International Journal of Advances in Medicine

Permanent URI for this collection

https://imsear.searo.who.int/handle/123456789/156150

Editor-in-Chief: Dr. K.N. Shah
ISSN: 2349-3925 (Print); 2349-3933 (Online)

Frequency: Quarterly

Language: English

Open Access Peer-reviewed journal

Web site: https://www.ijmedicine.com/

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Now showing 1 - 20 of 1334

Prurigo as the early sign of HIV infection: a review
(Medip Academy, 2025-06) Aryani, NM; Suryana, K
Prurigo is a common dermatological condition in HIV-infected individuals, particularly those with low CD4 counts. This condition can be the first manifestation and as the early sign of HIV-infected individuals. One form of prurigo in HIV-positive patients is prurigo nodularis. It presents with intensely pruritic, hyperkeratotic papules or nodules lesions, significantly impairing quality of life. The pathogenesis of PN involves complex immune dysregulation, including Th2-mediated inflammation and the release of cytokines like IL-31, which contribute to inflammation and pruritus. HIV infection exacerbates these processes, making PN more prevalent and severe in immunocompromised individuals. Early detection of prurigo and appropriate treatment, including rapid antiretroviral therapy, can help reduce the frequency and severity of prurigo in HIV-positive patients. Current treatments include topical steroids, UV therapy and systemic medications, with novel therapies targeting specific cytokines under investigation. Dermatologists are also encouraged to screen for psychiatric comorbidities due to the profound psychosocial impact of PN. This review aims especially for health workers to remind the importance of early detection of dermatological signs of prurigo in patients at risk of HIV, as an important step in improving clinical outcomes and patient quality of life.
High altitude marathon physiology changes
(Medip Academy, 2025-06) Oak, M; Oak, A; Oak, B
High-altitude marathons present unique physiological challenges due to environmental factors such as reduced oxygen availability, decreased atmospheric pressure, and extreme temperature fluctuations. These conditions impose significant stress on the human body, requiring acute and chronic physiological adaptations to maintain performance. Acute responses include increased ventilation, elevated heart rate, and enhanced oxygen delivery mechanisms, while chronic adaptations involve hematological changes such as elevated erythropoiesis, cardiovascular remodeling, and skeletal muscle adaptations. Despite these adaptations, high-altitude conditions can substantially impact athletic performance, reducing aerobic capacity and increasing the risk of hypoxia-induced fatigue. Effective training and acclimatization strategies, such as altitude training camps and pre-acclimatization protocols, are critical for optimizing performance and minimizing the risks of high-altitude illnesses, including acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE). Furthermore, genetic predispositions, as observed in high-altitude native populations, may influence an athlete's ability to adapt to these environments. This review explores the interplay between environmental challenges, physiological adaptations, and athletic performance in high-altitude marathons. It highlights current strategies for preparation, potential medical risks, and future research opportunities in understanding the unique demands of high-altitude endurance events. Insights from this study aim to guide athletes, coaches, and medical professionals in optimizing training, performance, and safety during high-altitude marathons.
A study on the prognostic value of red cell distribution width to total serum calcium ratio in acute pancreatitis and comparison with Ranson抯 and BISAP score - a prospective observational study from a tertiary care center in Chennai
(Medip Academy, 2025-02) Ancy, JMJ; Murali, R; Kini, PR; Premkumar, K; Shanthiselvi, A
Background: Acute pancreatitis (AP) is a severe inflammatory condition with variable outcomes, and current scoring systems have limitations in predicting its severity. Our study aimed to determine the prognostic value of the red cell distribution width (RDW) -to-total serum calcium ratio in patients with AP. Methods: This single-center prospective observational study included 100 patients at Madras Medical College, Rajiv Gandhi Government General Hospital between September 2023 and 2024. 16 patients with severe AP were compared to 84 mild AP cases by assessing demographics, aetiology, comorbidities, laboratory results, arterial blood gas, and RDW at 0 and 24 hours. The RDW-to-total serum calcium ratio was evaluated against the established prognostic scores within 24 h of admission. Results: A total of 100 patients with acute pancreatitis were included in the study, of which 84 (84%) had mild AP, and 16 (16%) had severe AP. The RDW/TSC ratio demonstrated excellent predictive value for mortality, with an area under the receiver operating characteristic curve (AUROC) of 0.909, sensitivity of 95.40%, and specificity of 85.70%. This outperformed RDW at 0 hours (AUROC=0.789), bedside index of severity in acute pancreatitis (BISAP) (AUROC=0.764), and Ranson抯 score (AUROC=0.711). RDW at 24 hours showed no significant predictive value (AUROC=0.529). Conclusions: RDW and RDW 0h-to-TSC ratio are cost-effective, non-invasive markers that predict acute pancreatitis (AP) severity and mortality more effectively than Ranson and BISAP scores. An RDW 0 hours >14.15 and RDW 0 hours-to-TSC ratio >1.45 were strong predictors of AP severity.
