International Journal of Advances in Medicine <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> Medip Academy en-US International Journal of Advances in Medicine 2349-3925 Scope of dermatological practice among transgenders seeking cosmetic advice <p>Transgender women are persons who are assigned male at birth, but who identify themselves as women. They aspire to display female characteristics both in appearance and attitude. Transgender women try to exhibit their female sexuality through the extensive usage of cosmetological interventions such as epilation of facial hair, control of acne, whitening treatments and excessive usage of makeup on face as the face serves as the part of body that helps to project their sexual characteristics. The prolonged and inappropriate usage of such interventions can lead to complications for which these group of individuals seek Dermatologic advice. Due to the rampant usage of steroid containing creams by our population in general and transgender community in particular as a means to overcome body dysmorphia, dermatologists have the responsibility to give proper advice regarding the complications following any cosmetological interventions. We report three transgender females who came to the OPD with skin thinning, acne, hypertrichosis and telangiectasia following the usage of topical steroid containing facial whitening creams.</p> <p> </p> Sukhada Anilkumar Irene Nirmala Thomas Nithya Priyadharshini Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 377 380 10.18203/2349-3933.ijam20241632 Relationship between neutrophil to lymphocytes ratio, red cell distribution width, procalcitonin, neutrophil to albumin ratio, and bun to albumin ratio with mortality of severe cap patients with septic shock <p><strong>Background:</strong> Septic shock is one of severe community-acquired pneumonia (CAP) complication with high mortality. Various laboratory parameters had been associated with poor outcome including neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), procalcitonin, neutrophil to albumin ratio (NAR), and bun to albumin ratio (BAR). This study aimed to know the relationship between inflammatory markers with mortality of severe CAP patients with septic shock.</p> <p><strong>Methods:</strong> This study is an observational analytic study using a cohort retrospective design conducted in Prof. I.G.N.G. Ngoerah General Hospital over a 3 years’ period (January 2020 to July 2023). The relative risk (RR) values showed relative risk of each parameter to mortality.</p> <p><strong>Results:</strong> Of total 73 subjects, mortality was found in 68.5%. Male predominance was found (65.8%). Comorbid disease was reported in 69 subjects (94.5%), most found was cardiovascular disease (63%). Majority of the subjects did not have history of prior antibiotics use (86.3%). In multivariate analysis, it was found that NLR with cutoff ≥16.5 (p value 0.044; 95% CI 1.039-14.011; RR 3.816), procalcitonin ≥1.82 (p value 0.029; 95% CI 1.148-13.560; RR 3.945), and BAR ≥8.13 (p value 0.003; 95% CI 1.961-21.912; RR 7.399) are associated with mortality. There was no relationship between RDW ≥14.65 (p value 0.159; 95% CI 0.658-12.877) and NAR ≥4.5 (p value 0.436; 95% CI 0.429-7.106) with mortality in this study.</p> <p><strong>Conclusions:</strong> Mortality of severe CAP patients with septic shock in this study is high. Higher NLR, procalcitonin, and BAR values have a significant relationship with mortality of severe CAP patients with septic shock.</p> Kadek Mien Dwi Cahyani Ni Wayan Candrawati Ni Luh Putu Eka Arisanti Ketut Suryana Ida Ayu Jasminarti Dwi Kusumawardani I. Gusti Ngurah Bagus Artana Ida Bagus Ngurah Rai Copyright (c) 2024 International Journal of Advances in Medicine 2024-05-09 2024-05-09 11 4 291 298 10.18203/2349-3933.ijam20241296 Fast-track paediatric and adult congenital cardiac surgery <p><strong>Background:</strong> Aim of the study was to evaluate the benefits and predictors of success of fast-track and ultra-fast track paediatric and congenital cardiac surgery.</p> <p><strong>Methods:</strong> Retrospective observational study of paediatric and adult congenital cardiac surgical patients presented for surgery in period between October 2023 and April 2024 at Queen Alia heart institute (QAHI). Patients’ demographic, clinical and perioperative date were collected and analysed. Patients were divided into groups according to their extubation time: UFTE (Ultra-fast track extubation group, FTE (Fast-track extubation) group, CE (Conventional extubation) group and DE (Delayed extubation) group. All groups were compared in reference to their age, weight, CPB time, AXC time, length of ICU stay and hospitalisation time. Statistical analysis was done to determine the benefits of early extubation after paediatric and congenital cardiac surgery. Predictors of early and DE were studied.