International Journal of Advances in Medicine 2024-04-26T20:33:25+0530 Editor Open Journal Systems <p>International Journal of Advances in Medicine (IJAM) is an open access, international, peer-reviewed journal that publishes medical news, original clinical research of interest to physicians in medicine, and reviews on all aspects of clinical medicine. The journal's full text is available online at The journal allows free access to its contents. International Journal of Advances in Medicine is dedicated to bringing physicians the best research and key information. The journal has a broad coverage of relevant topics in the various disciplines of medicine. International Journal of Advances in Medicine (IJAM) is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, analytic reviews such as meta-analyses, insightful editorials, medical news, case reports, adverse drug reactions, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new drug updates. The journal publishes all research study types, from study protocols to phase I-IV trials to meta-analyses, including small or specialist studies. It is published every<strong> two months</strong> and available in print and online version. International Journal of Advances in Medicine (IJAM) complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</p> <p><strong>Issues: 6 per year</strong></p> <p><strong>Email: </strong><a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></p> <p><strong>Print ISSN:</strong> 2349-3925</p> <p><strong>Online ISSN:</strong> 2349-3933</p> <p><strong>Publisher:</strong> <a href="" target="_blank" rel="noopener"><strong>Medip Academy</strong></a></p> <p><strong>DOI prefix:</strong> 10.18203</p> <p>Medip Academy is a member of Publishers International Linking Association, Inc. (PILA), which operates <a href="" target="_blank" rel="noopener">CrossRef (DOI)</a></p> <p> </p> <p><strong>Manuscript Submission</strong></p> <p>International Journal of Advances in Medicine accepts manuscript submissions through <a href="" target="_blank" rel="noopener">Online Submissions</a>:</p> <p>Registration and login are required to submit manuscripts online and to check the status of current submissions.</p> <ul> <li><a href="" target="_blank" rel="noopener">Registration</a></li> <li><a href="" target="_blank" rel="noopener">Login</a></li> </ul> <p>Please check out the video on our YouTube Channel:</p> <p>Steps to register and submit a manuscript:<br /><a href="" target="_blank" rel="noopener"></a></p> <p>Problem Logging In-Clear cookies:<br /><a href="" target="_blank" rel="noopener"></a></p> <p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></p> <p><strong> </strong></p> <p><strong>Abbreviation</strong></p> <p>The correct abbreviation for abstracting and indexing purposes is Int J Adv Med.</p> <p><strong> </strong></p> <p><strong>Abstracting and Indexing information</strong></p> <p>The International Journal of Advances in Medicine is indexed with</p> <ul> <li><strong><a href=";journalId=31393" target="_blank" rel="noopener">Index Copernicus</a> </strong></li> <li><a href="" target="_blank" rel="noopener"><strong>Index Medicus</strong> for South-East Asia Region (WHO)</a></li> <li><strong><a title="" href="" target="_blank" rel="noopener">Scilit (MDPI)</a></strong></li> <li><a href="" target="_blank" rel="noopener">ScopeMed</a></li> <li><a href="" target="_blank" rel="noopener">Journal Index</a></li> <li><a href="" target="_blank" rel="noopener">J-Gate</a></li> <li><a href="" target="_blank" rel="noopener">Google Scholar</a></li> <li><a href="" target="_blank" rel="noopener">CrossRef</a></li> <li><a href="" target="_blank" rel="noopener">Directory of Science</a></li> <li><a title=";subAction=pub&amp;publisherID=3072&amp;journalID=31629&amp;pageb=1&amp;userQueryID=66977&amp;sort=&amp;local_page=1&amp;sorType=&amp;sorCol=1" href=";subAction=pub&amp;publisherID=3072&amp;journalID=31629&amp;pageb=1&amp;userQueryID=66977&amp;sort=&amp;local_page=1&amp;sorType=&amp;sorCol=1" target="_blank" rel="noopener">JournalTOCs</a></li> <li><a href=";issn=23493925&amp;uid=r4bf18" target="_blank" rel="noopener">ResearchBib</a></li> <li><a href="" target="_blank" rel="noopener">ICMJE</a></li> <li><a href=";fIDnum=|&amp;mode=simple&amp;letter=ALL&amp;la=en" target="_blank" rel="noopener">SHERPA/RoMEO</a></li> </ul> Emerging trends in disturbed function of the pancreas and dyspepsia: an Indian perspective 2023-12-14T13:57:48+0530 Ramesh Roop Rai Partha Pratim Bose <p>Disturbed function of the pancreas, especially exocrine pancreatic insufficiency (EPI) results in inadequate synthesis or delivery of the pancreatic enzyme leading to maldigestion. Due to the lack of specific symptoms and overlapping manifestations of EPI, it often goes undiagnosed and untreated. Dyspepsia is another common condition characterized by upper gastrointestinal symptoms caused by a heterogeneous group of disorders. This consensus aims at providing a comprehensive overview of the diagnosis and management of disturbed function of the pancreas and dyspepsia. A total of 95 gastroenterologists participated in expert group meetings organized via virtual focus group discussions. Recent evidence elaborating various aspects like diagnosis and management of EPI and dyspepsia, including the use of pancreatic enzyme replacement therapy (PERT) and issues with compliance were discussed. The experts emphasized that clinical symptoms of maldigestion should not be ignored, and physicians should not wait to diagnose EPI until steatorrhea occurs. Fecal elastase (FE) test and imaging should be performed to confirm diagnosis. If EPI is diagnosed or the patient experiences weight loss or steatorrhea, PERT should be initiated while ensuring compliance. Reducing pill burden, active education, monitoring, and support from healthcare programs may help ensure compliance. EPI is also a cause of dyspepsia. Further, consuming lipid-rich foods worsens symptoms of dyspepsia. First-line treatment includes dietary changes and lifestyle modifications. Digestive enzyme supplements play a significant role in alleviating symptoms of indigestion. Routine enzyme supplementation is beneficial in managing dyspepsia caused by EPI, such as, in patients with EPI due to pancreatitis or diabetes.