomi Agbetoba
creator: Emeka Chinedum Nkwo
creator: Sunday Isaac Omisakin
creator: Kayode Ayodeji Adefemi
creator: Aloy Okechukwu Ugwu
rights: Copyright (c) 2026 Adetokunbo Agbolade Oyeleye, Muisi Alli Adenekan, Akeem Abayomi Agbetoba, Emeka Chinedum Nkwo, Sunday Isaac Omisakin, Kayode Ayodeji Adefemi, Aloy Okechukwu Ugwu https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-10
publication date: 2026-07-10
starting page: 207
ending page: 217
doi: 10.18051/UnivMed.2026.v45.207-217

Knowledge of people with visual impairment about contraceptives: an exploratory study
type: item
description: Background Knowledge and information about contraceptives are key factors for the protection of reproductive health. Evidence from various parts of the world reveal that women with disabilities are facing widespread barriers in accessing public services. The aim of the study was to determine the knowledge of visually impaired people about contraceptives in relation to gender and level of education. Methods A cross-sectional study involving 32 visually impaired people of whom 12 (37.5 %) were male and 20 (62.5%) were female between the ages of 20 and 30 years. Part of the Illustrative Questionnaire for Interviews - Surveys with Young People was used to assess knowledge about contraceptives. Chi-square tests were used to analyse the data. Results Respondents with visual impairment were familiar with contraceptives. They believe that condoms and birth control pills are the most effective means of protection against unintended pregnancy. With regard to the perception of the effectiveness of contraceptives, there are statistically significant differences by gender (p=0.011) only for abstinence as an effective contraceptive. Differences by level of education were found in the responses to the two statements "The condom is an effective means of contraception" (p=0.022) and "Condoms are only used in casual relationships, not in long-term relationships and marriage" (p=0.048). Conclusion Although the visually impaired respondents showed that they have some knowledge about contraceptives, it is necessary to consistently organize additional education and provide information about reproductive health in an accessible form.
subject: Original Articles
  topic: section
subject: Contraceptives
  topic: keywords
subject: visual impairment
  topic: keywords
subject: reproductive health
  topic: keywords
subject: sexuality education
  topic: keywords
creator: Dunja Stekić Djindjić
creator: Branka Jablan
creator: Vesna Vučinić
creator: Ivana Obrenović Ilić
creator: Valentina Martać
rights: Copyright (c) 2026 Dunja Stekić Djindjić, Branka Jablan, Vesna Vučinić, Ivana Obrenović Ilić, Valentina Martać https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-17
publication date: 2026-07-17
starting page: 228
ending page: 236
doi: 10.18051/UnivMed.2026.v45.228-236

Attitude towards telemedicine and e-health literacy among health sciences faculty students
type: item
description: Background Telemedicine is no longer a futuristic concept and is increasingly integrated into health care. The aim of this study was to determine the attitudes toward telemedicine in connection with e-Health literacy among students in a Faculty of Health Sciences. Methods This cross-sectional study was conducted involving 250 students aged 18 years and older. Data were collected using a sociodemographic information form, the Attitude Scale Toward the Use of Telehealth Services (ASTUTS), and the eHealth Literacy Scale (eHEALS). Mann-Whitney U test, the Kruskal–Wallis test, and the linear regression analysis were used. Statistical significance was set at p<0.05. Results Of the participants, 61.6% were aged 18–21 years, and 70.8% were female. Attitudes toward telehealth services were significantly higher among students aged 22 years and older (p<0.05). eHealth literacy scores were significantly higher among female students than among males (p<0.05) and differed significantly across academic departments (p<0.05). Regression analysis showed that attitudes toward telemedicine services were positively associated with eHealth literacy (β=0.195, p=0.002), indicating that higher telemedicine attitude scores were related to higher levels of eHealth literacy. All variables (attitudes to telemedicine, age, gender, place of residence, economic status, general health status, smoking status, alcohol use, chronic disease status, hospital appointment system used) explaining 9.1% of the variance in eHealth literacy (R²=0.091). Conclusion Students had moderate attitudes toward telemedicine and moderate eHealth literacy. Implementing a targeted, practical, and integrated curriculum to increase the use of telemedicine and digital health literacy in undergraduate health sciences programs could be beneficial.
subject: Original Articles
  topic: section
subject: Telemedicine
  topic: keywords
subject: e-Health
  topic: keywords
subject: Health Sciences
  topic: keywords
subject: Students
  topic: keywords
creator: Hilal DEMİRHAN KELEŞ
creator: Gulay YILMAZEL
rights: Copyright (c) 2026 Hilal DEMİRHAN KELEŞ, Gulay YILMAZEL https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-08-10
publication date: 2026-08-10
starting page: 259
ending page: 269
doi: 10.18051/UnivMed.2026.v45.259-269

Molecular progression of chronic rhinosinusitis: a pseudotime reconstruction of a transcriptomic dataset
type: item
description: Background Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease that is classified based on the presence of nasal polyps. However, whether CRS and nasal polyps represent discrete entities or a continuous progression remains unclear. Most studies have relied on cross-sectional comparisons, which limit insight into its pathophysiology. This study aimed to test whether CRS subtypes lie on a continuous trajectory by applying pseudotime ordering to CRS transcriptomic data. Methods Gene expression data were obtained from the Gene Expression Omnibus (GSE36830), which consists of control, chronic rhinosinusitis without nasal polyps (CRSsNP), uncinate tissue (CRSwNP UT), and nasal polyp tissue (CRSwNP NP) from chronic rhinosinusitis with nasal polyps. Pathway activity was quantified using Gene Set Variation Analysis (GSVA) based on gene sets for immune, inflammatory, and epithelial pathways. Highly variable pathways were selected and used as input to reconstruct a pseudotemporal disease trajectory. Statistical associations were assessed using Spearman correlation and the Jonckheere–Terpstra trend test. Results Pseudotime reconstruction showed an ordered molecular trajectory extending from control samples through CRSsNP and CRSwNP UT, with nasal polyp samples forming a distinct end stage. Pseudotime showed a strong monotonic association with disease stage (Spearman's ρ=0.743, p<0.001), indicating an ordered progression of molecular changes across disease states. Progressive disease was characterized by increasing activation of immune pathways, including hypersensitivity, alongside declining activity of epithelial stress response and metabolic pathways. Conclusion These findings demonstrate that CRS represents a continuous molecular disease spectrum. Nasal polyposis emerges as a distinct molecular end state characterized by dominant immune activation. This pseudotime-based framework provides insight into CRS pathogenesis and provides evidence for specific thera…
subject: Original Articles
  topic: section
subject: Gene Set Variation Analysis
  topic: keywords
subject: Chronic Rhinosinusitis
  topic: keywords
subject: Nasal Polyps
  topic: keywords
subject: Immune Pathways
  topic: keywords
subject: Inflammatory Mediators
  topic: keywords
subject: Disease Progression
  topic: keywords
creator: Eggi Erlangga
creator: Ray Soetadji
creator: Rafael Matteo
creator: Ardo Sanjaya
rights: Copyright (c) 2026 Eggi Erlangga, Ray Soetadji, Rafael Matteo, Ardo Sanjaya https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-19
publication date: 2026-07-19
starting page: 237
ending page: 248
doi: 10.18051/UnivMed.2026.v45.237-248