Prevalence of T3 thyrotoxicosis and it抯 management in new onset thyrotoxicosis patients: a prospective observational study
(Medip Academy, 2025-02) Singh, SK; Singh, R; Bedi, S; Pandey, AK; Tiwari, A; Rai, PK
Background: T3 toxicosis is a subtype of thyrotoxicosis where total triiodothyronine (TT3) level is high but total thyroxine (TT4) level is normal in presence of suppressed thyroid stimulating hormone (TSH). Accurate and rapid diagnosis is crucial in management of T3 toxicosis. Methods: In this prospective observational study from India, newly diagnosed thyrotoxicosis patients were enrolled. T3 toxicosis patients were diagnosed based on diagnostic criteria. T3 toxicosis patients were randomized into two arms, based on dose of carbimazole (CBZ) used for treatment. All patients are following up for 12-14 weeks. Results: Prevalence of T3 toxicosis was 8.5% in this study. 75% were diagnosed as Grave抯 disease (GD) and 25% were diagnosed as toxic nodular goiter (TNG). Low dose (5 mg/day) of CBZ is safer and more effective than higher dose (20 mg/day). Conclusion: Present study suggests that a significant number of patients with thyrotoxicosis are suffering from T3 toxicosis. So, for correct diagnosis of thyrotoxicosis one should investigate for TT3, TT4 and TSH, otherwise we can misdiagnose the T3 toxicosis as subclinical thyrotoxicosis (SCT). Majority of T3 toxicosis patients are diagnosed as GD. Low dose of CBZ is very much effective and safe in these patients. We recommend low dose of CBZ in all patients with T3 toxicosis.
Residual immune dysregulation in human immunodeficiency virus infection: implications for hypersensitivity
(Medip Academy, 2025-06) Pake, IAR; Widiasa, AAM; Suryana, K
Residual immune dysregulation persists in people living with human immunodeficiency virus (PLWHIV) despite antiretroviral therapy (ART), characterized by chronic immune activation and imbalances in immune responses that increase the risk of allergic conditions such as drug hypersensitivity, atopic dermatitis (AD), and asthma. This literature review explores the mechanisms underlying immune dysregulation in PLWHIV and its implications for hypersensitivity reactions. HIV infection shifts the immune response from Th1 to Th2, increasing cytokine production, particularly IL-4 and IL-13, and elevating IgE levels, contributing to allergic reactions. Drug hypersensitivity, especially to nevirapine and abacavir, occurs more frequently in PLWHIV, with a higher risk of severe conditions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The management of allergies in PLWHIV remains challenging due to persistent immune dysregulation, limited therapeutic options, and the lack of specific clinical guidelines. Understanding these immunological changes is crucial for developing better strategies for allergy prevention and management in this population
Association of SGLT2 inhibitors and urogenital infections in patients attending a tertiary care hospital: a prospective observational study
(Medip Academy, 2025-02) Benoy, A; Joseph, M; Sabu, JE; Bijuraj, PRA; Mathew, S; Varghese, TD; Joy, V; Punnose, E; Fischer, L
Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are known for efficacy in managing blood sugar levels in type 2 diabetes and also improving cardiovascular and renal outcomes. However, increased risk of urogenital infections (UGIs) remains a significant concern in their safety profile. This study aimed to investigate the association between SGLT2i therapy and UGIs in a real-world clinical set up of a tertiary care centre in India. The key hypothesis was SGLT2i use is associated with incidence of UGIs while the secondary hypothesis included the relationship of the incidence of risk with the dose. Methods: This was a six-month prospective observational study, that enrolled 309 adults ?18 years of age, who were newly prescribed SGLT2 inhibitors, particularly Dapagliflozin 5 mg and 10 mg from October 2023. The incidence of UGIs was assessed through patient interviews and medical records during the follow up from 2 weeks of initiation. UGIs were defined as clinical manifestations that resolved on SGLT2i discontinuation or appropriate treatment. Results: Of 309 initiators, 300 patients were followed up. 9 patients didn抰 follow up in OPD. From these, 58 (19.3%) patients developed UGIs, comprising of 47 (15.6%) bacterial infections and 11 (3.6%) UGIs of fungal origin. The association was performed on basis of logistic regression analysis which revealed a statistically significant association of UGIs with the prescription of SGLT2i. Higher doses of SGLT2 inhibitors was observed to be associated with significantly increasing the risk of UGIs (p<0.05). No significant risk factors such as body mass index (BMI), age, sex, HbA1c or educational status were identified to have significant associations with UGI occurrence. Conclusions: This study highlights a clinically relevant association between SGLT2i use and urogenital infections.
