International Journal of Advances in Medicine

The characteristics of dry eye syndrome patients in Wangaya Regional Hospital from April 2023 to April 2024

2025-06-27T06:52:42+0530

Background: Dry eye syndrome (DES) is a term used to describe a condition of the front of the eye that occurs in response to damage to the natural layer of tears that lines the front of the eye, called the tear film. Dry eye syndrome affects a person's quality of life, especially when reading, watching, driving, and when using laptops or similar gadgets. Dry eye syndrome is one of the diseases that has the most frequent morbidity of ocular surface disease. The purpose of this study is to identify the characteristics of patients with dry eye syndrome at Wangaya Regional General Hospital, Denpasar on April 2023-April 2024 based on age, gender, occupation, medical history, medication history, and lifestyle.

Methods: This is a quantitative study using purposive sampling technique to determine the participants. The data source in this study uses secondary data sources originating from medical records of dry eye syndrome patients who were treated at Wangaya Regional Hospital, Denpasar, Bali on April 2023-April 2024. This study enrolled 92 dry eye syndrome patients.

Results: Of the 92 patients, 64 (69,6%) were ≥40 years old, 59 (64,2%) were female, 37 (40,2%) were private sector workers, 40 (43,5%) has history of hypertensions, 59 (64,1%) has no history of smoking or drinking alcohol.

Conclusions: Most of dry eye syndrome patients were ≥40 years old, and most were female. Commonly the patient has history of hypertensions and has history of hypertensions medication. Most of the patients has no history of smoking or drinking alcohol.

The periodontal effect of bleeding on probing and probing depth for molar bands and bondable buccal tubes

2025-06-27T06:52:44+0530

Background: With rising life expectancy and esthetic awareness, more patients seek orthodontic treatment. This study shows molar bands cause more plaque retention, leading to higher bleeding on probing (BOP) and probing depth (PD) compared to bondable buccal tubes.

Methods: This non-randomized control clinical trial was conducted at the department of orthodontics, Bangabandhu Sheikh Mujib medical university hospital (BSMMU), Dhaka from the period of December 2016 to August 2017. The test sample was 40 molar teeth of 10 orthodontic patients who were selected consecutively from patients selected for fixed orthodontic treatment in BSMMU.

Results: The patients were aged 13-22 years [Mean (±SD) age=16.0±2.90 years]. The 20 molar teeth of the upper arch of selected patients were banded with molar bands (Group A). The 20 molar teeth of the lower arch of selected patients were bonded with bondable buccal tubes (Group B). The presence of BOP in molar bands at T₁, T₂ and T₃ was 0 (0.0%), 2 (10%) and 4 (20%). The presence of BOP in bondable buccal tubes at T₁, T₂ and T₃ was 0 (0.0%). There was a statistically significant increase was observed in the mean PD values for molar bands from T₁ to T₂ (p=0.001), from T₂ to T₃ (p=0.001), and from T₁ to T₃ (p=0.030).

Conclusions: This study analyzed data over three and six months, finding that molar bands led to greater increases in BOP and PD than bondable buccal tubes, but long-term periodontal effects remain unclear.

Asymptomatic congenital malaria among neonates of mothers attending antenatal clinic in University of Medical Sciences Teaching Hospital, Akure

2025-06-27T06:52:38+0530

Background: Congenital malaria can be a serious cause of morbidity and mortality in the neonates if not detected. Clinical features of congenital malaria are non-specific and could be confused with other forms of infections in the newborn. The study sets out to document presence of asymptomatic congenital malaria among neonates of mothers attending antenatal clinic in University of Medical Sciences Teaching Hospital, Akure.