</p> <p><strong>Results:</strong> Data of 73 paediatric and adult congenital cardiac surgical patients was reviewed and analysed. Patients were 37 males and 36 females. Average age of patients was 11.1 years (ranged from 5 days to 57 years). Average weight of patients was 29.3 kg (ranged from 2.4 to 109 kg) and average height was 104.8 cm. Average time of tracheal extubation was 13.1 hours (ranged from 0 to 168 hours). UFTE was accomplished in 11 patients (15.1%). FTE was done in 19 patients (26%). CE (between was 6 and 24 hours) was carried out in 38 patients (52.1%) and DE (after more than 24 hours) was noted in 5 patients (6.8%). The average ICU stay was 3 days (ranged from 1 to 15 days). Patients from the UFTE group had the shortest average ICU stay of 1.2 days, while patients from the FTE group had an average ICU stay of 1.9 days. Patients from the CE and the DE groups had an average ICU stay of 4 days and 9.4 days, respectively. Length of hospitalisation was shortest in the UFTE group with an average of 6 days. The hospitalisation time doubled in the DE group to 12 days. The shorter the CPB and AXC times the more likely patients were to have UFTE and FTE. Neonates were less likely to have UFTE and FTE.</p> <p><strong>Conclusions:</strong> UFTE and FTE were associated with shorter ICU stay and hospitalisation time. Predictors of UFTE and FTE were simple cardiac procedures, shorter CPB and AXC durations. Neonatal age and low body weight paediatric cardiac surgical patients were predictors for conventional or DE.</p> <p><strong> </strong></p> Ammar Mohammad Alomari Youssef Jamal Zureiqat Issa Hijazi Safwan Al-Fawares Monir Al-Dogum Ashraf Fadel Mohd Copyright (c) 2024 International Journal of Advances in Medicine 2024-05-18 2024-05-18 11 4 299 303 10.18203/2349-3933.ijam20241309 Examining the prevalence of cardiovascular complications among individuals with early-onset type 2 diabetes: a cross-sectional analysis at a tertiary care hospital <p><strong>Background:</strong> Type 2 diabetes mellitus poses a global health threat, with over 60% of cases in Asia. T2DM significantly increases the risk of diabetic cardiomyopathy and cardiovascular disease, contributing to heart failure through mechanisms like myocardial infarction. Diabetic patients face a two to fourfold increased likelihood of developing coronary artery disease and myocardial infarction. The objective of this investigation was to assess the frequency of cardiovascular complications in individuals with early-onset type 2 diabetes.</p> <p><strong>Methods:</strong> This cross-sectional observational study was conducted at the Department of Cardiology, Jashore Medical College, Jashore, Bangladesh. The study duration was one year from January 2023 to December 2023. and focused on adult Type 2 Diabetes patients admitted to tertiary care wards. Inclusion criteria encompassed ages 20-35, both sexes, Type 2 Diabetes diagnosis, and voluntary participation. Exclusion criteria included age under 20, severe concomitant diseases, Gestational Diabetes, advanced renal failure, and Type 1 Diabetes.</p> <p><strong>Results:</strong> This study analyzed 270 cases, with participants predominantly aged 32-35 years (48.52%). Gender distribution showed 56.36% female and 43.64% male participants. Echocardiographic findings revealed normal electrocardiograms in 81.82% of cases, with myocardial infarction observed in 16 cases showing diverse cardiac abnormalities. Diabetic patients exhibited left ventricular diastolic dysfunction 1(0.91%) and hypertrophy 2(1.82%).</p> <p><strong>Conclusions:</strong> The high prevalence of risk factors like obesity and hypertension highlights the intricate connection between metabolic and cardiovascular health. Early monitoring and intervention in young adults with type 2 diabetes are crucial for reducing cardiovascular risks.</p> M. Shawqat Ali Golam Mahfuz Rabbani Mohammad Touhidul Islam Muhammad Fazlul Haque Khalid M. Monirul Islam M. Hamid Uddin Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 304 308 10.18203/2349-3933.ijam20241621 Microbial patterns in acute exacerbation of chronic obstructive pulmonary disease at tertiary care <p><strong>Background:</strong> In patients experiencing acute exacerbation of chronic obstructive pulmonary disease, infections represent a prevalent cause of mortality.</p> <p><strong>Methods:</strong> This study comprised a prospective cohort analysis involving 50 AECOPD patients at a tertiary care hospital located in Cumilla. The sputum culture of these patients was assessed to detect the presence of Gram-positive and Gram-negative microorganisms. Additionally, the sensitivity and resistance patterns of these microorganisms to commonly prescribed antibiotics were investigated.