Female university students’ attitude toward fertility and childbearing in Vietnam
type: item
description: Background Population aging and declining fertility rates are emerging concerns worldwide. In Vietnam, fertility rates have decreased rapidly in recent years. Understanding young women’s attitudes toward fertility and childbearing is important for developing appropriate reproductive and population policies. This study aimed to assess attitudes toward fertility and future childbearing among female students at the University of Medicine and Pharmacy, Vietnam National University, Hanoi. Methods A cross-sectional online survey was conducted among 187 nulliparous female students from September 2024 to March 2025. Data were collected using the Attitudes Toward Fertility and Childbearing Scale (AFCS). Descriptive statistics, chi-square tests, independent t-tests, and one-way analysis of variance were used to analyze the data. Results Overall, 66.3% of participants expressed a desire for future childbearing, 23.0% were uncertain, and 10.7% did not desire children. The desire for future childbearing was significantly higher among students aged >22 years compared with those aged ≤22 years (85.1% vs. 60.0%) and among participants in a relationship compared with single students (79.5% vs. 62.2%). The mean scores for the AFCS domains “Importance of fertility for the future,” “Childbearing as a hindrance at present,” and “Female identity” were 3.41 ± 0.97, 3.90 ± 0.74, and 2.96 ± 0.93, respectively. Greater importance placed on future fertility was associated with older age, rural residence, cohabiting parents, and desire for children (p<0.05). Conclusion Future childbearing intention among female students was relatively low and influenced by age and relationship status. Although fertility was considered important, childbearing was widely perceived as a present burden.
subject: Original Articles
  topic: section
subject: Fertility attitudes
  topic: keywords
subject: childbearing intention
  topic: keywords
subject: female students
  topic: keywords
subject: AFS
  topic: keywords
subject: reproductive attitudes
  topic: keywords
subject: Vietnam
  topic: keywords
creator: Thi Thu Ha Nguyen
creator: Hoang Thanh Luong
creator: Thi Thu Phuong Pham
rights: Copyright (c) 2026 Nguyen Thi Thu Ha, Hoang Thanh Luong, Thi Thu Phuong Pham https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-06-20
publication date: 2026-06-20
starting page: 191
ending page: 198
doi: 10.18051/UnivMed.2026.v45.191-198

Clinical utility of artificial intelligence in prehospital emergency medical services : a systematic review and meta-analysis
type: item
description: Background The emergency medical services (EMS) sector presents substantial hurdles in providing excellent treatment while operating within limited resources. Artificial intelligence (AI) has significant potential in prehospital EMS, where rapid and accurate decision-making is essential. However, a comprehensive synthesis of AI’s effectiveness in this setting remains limited. The objective of this systematic review and meta-analysis was to evaluate AI’s predictive accuracy, compare its performance with human-based triage, and assess its feasibility in prehospital care. Methods Following PRISMA guidelines, PubMed, Cochrane Library, and Web of Science were searched up to February 20, 2025. Fourteen peer-reviewed studies reporting quantitative outcomes were included. Study quality was assessed using the Newcastle-Ottawa Scale (median score = 7). Random-effects meta-analyses in R were conducted to synthesize area under the curve (AUC), AI-human AUC differences, and feasibility outcomes. Results Across 14 studies involving 9,107,906 patients, AI demonstrated strong predictive performance with a pooled AUC of 0.874 (95% CI: 0.843–0.905). Individual study AUCs ranged from 0.805 to 0.997, with moderate heterogeneity (I²=52.3%). In eight studies, AI significantly outperformed human triage, showing a pooled AUC improvement of 0.074 (95% CI: 0.045–0.103; p<0.001), despite high heterogeneity due to varying human benchmarks. Feasibility analysis showed high clinical utility, with a pooled proportion of 0.929 and no heterogeneity (I²=0%). Funnel plots suggested slight asymmetry, but Egger’s tests indicated no significant publication bias. Conclusion Artificial intelligence demonstrated high predictive accuracy, slight superiority over human triage, and strong feasibility in prehospital care, supporting its integration into EMS with further validation and standardized reporting.
subject: Review Article
  topic: section
subject: Artificial Intelligence (Ai)
  topic: keywords
subject: Prehospital Care
  topic: keywords
subject: Emergency Medical Services (EMS)
  topic: keywords
subject: Meta-Analysis
  topic: keywords
subject: Prediction Accuracy
  topic: keywords
subject: Triage
  topic: keywords
subject: Feasibility
  topic: keywords
subject: Medical
  topic: subjects
subject: Emergency Medical
  topic: subjects
subject: Medical Sciences
  topic: disciplines
creator: Abdullah Alsamhari
creator: Rafiulla Gilkaramenthi
creator: Bader Hussain Alamer
creator: Saad M. Mushawwah
rights: Copyright (c) 2026 Abdullah Alsamhari, Rafiulla Gilkaramenthi, Bader Hussain Alamer, Saad M. Mushawwah https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-06-15
publication date: 2026-06-15
starting page: 294
ending page: 309
doi: 10.18051/UnivMed.2026.v45.294-309

Clinico-epidemiological profile of disorders of sex development at a tertiary referral hospital in South Kalimantan, Indonesia
type: item
description: Background Disorders of sex development (DSD) comprise a group of complex conditions that pose significant diagnostic and clinical issues. This study aimed to describe the clinical spectrum, temporal patterns, and geographical distribution of DSD cases at a tertiary referral hospital in South Kalimantan, Indonesia. Methods This retrospective descriptive study analyzed medical records of patients with clinical features suggestive of DSD at Ulin General Hospital, Banjarmasin, between 2022 and 2025. Clinical diagnoses were established by a consultant pediatric endocrinologist based on phenotypic evaluation, consistent with approaches used in other Indonesian centers with limited access to karyotyping. Variables assessed included clinical diagnosis, age, sex, year of diagnosis, and domicile, whilst spatial analysis used Geographic Information System (GIS) software. Results Among the 100 cases analyzed, severe hypospadias dominated (45 cases, 45%), followed by primary amenorrhea (28 cases, 28%) and micropenis (13 cases, 13%). Males accounted for 67% of cases, females for 32%, and one case had undetermined sex. Mean age at diagnosis was 9.41 ± 7.32 years (range: neonatal period to 35.4 years). Geographic analysis revealed notable disparities, with Banjarmasin contributing 40% of cases, while other districts each accounted for approximately 5%. Conclusions The findings indicate delayed diagnosis, potential underdiagnosis in rural areas, and geographic disparities that likely reflect differences in access to tertiary services rather than true occurrence variation. This highlights the importance of evaluating boys presenting with proximal penile hypospadias or micropenis and girls with primary amenorrhea for timely intervention. Strengthening early detection and expanding diagnostic capacity are essential to improve DSD clinical outcomes.
subject: Original Articles
  topic: section
subject: Disorders of sex development
  topic: keywords
subject: clinical spectrum
  topic: keywords
subject: epidemiology
  topic: keywords
subject: Medicine; Public Health
  topic: disciplines
subject: Pediatrics
  topic: disciplines
subject: Endocrinology
  topic: disciplines
creator: Maria Ulfah
creator: Indra Widjaya Himawan
creator: Niarsari Anugrahing Putri
creator: Naisya Balela
creator: Aulia Mufida
creator: Nashwa Rifda Agustina
creator: Nur Aisyah Munawaroh Ayu
rights: Copyright (c) 2026 Maria Ulfah, Indra Widjaya Himawan, Niarsari Anugrahing Putri, Naisya Balela, Aulia Mufida, Nashwa Rifda Agustina, Nur Aisyah Munawaroh Ayu https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-12
publication date: 2026-07-12
starting page: 218
ending page: 227
doi: 10.18051/UnivMed.2026.v45.218-227