Methods: Mother-baby pairs were recruited into the study from the maternity section of the hospital, blood samples were taken from maternal peripheral blood, placental maternal side, cord blood and peripheral blood of the newborn babies and analyzed for presence of malaria parasite by microscopy methods. Data analyses were done using Statistical Package for the Social Sciences (SPSS) version 24.0

Results: Eighty-six (79.6%) of the babies were positive for malaria parasites, 59 (54.6%) of them were male children and 49(45.4%) were female. Fifty mothers (58.1%) had peripheral or placental parasitaemia. Babies of mothers who used long lasting insecticide treated nets (LLIN) and intermittent preventive therapy IPT-SP were significantly less infected while babies of first- and second-time mothers were significantly more infected. Majority of the babies 77/86 (89.5%) however had low intensity parasitaemia.

Conclusions: Congenital malaria is no more a rare disease especially in endemic regions, prevention of mother-to-child transmission should be aggressively pursued.

Impact of lobectomy on pulmonary function in tubercular patients: a prospective analysis

2025-06-27T06:52:34+0530

Background: Tuberculosis (TB) is a leading cause of death globally, with South Asia bearing a significant burden. In Bangladesh, TB poses major health challenges, especially in rural areas. For patients with TB sequelae, lobectomy may be necessary. Assessing pulmonary function before and after surgery is crucial for understanding the impact on patients. This study aimed to evaluate the changes in pulmonary function in TB patients undergoing lobectomy.

Methods: The study employed a prospective longitudinal design at the National Institute of Diseases of the Chest and Hospital, spanning from January 2022 to June 2023. Thirty patients, aged over 18 years and capable of undergoing spirometry, were enrolled. These patients had diagnoses including post-tuberculous sequelae, were scheduled for lobectomy. Data were collected through interviews and lung function tests conducted before and two months post-surgery. Statistical analyses were performed using SPSS version 29.

Results: The study included 30 patients with an average age of 37.77 years, predominantly male (73.33%). Significant reductions in pulmonary function were observed post-lobectomy: the mean Forced Expiratory Volume in the first second (FEV1) decreased from 1.82 liters to 1.56 liters postoperatively (p=0.034) and the mean Forced Vital Capacity (FVC) dropped from 2.28 liters to 1.91 liters (p=0.005). The FEV1/FVC ratio decreased slightly from 76.67% to 73.37%.

Conclusions: Lobectomy in patients with TB results in significant declines in pulmonary function, as indicated by reductions in FEV1 and FVC post-surgery.

Progression of diabetic nephropathy in patients with uncontrolled type 2 diabetes mellitus: a cross-sectional study

2025-06-27T06:52:39+0530

Background: Diabetic nephropathy (DN) is a major complication of uncontrolled type 2 diabetes mellitus (T2DM), leading to chronic kidney disease (CKD) and end-stage renal disease (ESRD). This study aimed to assess the progression of DN in patients with uncontrolled T2DM and its association with clinical and biochemical parameters.

Methods: A cross-sectional study was conducted on 147 T2DM patients aged 45-60 years at Enam medical college, Sir Salimullah medical college, and Dhaka medical college from March 2024 to December 2024. Purposive sampling technique was applied in sample selection Patients were categorized into two groups: poorly controlled diabetes (HbA1c≥7%) and controlled diabetes (HbA1c<7%). Data were analyzed by using SPSS version 23.0 program.

Results: This study of 147 T2DM patients found 53.1% had poorly controlled diabetes (HbA1c≥7%), associated with higher urinary ACR, reduced eGFR, and elevated serum creatinine. Advanced CKD (eGFR<60 mL/min/1.73 m²) was present in 67.3%, with 33.3% microalbuminuria and 19.7% macroalbuminuria. Grade 2 hypertension (HTN) (43.5%) was significantly linked to renal impairment, highlighting the need for better glycemic and blood pressure (BP) control.

Conclusions: Poor glycemic control and HTN significantly accelerate DN progression in T2DM patients. Early intervention targeting glycemic control, BP management, and regular renal screening is essential to mitigate renal complications and improve outcomes.

Heparin-binding protein as a new biomarker for acute kidney injury related to sepsis

2025-06-27T06:52:44+0530

Background: In emergency settings, physicians frequently encounter critically ill patients with acute kidney injury (AKI). This severe organ dysfunction leads to high morbidity and mortality, even post-discharge. To determine the association between Heparin-binding protein (HBP) and sepsis-associated AKI, facilitating early AKI prediction and intervention.