</p> 2024-03-16T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine An innovative development of a whole-body diagnostic device led to the ingenious discovery of comprehensive digital medicine that has potential to lead to health promotion of humankind and consequential rapid economic growth of the world 2024-03-06T15:39:48+0530 Abhijit Biswas Krishnan Ramasubramanian <p>After working for a few decades, gas-discharge-visualization (GDV) device, alternatively called electro-photonic-imaging (EPI) device, was innovatively developed by Prof. K.G. Korotkov in 1995. The sophisticated GDV diagnostic device additionally is being used as an important tool for generating comprehensive-digital-medicine by feeding an electromagnetic signal from the GDV device to the comprehensive-digital-medicine preparation device, involving very low cost. This medicine helps to achieve near zero disease-levels in the various organs as well as the immune, endocrine and nervous systems of all health-conscious persons, who want to continue sincerely with the optimal combination of the preventive medicines of digital-homeopathy and evolved-homeopathy, and occasional GDV (once in a month) check-up. When this condition is achieved, about 20 years age-reduction is felt along with improvement of physical and mental stamina and increment in longevity. To begin with, the global organizations and insurance companies will have to provide for the first few years fund and offer suitable incentives (may be, appropriate annual cash-incentives after remaining under coverage of comprehensive-digital-medicine prevention scheme), since vast majority of the apparently healthy part of humankind believe that they’re healthy, although all of their organs are having imperceptible disease level between 0.8 to 1.0, and such disease level in immune system (including Spleen) cannot prevent tumors/ cancer and many other severe diseases. After a span of few years, global GDP can increase by 5% over a year (in contrast with the present 3%), when this increased GDP (due to better health and increase in retirement age) can fund such schemes.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Tackling carbapenem resistance: ceftazidime - avibactam in contemporary clinical scenarios 2024-03-21T14:37:46+0530 Manish Maladkar Shrikant Patil Namita Anchan <p>Antimicrobial resistance poses a formidable challenge in treating severe infections, with the prevalence of extended-spectrum beta-lactamase (ESBL) - producing, <em>Klebsiella pneumoniae</em> carbapenemase (KPC) - producing, and multidrug-resistant (MDR) organisms on the rise. This necessitates careful consideration of various factors, including local resistance patterns, patient-specific characteristics, and drug properties, in treatment decisions for critically ill patients. Ceftazidime-Avibactam demonstrates efficacy against aerobic Gram-negative bacteria and offers a crucial advancement against carbapenem-resistant organisms (CRO) with its effectiveness against key pathogens, including ESBL, AmpC, KPC, and OXA-48-producing <em>Enterobacteriaceae</em> and drug-resistant <em>P. aeruginosa</em>. Ceftazidime-Avibactam emerges as a valuable option for critically ill patients with limited treatment choices. The drug's excellent safety profile demonstrated in clinical trials, further positions it as a crucial addition to antimicrobial treatment options. As the global threat of drug-resistant bacteria grows, Ceftazidime-Avibactam plays a pivotal role in addressing this challenge and offers a promising solution for critically ill patients facing infections caused by antimicrobial-resistant pathogens. The article delves into therapeutic efficacy and the prospective role of Ceftazidime-Avibactam in managing MDR Gram-negative organisms, underscoring the critical role of appropriate antibiotic administration in reducing mortality associated with Gram-negative infections.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Thyroid dysfunction in India: what is different 2024-03-22T20:21:10+0530 S. K. Singh Rina Singh Santosh Kumar Singh Arun Kumar Pandey Sarika Jaiswal Pradeep Kumar Rai <p>Thyroid dysfunction (TD) is a common endocrine condition worldwide. Thyroid hormone is essential for growth, development, and energy metabolism. TD if left untreated leads to various serious health consequences. Various risk factors for the development of TD are iodine deficiency, ageing, genetic susceptibility, smoking status, ethnicity, and endocrine disruptors. Indians are at high risk for the development of TD as compared to Caucasians. Indian thyroid patients differ than Caucasians in many aspects such as higher prevalence of congenital hypothyroidism and other TD, higher rate of progression of subclinical hypothyroidism (SCH) to overt hypothyroidism (OH), and lower prevalence of thyroid associated ophthalmopathy (TAO). In this article, we tried to summarize the current evidences regarding environmental and biological factors that place Indians at high risk of TD as compared to other ethnic groups. High prevalence and different characteristics of Indian TD call for investigation into cause of increased susceptibility and way to prevent TD at individual and population levels.