Effect of using normal saline, alcohol and acetone on pain during removal of polyacrylate adhesive dressings in children aged 10–15 years: a pilot randomized controlled trial
type: item
description: Background Removing wound dressings containing polyacrylate adhesives can cause pain, especially in pediatric patients with more sensitive skin and lower pain thresholds. This study aimed to evaluate the effects of normal saline, alcohol, and acetone on pain during dressing removal in children and evaluate their associated side effects. Methods The study used a pilot randomized controlled trial involving 16 children aged 10-15 years at the Surgical Clinic of Dr. Saiful Anwar Regional General Hospital, Malang. Pain levels were measured using the Wong-Baker Faces Pain Scale, while side effects were assessed using the Skin Irritation Score and Itchyquant Score. The children's pain was assessed 1 min after the procedure. Kruskal-Wallis test, followed by Dunn's post hoc test were used for data analysis. Results The results demonstrated that acetone was significantly more effective than normal saline and alcohol in reducing pain during dressing removal (p<0.050). Normal saline and alcohol did not show significant differences compared to the control group, likely due to their limited ability to dissolve the polyacrylate adhesive. Mild irritation and temporary pruritus occurred in all groups, with acetone producing the least reaction. Acetone's effectiveness is attributed to its ability to disrupt van der Waals forces and polymer bonds within the adhesive, thereby reducing the force required for removal. Conclusions Acetone is the most effective agent for reducing pain during dressing removal, with minimal side effects compared to other solvents. Further research is necessary to determine optimal formulations and assess the stability of acetone for the development of acetone swab products.
subject: Original Articles
  topic: section
subject: Pain Management
  topic: keywords
subject: Pediatric
  topic: keywords
subject: Polyacrylate Adhesive
  topic: keywords
subject: acetone
  topic: keywords
subject: children
  topic: keywords
subject: Pediatric Surgery
  topic: disciplines
subject: Plastic Reconstructive and Aesthetic Surgery
  topic: disciplines
creator: Edith Sumaregita Rinhastyanti
creator: Herman Wihastyoko
creator: Tommy Alfandy Nazwar
rights: Copyright (c) 2026 Edith Sumaregita Rinhastyanti, Herman Wihastyoko, Tommy Alfandy Nazwar https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-06-25
publication date: 2026-06-25
starting page: 183
ending page: 190
doi: 10.18051/UnivMed.2026.v45.183-190

Dendrophthoe pentandra (Mango Mistletoe) leaves modulate steroidogenic acute regulatory protein, aromatase, and estrogen receptor expression in aged mice
type: item
description: BACKGROUND Ovarian aging is associated with impaired steroidogenesis and estrogen signaling, contributing to reproductive dysfunction. Dendrophthoe pentandra (Mango Mistletoe), a flavonoid-rich plant with antioxidant properties, has demonstrated anti-inflammatory and cytoprotective effects in experimental studies. However, its role in modulating the integration of ovarian steroidogenic and estrogen-responsive pathways during aging remains unclear. This study evaluated the effects of D. pentandra leaf extract on the expression of steroidogenic acute regulatory protein (StAR), aromatase (CYP19A1), estrogen receptor α (ERα), and ERβ in aged female mice. METHODS This experimental study included 25 female mice: 5 young (8–12 weeks) and 20 aged (18–20 months). Animals were allocated to five groups (n=5 per group): young controls, aged controls, and three aged treatment groups receiving D. pentandra leaf extract at doses of 150, 300, and 600 mg/kg BW, respectively, for 30 days. Protein expression was evaluated using immunohistochemistry and analyzed using one-way ANOVA followed by Tukey HSD post hoc test. RESULTS Aged mice exhibited significantly lower expression of StAR, aromatase, ERα, and ERβ compared with young controls. Administration of D. pentandra extract significantly increased expression of all evaluated markers in a dose-dependent manner (p<0.001). Post hoc analysis demonstrated significant restoration of steroidogenic and estrogen-signaling–related protein expression, particularly in the highest-dose group, where aromatase, ERα, and ERβ expression approached or exceeded levels observed in young controls. CONCLUSION D. pentandra leaf extract restored key components of ovarian steroidogenesis and estrogen signaling in aged mice, suggesting potential phytoendocrine modulatory activity against age-related ovarian endocrine decline.
subject: Original Articles
  topic: section
subject: Dendrophthoe pentandra
  topic: keywords
subject: STAR
  topic: keywords
subject: aromatase
  topic: keywords
subject: estrogen receptors
  topic: keywords
subject: reproductive aging
  topic: keywords
subject: mice
  topic: keywords
creator: Lilik Indahwati
creator: Linda Ratna Wati
creator: Inmas Andi Sermoati
creator: Kusworini Handono
creator: Wibi Riawan
rights: Copyright (c) 2026 Lilik Indahwati, Linda Ratna Wati, Inmas Andi Sermoati, Kusworini Handono, Wibi Riawan https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-07
publication date: 2026-07-07
starting page: 199
ending page: 206
doi: 10.18051/UnivMed.2026.v45.199-206

Prevalence and risk factors of Entamoeba histolytica and Giardia lamblia infection among patients with gastrointestinal complaints
type: item
description: Background Intestinal parasitic infections remain a significant public health problem in developing regions, primarily driven by inadequate hygiene and sanitation standards. The most prevalent protozoan parasites causing gastrointestinal illness are Entamoeba histolytica and Giardia lamblia. This study aimed to investigate the prevalence of these infections and evaluate their association with socio-demographic factors and clinical stool consistency. Methods A total of 122 subjects aged 1-60 years were involved in this cross-sectional study. Data was collected via direct interviews and parasitological diagnosis using standard laboratory protocols to identify the presence of cysts or trophozoites. Data were stratified by age group, gender, and stool consistency, and a Chi-square test was used for data analysis. Results The findings revealed a high overall prevalence, with E. histolytica being the main parasite at 84.42% (103/122) compared to G. lamblia at 15.57% (19/122). Age-specific data showed that the 31-40 year age group had the highest infection rate for E. histolytica (92.31%), while the 21-30 year age group showed the highest occurrence of G. lamblia (25.81%). Gender-wise, males exhibited a significantly higher infection rate for E. histolytica (91.93%) compared to females (76.66%) (p=0.038). Regarding stool consistency, a highly significant association was observed (p<0.001). Conclusion The study highlights a substantial burden of protozoan infections, particularly E. histolytica. The significant association between stool consistency and parasite type emphasizes the importance of clinical presentation in diagnostic suspicion. Enhanced community-level health education and improved sanitation infrastructure are urgently needed to mitigate the transmission of these intestinal parasites.
subject: Original Articles
  topic: section
subject: E. histolytica
  topic: keywords
subject: G. lamblia
  topic: keywords
subject: gastrointestinal
  topic: keywords
subject: patients
  topic: keywords
creator: Hussein A. Sadeq
creator: Shivan O. Haydar
creator: Ghanem M. Jaafar
creator: Mohammad I. Alberfkani
rights: Copyright (c) 2026 Hussein A. Sadeq, Shivan O. Haydar, Ghanem M. Jaafar, Mohammad I. Alberfkani https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-26
publication date: 2026-05-26
starting page: 175
ending page: 182
doi: 10.18051/UnivMed.2026.v45.175-182