Methods: A cross-sectional prospective observational comparative study was conducted at K.P.S PG Institute of Medicine, Kanpur, from June 2023 to July 2024. Patients aged 18 years and older, suspected of sepsis, were enrolled and investigated for sepsis and AKI, along with serum heparin-binding protein.

Results: Baseline HBP levels were 5.222 (SD 3.046) in the non-AKI group and 11.979 (SD 5.972) in the AKI group. An optimum HBP cut-off >8.28 was determined. HBP levels progressively increased with AKI severity: Stage I (7.392), Stage II (10.842), and Stage III (19.623). The findings were statistically significant (F=51.854, p<0.001).

Conclusion: Sepsis-associated AKI patients had elevated HBP levels. The baseline cut-off of 8.28 aids in AKI detection.

Role of magnesium supplementation on glycaemic control in patients with type 2 diabetes mellitus: a prospective, double-blind, placebo-controlled study

2025-06-27T06:52:43+0530

Background: Magnesium is a crucial cofactor in various enzymatic processes involved in glucose metabolism and insulin sensitivity. Magnesium supplementation improves insulin signalling pathways, reduces oxidative stress, and enhances glycaemic control. This study aimed to assess the role of magnesium in improving glycaemic control among patients with type 2 diabetes mellitus.

Methods: This study was a prospective, interventional, double-blind, placebo-controlled study conducted at a tertiary care centre in Mumbai. 100 patients aged 18 to 80 years, diagnosed with T2DM and with HbA1c levels between 6.5%-8%, were randomized into two groups: the intervention group receiving magnesium supplementation with standard of care and the placebo group receiving standard of care alone. HbA1c, fasting blood glucose, and postprandial blood glucose levels were measured at baseline and after three months.

Results: The study included 100 participants, 50 (Intervention Group) and 50 (Control Group) with an average age of 57 years. After three months, the intervention group showed a statistically significant reduction in HbA1c (p<0.0001), fasting blood sugar (p<0.0001), and postprandial blood sugar (p<0.0001), with percentage decreases of 9.85%, 19.11%, and 26.55%, respectively. In the placebo group, there was a significant increase in HbA1c (7.09%) and postprandial blood sugar (12.38%) levels after three months.

Conclusion: The results demonstrate that magnesium supplementation significantly improves glycemic control, with reductions in HbA1c, fasting blood sugar, and postprandial blood sugar in the intervention group. In contrast, the placebo group showed no significant improvement in fasting blood sugar and an increase in HbA1c. These findings suggest that magnesium supplementation may play a valuable role in managing glycemic variability in diabetic patients and support its inclusion as part of diabetes treatment to stabilize glucose levels and reduce long-term complications.

Postoperative pain relief after laparoscopic cholecystectomy: a comparison between intraperitoneal instillation of ropivacaine and bupivacaine

2025-06-27T06:52:41+0530

Background: Although some studies have reported a significant reduction in postoperative pain after the use of intraperitoneal local anaesthetic in laparoscopic cholecystectomy (LC), others have reported no benefit or reduction in analgesic requirement. The present randomized controlled study compares the analgesic efficacy of intraperitoneally instilled local anaesthetic ropivacaine and bupivacaine after LC.

Methods: Sixty patients aged between 18 and 65 years, scheduled to undergo LC and American Society of Anesthesiologist grades I-II were randomly divided into two groups by computer-generated tables. Group A patients received an intraperitoneal instillation of 20 ml of 0.50% ropivacaine and group B patients received an intraperitoneal instillation of 20 ml of 0.50% bupivacaine after completion of the surgery. The primary objective was to compare the presence of post-operative shoulder-tip pain, whereas the secondary objectives were to compare adverse effects and hemodynamic changes. The visual analogue scale (VAS) score and hemodynamic parameters were recorded up to 24 hours postoperatively.