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Emerging approaches in secondary hypertension due to renal artery stenosis: evaluation and treatment - systematic review 2024-04-05T00:38:07+0530 Mateo D. F. Vera Josselyn N. V. Enriquez Jorge D. B. Paladines Christian A. O. Franco Gabriela S. M. Pacheco Ivana P. M. Vera Josselyne C. B. Oscullo <p>Hypertension, a global health concern, affects a staggering 1.28 billion people worldwide, as stated by the World Health Organization (WHO) however renal artery stenosis (RAS), a common cause of secondary hypertension, is characterized by the narrowing of renal arteries, leading to physiological changes such as arterial stiffening and elevated blood pressure. The major causes of RAS include atherosclerosis and fibromuscular dysplasia. Diagnosis involves clinical suspicion and imaging studies such as Doppler ultrasonography and angiography. Treatment strategies encompass lifestyle modifications, pharmacotherapy, interventional procedures like angioplasty with stenting, and emerging options such as renal denervation and gene therapy. Our aim is to provide a comprehensive examination of the pathophysiology, prevalence, risk factors, causes, diagnosis, and treatment modalities through a systematic search gathering qualitative and quantitative data. We address the challenges in diagnosis and treatment, emphasizing the need for tailored approaches considering patient-specific factors. We will review emerging approaches in evaluating and treating secondary hypertension due to RAS.</p> 2024-04-12T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Robotic intersphincteric resection of low rectal cancer versus laparoscopic intersphincteric resection of low rectal cancer 2024-04-14T16:19:32+0530 Ahmed Z. Alotaibi <p>This systematic review evaluated and compared the two currently available intersphincteric resection techniques (robotic and laparoscopic intersphincteric resection) for low rectal cancer, with the final aim of comparing associated factors between the two techniques. The assessed factors included surgical duration, hospital stay, complications, overall survival, local recurrence, and low anterior resection syndrome (LARS). A literature search of the search engines “PubMed”, “SCOPUS”, and “Web of Science” was conducted, with a time interval set between 2015 and 2023. The initial search yielded 57 studies, of which 10 met the inclusion and exclusion criteria. Hence, data was extracted from only these 10 studies. The average reported robotic surgery time varied between 197 and 472 mins, while the laparoscopic surgery time varied between 240 and 325 mins. Conversely, the overall survival and local recurrence rates were 89.7% and 6.7% for robotic and 87.9% and 6.2% for laparoscopic resection, respectively. In addition, complications were reported in 16.5% and 18.2% of robotic and laparoscopic resection cases, respectively. This systematic review showed that although the surgery duration is longer in robotic resection compared to laparoscopic resection, the former technique is associated with lower rates of complications and local recurrence, and improved overall survival. In addition, few studies have reported on the prevalence of LARS; therefore, we recommend that this field be studied and included in the reported data of the upcoming studies to allow more conclusive evidence regarding prevalence of LARS among the two groups of intersphincteric resections.</p> <p> </p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Hepatitis A and cryptogenic cirrhosis of liver: a case series 2024-03-20T19:17:39+0530 Nisha Narang Avtar S. Dhanju Rishabh Rikhye Manavdeep Kaur Adab Alwinder Singh Pankaj Jassal <p>We are discussing a case series of 12 patients that presented with either compensated or decompensated chronic liver disease that were labelled as cryptogenic cirrhosis of liver after ruling out most of the known causes of chronic liver disease. They were found to be positive for hepatitis A IgG antibody. Cryptogenic cirrhosis has been attributed to various possible causes like non- alcoholic fatty liver disease, various metabolic disorders or occult viral infections. Hepatitis A virus is known to cause acute viral hepatitis. Presence of hepatitis A IgG antibodies in serum of patients with chronic liver disease may act as a clue to fill the voids in our understanding of cryptogenic cirrhosis of liver. Possibility of hepatitis A and various other viruses as potential causes of chronic liver disease needs to be explored.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine A study on fibro-calculous pancreatic diabetes conducted in a tertiary medical institution in Northern Bihar 2024-03-09T00:23:28+0530 Animesh Paul Yuvraj Singh Rathore Naushad Akhtar Uttam Kumar Paul <p>Fibro-calculous pancreatic diabetes (FCPD), which is seen in tropical areas and is caused by idiopathic nonalcoholic chronic pancreatitis, is characterized by pancreatic calcification and stomach pain. One female patient and nine male patients were identified as having FCPD. Half of the patients were under 30 years old, with an average age of 28.44±7.07. Seven individuals had diabetes for a shorter period of time than five years. Four patients reported with problems related to various infections, while six patients had osmotic complaints due to uncontrolled diabetes. With a mean waist-hip ratio of 0.89 and a mean BMI of 19.42, all of the patients were thinly built. With mean FBS of 231 mg/dl, PPBS of 469 mg/dl, and HbA1c of 11.96, all patients had uncontrolled diabetes. Microvascular issues affected 30% of the patients, while none of the patients experienced macrovascular complications. A rare type of secondary diabetes called FCPD is becoming more widespread in northern states like Bihar. </p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Early chest re-exploration after adult cardiac surgery 2024-03-04T19:47:27+0530 Wael Alshoubaki Hayel Al-Adwan Mohammad Abdallah Khasawne Odai Al-Momani Qais Alqsoos Ashraf Fadel Mohd Abdullah Ibrahim Alqaisi <p><strong>Background:</strong> Aim of the study was to determine the rate, causes, consequences of early re-sternotomy after cardiac surgery and to compare between re-opening in the operative theatre and re-opening in the intensive care unit (ICU).