Trends of early-onset colorectal cancer biomarkers from 1985 to 2024 : a bibliometric analysis
type: item
description: Early-onset colorectal cancer (EOCRC) is increasingly recognized as a global public health concern. Biomarker research in EOCRC has expanded across hereditary, molecular, epigenetic, liquid biopsy, microbiome, and multi-omics domains, but the overall research landscape remains fragmented. This study aimed to map global research trends and identify prominent and underdeveloped topics in EOCRC biomarker research. A bibliometric analysis was conducted using publications on EOCRC biomarkers retrieved on October 27, 2024. Eligible documents were limited to English-language articles, reviews, and conference proceedings, with a final publication stage and no restriction on publication year. After screening, 134 relevant documents published between 1985 and 2024 were included. Bibliometric indicators, including publication trends, leading contributors, influential publications, topic evolution, and keyword co-occurrence patterns, were analyzed using Biblioshiny (Bibliometrix R package v4.1.3) and VOS viewer (v1.6.18). Early-onset colorectal cancer biomarker research showed steady growth, with an annual growth rate of 7.54% and a publication peak in 2023. The dataset included 134 documents from 92 sources and involved 1,121 authors, with international collaboration observed in 20.9% of publications. Earlier studies focused mainly on hereditary predisposition, Lynch syndrome, mismatch repair genes, and microsatellite instability. More recent research shifted toward molecular profiling, epigenetic alterations, liquid biopsy, gut microbiota, tumor microenvironment, and multi-omics approaches. Underdeveloped areas included diagnostic biomarker validation, screening implementation, gut microbiota, risk factors, and machine learning-based biomarker discovery. Overall, EOCRC biomarker research has evolved from a hereditary-centered focus toward a broader precision oncology framework, but further work is needed to strengthen validation, translational relevance, and clinical applicab…
subject: Review Article
  topic: section
subject: Colorectal Cancer
  topic: keywords
subject: Biomarker
  topic: keywords
subject: Bibliometric analysis
  topic: keywords
subject: Digestive surgery
  topic: keywords
subject: Colorectal cancer
  topic: subjects
subject: Biomarkers
  topic: subjects
subject: Tumor
  topic: subjects
subject: Bibliometrics
  topic: subjects
subject: medicine
  topic: disciplines
subject: Anatomic Pathology
  topic: disciplines
creator: Hamzah Haryo Prakoso
creator: Andre Setiawan
creator: Nur Rahadiani
rights: Copyright (c) 2026 Hamzah Haryo Prakoso, Andre Setiawan, Nur Rahadiani https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-06-08
publication date: 2026-06-08
starting page: 279
ending page: 293
doi: 10.18051/UnivMed.2026.v45.279-293

Effect of brain endurance training on fatigue and physical endurance among stroke survivors: a non-blinded randomized controlled trial
type: item
description: Background Post-stroke fatigue (PSF) is a multifactorial impairment characterized by persistent tiredness not relieved by rest, and affects nearly half of stroke survivors, leading to poor physical endurance which limits recovery and overall quality of life. Limited evidence suggests that combining cognitive and physical training might help in reducing fatigue. Brain endurance training (BET) involves both cognitive training and physical training, targeting PSF. The study aimed to evaluate the effect of BET on fatigue and physical endurance among stroke survivors. Methods A parallel group pilot randomized controlled trial was carried out in a private setting with 30 stroke survivors. Patients were randomized into two groups. Group A (n=15) received BET and group B (n=15) received conventional physiotherapy. Both groups underwent training for 65 minutes per day, thrice a week for eight weeks. Primary outcomes were Fatigue Severity Scale (FSS) and Six-Minute Walk Test (6MWT). Statistical analysis was performed using the chi-square test and independent t-test. Results At baseline, no significant differences were observed between groups for FSS and 6MWT (p>0.05). The BET group reported better reduction in fatigue (FSS: 5.39 ± 0.18 to 3.48 ± 0.16, p<0.001) and improvement in physical endurance (6MWT: 202.03 ± 4.35 to 273.35 ± 6.26, p<0.001) than the control group (FSS: 5.25 ± 0.10 to 4.19 ± 0.06) (6MWT: 200.53 ± 2.72 to 222.70 ± 3.64). Conclusion Brain endurance training is a feasible and safe approach for reducing fatigue and improving physical endurance among stroke survivors.
subject: Original Articles
  topic: section
subject: stroke
  topic: keywords
subject: fatigue
  topic: keywords
subject: physical endurance
  topic: keywords
subject: cognitive training
  topic: keywords
subject: physical exercises
  topic: keywords
subject: quality of life
  topic: keywords
subject: stroke
  topic: subjects
subject: fatigue
  topic: subjects
subject: physical endurance
  topic: subjects
subject: cognitive traininig
  topic: subjects
subject: physical exercises
  topic: subjects
subject: Quality of Life
  topic: subjects
subject: physiotherapy
  topic: disciplines
subject: physical medicine and rehabilitation
  topic: disciplines
subject: rehabilitation medicine
  topic: disciplines
subject: Health sciences
  topic: disciplines
subject: neuroscience
  topic: disciplines
creator: Jayasree Sai L
creator: Prathap Suganthirababu
creator: Dhanusia S
creator: Harika Valluri
rights: Copyright (c) 2026 Jayasree Sai L, Prathap Suganthirababu, Dhanusia S, Harika Valluri https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-01
publication date: 2026-04-01
starting page: 59
ending page: 67
doi: 10.18051/UnivMed.2026.v45.59-67

The effect of war on displaced hemodialysis patients in Sudan
type: item
description: BACKGROUND The Sudan war has severely disrupted healthcare services, particularly for patients with end-stage renal disease (ESRD) dependent on regular hemodialysis. Conflict-related displacement, damaged infrastructure, medication shortages, and financial hardship have compromised dialysis continuity and patient outcomes. This study assessed the impact of war-related displacement on dialysis care among Sudanese hemodialysis patients. METHODS This cross-sectional observational study included 101 displaced ESRD patients receiving maintenance hemodialysis. Data collection comprised demographic characteristics, causes of ESRD, dialysis access and adequacy, treatment interruptions, complications, medication availability, hospital admissions, and functional status before, during, and after the war. Comparisons of dialysis parameters and functional status before, during, and after the war were performed using Cochran’s Q test. RESULTS War-related displacement was associated with statistically significant worsening of dialysis care. Dialysis frequency decreased from two to 1.5 sessions per week, and session duration declined from four to three hours (both p<0.05). Patients missed a median of one dialysis session per week. Consequently, out-of-pocket payment for medications surged from 42 (41.6%) pre-war to 93 (92.1%) during the war and persisted at 89 (88.1% in the current period (p<0.0001). Erythropoietin use declined from 98 (97.1%) to 39 (38.6%) (both at p<0.001). Displacement was also associated with significantly increased complications, hospitalizations, reduced medication adherence, and marked fatigue (p < 0.05). CONCLUSION War-related displacement significantly reduced dialysis adequacy, medication access, and continuity of care, resulting in increased morbidity. Immediate humanitarian and health-system interventions are essential to prevent excess mortality among displaced hemodialysis patients.
subject: Original Articles
  topic: section
subject: Displacement
  topic: keywords
subject: Healthcare Disruption
  topic: keywords
subject: Hemodialysis Complications
  topic: keywords
subject: Humanitarian Aid
  topic: keywords
subject: Sudan-War
  topic: keywords
creator: Sara Mohamed Abdelgadir
creator: Sufian Khalid Mohamed
creator: Mohamed Osman Elamin
creator: Wahaj A. Khan
creator: Hatim O. Badri
creator: Abdullah Muhammad Alzhrani
creator: Osama Banah
creator: Ahmad Salah Alkathiri
creator: Ahmed A. Osman
creator: Fowzi O. Elamin
rights: Copyright (c) 2026 Sara Mohamed Abdelgadir, Sufian Khalid Mohamed, Mohamed Osman Elamin, Wahaj A. Khan, Hatim O. Badri, Abdullah Muhammad Alzhrani, Osama Banah, Ahmed Alkathiri, Ahmed A. Osman, Fowzi O. Elamin https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-02-10
publication date: 2026-02-10
starting page: 27
ending page: 38
doi: 10.18051/UnivMed.2026.v45.27-38