Atypical presentation of COVID-19 in a patient with spontaneous pneumothorax and pleural effusion: a case report
(Medip Academy, 2025-06) Venkatesan, T; Bulut, M; Lazarevic, M
Common COVID-19 symptoms include fever, cough, myalgia, and fatigue, with various complications possible. Pleural effusion and pneumothorax are rare and infrequently co-occur. These complications usually appear in hospitalized patients and often signal a poor prognosis. This report examines an 82-year-old male with severe abdominal pain, mild cough, and runny nose. Abdominal CT showed a small to intermediate right pleural effusion and a small left pneumothorax. Chest CT confirmed these findings and interstitial infiltrates. He tested positive for COVID-19. Treatment involved ceftriaxone (2 g), dexamethasone (6 mg), and remdesivir (100 mg); no chest tube or thoracentesis was required. By the 4th day, chest CT showed resolved pneumothorax and pneumonia, with the pleural effusion unchanged. On the 7th day, after completing a five-day remdesivir course, he was stable and discharged. This case suggests pleural effusion and spontaneous pneumothorax can co-occur in early COVID-19 without severe respiratory symptoms and are not always indicative of a poor prognosis.
Chiari 1.5 malformation: a case report and review of literature
(Medip Academy, 2025-06) Selvan, R; Pandey, N; Nandhini, M; Hrishikaanthan, SS.
Chiari 1.5 malformation, a rare neurological disorder, involves cerebellar tonsil herniation and slight brainstem descent through the foramen magnum. A 25-year-old woman presented with recurrent headaches exacerbated by coughing, straining, and difficulty in maintaining head posture despite normal motor functions and reflexes. MRI revealed a Chiari 1.5 malformation with a 13.5 mm cerebellar tonsil herniation, minor brainstem descent, and C2-C3 vertebrae fusion. Suboccipital craniectomy with foramen magnum decompression significantly alleviated her symptoms. This case emphasizes the importance of recognizing Chiari 1.5 malformation as a cause of headaches in young adults and supports surgical intervention to prevent neurological decline. Although the aetiology is unknown, theories suggest a pressure differential between the cranial and spinal subarachnoid spaces during fetal development. Early diagnosis and posterior fossa decompression are crucial for symptom management and outcome improvement in CHIARI 1.5.
Role of yoga prana vidya in healing psychosomatic disorders: a multiple case study in a family setting
(Medip Academy, 2025-06) Chinnusamy, M; Sukumar, A; Nanduri, VS
Psychosomatic disorders (PD) stem from complex interactions among the central nervous system, endocrine system, and immune system. Prolonged stress and psychological turmoil trigger the release of stress hormones like cortisol, which negatively impact immune function, inflammation, and the body's balance. Consequently, physical symptoms arise due to psychological influences, including chronic pain, digestive issues, or respiratory problems. This paper presents two cases of women, close family members, who suffered PD due to toxic home environment, and sought YPV healing. Multiple case study method is used in this study by collecting data from the subjects, and their YPV Trainer- healer抯 records. It is found that both subjects were healed of their physical and mental health issues successfully by their Trainer-healer. They sought and received training to become YPV healers themselves with a view to self-healing and healing others to serve the society at large. It is concluded that the YPV system is playing a key role as a platform for complete recovery from physical health and mental health issues, and further personality and spiritual development of women, and men, who suffer psychosomatic disorders due to toxic home environment and vulnerability. Such people are motivated to become trained healers and serve the society to uplift others. Thus, they see a higher purpose in life fulfilled. Further studies with appropriate samples and methodology are highly recommended.