</p> <p><strong>Methods:</strong> This is an observational retrospective study of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia heart institute in the between September 2023 and February 2024. Incidence, risk factors, causes, site and consequences of early re-sternotomy are studied.</p> <p><strong>Results:</strong> Data from 182 patients was analysed. Male patients were 82.4% and female patients were 17.6%. Reopening was needed in 12.1%. Incidence of reopening was highest after combined procedures (33.3%) and aortic surgery (33.3%). Reopening was performed in the operative theatre in 72.3% of cases, while 27.3% had reopening in the ICU. Risk factors for re-opening were longer average CPB (127 minutes vs 107 minutes) and aortic clamp times (71 vs 65 minutes). Patients who had reopening spent on average 55.45 hours on mechanical ventilation, while those who did not were extubated after 32 hours. The overall mortality rate was 11%; however, mortality in the reopening group was much higher (36.4%). Those who were reopened in ICU were at an older age (mean 61.6 vs 56.9 years), required more blood transfusions (mean 2.4 units vs 1.5 units) and had higher mortality (mean 60% vs 23.5%).</p> <p><strong>Conclusions:</strong> Incidence of re-opening after cardiac surgery was 12.1%. The two main causes of re-opening were excessive bleeding and haemodynamic instability. Higher incidence of mortality was seen when re-opening took place in the ICU. Predictors for re-opening are old age, more complex (combined) procedures, aortic surgeries and prolonged cardiopulmonary bypass (CPB) and aortic cross clamp (ACC) durations.</p> 2024-03-14T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Comparison of response and toxicity of induction chemotherapy with cisplatin and 5-fluorouracil versus cisplatin and paclitaxel followed by concurrent chemoradiotherapy in advanced head and neck cancer 2024-01-28T17:09:24+0530 Towhidul Islam S. M. Nazmul Alam M. Fazle Robbi <p><strong>Background:</strong> Head and neck cancer poses a prevalent oncological challenge in Bangladesh, often diagnosed in advanced stages. Standard treatment for inoperable cases involves concurrent chemo-radiotherapy, but induction chemotherapy has shown significant benefits. This study aimed to compare the response and toxicity of induction chemotherapy with cisplatin and 5-fluorouracil versus cisplatin and paclitaxel followed by concurrent chemo-radiotherapy in advanced head and neck cancer.</p> <p><strong>Methods:</strong> From January 2019 to June 2020, a multicenter study enrolled 150 cases with inoperable squamous cell carcinomas in the head and neck. Ethical approval was obtained from Bangabandhu Sheikh Mujib Medical University. Divided into two arms, Arm A had 75 patients receiving cisplatin and 5-fluorouracil, while Arm B had 75 patients receiving cisplatin and paclitaxel for three cycles.</p> <p><strong>Results:</strong> After 24 weeks of treatment, complete response rates were 53.33% in Arm A and 56.0% in Arm B, with partial response rates of 29.33% and 32.0% respectively. Overall response was 82.66% in Arm A and 88.0% in Arm B, showing no statistically significant difference (p&gt;0.05). Arm A exhibited more anemia, oral mucositis, skin toxicity, and hand- foot syndrome, while Arm B had higher neuropathy. Hematological and non-hematologic toxicities during concurrent chemo-radiotherapy were similar in both arms.</p> <p><strong>Conclusions:</strong> Induction chemotherapy with cisplatin and paclitaxel, followed by concurrent chemo-radiotherapy, is equally effective as induction chemotherapy with cisplatin and 5-fluorouracil, followed by concurrent chemo-radiotherapy, in treating advanced head and neck squamous cell carcinoma. However, the former regimen demonstrates significantly fewer toxicities, indicating a safer treatment option.</p> <p> </p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine The relationship between knowledge and willingness COVID-19 vaccination among adolescence, in Samarinda, Indonesia 2024-03-14T21:27:33+0530 Sitti M. Arif Dian A. Fitriani Sagena N. Carisma <p><strong>Background:</strong> In 2020, infections caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are still a pandemic, including in Indonesia. Numerous efforts have been made to reduce morbidity and mortality rates caused by the virus, including vaccination. The existence of a vaccine for COVID-19 in the Indonesian community faces pros and cons. The achievement rate of vaccination, in general, is still not as expected. To accelerate vaccination, the government through the Ministry of Health has issued a circular on the acceleration of COVID-19 vaccination for children from 12-17 years old. The study aims to assess the relationship between the level of knowledge and willingness to vaccinate against COVID-19 in adolescents from 12-17 years old in Sambutan Village, Samarinda city, Indonesia.</p> <p><strong>Methods:</strong> This study is observational analytic with a cross-sectional design. We took samples through online questionnaires distributed to adolescents aged 12-17 years old, in Sambutan village, Samarinda city from September to December 2021.</p> <p><strong>Results:</strong> The sample was 179 people, consisting of 86 people (48.04%) male and 93 people (51.96%) female. Based on the knowledge level, 144 (80.4%) have good knowledge and 35 (19.6%) have less knowledge about vaccination. As for the willingness to vaccinate, 150 (83.8%) people are willing, and 29 (16.2%) are unwilling to be vaccinated. The analysis test, obtained p&lt;0.001, indicating that there is a relationship between the level of knowledge and willingness to vaccinate.