Microbiota as a reservoir of antibiotic resistance genes: relevance and urgency
type: item
description: 'Antimicrobial resistance' (AMR) is one of the top threats to global public health and developments.
subject: Editorial
  topic: section
subject: Antibiotic resistance
  topic: keywords
subject: Genes
  topic: keywords
subject: Microbiota
  topic: keywords
subject: Antibiotic resistance
  topic: subjects
subject: Genes
  topic: subjects
subject: Microbiota
  topic: subjects
subject: Human health
  topic: disciplines
creator: Naga Raju Maddela
rights: Copyright (c) 2026 Naga Raju Maddela https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-01-07
publication date: 2026-01-07
starting page: 1
ending page: 3
doi: 10.18051/UnivMed.2026.v45.1-3

Gamma-oryzanol as a potential intervention for normalizing insulin secretion and pancreatic β-cell function
type: item
description: The bioactive substance gamma-oryzanol (GO), which is mostly present in rice bran oil, has attracted a lot of interest due to its possible therapeutic application in metabolic conditions like diabetes mellitus. The effects of GO on insulin secretion and pancreatic β-cell function are examined in this study. Gamma-oryzanol improves β-cell viability, lowers oxidative stress, and modifies intracellular signaling pathways linked to glucose metabolism, all of which increase insulin secretion, according to experimental and clinical evidence. Additionally, GO's anti-inflammatory and antioxidant qualities shield β-cells from dysfunction and apoptosis brought on by hyperglycemia and lipid toxicity. Relevant studies were identified through a systematic search of PubMed, ScienceDirect, and Google Scholar for articles published between 2017 and 2026 using the keyword “gamma-oryzanol”, “insulin secretion”, ‘pancreatic β-cell function”. Additionally, the substance seems to support glucose homeostasis and pancreatic function by upregulating important genes involved in insulin synthesis and secretion. All things considered, GO shows great promise as a natural agent for maintaining β-cell integrity and increasing insulin secretion, providing a novel complementary approach to managing diabetes. Gamma-oryzanol is frequently linked to anti-inflammatory, anti-cancer, anti-diabetic, and cholesterol-lowering properties. Because Orz reduces insulin activity, cholesterol metabolism, and associated chronic inflammation, its potential to treat metabolic diseases has recently been investigated. After apoptosis and increased endoplasmic reticulum (ER) stress were decreased, oral GO administration increased glucose-stimulated insulin secretion in islets from diabetic mice fed a high-fat diet. We also examined the effects of GO on low-dose streptozotocin-induced diabetic mice, which demonstrated elevated ER stress and consequent β-cell apoptosis. Furthermore, γ-oryzanol improved glucose dysmetabo…
subject: Review Article
  topic: section
subject: Rice bran oil
  topic: keywords
subject: glucose homeostasis
  topic: keywords
subject: pancreatic β-cells
  topic: keywords
subject: gamma-oryzanol
  topic: keywords
subject: insulin secretion
  topic: keywords
creator: Mamoun Abdelwahab Mohammed Elamin Alfaki
creator: Md Nadeem Bari
creator: Md Rizwan Ansari
creator: Imran Mohammad
creator: Mohammad Anwar
rights: Copyright (c) 2026 Mamoun Abdelwahab Mohammed Elamin Alfaki, Md Nadeem Bari, Md Rizwan Ansari, Imran Mohammad, Mohammad Anwar https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-23
publication date: 2026-05-23
starting page: 270
ending page: 278
doi: 10.18051/UnivMed.2026.v45.270-278

Machine learning models for predicting 48-hour mortality in acute intracerebral hemorrhagic stroke
type: item
description: BACKGROUND Identifying patients with intracerebral hemorrhagic (ICH) at high risk of mortality is crucial for timely intervention. Machine learning (ML) offers novel methodologies for precise predictive models for ICH. Therefore, the aim of this study was to develop an ML-based predictive model for 48-hour mortality in patients with acute hemorrhagic stroke. METHODS A cross-sectional study was conducted using secondary data from 657 patients diagnosed with acute ICH. Demographic, clinical, laboratory, and radiological variables were extracted from medical records. Data preprocessing included cleaning, normalization, and class balancing using the Synthetic Minority Oversampling Technique (SMOTE). Three supervised algorithms—Random Forest, Decision Tree, and Gaussian Naïve Bayes—were developed and evaluated using stratified 5-fold cross-validation. Model performance was assessed using accuracy, sensitivity, specificity, precision, recall, F1-score, and AUC. RESULTS Random Forest achieved the best overall performance for predicting 48-hour mortality, with an accuracy of 84.77%, F1-score of 84.63%, and AUC of 80.51, outperforming Decision Tree (AUC 61.12) and Gaussian Naïve Bayes (AUC 82.94). Random Forest most accurately identified >48-hour survival, with high sensitivity (93.5%) and PPV (92.9%), while Naïve Bayes provided the most reliable positive classification for this category (PPV 99.0; specificity 94.2%). For ≤24-hour mortality, Naïve Bayes showed the best detection performance (sensitivity 85.4%; NPV 98.7%). CONCLUSIONS Machine learning, particularly the Random Forest algorithm, enables reliable prediction of 48-hour mortality in patients with acute ICH using basic clinical and radiological data available at admission. The model offers practical potential for early risk stratification in emergency and critical care settings.
subject: Original Articles
  topic: section
subject: Intracerebral hemorrhage
  topic: keywords
subject: machine learning
  topic: keywords
subject: early mortality
  topic: keywords
subject: predictive model
  topic: keywords
subject: 48-hour
  topic: keywords
creator: Intan Kemaladina
creator: Syahrul Syahrul
creator: Taufik Fuadi Abidin
creator: Nasrul Musadir
creator: Imran Imran
rights: Copyright (c) 2026 Intan Kemaladina, Syahrul Syahrul, Taufik Fuadi Abidin, Nasrul Musadir, Imran Imran https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-01-12
publication date: 2026-01-12
starting page: 13
ending page: 26
doi: 10.18051/UnivMed.2026.v45.13-26