</p> <p><strong>Results:</strong> From January 2023 July 2023, sputum cultures of 42% of patients yielded positive results for pathogenic microorganisms. Predominantly, gram-negative organisms such as <em>Klebsiella</em>, <em>Citrobacter</em>, <em>Pseudomonas</em>, and <em>Acinetobacter</em> were isolated. The most prevalent age group among the fifty patients was 61-80 years, constituting 70% of the sample. Subsequently, the age groups of 41-60 years and 81-100 years represented 18% and 12% of the cohort, respectively. Among clinically diagnosed COPD patients experiencing acute exacerbations, 90% were male, with the majority being smokers or exposed to passive smoking. Notably, 26% of patients had a family history of COPD. Furthermore, 97% of patients had a history of respiratory infections, with 20% experiencing upper respiratory tract infections and 80% suffering from lower respiratory tract infections, including acute bronchiolitis, pneumonia, and tracheitis.</p> <p><strong>Conclusions:</strong> Klebsiella exhibited relatively high susceptibility to antibiotics such as amoxicillin, azithromycin, ciprofloxacin, and cephalosporins. Conversely, <em>Citrobacter</em> and <em>Pseudomonas</em> displayed diverse susceptibility profiles, showing varying responses to different antibiotics. Additionally, <em>Acinetobacter</em> demonstrated relatively lower susceptibility to several antibiotics tested, suggesting potential challenges in its management.</p> Mohammad Amir Hossain Miah Mohammad Abdul Mannan Mirza Mohammad Idris Ali Mohammad Delwar Jahan Khan A. F. M. Abdul Hoque Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 309 313 10.18203/2349-3933.ijam20241622 Exploring the seasonal impact on appendectomy: incidence, patterns, predictors, and healthcare implication of appendectomy at Prince Ali military hospital <p><strong>Background:</strong> This study at Prince Ali military hospital in Al Karak, Jordan, investigates seasonal variations in appendicitis incidence and outcomes, assessing diagnostic and treatment strategies across different seasons. The aim is to understand how seasonal changes influence appendicitis rates and to evaluate the effectiveness of diagnostic methods and treatment approaches.</p> <p><strong>Methods:</strong> A retrospective observational study was conducted on 321 confirmed cases of inflamed or perforated appendicitis from March 2021 to February 2024. Patient demographics, dates of surgery, surgical interventions, and postoperative complications were analyzed, with a focus on seasonal trends.</p> <p><strong>Results: </strong>Out of 394 reviewed cases, 321 (81.47%) met the inclusion criteria, showing significant seasonal variations in appendicitis incidence. Autumn saw the highest rate of appendicitis cases at 32.09% while the lowest was in Winter (22.12%). Regarding normal appendix, the highest rate was in winter (21.98%), and the lowest was in summer (13.09%). The mean patient age was 25.20 years, with a majority being male (66.36%). Open surgeries were the most common, comprising 91.9% of cases, compared to 8.1% for laparoscopic procedures. Diagnostic analysis revealed a very strong correlation between CT findings and histopathological outcomes (p=3.23×10^-11) and a significant but less strong correlation for ultrasound findings (p=0.000446). These results suggest that both diagnostic methods are effective, with CT scans showing a stronger correlation. The distribution of cases across seasons was 32.087% in autumn, 23.05% in spring, 22.741% in summer, and 22.118% in winter.</p> <p><strong>Conclusions:</strong> Significant seasonal peaks in appendicitis are evident, particularly in autumn, driven by changes in diet and viral infections. The superior effectiveness of CT scans during winter highlights the need for adaptive diagnostic strategies across seasons. These findings advocate for healthcare systems to seasonally adjust resources and diagnostics to optimize appendicitis management, with further research needed to expand these insights globally.</p> Bilal Al-Bdour Wael Alshoubaki Rawan M. Ayyad Murad M. Hamiedeh Moath R. Alzboon Mohammad S. Khlifat Ahmad J. Saádeh Ahmad T. Alhabashneh Maysaa M. Al-lassasmeh Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-03 2024-06-03 11 4 314 318 10.18203/2349-3933.ijam20241593 Vitamin D status and its association with the severity of COVID-19 among hospitalized patients <p><strong>Background:</strong> Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), causing COVID-19, manifests with outcomes ranging from mild to severe, even fatal. The reason for severe symptoms remains unclear. Vitamin D is implicated in the pathogenesis of severe COVID-19, including ARDS, cytokine storms, and thrombotic complications. The aim of this study was evaluation of vitamin D status and its association with the severity of COVID-19 patients attending Bangabandhu Sheikh Mujib medical University (BSMMU).