</p> <p><strong>Conclusions:</strong> The better adolescents comprehend vaccination, then their willingness to be vaccinated is higher.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Effect of neoadjuvant concurrent three-dimensional conformal chemoradiotherapy with conventional two-dimensional chemoradiotherapy in locally advanced rectal cancer 2024-01-28T17:15:16+0530 S. M. Nazmul Alam Towhidul Islam M. Fazle Robbi M. Mahmudur Rahman Jannatul Ferdos M. Abdullah Al Maruf <p><strong>Background:</strong> Rectal carcinoma is a prevalent clinical condition, and treatment hinges on factors like tumor specifics, staging, grading, and histopathological characteristics. While surgery remains the primary treatment, neoadjuvant chemoradiotherapy, particularly using 3D-CRT, has proven effective in reducing local recurrence rates for locally advanced cases. Alternatively, 2D-RT is considered for neoadjuvant treatment. This study aimed to compare the impact of neoadjuvant concurrent three-dimensional conformal chemoradiotherapy with conventional two-dimensional chemoradiotherapy in the context of locally advanced rectal cancer.</p> <p><strong>Methods:</strong> In this multicentre quasi-experimental study, 60 patients with biopsy-proven adenocarcinoma and clinically confirmed locally advanced rectal cancer, were divided into Group A (receiving oral capecitabine with three-dimensional conformal radiotherapy) and Group B (receiving the same capecitabine dose with 50 Gy two-dimensional radiotherapy). After surgery within 6-12 weeks, outcomes were analysed.</p> <p><strong>Results:</strong> After neoadjuvant chemoradiotherapy, clinical complete response rates were 16.7% in Group A and 10.0% in Group B, with a higher pathological complete response in Group A (10.0% vs. 3.3%). Tumor downsizing occurred in 83.3% of Group A and 73.3% of Group B, and sphincter-sparing surgery was achieved in 73.3% of Group A and 56.7% of Group B. Grade 2 toxicities included anemia (10.0% vs. 13.3%), leucopenia (13.3% vs. 20.0%), diarrhoea (10.0% vs. 16.7%), proctitis (13.3% vs. 40.0%), and urinary toxicity (10.0% vs. 20.0%). Grade-1 toxicities were nausea (20.0% vs. 40.0%), vomiting (20.0% vs. 36.7%), mucositis (56.7% vs. 60.0%), hand-foot syndrome (33.3% vs. 40.0%), and urinary toxicity (43.3% vs. 56.67%), with significant proctitis in Group A (p=0.012). Other toxicities showed non-significant p-values (&gt;0.05).</p> <p><strong>Conclusions:</strong> Tumour response was not statistically significant between the patients of concurrent 3D-CRT and 2D-RT Arms. But the patients of 3D-CRT arm showed better response arithmetically. Also, there was an observable significant reduction of toxicities (lower gastrointestinal) in the 3D-CRT arm.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Impact of duration of cardiopulmonary bypass on recovery after open heart surgery 2024-03-18T02:56:07+0530 Hayel Aladwan Wael Alshoubaki Abdullah Ibrahim Alqaisi Hamza A. Abuamereh Lara M. Alatoum Ashraf Fadel Mohd <p><strong>Background:</strong> Objective of the study was to examine the impact of cardiopulmonary bypass (CPB) duration on recovery from cardiac surgery.</p> <p><strong>Methods:</strong> This is an observational retrospective study. Data from adult cardiac surgical patients presented at Queen Alia Heart Institute (QAHI) in the duration between September 2023 and February 2024 was retrospectively analysed. The impact of CPB duration was examined. Patients were divided into groups according to CPB duration (0 to 60 minutes, 60 to 120 minutes, 120 to 180 minutes, 180 to 240 minutes and 240 to 300 minutes). For each group intra-operative and post-operative variable were examined. The intra-operative variables studied were need for blood transfusion, haemofiltration and intra-aortic balloon pump. The post-operative variables studied were duration of post-operative mechanical ventilation, intensive care unit (ICU) stay, hospitalization time and mortality.</p> <p><strong>Results:</strong> Consecutive data of 202 adult cardiac surgical patients (34 females and 168 males) was analysed. Average age of patients was 57.149 years. Average duration of CPB was 109.9 minutes (ranged from 29 to 300 minutes). Half of the patients (50.5%) had CPB duration between 1 and 2 hours. Blood transfusion was needed in 88 patients (43.6%). Haemofiltration was used in 32 patients (15.8%) and intra-aortic balloon pump (IABP) was used in 29 patients (14.4%). The average postoperative time of mechanical ventilation was 34 hours and the average ICU stay was 5.5 days. Chest re-exploration was needed in 30 patients (15%). Hospital stay was on average 12 days and in-hospital mortality was witnessed in 20 patients (9.9%). Patients who had CPB for less than one hour (17.3%) had the lowest incidence of blood transfusion (37.1%), lowest incidence of haemofiltration (8.6%), low incidence of IABP use (11%). They also had lowest incidence of chest re-opening (5.7%), shortest time of postoperative mechanical ventilation (13 hours) and shortest ICU and hospital stay (4.1 and 8.5 days, respectively). There was a significant increase in postoperative sternal re-opening and postoperative mortality when the duration of CPB exceeded 3 hours.</p> <p><strong>Conclusions:</strong> Duration of CPB is a key predictor of recovery and outcome of cardiac surgery. Shorter CPB time was associated with earlier extubation, less ICU stay and shorter hospitalisation time. Prolonged CPB was associated with higher rates of complications, delayed recovery, longer ICU stay, protracted hospitalisation and higher mortality rates.