Role of global deoxyribonucleic acid methylation and molecular hypoxia changes in male infertility
type: item
description: Infertility is recognized as a major global health issue and has become one of the primary challenges in reproductive health; its prevalence and incidence are steadily increasing worldwide. Recent research has highlighted the critical role of epigenetic dysregulation as a direct factor affecting male infertility. The objective of this review is to investigate the relationship between epigenetic modifications (specifically 5-methylcytosine and 5-hydroxymethylcytosine) and essential male reproductive outcomes, including the spermatogenesis process, testicular function, and semen quality parameters. Furthermore, this study explores the influence of micronutrients such as vitamin B12, homocysteine metabolism, and antioxidant capacity on DNA methylation and genomic stability. Significantly, this review establishes a novel link between infertility and cellular hypoxia focusing on the modulation of hypoxia-inducible factor (HIF-1α and HIF-2α) as a potential therapeutic strategy. Additionally, this work introduces the overlooked association between HIF-2α and infertility, offering novel insights since current findings regarding HIF-2α in male infertility are remarkably limited. A literature search was conducted on PubMed, ScienceDirect, Springer Link, Oxford Academic and Nature databases for sources published in English from 2015 to 2025, using the following keywords: male infertility, DNA methylation, hypoxia, HIF-1α, and immunity. Our work investigates the interruption of inflammatory cytokines and immunological markers by linking them with molecular factors, micronutrients and hypoxia pathways. This approach provides an integrated foundation for advanced diagnostic and therapeutic strategies. Ultimately, understanding these molecular signatures provides ways to enhance reproductive outcomes and improve success rates of assisted reproductive techniques.
subject: Review Article
  topic: section
subject: Male infertility
  topic: keywords
subject: DNA methylation
  topic: keywords
subject: vit. B12
  topic: keywords
subject: homocysteine
  topic: keywords
subject: hypoxia
  topic: keywords
subject: HIF-1α
  topic: keywords
subject: HIF-2α
  topic: keywords
subject: interleukin-41
  topic: keywords
creator: Zainab Abdul Jabbar
creator: Rakad Mohammed Khamas AL-Jumaily
rights: Copyright (c) 2026 Zainab Abdul Jabbar, Rakad Mohammed Khamas AL-Jumaily https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-03-06
publication date: 2026-03-06
starting page: 99
ending page: 112
doi: 10.18051/UnivMed.2026.v45.99-112

Clinical significance of pre-operative prognostic nutritional index in predicting survival in patients with renal cell carcinoma
type: item
description: Background Renal cell carcinoma (RCC) is a prevalent urologic malignancy with heterogeneous outcomes even after surgery. Conventional prognostic factors are insufficient to capture host-related influences on survival. The prognostic nutritional index (PNI), derived from serum albumin and lymphocyte count, reflects nutritional and immunological status and has emerged as a potential prognostic biomarker. The objective of this study was to determine preoperative PNI in predicting survival outcomes of RCC patients. Methods This was a retrospective cohort study involving 107 RCC patients who underwent radical or partial nephrectomy. Patients were categorized into normal and low PNI. Associations between PNI and clinicopathological features were assessed, while survival outcomes were evaluated using Kaplan–Meier analysis and Cox proportional hazards regression. Results Patients’ mean age was 53.1 ± 13.5 years, and 58.9% of the patients were male. Clear cell carcinoma was the most common histological type (69.2%). Low PNI was significantly associated with older age (p=0.04), metastatic disease (p<0.001), and advanced tumor stage (p=0.014). Kaplan–Meier analysis demonstrated significantly poorer survival in the low-PNI group (p<0.001). In the multivariate Cox model, PNI remained the strongest independent predictor of overall survival (HR = 0.29, 95% CI: 0.13–0.67, p=0.003), while metastasis also retained independent significance (HR = 2.04, 95% CI: 1.06–3.93, p=0.031). Conclusion The PNI is an independent, simple, and cost-effective prognostic factor for overall survival in RCC. Incorporating PNI into preoperative risk stratification may enhance clinical decision-making. Therefore, PNI could be used as an effective prognostic indicator in RCC.
subject: Original Articles
  topic: section
subject: Renal cell carcinoma
  topic: keywords
subject: prognostic nutritional index
  topic: keywords
subject: overall survival
  topic: keywords
subject: cancer prognosis
  topic: keywords
subject: immunological status
  topic: keywords
creator: Eldo Taufila Putra Utama
creator: Raden Danarto
rights: Copyright (c) 2025 Eldo Taufila Putra Utama, Raden Danarto https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-17
publication date: 2025-12-17
starting page: 345
ending page: 351
doi: 10.18051/UnivMed.2025.v44.345-351

Association of toxoplasmosis with risk factors among adults in Duhok Province, Kurdistan Region, Iraq
type: item
description: BACKGROUND Toxoplasma gondii is a widespread zoonotic parasite that infects approximately one-third of the global population. Humans become infected mainly by consumption of undercooked meat or water or fruits and vegetables contaminated with oocysts. This study aimed to investigate the seroprevalence of toxoplasmosis and associated risk factors in adults from Duhok province, Iraq. Methods A cross-sectional study was conducted with 600 participants (ages 22–60 years, both genders) from Duhok. Variables included age, gender, occupation, interaction with cats, and hygiene practices were collected. Blood samples were analyzed for anti-Toxoplasma IgM and IgG antibodies, using ELISA. Multiple logistic regressions were used to identify risk factors for toxoplasmosis. Results The overall seroprevalence was 39.17% (IgG: 31.67%, IgM: 7.5%). Both IgM and IgG prevalence were significantly associated with gender (p<0.001). IgG was more prevalent in participants aged 31–40 years (p<0.001). Key risk factors included cat contact (aOR=4.50, 95% C.I.: [2.10, 9.50], p<0.001), drinking tap water (aOR=3.00, 95% C.I.: [1.50, 6.00], p=0.005), consuming undercooked meat (aOR=3.20, 95% C.I.: [2.00, 5.30], p<0.001), eating unwashed vegetables (aOR=2.50, 95% C.I.: [1.50, 4.30], p<0.001), eating outside home (aOR=2.50, 95% C.I.: [1.50, 4.00], p<0.001), and a history of arthritis (aOR=3.00, 95% C.I.: [2.00, 4.50], p<0.001), hygiene practices, such as handwashing (aOR=0.30, 95% C.I.: [0.15, 0.60], p=0.001) and hygienic measures (aOR=0.35, 95% C.I.: [0.20, 0.60], p<0.001), reduced risk former Covid-19 (aOR=7.00, 95% C.I.: [3.50, 14.00], p<0.001). Conclusions Toxoplasmosis in Duhok is associated with dietary habits, sanitation, and cat contact. Enhancing hygiene and food safety can reduce the disease burden, particularly in immunocompromised individuals.
subject: Original Articles
  topic: section
subject: Toxoplasmosis
  topic: keywords
subject: prevalence
  topic: keywords
subject: risk factors
  topic: keywords
subject: arthritis
  topic: keywords
subject: COVID-19
  topic: keywords
subject: adult
  topic: keywords
creator: Mustafa Riadh Hussein
creator: Wijdam Mero
rights: Copyright (c) 2026 Mustafa Riadh Hussein, Wijdam Mero https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-26
publication date: 2026-04-26
starting page: 68
ending page: 75
doi: 10.18051/UnivMed.2026.v45.68-75