</p> <p><strong>Methods</strong><strong>:</strong> This cross-sectional study, conducted at BSMMU, Dhaka from January to December 2021, included 103 adult COVID-19-positive patients from both genders. Disease severity was assessed using WHO guidelines, and vitamin D levels recorded. Data were collected using a pre-designed datasheet after obtaining written informed consent.</p> <p><strong>Results: </strong>Among 103 COVID-19 patients, 55.3% were vitamin D deficient, 26.2% insufficient, and 18.4% sufficient. Most were male (65%) in their sixth and seventh decades. The mean vitamin D level was 20.97±10.96 ng/ml with a median of 18.10 ng/ml. Vitamin D deficiency was highest among critical patients (84.6%), followed by severe (71.1%), moderate (41.9%), and mild (28.6%) cases (p&lt;0.001). Severe patients had a significantly higher deficiency rate (74.5%) compared to non-severe (36.5%) cases (p&lt;0.001). Symptoms such as cough (96.5%), fever (89.5%), and shortness of breath (78.9%) were prevalent in the vitamin D deficiency group.</p> <p><strong>Conclusions: </strong>This study reveals a 55% prevalence of vitamin D deficiency in COVID-19 patients, correlating independently with disease severity. Hypertension and diabetes are notable comorbidities. It underscores the importance of assessing vitamin D levels in clinical practice.</p> Abir Hasan Dip Shaiful Azam Quadry M. Shariful Alam M. Tanimul Haque Rijvy Uma Dhar Shilpy Akter Hosneara Parvin Mohammad Arbab Sarker Shamim Ahmed Rajashish Chakrobortty Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 319 327 10.18203/2349-3933.ijam20241623 Factors associated with prolonged length of stay in dengue hemorrhagic fever patients at Wangaya Hospital, Denpasar, Bali <p><strong>Background:</strong> Dengue hemorrhagic fever (DHF) is a vector bone disease which is being a serious public health concern in tropical and sub-tropical countries around the world. A high number of dengue cases are reported annually in Bali. Prolonged hospital stays affect the high cost of dengue treatment. The aim of the study was to analyze the factors associated with prolonged lengths of stay in dengue hemorrhagic fever patients.</p> <p><strong>Methods:</strong> This study was an analytic observational study with a retrospective study design. The data was collected from the medical records of DHF patients at Wangaya Hospital between January - May 2024. The data analysis method used was the Chi square test as a bivariate test.</p> <p><strong>Results:</strong> A total of 152 subjects, mostly DHF patients, were male (54.61%), &lt;40 years old (73.68%), without comorbid disease (71.05%), without low food intake (56.58%), and with a length of stay ≥4 days (66.45%). Most of the patients (&gt;50%) had clinical symptoms of fever (100%), headache (91.45%), and myalgia (83.55%). A statistically significant association was found between comorbid disease and prolonged length of hospital stay with a p value of 0.039 (p&lt;0.05), and low food intake showed a significant association with prolonged length of stay with a p value of 0.001 (p&lt;0.05).</p> <p><strong>Conclusions:</strong> This study identified that comorbid disease and low food intake were factors associated with prolonged lengths of stay in DHF patients. Findings of this study may still prove beneficial for physicians to do early identification of DHF patients who have high risk factors for prolonged hospitalization, which can be an effective tool to combat the increasing disease burden.</p> <p> </p> Desak Putu Sukasanti Adi Kunti Ketut Suryana Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 328 332 10.18203/2349-3933.ijam20241624 Impact of body mass index on outcome of adult cardiac surgery <p><strong>Background:</strong> The objectives of study were to determine the incidence of overweight and obesity in adult cardiac surgical patients, and to evaluate the impact of BMI on outcome from cardiac surgery.</p> <p><strong>Methods:</strong> Retrospective observational analysis of data of adult cardiac surgery at Queen Alia heart institute (QAHI) in the period of time between September 2023 and February 2024. Patients’ data were recorded and analysed. Patients were divided in categories according to the world health organisation (WHO) body mass index (BMI) classification. The WHO BMI categories were compared regarding their pre-operative, intra-operative and post-operative characteristics. Recovery parameters such as extubation time, length of ICU stay, length of hospitalisation and mortality were also compared between normal weight, overweight and obesity categories. Ethical committee approval obtained.