</p> 2024-04-01T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Study of potency determination of 3X antimuonium crudum in patients with corn 2024-01-24T09:52:07+0530 Rekha Kumar Aarti Prajapati Pooja Prajapati <p><strong>Background: </strong>Corn is a hyperkeratotic lesion and present under the area of pressure such as the metatarsal head. The thickening of the stratum corneum suggested that the normal physiological phenomena to protect under lying soft tissue from the mechanical pressure or stress.</p> <p><strong>Methods: </strong>32 patients taken data from OPD, IPD and frequently organized camps by department according to inclusion criteria and as per principles of homeopathy, follow up done every 15 days. Size of corn measured with measuring scale/tape and vernier caliper by Measuring the height, width and diameter of corn pre and post treatment.</p> <p><strong>Results: </strong>Statistical analysis done using paired Student’s t test, considering degree of freedom=16. We find a table value 2.120 (p=0.05) and 2.921 (p=0.011) and the null hypothesis got rejected.</p> <p><strong>Conclusions: </strong>There is significant reduction of disease intensity score, after the homoeopathic treatment. Which shows the efficacy and potency of 3X Antimuonium crudum in the treatment of corn.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Assessing the acceptability and usability of digital interventions for pregnancy health 2024-01-22T13:40:22+0530 Sneha Damse Manvi Gupta <p><strong>Background:</strong> Despite the promising potential of digital interventions to enhance maternal health outcomes, there is a lack of comprehensive exploration into their real-world acceptability, usability, and effectiveness among pregnant women. This study was conducted to evaluate the acceptance and usability of digital interventions among pregnant women to gain insights into real-world applications.</p> <p><strong>Methods:</strong> The study enrolled fifteen pregnant women (ages 20 to 40 years) using an online application between November 2022 and May 2023. Data collection comprised a usability survey, and statistical analysis employed descriptive statistics and Chi-square tests.</p> <p><strong>Results:</strong> Significant variations in age (mean 29.33 years) and gestational age (mean 13.80 weeks) were observed (p&lt;0.001). Ease of use received positive ratings (73.3% found it easy; p=0.071), with no participants finding it difficult (p&lt;0.001). The introduction to the application was well-received (p=0.004). Monitoring utilities were deemed helpful by 73.3% (p=0.071), with strong agreement from 26.7%. App engagement was high, with 86.7% disagreeing it was boring and 13.3% strongly disagreeing with the same (p=0.020). Motivational impact for a healthy diet was endorsed by 80% (p=0.091), and medication adherence support by 93.3% (p=0.015). Recordkeeping ease was significant (80% agreement; p=0.247). Notably, 86.7% remained active users after 30 days, with no dropouts (p&lt;0.001).</p> <p><strong>Conclusions:</strong> This pilot study suggests that digital interventions can positively influence maternal health, offering valuable insights for their integration into healthcare strategies.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Prominent early adulthood hyperferritinemia in scrub typhus 2024-02-02T23:24:35+0530 Sayan Naskar Bhaskar Narayan Chaudhuri Amrita Basak Partha Guchhait Satadal Das <p><strong>Background:</strong> Scrub typhus is an acute infectious disease, caused by <em>Orientia tsutsugamushi</em>. It is endemic to a geographically distinct region of Japan, Taiwan, China, and South Korea, known as the tsutsugamushi triangle, as well as in Nepal, Pakistan, and Papua New Guinea. In India, the incidence of this disease varies from 4-46% with high morbidity and mortality.</p> <p><strong>Methods:</strong> In this cross-sectional study at a tertiary care hospital in Kolkata, India we analysed ferritin blood levels along with different demographic and laboratory test parameters of 60 suspected scrub typhus patients who were also scrub typhus IgM antibody positive during a one-year study period.</p> <p><strong>Results:</strong> It was found that serum ferritin levels were unusually high in 21-40 years age group patients along with mildly increased urea and creatinine levels. Other important findings were below 40 years of age males were mostly affected, but above 40 years of age, females were generally affected. Haemoglobin and platelet levels were normal in all age groups. Although WBC count and neutrophils were normal in the 21-40 years age group, in other age groups increased levels were observed. CRP, SGPT, and SGOT levels were uniformly high above 20 years of age. Electrolytes were mildly decreased.</p> <p><strong>Conclusions:</strong> It appears that oxidative stress-induced acute kidney injury may be an important reason for the rising ferritin levels in the 21-40 years age group. These important findings may be helpful to clinicians in management of these patients.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Clinical disease activity index versus disease activity score (28 joints) for assessment of disease activity in obese patients of rheumatoid arthritis 2024-02-21T17:22:03+0530 Sarthak Saxena B. K. Kundu <p><strong>Background:</strong> Measurement of disease activity by Disease Activity Score 28 joints -Erythrocyte Sedimentation Rate (DAS28-ESR), Disease Activity Score (28 joints)-C-Reactive Protein (DAS28-CRP), and Clinical Disease Activity Index (CDAI) has become an integral part of management of Rheumatoid Arthritis (RA), by ‘Treatment to Target’ approach. With the exception of CDAI, the other two use inflammatory markers ESR and CRP to measure disease activity. Obesity is also known to increase inflammatory markers like CRP. We undertake this study to examine if obesity confounds the disease activity measurement in RA leading to overestimation of disease activity.