Results: The mean VAS score, heart rate and systolic blood pressure were significantly higher in Group B than in Group A (p value=0.001). The mean diastolic blood pressure was comparable between the two groups (p-value=0.215). The requirement for rescue analgesia was significantly higher in Group B than in Group A (p-value=0.001). The incidence of nausea and shoulder tip pain were comparable between the two groups (p values=0.612).

Conclusions: Intraperitoneal instillation of ropivacaine provides an excellent alternative for intraperitoneal analgesia in laparoscopic cholecystectomy cases.

Comparative study of efficacy of dexmedetomidine and propofol for sedation in intensive care unit

2025-06-27T06:52:40+0530

Background: Sedation is a crucial requirement for all patients in the intensive care unit (ICU). It enhances patient comfort, aids in reducing anxiety, stabilizes vital signs and shortens the discharge from the ICU.

Methods: A total of 60 patients randomized into group D and group P of 30 each. Group D received 1 mcg/kg/10min dexmedetomidine as loading dose and 0.2-0.7 mcg/kg/hour as maintenance dose. Group P received 1mg/kg propofol as loading dose followed by an infusion of 25-75 mcg/kg/hr as maintenance dose. Patient’s heart rate (HR), blood pressure, Ramsay sedation score (RSS) and visual analogue scale (VAS) were monitored and recorded all through the ICU stay.

Results: Study shows that, there was no significant difference with regard to age, sex, weight in both the groups. The mean HR at various time intervals did not show statistical significance; however, the reduction in HR was more in group D compared to group P. We found that the differences in mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) at different time intervals were not statistically significant. In overall group D showed significantly higher (p<0.0001) RSS score after 1 hour, 2 hours, 6hours after sedation compared to group P. Furthermore, the mean VAS score was significantly lower in the group D compared to the group P.

Conclusions: Dexmedetomidine has been identified as a superior option for sedation in the intensive care unit when compared to propofol.

GLIMPSE study: exploring the effectiveness of glimepiride and metformin combination therapy in newly diagnosed type 2 diabetes in India

2025-06-27T06:52:38+0530

Background: Glimepiride and metformin FDC are still relevant in Indian settings as it promotes beta cell responsiveness, protects them from apoptosis and is highly cost-effective. The study aims to primarily understand the usage pattern of initial combination therapy of metformin and glimepiride in newly diagnosed T2DM patients in India.

Methods: A retrospective multi-center cross-sectional study was conducted on 17994 newly diagnosed diabetic patients receiving an FDC of glimepiride and metformin. Baseline data included patient demographics and clinical examination findings, while glycemic parameters were measured at baseline and after 3 months of combination therapy. Key variables assessed included FDC strength, dosage frequency and the rationale for selecting the glimepiride-metformin combination. The clinician’s global assessment of therapy safety and effectiveness was also recorded.

Results: The most frequently prescribed fixed-dose combinations (FDCs) were glimepiride 2 mg with metformin 500 mg (30.49%) and glimepiride 1 mg with metformin 500 mg (30.15%). Age was a significant determinant in the selection of combination therapy (p<0.001). At baseline, the mean hemoglobin A1c (HbA1c) level was 8.3%, which significantly improved to 7.3% following treatment for 3 months (p<0.001). Post-treatment FBG levels decreased from 172.8 mg/dl to 134.2 mg/dl, while postprandial blood glucose (PPBG) levels were reduced from 245.9 mg/dl to 187.8 mg/dl (both p<0.001). The majority of patients demonstrated either excellent or good outcomes based on the clinician’s global assessment of treatment effectiveness and safety.

Conclusions: Metformin 500 mg with either 1 mg or 2 mg of glimepiride is the most frequently prescribed FDC in newly diagnosed T2DM patients as it offers mechanistic complementarity for insulin resistance and β-cell dysfunction, with good safety profile, along with cost effectiveness.