A case report of thrombotic microangiopathy in a patient with advanced pancreatic carcinoma: an emerging, rare, and serious complication
(Medip Academy, 2025-06) Kandari, S; Singh, A; Puri, R; Cheriyan, A; Kaur, S
Thrombotic microangiopathies are characterized by microangiopathic hemolytic anemia and end-organ damage following endothelial injury. The chemotherapeutic agents used in malignancy are one of the important causes of secondary TMA. Both malignancy and TMA are associated with significant morbidity and mortality. Timely recognition of both can result in early target-specific treatment initiation and better outcomes for both diseases. Here, we present a case of TMA in a patient with stage 4 pancreatic carcinoma being treated with Gemcitabine presented with acute kidney disease with new-onset hypertension, edematous illness, and anemia. The patient was Hemodialysis dependent and was treated with steroids, plasma exchange, and rituximab. The patient remained HD dependent 6 months post-treatment and was declared ESRD. Highlighting the importance of early recognition and timely treatment initiation.
Patients with acute liver failure due to hepatitis B: a case report
(Medip Academy, 2025-06) Antari, NKRJ; Pramarta, DY.
Hepatitis B is an infectious disease of liver cells by the hepatitis B virus (HBV). Hepatitis B is characterized by symptoms such as jaundice, decreased appetite, and abdominal pain. Acute liver failure (ALF) is one of the serious complications of hepatitis B. Previous studies reported that the incidence of acute hepatitis B patients reached 41.7% within 28 days after hospitalization, with high mortality rates on the 28th and 90th days, namely 43.9% and 70.4%. In these patients, they showed classic symptoms of persistent jaundice, nausea, vomiting, pain in the right upper quadrant, and progressive bloating. Extreme elevations in bilirubin and liver enzymes indicate a high level of hepatocyte necrosis, which is common in ALF due to acute HBV infection or reactivation of chronic infection. Patients with a history of hepatitis B develop ALF. ALF due to hepatitis B infection is a serious condition that requires immediate medical attention. Early diagnosis, including identification of classic symptoms such as jaundice, nausea, and abdominal pain, is essential. Management should include combination antiviral and supportive therapy to prevent further complications, including death. With better knowledge and understanding of the disease mechanism and clinical management, it is hoped that the prognosis of patients with this condition can improve in the future.
Study of factors affecting sarcopenia in PLHIV
(Medip Academy, 2025-02) Ravi, K; Suresh, R; Vinay, N
Background: This study aims to determine the frequency of sarcopenia in PLHIV and determine the factors affecting sarcopenia in PLHIV. Methods: The patients fulfilling the inclusion criteria were enrolled for the study after obtaining informed consent. Case record form was used to record relevant history. SARC-F (sluggishness, assistance in walking, rising from a chair, climbing stairs, falls) score is recorded by questionnaire. Hand grip strength and skeletal muscle mass index (SMI) were recorded. The correlation between grip strength and SMI with the duration of treatment in different regimens of HAART in PLHIV were studied. Possible factors affecting sarcopenia were determined based on history taken. All the parameters were compared between patients with and without sarcopenia. P value <0.05 was considered statistically significant. R version 4.1.2 statistical software was used for the statistical analysis. Results: Sarcopenia was more commonly found in middle aged participants, who were less adherent to therapy, had a past history of tuberculosis, consumed alcohol, followed a vegetarian diet and did not exercise regularly. Conclusion: Sarcopenia is more common in middle-aged individuals with long-term AIDS, especially those on prolonged ART. It抯 linked to non-adherence to ART, alcohol consumption, history of tuberculosis, and reduced physical activity. Strict adherence to ART, avoiding alcohol, increasing protein intake, and exercising regularly helps to combat this.
Assessment of correlation of mean arterial pressure and left ventricular mass with left atrial volume index in hypertensive patients
(Medip Academy, 2025-06) Edwin, AN; Ashok, G; Satish, P.