</p> <p><strong>Results:</strong> Data from 141adult cardiac surgical patients was analysed. Male patients were 115 (81.56%) and female patients were 26 (18.44%) with a male to female ratio of 4.4. Mean age of patients was 56.66 (SD 10.26). Majority of patients were obese (39%) and overweight (34%). The Incidence of diabetes in the normal weight category was 41.7%; while in the overweight category it increased to 58.4% and reached 60% in the obese category. The incidence of hypertension (75% in the overweight and 76.4% in the obese categories) increased with the increase of the BMI. Obese category had prolonged mean duration of hospitalisation (13 days); however, lower rates of re-opening and mortality.</p> <p><strong>Conclusions:</strong> Most of the adult cardiac surgical patients in this study are obese and overweight. The overweight and obese patients had higher rates of hypertension, diabetes and ischaemic heart disease. Longer hospitalisation and lower mortality rates were noted in patients with higher BMI.</p> Anan Hasan Qabaha Safwan Galeb Al-Fawares AbdaAllah Ibrahim Alqaisi Wael Ibrahim Alshobaki Rawand Hayel Al-Adwan Ashraf Fadel Mohd Nisrein Mousa Al-Aqqad Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-05 2024-06-05 11 4 333 337 10.18203/2349-3933.ijam20241597 Effectiveness of ultrasound guided platelet rich plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function in medial epicondylitis of elbow: a randomized controlled trial <p><strong>Background: </strong>Effectiveness of ultrasound guided Platelet Rich Plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function in medial epicondylitis of elbow: A randomized controlled trial Objective was to determine the effectiveness of ultrasound guided Platelet Rich Plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function in medial epicondylitis of elbow.</p> <p><strong>Methods:</strong> Randomized controlled trial was conducted on fifty-four patients with medial epicondylitis of elbow attending Sports Medicine OPD at RIMS, hospital, Imphal, were selected for this study and randomized into 2 treatment groups: platelet rich plasma injection and extracorporeal shock wave therapy. The outcome measures were visual analog scale and Mayo elbow performance score. For descriptive statistics mean, standard deviation and frequency were used. Students t-test and Chi square tests were used for analysis of different variables. A p-value &lt;0.05 was taken as significant.</p> <p><strong>Results: </strong>The baseline characteristics of the patients in the control and intervention group were not statistically significant. At the end of 12 weeks and 24 weeks, there was statistically significant improvement in both mean difference of VAS (p=0.04) (p=0.03) and MEPS (p=0.00) (p=0.03) from baseline in both the groups but this improvement was significantly more in the PRP group.</p> <p><strong>Conclusions: </strong>Platelet rich plasma injection is superior to extracorporeal shock wave therapy on improving pain and function in medial epicondylitis at the end of 6 months.</p> Sagolsem Adarsh Singh Akoijam Joy Singh Yumnam Nandabir Singh Yumnam Ningthemba Singh Pheiroijam Bhupes Kongkham Purnimala Chanu Laimujam Sobhasini Devi Ramkumar R. Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 338 343 10.18203/2349-3933.ijam20241625 Correlation of ECHO findings with duration of hospital stay in heart failure patients <p><strong>Background: </strong>The study aimed to assess the correlation, if any, between echocardiographic findings of heart failure patients and their duration of hospital stay</p> <p><strong>Methods: </strong>A retrospective, analytical study was conducted at a tertiary care centre in Chennai to assess the correlation between the duration of hospital stay and the severity of heart failure, determined by echocardiographic findings. The study population of 50 heart failure cases were categorised into heart failure with preserved EF, heart failure with mid-range EF, heart failure with reduced EF as per the 2022 AHA/ACC/HFSA guideline for the management of heart failure. Each case was assessed based on age, sex, comorbidities, symptomology at the time of admission based on NYHA classification.</p> <p><strong>Results: </strong>Of the 50 heart failure cases, 33 (66%) patients had HFrEF, 12 (24%) had HFmrEF and 5 (10%) had HFpEF. As per NYHA functional classification of effort-related dyspnoea, 12% belonged to class 1, 34% to class 2, another 34% to class 3 and 20% to class 4 heart failure. The mean duration of hospital stay was 7.2 days, with the longest duration of stay being 22 days and the shortest, only 2 days.</p> <p><strong>Conclusions:</strong> A fall in ejection fraction in a case of heart failure tends to lead to a longer duration of hospital stay. It was found that older patients and those with more comorbidities were also hospitalized for a greater period of time.