Study of cardiac manifestations in people living with HIV using echocardiography and association with CD-4 counts and other factors

2025-06-27T06:52:35+0530

Background: As the AIDS related deaths have declined, due to introduction of ART, the survival of people living with HIV (PLWH) has increased, leading to increased prevalence of chronic conditions like cardiovascular diseases. India has the second highest burden of HIV-AIDS globally so there is a need for studying cardiovascular diseases in this population. Present study was undertaken to study the cardiac manifestations in people living with HIV using echocardiography and other tools and their correlation with CD4-counts and other factors.

Methods: A cross-sectional study was done on 200 patients divided into two equal groups based on HIV-ELISA status. Known cases of coronary heart disease, structural and valvular heart disease were excluded. Participants underwent basic investigations, chest X ray, ECG, TMT, NTProBNP and echocardiography. PLWH also had their CD4-counts measured. A statistical analysis was performed and the prevalence of cardiovascular abnormalities and presence of related associations was sought.

Results: 26% of PLWH showed abnormal echocardiography with prevalence odd’s ratio of 3.16 when compared to non-HIV group. Diastolic dysfunction was the most common abnormality found. Older age (>50 years), presence of comorbidities, low CD4 counts, advanced WHO staging, non-intake of ART and presence of opportunistic infections were positively and significantly associated with echocardiographic abnormalities in PLWH.

Conclusions: There is high prevalence of cardiovascular diseases among PLWH. Echocardiography may be used as screening tool. Newer ART regimens and High CD4-counts seem to be cardioprotective. There is need for further prospective studies on larger scale to accurately determine associated risk factors.

Correlation between ambulatory blood pressure monitoring and office blood pressure monitoring in healthcare professionals

2025-06-27T06:52:35+0530

Background: Hypertension is a leading global risk factor for cardiovascular morbidity and mortality. Accurate blood pressure (BP) measurement is crucial for effective diagnosis and management. Office blood pressure monitoring (OBPM) is commonly used but may be influenced by the white coat effect and masked hypertension, leading to misdiagnosis. Ambulatory blood pressure monitoring (ABPM), which records BP over 24 hours, provides a more comprehensive assessment, particularly in high-stress populations like healthcare professionals.

This study aimed to assess the prevalence of hypertension, white coat hypertension, and masked hypertension among healthcare professionals and evaluate the concordance between OBPM and ABPM.

Methods: A cross-sectional study was conducted at Maharani Laxmi Bai Medical College, Jhansi, involving 300 healthcare professionals, including doctors, nursing staff, and paramedical personnel. Participants underwent both OBPM under standardized conditions and 24-hour ABPM during routine activities. The data were analyzed to compare BP readings and identify discrepancies between the two methods.

Results: OBPM underestimated the prevalence of hypertension compared to ABPM. Among 300 participants, ABPM detected 26 individuals (8.67%) with masked hypertension and 17 (5.67%) with white coat hypertension. Significant discrepancies were observed, particularly in identifying nocturnal hypertension and BP variability.

Conclusions: The findings highlight the limitations of OBPM in diagnosing hypertension among healthcare professionals. ABPM provides a more accurate assessment, improving hypertension detection and management. Routine use of ABPM may help mitigate cardiovascular risk by identifying undiagnosed cases of hypertension.

The relationship between cataract surgery technique and the incidence of dry eye syndrome at Wangaya Regional General Hospital, Denpasar, Bali

2025-06-27T06:52:41+0530

Background: Cataracts are opacities in the natural intraocular lens that focuses light entering the eye onto the retina. These opacities can cause decreased vision and can eventually lead to blindness if left untreated. Modern cataract surgery, which involves removal of the cloudy lens and implantation of a clear intraocular lens (IOL), is the only definitive therapy for cataracts. Starting from Small Incision Cataract Surgery (SICS) techniques that involve cutting the conjunctiva and sclera, to phacoemulsification (PHACO). Some surgical procedures such as cataract surgery are also responsible for causing dry eye syndrome or worsening existing symptoms in dry eye syndrome. Dry eye syndrome affects a person's quality of life, especially when reading, watching, driving and when using a laptop or similar electronic device. Based on the background above, the researcher is interested in conducting a scientific study entitled "The relationship between cataract surgery technique and the incidence of dry eye syndrome at Wangaya Regional General Hospital, Denpasar, Bali".