Background: Hypertension leads to left ventricular remodeling and left atrial enlargement (LAE), which are critical indicators of hypertensive heart disease. Left atrial volume index (LAVI) is a sensitive marker of LAE and diastolic dysfunction. This study aims to assess the correlation between mean arterial pressure (MAP), left ventricular mass (LVM), and LAVI in hypertensive patients to improve cardiovascular risk stratification. Methods: This prospective observational study included 50 hypertensive patients admitted to Chettinad Super Speciality Hospital over three months. Using 2D echocardiography, LAVI was measured via the area-length method, while LVM was calculated using the Teichholz cubed formula. Relative wall thickness (RWT) was also determined to characterize left ventricular hypertrophy (LVH). Hemodynamic parameters, including MAP, were recorded. Patients were categorized based on the presence or absence of LVH, and correlations between MAP, LVM, and LAVI were analysed. Results: Patients aged 60� years were predominant (42%), followed by 40� years (38%) and 20� years (20%). Males constituted 58% of the study group. LVM was higher in the LVH group (0.74) than in non-LVH (0.72). RWT was greater in LVH patients (0.59 versus 0.48), while MAP was lower in LVH patients (101.4 versus 113.5). LAVI was lower in LVH patients (19.4 versus 25.5). A weak positive correlation was found between LAVI and MAP (r=0.3984), indicating that while MAP influences LAVI, other factors may contribute significantly. Conclusions: Chronically elevated blood pressure leads to structural cardiac remodelling, with LAVI being an early marker of hypertensive heart disease. Monitoring LAVI can aid in risk assessment and treatment planning for hypertensive patients.
A study on cognitive profile in parkinsons disease
(Medip Academy, 2025-06) Ragasivamalini, S; Gobinathan, S; Balambighai, V.
Background: Parkinson抯 disease (PD) is a neurodegenerative disorder characterized by ?-synuclein accumulation, leading to motor and non-motor complications. Cognitive decline in PD ranges from mild cognitive impairment to Parkinson抯 disease-related dementia. This study aimed to examine the cognitive profile and identify the subclinical range of cognitive impairments in patients with Parkinson抯 disease. Methods: This cross-sectional study was conducted on 85 patients with Parkinson抯 disease at Sree Balaji Medical College and Hospital, Chennai, between October 2022 and January 2025. Standardized neuropsychological tests, including the MMSE, ACE-R, MoCA and FAB, were used for cognitive assessment. Demographic and clinical data were collected through interviews and medical records and cognitive function was assessed at baseline. Results: Most patients were male, 66 (77.6%) and 23 (27.1%) patients were aged 71-75 years. Parkinson抯 disease duration was <5 years in 38 (44.7%) patients. Hypertension and diabetes were present in 64 (75.3%) and 39 (45.9%) patients, respectively. The most common Hoehn and Yahr stage was 2.5 in 17 (20.0%) patients, followed by stage 1 in 15 (17.6%) and stage 3 in 13 (15.3%) patients. MMSE scores showed mild cognitive impairment in 45 (52.9%) patients, moderate in 27 (31.8%) and severe in 13 (15.3%). MoCA scores indicated severe impairment in 26 (30.6%) patients, moderate impairment in 23 (27.1%), mild impairment in 21 (24.7%) and normal cognition in 15 (17.6%). Conclusions: The demographic profile showed a predominance of older adults. Comorbidities such as hypertension and diabetes mellitus are common and complicate PD management.
Discrepancy between clinical symptoms and electrodiagnostic examination in Guillain Barre syndrome: a case report
(Medip Academy, 2025-06) Samuel, I; Congdro, J.