</p> <p><strong>Methods:</strong> A cross-sectional observation study was conducted on one hundred patients of RA (40 obese and 60 non obese) in remission or low disease activity as defined by CDAI. They were divided into obese and non-obese groups based on Indian standards (BMI&gt;25kg/m<sup>2</sup>). ESR and CRP were measured in both the groups. DAS28-ESR and DAS28-CRP were calculated and compared using relevant statistical tests.</p> <p><strong>Results:</strong> DAS28-ESR and DAS-28-CRP scores were significantly higher in the obese subjects, despite both groups having comparable CDAI scores. Similar findings were also observed with inflammatory markers ESR and CRP, both being higher in obese patients.</p> <p><strong>Conclusions:</strong> We conclude that indices incorporating inflammatory markers, like DAS28 overestimate disease activity in obese RA patients. Treatment decisions regarding escalation or addition of DMARDs should be taken after considering the same. CDAI appears to be better suited for disease activity measurements in obese RA patients as compared to DAS 28.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Assessing the effectiveness of software driven digital therapeutics in patients with coronary artery disease or post coronary intervention: real-world evidence study 2024-03-05T16:39:50+0530 Abhijeet A. Palshikar Chetan Gharat Kamlesh Patel <p><strong>Background: </strong>Coronary artery disease (CAD) is a significant health concern worldwide. Acute coronary syndrome (ACS) is a common form of CAD that requires immediate treatment. Digital therapeutics (DTx) have emerged as a promising field for disease management, utilizing remote monitoring and promoting behavioral changes. This study aims to evaluate the effectiveness of LYFE app intervention in improving outcomes for patients with CAD, specifically those with ACS or who have undergone percutaneous coronary intervention (PCI).</p> <p><strong>Methods: </strong>This pilot, single-center, real-world evidence study evaluates the effectiveness of the LYFE in CAD and/or post-PCI patients. The primary goal was to assess adherence to medication, physical exercise, diet, and well-being of the participants. Secondary outcomes included assessing vital changes and the incidence of major adverse cardiovascular events over 6 months.</p> <p><strong>Results: </strong>Among all participants, the majority were male (93.3%) with a mean age of 53.2±12.1 years. After implementing the LYFE app, 90% adhered to regular exercise, 79.3% to prescribed diet and 79.3% reported that they had no difficulty in remembering medication over 6 months. Additionally, notable improvements were observed in the well-being of the participants using the Dartmouth COOP questionnaire. Furthermore, the intervention significantly reduced SBP (-5.52 mmHg, p=0.038), and DBP (-2.63 mmHg, p=0.044) over 6-month follow-up. By the end of the study, 88.9% of the patients had their blood pressure under control. No cardiovascular death or major bleeding events were reported.</p> <p><strong>Conclusions: </strong>LYFE has the potential to enhance cardiovascular health and well-being in CAD and/or post-PCI patients.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine A study of potency determination of 3C antimuonium crudum in the treatment of corn 2024-01-25T08:49:04+0530 Rekha Kumar Aarti Prajapati Pooja Prajapati <p><strong>Background: </strong>Planter skin is anatomically different from the normal skin of the body due to prominence of keratin filaments such as k6, k7, k9, k16 and k17. As per Hahnemann statement in chronic disease, Antimuonium crudum is basically the native ore (persulphuric of antimony) found in blocks of parallel block needle with a metallic lustre and are composed of twenty-eight parts of sulphur combined with 100 parts of metallic antimony.</p> <p><strong>Methods: </strong>An observational comparative prospective open label study was conducted from September 2019 to September 2020. 32 patients were included in the study. Follow up of the cases were done after every 15 days where the size of the corn was measured using a vernier caliper. Height, width and diameter of the corn was also measured pre and post-treatment to analyse the results.</p> <p><strong>Results: </strong>A total of 32 patients were studied. The size of the corn was considerably reduced after taking the medication. There was a significant reduction in the intensity of the pain due to corn after medication as well.</p> <p><strong>Conclusions: </strong>There is a significant reduction of disease intensity score, after the homoeopathic treatment. Which shows the efficacy and potency of 3C Antimuonium crudum in the treatment of corn.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Recurrent hypocalcemia due to postoperative total thyroidectomy: a case report 2024-02-07T20:34:33+0530 I. Dewa Gede Amara Putra Wibawa Dewi Catur Wulandari <p>Hypocalcemia is a common complication following total thyroidectomy, caused by inadvertent damage or removal of the parathyroid glands responsible for calcium regulation. This condition poses a significant challenge in postoperative management, often leading to symptoms such as carpopedal spasm, convulsion, and airway constriction occur during hypocalcemia. Patients undergoing total thyroidectomy require vigilant monitoring of serum calcium levels, especially in the immediate postoperative period. Treatment typically involves calcium to prevent hypocalcemic episodes. Long-term management strategies may include the use of calcitriol. We report 30-years-old Indonesian woman suffer hypoparathyroidism because postoperative total thyroidectomy. For a month she did not have any complaints after being prescribed calcium supplement and levothyroxine. But she has stopped the calcium supplement and levothyroxine for 2 days, then she went to emergency room with stiffness all part of body. This report describes proper education of patients on recognizing symptoms of hypocalcemia and ensuring regular follow-up care are essential to prevent complications and improve quality of life post-thyroidectomy.