Methods: This study uses an observational analytical research design using a cross-sectional approach with secondary data collection obtained from medical records at Wangaya Regional General Hospital in 2021-2024. The statistical test employed in this study was the Chi-Square test, with a significant relationship between variables considered if the p-value is less than 0.05. This study enrolled 55 cataract surgery patients.

Results: Of the 55 patients, 38 (69.1%) has dry eye syndrome, amongst the dry eye syndrome patients that had cataract surgery, 21 (55.3%) were 61-70 years old, 21 (55.3%) were male, 34 (89.5%) has non-bachelor level of education, 19 (50.0%) has history of comorbid disease, 29 (76.3%) went through SICS procedure of cataract surgery.

Conclusions: There is a relationship between cataract surgery techniques and the incidence of dry eye syndrome at Wangaya Regional General Hospital, Denpasar, Bali, proven by the results of statistical calculations obtained ρ value=0.016. Commonly the patient that underwent cataract surgery also has dry eye syndrome. Most of the patient that has dry eye syndrome went through SICS procedure of cataract surgery.

Interstitial lung disease as initial presentation of ANCA associated vasculitis

2025-06-27T06:52:33+0530

Interstitial lung disease (ILD) can occur in relation to many autoimmune processes. Occasionally, ILD may also occur in the presence of anti-neutrophil cytoplasmic antibodies (ANCA). In this paper, we report the case of a 60-year-old female with a long-standing history of ILD who later developed anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and glomerulonephritis. Her clinical progression, where ILD emerged prior to systemic manifestations of AAV, supports the hypothesis that rarely ILD may be an early manifestation of ANCA-associated vasculitis. Additionally, we reviewed existing literature examining the connection between ILD and AAV. The published data suggest that ILD may precede ANCA-associated vasculitis, reinforcing the importance of a multidisciplinary approach for optimal management. Further research is necessary to further understand the underlying mechanisms linking ILD and AAV and to develop evidence-based treatment guidelines.

Case report of thrombotic thrombocytopenic purpura with severe acquired ADAM TS 13 deficiency in a previously healthy adult male

2025-06-27T06:52:30+0530

This was a 23 years old, previously healthy male, who presented with status epilepticus, fever and hematuria. Peripheral blood smear showed severe hemolytic anemia and thrombocytopenia. Thrombotic thrombocytopenic purpura (TTP) was suspected and treatment initiated with therapeutic plasma exchange and corticosteroids following which patient showed minimal improvement. Subsequently, blood reports showed critically low ADAM TS 13 activity, which confirmed the diagnosis of TTP. Plasmapheresis was continued along with methyl prednisolone and Rituximab, following which patient showed considerable clinical improvement.

Early management of pediatric pulmonary tuberculosis with iron deficiency anemia: a case report

2025-06-27T06:52:28+0530

Tuberculosis (TB) in children is often difficult to diagnose due to nonspecific symptoms and limited microbiological testing. Severe anemia in children is usually evaluated for nutritional deficiencies or hematological disorders, but can also be an indicator of chronic infections such as TB. In this case, a child with severe anemia without typical respiratory symptoms was finally diagnosed with TB after further evaluation. This case report emphasizes the importance of high suspicion of TB in unclear anemia, as well as the role of transfusion in stabilization and diagnosis. A 4-year-old girl was referred to Wangaya with moderate hypochromic microcytic anemia, suspected iron deficiency anemia (IDA). The patient had fever, cough, and runny nose since 23 November 2024, accompanied by a decrease in haemoglobin (Hb) to 6.7 g/dl. Peripheral blood examination showed hypochromic microcytic with poikilocytosis, suggesting IDA or possibly thalassemia. Nutritional status was good, but there was underweight and short stature. The patient was admitted for further evaluation. In this case, continued evaluation of the unimproved anemia led to the diagnosis of tuberculosis, despite the absence of prominent respiratory symptoms. This emphasizes the importance of considering TB as a differential diagnosis in children with anemia of unclear etiology. Blood transfusion can play an important role in clinical stabilization while supporting the diagnosis and management process.