Guillain-Barr� syndrome (GBS) is an autoimmune disease that targets the peripheral nerves. This case report presents an atypical GBS case with purely motor symptoms but mixed axonal and demyelinating lesions. A 35-year-old man presented with complaints of weakness in four extremities for 2 days before being admitted to the hospital. Four days prior, patient vomited. Motor strength in upper and lower extremities was 3334/4333 and 2334/4332, respectively. Physiological and pathological reflexes were absent in all four extremities. Sensibility was within normal limits. Cerebrospinal fluid (CSF) analysis revealed albumin-cytologic dissociation. Nerve conduction velocity (NCV) examination indicated motor polyneuropathy in 3 extremities, with axonal and demyelinating lesions. Patient was diagnosed with GBS, acute inflammatory demyelinating polyneuropathy (AIDP) subtype. AIDP is the most common subtype of GBS. The patient in this case only had motor symptoms which could occasionally happen in AIDP. However, NCV studies revealed axonal and demyelinating lesions. This discrepancy could be due to secondary axonal degeneration that had been reported in demyelinating neuropathies. Initial mixed pattern had also been reported to evolve into other subtypes during serial electrodiagnostic evaluations. The discrepancy can complicate the diagnosis and further observation may be needed. Patient in this case report improved spontaneously with supportive treatment. GBS is a complex disease to diagnose and manage due to its heterogeneous clinical presentation and variable prognosis. This case report presents an AIDP-subtype GBS patient with purely motor symptoms but mixed demyelinating and axonal lesions. Further electrodiagnostic examination might be needed to establish a diagnosis.
The effect of time restricted eating on weight in patients of type 2 diabetes mellitus
(Medip Academy, 2025-06) Jain, MK; Gupta, VK; Rawat, KS.
Background: The prevalence of diabetes mellitus has tripled in the past two decades, becoming a major public health concern. Time-restricted eating (TRE) shows potential in reducing weight in individuals with type 2 diabetes mellitus (T2DM). This study evaluated the efficacy of TRE for weight management in adults with T2DM. Methods: This 14-month quasi-experimental pre-post study was conducted at LLR Hospital, Kanpur and included 50 T2DM patients aged 18-70 years. Exclusion criteria included type 1 diabetes, MODY, insulin therapy, pregnancy-related diabetes, fibro calculus pancreatitis, chronic kidney or liver disease, thyroid disorders, and HbA1c >10%. Participants underwent baseline assessments, including weight, blood sugar levels, HbA1c, kidney and liver function tests, and abdominal ultrasonography. They were instructed to follow a TRE plan, fasting from 10:00 PM to 2:00 PM, with monthly follow-ups for 12 weeks to assess adherence and weight changes. Results: After 12 weeks, participants showed significant weight reduction, with the mean weight decreasing from 67.56 kg to 65.78 kg (p <0.0001). Other metabolic parameters were monitored to ensure the intervention抯 safety and efficacy. Conclusion: TRE is an effective and feasible dietary strategy for weight management in T2DM patients. Its implementation could significantly improve weight and potentially enhance overall metabolic health in this population.
Impact of two different head and neck alignment planes on glottic visualization at laryngoscopy in adults
(Medip Academy, 2025-06) Aggo, AT; Hart, F
Background: Optimal head and neck positioning is key to rapid, successful tracheal intubation enabling circumvention of peri-intubation sequelae; thus, scientific search for definite anatomical landmarks to serve as reference points for favorable head and neck alignment during laryngoscopy is warranted. Methods: Ethical approval obtained, 78 adults aged 18-60 years, of American society of anesthesiologists (ASA) class I and II, were randomized into groups A and B, of 39 each. All patients had general anaesthesia with oro-tracheal intubation. Group A had the suprasternal notch and external auditory meatus (SN-EAM) plane aligned horizontally, while group B had the sternal angle of Louis and external auditory meatus (SAL-EAM) plane horizontally aligned, for direct laryngoscopy. Glottic view achieved and external laryngeal manoeuvre with backward, upward, rightward pressure (BURP) application was assessed using Cormack-Lehane grading and four-point Likert scale respectively; intubation attempts, immediate post-intubation arterial oxygen saturation (SpO2), and time to orotracheal intubation (TTOTI) defined as the period from removal of preoxygenating face mask to first capnographic evidence of correct tracheal intubation, were recorded. Results: All 78 subjects completed the study. Groups A and B were similar in degree of glottic visualization (p=0.642) and TTOTI (33.38�09 versus 33.18�77, p=0.868); tracheal intubation attempts, BURP application and immediate post-intubation SpO2 (98.25�72 versus 98.23�81, p=0.833) were also comparable. Conclusion: Aligning the SN-EAM plane horizontally achieved degree of glottic visualization comparable to keeping horizontally the SAL-EAM plane, during direct laryngoscopy in adults.