Umbilical cord mesenchymal stem cells and their secretome: a new frontier in orthopedic medicine
type: item
description: Umbilical cord mesenchymal stem cells (UC-MSCs) have gained significant attention in regenerative medicine due to their unique biological properties, including high proliferation capacity, low immunogenicity, and potent immunomodulatory effects. These characteristics make UC-MSCs particularly promising for orthopedic applications, where the repair and regeneration of musculoskeletal tissues such as bone, cartilage, tendons, ligaments, and nerves are critical for restoring function. The secretome of UC-MSCs—comprising bioactive molecules such as exosomes, cytokines, and growth factors—offers a powerful, cell-free therapeutic option through paracrine signaling, further enhancing their therapeutic potential. A literature search was conducted in major databases (PubMed, ScienceDirect, SpringerLink, Google Scholar) for English articles from 2010–2025 using keywords related to UC‑MSCs and orthopedic regeneration. This review explores the role of UC-MSCs and their secretome in orthopedic tissue repair, focusing on their application in bone healing, cartilage regeneration, tendon-ligament repair, and nerve regeneration with their innovative delivery. Despite the promising potential of UC-MSC therapies, several challenges remain, including regulatory hurdles, long-term safety concerns, and the scalability of cell-based and secretome-based therapies for widespread clinical use. Although umbilical cord MSCs are not yet widely applied in clinical practice, increasing evidence suggests that they offer significant therapeutic potential, especially in the treatment of autoimmune and neurodegenerative diseases. The UC-MSCs and their secretome represent a transformative approach in orthopedics, offering new avenues for treating complex musculoskeletal injuries and degenerative diseases. Ongoing advancements in this field will likely unlock their full potential, making them viable options for clinical use in the near future.
subject: Review Article
  topic: section
subject: Umbilical cord-mesenchymal stem cells (UC-MSCs)
  topic: keywords
subject: secretome
  topic: keywords
subject: orthopedics
  topic: keywords
subject: neurodegenerative diseases
  topic: keywords
creator: Tito Sumarwoto
creator: Romaniyanto
creator: Sholahuddin Rhamtomy
creator: Mujaddid Idulhaq
creator: Asep Santoso
rights: Copyright (c) 2026 Tito Sumarwoto, Romaniyanto, Sholahuddin Rhamtomy, Mujaddid Idulhaq, Asep Santoso https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: 135
ending page: 152
doi: 10.18051/UnivMed.2026.v45.135-152

Validity of core needle biopsy in diagnosing primary thyroid lymphoma: a systematic-review and meta-analysis
type: item
description: Background Primary thyroid lymphoma (PTL) is a rare thyroid malignancy, accounting for less than 5% of thyroid malignancies. The prognosis of PTL depends on the histologic subtype and stage of disease at diagnosis, hence an effective diagnostic method is needed to ensure prompt treatments. Fine needle aspiration (FNA) is the first test for microscopic examination of a rapidly enlarging thyroid mass, but its limitations and low sensitivity have been observed. After the often “inconclusive” result is known, core-needle biopsy (CNB) should be performed as the natural next diagnostic step. This systematic review and meta-analysis aimed to evaluate the diagnostic value of core needle biopsy (CNB) in diagnosing PTL. Methods This systematic review and meta-analysis follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A PubMed and Embase database search was performed in August 2025. Populations included were patients with final diagnosis of PTL. Pooled sensitivity was calculated using a random-effects model. Results This systematic review and meta-analysis of 12 studies comprised a total of 1091 patients. Core needle biopsy proved to be highly effective, with a pooled sensitivity of 91.6% (95% CI: 82.1%–96.3%). The development of tumor-cell seeding following CNB has been a major concern, but this complication is extremely rare. Other potential complications include bleeding and infection. Conclusion Core needle biopsy demonstrates high diagnostic sensitivity and a favorable safety profile in diagnosing primary thyroid lymphoma, supporting its role as a valuable diagnostic modality, particularly when PTL is clinically suspected or FNA results are inconclusive.
subject: Review Article
  topic: section
subject: Core needle biopsy
  topic: keywords
subject: primary thyroid lymphoma
  topic: keywords
subject: thyroid carcinoma
  topic: keywords
subject: thyroid malignancy diagnosis
  topic: keywords
creator: Nadira Prajnasari Sanjaya
creator: Kevin Varian Marcevianto
creator: Indira Saraswati Sanjaya
creator: Kelvin Kohar
creator: Hayatun Nufus
rights: Copyright (c) 2026 Kevin Varian Marcevianto, Nadira Prajnasari Sanjaya, Indira Saraswati Sanjaya, Kelvin Kohar, Hayatun Nufus https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: 153
ending page: 165
doi: 10.18051/UnivMed.2026.v45.153-165

Effect of Muay Thai training frequency on VO2 max and muscle endurance in non-athletic adults: a randomized clinical trial
type: item
description: Background Urban lifestyles have become increasingly sedentary, contributing to reduced physical fitness. Muay Thai, a high-intensity martial art, has been proposed as an effective exercise modality to improve aerobic capacity and muscle endurance. This study aimed to evaluate the effects of different weekly Muay Thai training frequencies on VO₂ max and muscle endurance in non-athletic adults. Methods A randomized experimental study with a pre-test–post-test design was conducted involving 40 non-athletic adults (aged 20–25 years). Participants were randomly allocated into two groups: training twice weekly (MT2X) or four times weekly (MT4X) for eight weeks. Outcomes included VO₂ max and upper, abdominal, and lower body muscle endurance. Baseline characteristics were described descriptively. Between-group differences in post-intervention outcomes were analyzed using analysis of covariance (ANCOVA), with baseline values included as covariates. Results At baseline, VO₂ max, abdominal, and lower body muscle endurance were higher in the MT4X group. After adjustment for baseline values using ANCOVA, the MT4X group demonstrated significantly higher post-intervention VO₂ max compared with the MT2X group (adjusted mean difference, p<0.001). Significantly greater improvements favoring the MT4X group were also observed for upper body muscle endurance (push-ups, p<0.001), abdominal muscle endurance (sit-ups, p<0.001), and lower body muscle endurance (squats, p=0.018). Conclusion A higher frequency Muay Thai training program is effective in significantly improving participants' aerobic capacity and muscle endurance. Practitioners are able to choose their training frequency preference, since both frequencies provide similar adaptation.
subject: Original Articles
  topic: section
subject: Cardiovascular fitness
  topic: keywords
subject: Muay Thai
  topic: keywords
subject: muscle endurance
  topic: keywords
subject: sedentary lifestyle
  topic: keywords
subject: VO₂ max
  topic: keywords
creator: Al Husni Hadi Pasca Putra
creator: Julia Windi Gunadi
creator: Yenni Limyati
creator: Oeij Anindita Adhika
rights: Copyright (c) 2026 Al Husni Hadi Pasca Putra, Julia Windi Gunadi, Yenni Limyati, Oeij Anindita Adhika https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-03-17
publication date: 2026-03-17
starting page: 46
ending page: 58
doi: 10.18051/UnivMed.2026.v45.46-58