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine A rare case of acquired hemophilia A 2024-01-01T11:17:36+0530 Shipra Gulati Rishikesh Dessai Kunal Chawla Anjali Pandey <p>Acquired hemophilia A (AHA) is a rare bleeding disorder characterized by IgG autoantibodies directed against circulating coagulation factor (F) VIII neutralizing its coagulant function. The usual clinical presentation of AHA is spontaneous or provoked bleeding in a person with a negative personal or family history of a coagulopathy and can lead life threatening bleeding especially in older patients. Here we report a case of 54-year-old male patient presenting with blood and passage of clots in urine. He was treated with recombinant factor VII and VIII with steroid as eradication therapy. Underlying cause remained unclear in this case.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Rare presentations of Sjogren syndrome 2024-03-12T20:39:28+0530 Miet D. Shah Atiullah I. Malik Niharika H. Gill Murtuza N. Ghiya Ashish K. Jain <p>Sjögren’s syndrome is a chronic systemic autoimmune disease characterized by lymphocytic infiltration of exocrine glands. It most commonly presenting with sicca symptoms. Sicca refers to dryness most often involving the eyes and mouth due to inflammation and resultant pathology of the lacrimal and salivary glands. Up to one-half of affected individuals also develop extra-glandular involvement in organs such as the joints, skin, lungs, gastrointestinal (GI) tract, nervous system, and kidneys. This condition is frequently associated with other autoimmune disorders including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) - called the secondary Sjogrens syndrome. Evaluation of a patient with suspected Sjogren syndrome should include an evaluation of oral and ocular dryness and function. In addition to the history, this may include the performance of a Schirmer test, slit-lamp exam with vital dye staining, salivary flow rate, and/or nuclear scintigraphic evaluation of the salivary glandular function. Assessment of autoantibodies (ANA, RF, SS-A, and SS-B) should also be performed. Of these, SS-A is probably the most sensitive and specific antibody for Sjogren's but alone is not diagnostic since it may be present in other autoimmune disorders and may be absent in up to a third of Sjogren cases. The most specific single test is a minor salivary gland (lip) biopsy which will demonstrate focal lymphocytic sialadenitis (FLS). Therapies are directed toward replacing moisture at affected glandular sites and suppressing the autoimmune response locally as well as systemically. This activity reviews the evaluation and management of Sjogren syndrome and explains the different rare presentations in which it can present.</p> <p> </p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Lower limb lymphedema mimicking as elephantiasis in intravenous drug user 2024-01-22T11:04:38+0530 Shubham Aryan Mandeep Singh Chavi Sharma Himanshu Khutan Jasmeen Chahal Naveen Kumar <p>India been the population of over a billion, it is estimated that 62.5 million people use alcohol, 8.75 million use cannabis, two million use opiates, and 0.6 million use sedatives or hypnotics. Intravenous (IV) drug abuse is fairly spreading throughout the country. Rapid urbanization and migration to metro cities have led to disturbance in the social life render an individual more vulnerable to stresses and strain of modern life and with easy availability of drugs, sharing needle, peer pressure are also among the commonest reason for exponential rise of intravenous drug user (IVDU) especially among the young generation. IV drug abuse is one of most serious and social evil, prevailing in our society that leads to number of infections from local cutaneous infections to dreadful like human immuno-deficiency virus (HIV) which in turn not only increase the morbidity but mortality as well. Here we have patient who had history of IV drug injection to lower limb that led to chronic lower limb swelling which on further investigation turns out to be grade IV lymphedema.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine Acute mercury poisoning complicated by gastrointestinal bleeding 2024-03-21T12:44:15+0530 Manna Bhattacharjee Ashok K. Mahawar XFGHHJ@GMAIL.COM Harshkumar Paghdar <p>Mercury poisoning is a rare but potentially serious condition that can result from environmental exposure to elemental mercury. We present a case of a 22-year-young male who presented to the emergency department (ED) with symptoms of mercury poisoning after his family members brought home a vial of elemental mercury. The patient experienced nausea, anxiety, abdominal pain, diarrhea, and fever. Despite normal initial laboratory tests and imaging studies, a presumptive diagnosis of mercury poisoning was made based on the patient's history of exposure and clinical presentation. Although his hospital stay was complicated by passage of blood in stool, possibly lower GI bleed, but treatment with N-acetylcysteine (NAC) was initiated empirically, leading to resolution of symptoms and a favorable outcome. This case highlights the importance of considering mercury poisoning in patients with appropriate exposure history and the effectiveness of NAC in the treatment of acute mercury poisoning. Public education on the hazards of mercury and the importance of prompt recognition and treatment are essential in preventing severe complications associated with mercury exposure.</p> 2024-04-26T00:00:00+0530 Copyright (c) 2024 International Journal of Advances in Medicine