An observational study on global longitudinal strain in acute coronary syndrome and its correlation with coronary angiogram
(Medip Academy, 2025-02) Raghupathi, A; Kannan, P; Veeramani, C; Sivanesan, P
Background: Coronary angiography (CA) is crucial for diagnosing acute coronary syndrome (ACS) and assessing coronary artery disease (CAD), enabling healthcare providers to determine treatment options and assess the risk of cardiovascular events. Global longitudinal strain (GLS) is a sensitive marker of cardiac function. This study aimed to determine the correlation between GLS in ACS and CA findings. Methods: This prospective observational study was conducted at the cardiology department of the Salem government medical college. The study involved transthoracic echocardiography (TTE) to assess LV volumes, ejection fraction (EF), and LVGLS and strain analysis using 2D echocardiography to measure regional longitudinal peak systolic strain in different LV segments. CA was performed to visualise the coronary vessels and detect significant CAD. Results: The study population consisted predominantly of male patients (n=93, 62%), with notable smoking (n=48, 32%) and alcohol consumption (n=36, 24%). A significant majority of the patients (n=111, 74%) exhibited ECG abnormalities. Obstruction was present in 82% of the patients (n=123), with those showing impaired myocardial function compared to those without obstruction. GLS values below 13.95 were more common in patients with obstruction (n=8 out of 11), indicating reduced myocardial deformation. The GLS demonstrated excellent diagnostic performance for detecting significant coronary artery obstruction, with a high sensitivity of 88.89%, specificity of 90.63%, and overall accuracy of 90.24%. Conclusions: Our study revealed a strong correlation between reduced GLS and CAD, highlighting its importance in CAD assessment and risk stratification in ACS. GLS demonstrated excellent diagnostic performance for detecting significant CAD, showing high sensitivity and specificity.
Vitamin D supplementation to reduce chronic obstructive pulmonary disease exacerbation: a scoping review
(Medip Academy, 2025-04) Kadir, Y; Indarta, PP
Acute exacerbations are prevalent in chronic obstructive pulmonary disease (COPD) and are associated with poor clinical outcomes. Deficiency of vitamin D, a nutrient well-known for its immunomodulatory and anti-inflammatory properties, is relatively common in patients with COPD. Yet, researches on the role of vitamin D in the management of COPD exacerbations have yielded conflicting results. This systematic review aims to thoroughly investigate the effectiveness of vitamin D supplementation in reducing COPD exacerbations. The PubMed, Embase, and Cochrane databases were searched from inception to 14 March 2024. All clinical trials comparing the efficacy of vitamin D supplementation versus placebo that reported incidence of acute exacerbations as their primary or secondary endpoints were included. Eight randomized controlled trials (RCTs) involving 1,254 COPD patients were included in the analysis. Study durations ranged from 6 months to 3.3 years. The dosage regimen of vitamin D supplementation varied widely, from 1,200 IU daily to 100,000 IU monthly. Five studies reported significant reduction in COPD exacerbations (p<0.05), with two of them noting significant reductions only in patients with severe vitamin D deficiency. Three studies found no significant difference in exacerbation rate. Vitamin D supplementation generally reduced COPD exacerbation rate, particularly in patients with severe vitamin D deficiency. Further clinical studies are required to determine the optimal and safe dosage regimen for this special population.
Ambulatory blood pressure monitoring for Indian hypertensive patients-where we stand right now?
(Medip Academy, 2025-04) Jasuja, S; Oomman, A; Shrivastava, S; Ahmad, P; Modi, KD; Godbole, S; Prajapati, HK; Prajapati, M
Hypertension remains a leading cause of morbidity and mortality globally, with significant impacts on public health due to its role in cardiovascular disease and stroke. In India, hypertension prevalence is estimated at 35.5%, emphasizing the need for effective management strategies. Traditional office blood pressure (OBP) measurements are widely used for screening, but they may not fully capture the variability and true patterns of BP. Out-of-office monitoring methods, particularly ambulatory BP monitoring (ABPM), provide a more precise and immediate assessment of BP, as endorsed by international guidelines. This article highlights the value of ABPM in identifying unique BP phenotypes and improving hypertension management, with a focus on its relevance and application within Indian healthcare settings.

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