When the skin speaks: cutaneous vasculitis complicating a Klebsiella urinary tract infection

2025-06-27T06:52:37+0530

Cutaneous small-vessel vasculitis (CSVV) occurs due to leukocytoclastic vasculitis of dermal post-capillary venules. It can be triggered by infections, autoimmune conditions, or medications. Our case report highlights a rare association between CSVV and a urinary tract infection caused by Klebsiella pneumoniae in an immunocompetent individual. A 31-year-old female with no prior known comorbidities presented with painful, pruritic lesions over both lower limbs and right arm preceded by gastrointestinal symptoms. On examination, there were erythematous macules, crusted plaques and haemorrhagic vesicles noted. A skin biopsy confirmed CSVV. Autoimmune markers were negative, while complement C3 levels were reduced. Urine culture grew Klebsiella pneumoniae, suggesting a post-infectious etiology. The patient was treated with antibiotics and steroids resulting in marked clinical improvement. Infections are common triggers of CSVV, however Klebsiella pneumoniae is an uncommon cause, particularly in immunocompetent individuals. This case underlines the importance of considering uncommon etiologies in the differential diagnosis of CSVV and emphasizes that prompt identification and treatment of the underlying infection can lead to complete resolution. This case contributes to the limited literature on Klebsiella pneumoniae-associated CSVV in immunocompetent individuals and underscores the value of biopsy, infectious work-up, and early therapy in achieving good outcomes.

The outcomes of intra-articular injection of tranexamic acid in arthroscopic anterior cruciate ligament reconstruction: a systematic review

2025-05-09T08:38:21+0530

Arthroscopy is the gold standard for anterior cruciate ligament (ACL) rupture nowadays. Although minimal invasive, this procedure carries the risk of hemarthrosis. Hemarthrosis and pain can interfere with the patient's rehabilitation process and can develop into arthrofibrosis. The administration of antifibrinolytic agents such as tranexamic acid (TXA) has long been developed but it had various results. Compared with intravenous administration, intra-articular (IA) injection of TXA in ACL reconstruction cases is still rarely done. The purpose of this study was to assess the outcomes of intra-articular administration of TXA in ACL reconstruction cases. Identification of relevant studies was developed with a comprehensive search strategy. The eligibility of each study was assessed based on predetermined inclusion and exclusion criteria. The inclusion criteria were studies that discussed the outcomes of giving IA TXA in ACL reconstruction, randomized controlled trial study design comparing IA TXA with control, and full-text English-language journals from 2019-2024. IA administration of TXA is given immediately after the arthroscopy procedure. This systematic review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Four studies comprising 550 patients who were treated with IA TXA were included. Assessed from postoperative bleeding, patients who underwent IA TXA tended to have less bleeding than the control group with most studies showed a significant difference in the amount of bleeding (<0,05). Most studies represented that administration of IA TXA was able to significantly reduce postoperative pain. No patients presented with systemic side effects or complications such as infection, deep vein thrombosis, retears, or revisions through the administration of this procedure. IA administration of TXA can be considered as a safe modality with good tolerance to overcome bleeding or pain in ACL patients undergoing arthroscopy.