Hypoxic mesenchymal stem cell-derived secretome and alkaline water synergistically reduce apoptosis and insulin resistance in type 2 diabetes mellitus rat model
type: item
description: BACKGROUND Type 2 Diabetes Mellitus (T2DM) is characterized by chronic inflammation and insulin resistance. These factors contribute to pancreatic β-cell apoptosis, reducing insulin production and impairing glucose homeostasis. This study aims to evaluate the protective effects of hypoxic mesenchymal stem cell-derived secretome (HMSCS) and alkaline water on inflammation, apoptosis, and insulin resistance in a T2DM rat model. METHODS An experimental study was conducted involving 24 male Wistar T2DM model rats (aged 6-8 weeks, 200-250g). They were randomized into four groups: T2DM rats only as negative control (K-), T2DM rats with metformin as positive control (K+), HMSCS treatment (P1), and HMSCS plus alkaline water group (P2). Caspase-3 expression was measured to assess apoptosis levels using RT-PCR, while homeostatic model assessment for insulin resistance (HOMA-IR) was measured using ELISA. One way ANOVA followed by a post hoc LSD test were used to analyse the data. RESULTS The P1 group (3.03 ± 1.26 a.u) and P2 group (2.93 ± 0.52 a.u.) had significantly lower caspase-3 expression compared to K- group (6.66 ± 2.76 a.u.) (p<0.05), but were not significantly different from K+ group (3.83 ± 1.61 a.u.) (p>0.05). Additionally, P2 group (6.76 ± 0.96) had a significantly lower HOMA-IR than K- group (18.92 ± 2.63) and K+ group (10.85 ± 1.39) (p<0.05), and similarly the P1 (7.71 ± 0.53) group also showed significant difference from K- and K+ groups (p<0.05). CONCLUSION Higher doses of HMSCS and alkaline water are associated with reduced pancreatic β-cell apoptosis and improved insulin sensitivity, highlighting its potential as a novel therapeutic approach for T2DM.
subject: Original Articles
  topic: section
subject: Caspase-3
  topic: keywords
subject: HOMA-IR
  topic: keywords
subject: inflammation
  topic: keywords
subject: insulin resistance
  topic: keywords
subject: HMSCS
  topic: keywords
subject: T2DM
  topic: keywords
subject: rats
  topic: keywords
creator: Melisa Septi Mawarini
creator: Eko Setiawan
creator: Agung Putra
rights: Copyright (c) 2025 Melissa Septi Mawarini, Eko Setiawan, Agung Putra https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-11-11
publication date: 2025-11-11
starting page: 310
ending page: 317
doi: 10.18051/UnivMed.2025.v44.310-317

Association between homicide and myocardial infarction mortality: a population-level analysis in Mexico from 2000 to 2019
type: item
description: Background Globally, violent deaths represent a serious public health issue, and Mexico has shown an increase in homicides. Exposure to violence has been linked to adverse mental and physical health outcomes, including cardiovascular disease. However, population-level evidence linking homicide mortality to myocardial infarction (MI) mortality remains limited. This study assesses the association between homicides and mortality from myocardial infarction in Mexico from 2000 to 2019. Methods This ecological time-series study used national mortality data from the Mexican National Institute of Statistics and Geography (INEGI). Adjusted annual mortality rates were calculated. Mortality trends were evaluated using Joinpoint software. The association between homicides and other causes of mortality was analyzed using Pearson correlation and univariate and multivariate regression analyses. Results During the study period, the average adjusted mortality rates were 16.8/100,000 for homicides and 67.4/100,000 for myocardial infarction. Both homicide and MI mortality rates increased significantly over time. In simple linear regression, homicides only showed significant associations with myocardial infarction (B=0.55, p<0.05). In multivariate regression analyses, homicide mortality remained significantly associated with MI mortality after adjustment for unemployment, gross domestic product per capita (GDP-PC), and diabetes mortality, although the association was attenuated when suicide mortality was included in the model. Conclusion At the population level, from 2000 to 2019 both homicide and MI mortality rates increased significantly, while homicides were positively associated with myocardial infarction mortality in Mexico. Elevated homicide rates act as a population-level stressor that coincides with higher mortality from heart attacks.
subject: Original Articles
  topic: section
subject: Violence exposure
  topic: keywords
subject: Homicides
  topic: keywords
subject: Myocardial infarction
  topic: keywords
subject: Suicides
  topic: keywords
subject: Mexico
  topic: keywords
creator: Omar González-Santiago
rights: Copyright (c) 2026 Omar González-Santiago https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-06-09
publication date: 2026-06-09
starting page: 169
ending page: 174
doi: 10.18051/UnivMed.2026.v45.169-174

Bench to bedside and beyond: evolving trends in translational research
type: item
subject: Editorial
  topic: section
creator: Juhi Aggarwal
rights: Copyright (c) 2025 Juhi Aggarwal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-10-12
publication date: 2025-10-12
starting page: 285
ending page: 287
doi: 10.18051/UnivMed.2025.v44.285-287

Application of international classification of functioning, disability and health in salat: a scoping review
type: item
description: Background Salat has been linked to physical, cognitive, emotional and psychological health benefits. This scoping review classifies the health benefits of salat based on the International Classification of Functioning, Disability, and Health (ICF) conceptual framework. The ICF illustrates how Salat may be used as a multi-modal and multidisciplinary framework to rehabilitate clients with different conditions tailored to their clinical, psychosocial and environmental contexts. Purpose To conduct a scoping review on the health benefits of salat (muslim prayer) based on the ICF conceptual framework. Methods A literature review was conducted from February to April 2023 using PubMed, EBSCO, and the Scopus Library databases. Articles published between 2012 and 2023 were retrieved using the following keywords: "impact" OR "effect" OR "health benefit" OR "functional outcome" AND "shalat" OR "Muslim prayer" OR "Salat”. Health benefits of salat were subsequently categorised into five domains of the ICF. Results A total of 596 articles were identified through PubMed (404), EBSCO (124), and Scopus (68). Thirty-one records met the predefined inclusion criteria: 21 original articles, two systematic reviews, five literature reviews, one case study, one case series, and one short report. Salat had positive benefits on the cardiorespiratory, haematological, immunological, mental and neuromuscular functions. Salat may serve as a coping mechanism to reduce stress and depression. The frequency and duration of salat had positive associations with maintaining employment, social support and better quality of life. Conclusion Salat is associated with many health benefits, which can be categorised systematically and summarised using the ICF conceptual framework.
subject: Review Article
  topic: section
subject: Functional outcome
  topic: keywords
subject: health benefit
  topic: keywords
subject: muslim prayer
  topic: keywords
subject: salat
  topic: keywords
subject: International Classification of Functioning
  topic: keywords
subject: disability
  topic: keywords
subject: health
  topic: keywords
creator: Irma Ruslina Defi
creator: Intan Sabrina Mohamad
creator: Nuzula Chafidh Al Barqi
creator: Adziqa Ammara Qiantori
creator: Andri Qiantori
rights: Copyright (c) 2025 Irma Ruslina Defi, Intan Sabrina Mohamad, Nuzula Chafidh Al Barqi, Adziqa Ammara Qiantori, Andri Qiantori https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2025-12-04
publication date: 2025-12-04
starting page: 406
ending page: 418
doi: 10.18051/UnivMed.2025.v44.406-418