Breast cancer incidence after prophylactic mastectomy: a systematic review

2025-06-27T06:52:31+0530

Nowadays, many women in the world are living in fear of encountering breast cancer (BC). In 2020, WHO stated that BC is the most common cancer in the world and the fifth most common leading cause of cancer-related death. The progress made in medical science has made it possible for women to undergo prophylactic mastectomy (PM), which lowers their chances of developing BC. This article will discuss the incidence of BC after PM in women with no prior history of BC in one or both breast tissues. A systematic literature search was done in some databases, namely ProQuest, EBSCO, and PubMed, with a total of 380 articles. After a thorough screening, eight articles that met the criteria were enrolled. In addition, two articles were added from a manual search using Google Scholar. Of those articles, the risk of bias was assessed using the risk of bias tools from CLARITY. All articles suggested that most patients are middle-aged women, mostly around 45 years old. The surgical technique used in most cases is nipple-sparing mastectomy (NSM) due to its cosmetic advantage. Moreover, mutations in the BRCA gene were found to be positive in PM patients. The incidence of BC is substantially reduced after PM, reducing it to approximately 90%. The rest of it still has a chance to develop BC. PM may reduce the incidence of BC. However, further research, specifically on PM, is required to find out the long-term effect and efficacy.

Long-term indwelling urinary catheterization and bladder cancer

2025-06-27T06:52:29+0530

Bladder cancer is cancer that originates from the bladder mucosa. The causes of bladder cancer are multifactorial. Long-term use of urinary catheters will increase the risk of bladder cancer. There has been no systematic review that discusses the association between indwelling catheters and bladder cancer. We aim to assess the association between long-term indwelling catheters and bladder cancer. We performed a literature search from PubMed/MEDLINE, Cochrane Library, and Scopus. The data included in the study were only observational studies that were relevant to the study objective. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). The data was then synthesized using the Review Manager 5.4 application to determine heterogeneity and cumulative hazard ratio values. There were 640 studies obtained from the PubMed/MEDLINE, Cochrane Library, and Scopus databases. After removing 16 duplicated studies, there were 624 results left. Out of these studies, 6 qualified for systematic review. Data on indwelling catheters for bladder cancer are highly heterogeneous. The incidence of individuals with indwelling catheters with probable bladder cancer was 4.87% (95% confidence interval (CI), 1.7–13.96%, I2 = 84%). The use of indwelling catheters significantly increases the risk of bladder cancer (p=0.003). The bias assessed using the Newcastle Ottawa scale (NOS) showed a poor-quality result (4.83 final score). Long-term indwelling catheter are associated significantly with an increased risk of bladder cancer.

Long-term cardiovascular outcomes in peritoneal dialysis patients: a systematic review

2025-06-27T06:52:36+0530

Peritoneal dialysis (PD) is a therapy for end-stage kidney disease that is increasingly used worldwide, especially in developing countries. Despite its benefits, PD patients remain at high risk for cardiovascular disease and related mortality due to unique metabolic and inflammatory risk factors. We performed a systematic review of cohort studies reporting cardiovascular and all-cause events in adult patients receiving PD. A search of PubMed, Embase, Scopus, and the Cochrane Library identified 716 studies; following after the screening and full-text review, 20 studies (7 prospective, 13 retrospective) were included. Data were extracted on study and participant characteristics, PD modality, outcomes, risk factors and methodological quality. All-cause mortality varied between 19.4 and 42.4% with CVD-related mortality representing 40–55% of all deaths. Vascular calcification (HR 8.01 for AAC >39%), hypoalbuminemia (HR 2.84), hypomagnesemia (HR 1.58), and inflammation (elevated neutrophil-to-lymphocyte ratio, HR 2.60; platelet-to-albumin ratio, HR 1.50) were significant modifiable risk factors for events. The incidence of peritonitis predicted cardiovascular death in a dose-response relationship. Cardiopathy (LV diastolic dysfunction, HR 2.25) and metabolism (remission of low triiodothyronine, HR 0.86 for each 10 ng/dl) were also independent predictors. Confounding and missing data yielded risk of bias as moderate or serious in most studies. Long-term cardiovascular outcomes in PD patients are driven by a complex interplay of vascular, inflammatory, metabolic, and cardiac factors. Addressing these modifiable risks should be prioritized in clinical management and research to improve survival in this high-risk population.