</p> Aishwarya Harikrishnan N. Gunasekaran Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 344 347 10.18203/2349-3933.ijam20241626 Assessment of the effectiveness of artificial intelligence-based oral screening solution in the diagnosis of dental calculus, stains, and dental caries (Logy AI oral screening solution) <p><strong>Background:</strong> The objective of this study was to clinically evaluate the precision of Logy AI's oral screening solution. This innovative module, driven by artificial intelligence, operates seamlessly through WhatsApp and as a standalone smartphone application. It is designed to detect various dental issues such as stains, calculus, and caries, utilizing images captured by a smartphone camera. The accuracy of the module was assessed by comparing its diagnoses with those made by dental professionals.</p> <p><strong>Methods:</strong> A prospective clinical study was conducted in Saveetha Dental College, a tertiary care hospital in the southern part of India with 325 patients. Smartphone images taken were sent to the Logy AI oral screening solution which predicted if the patient had any oral hygiene issues like stains, calculus, and caries. Patients were examined by a dentist with visual-tactile and orthopantomogram (OPG) examination and were documented. Both were compared.</p> <p><strong>Results:</strong> The accuracy of the Logy AI oral screening solution for the detection of stains, calculus, and caries was comparable with the dentist's diagnosis. The accuracy was 85% for caries, 97% for stains, and 83% for calculus. The sensitivity was 88% for caries, 89% for stains, and 82% for calculus.</p> <p><strong>Conclusions:</strong> The Logy AI oral screening module demonstrates potential as an efficient oral screening tool suitable for community-level deployment, particularly in remote regions lacking access to costly dental equipment and healthcare professionals. Its accuracy and efficiency make it well-suited for operation in low-resource settings. Moreover, it holds promise as a valuable home screening tool for individuals seeking to monitor their oral health proactively.</p> Pradeep Kumar R. Nivedita Tiwari Anand Panchbhai Lalitha R. Chellappa Sushanthi Suresh Indumathy Pandiyan Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 348 352 10.18203/2349-3933.ijam20241627 Expert opinion on the prescription practice of vildagliptin and its combinations in managing type 2 diabetes mellitus in Indian settings <p><strong>Background:</strong> The aim of the study was to gather expert opinion regarding the use of vildagliptin and its combinations in T2DM in Indian settings.</p> <p><strong>Methods:</strong> This cross-sectional study involved 24 questions and collected perspectives of experts across various clinical settings in India regarding the use of vildagliptin and its combinations for the management of type 2 diabetes mellitus (T2DM) in their clinical practice.</p> <p><strong>Results:</strong> Among 195 participants, most clinicians (73%) advocated vildagliptin once-daily formulation for newly diagnosed young diabetics, elderly patients with long-standing diabetes, and those with uncontrolled diabetes as an add-on therapy. Around 92% favored vildagliptin for its weight-neutral nature, preservation of beta-cell function, minimal glycemic variation, and low risk of adverse effects. Most clinicians (66%) preferred initiating vildagliptin and metformin combination therapy in diabetic individuals aged 40 to 50 years, with 53% opting for it when HbA1c levels exceeded 8%. Approximately 83% favored this combination for young, elderly, and long-standing diabetic individuals. More than half (54%) of the clinicians preferred prescribing the fixed-dose combination (FDC) of vildagliptin and dapagliflozin to 11-25% of the patients. </p> <p><strong>Conclusions:</strong> The survey underscored the effectiveness of vildagliptin and its combinations in managing T2DM. Clinicians widely endorsed vildagliptin once-daily formulation and vildagliptin and metformin therapy for diverse diabetic populations due to their efficacy and tolerability. They also advocated the use of vildagliptin and dapagliflozin therapy, especially in patients with specific comorbidities or higher HbA1c levels, citing its benefits in achieving better glycemic control and reducing disease progression.</p> <p> </p> Manjula S. Krishna Kumar M. Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 353 358 10.18203/2349-3933.ijam20241628 Study on analysis of gender trends among the first authors of publications on Kawasaki disease <p><strong>Background:</strong> Kawasaki disease is an inflammatory disorder predominantly affecting children less than 5 years of age. If left untreated, it has the potential to cause life-threatening cardiac complications. There have been numerous articles published on it concerning various aspects of the disease over the last 20 years. Thus, the study aims to compare the number of male and female first authors for published Kawasaki disease articles and study whether there is any association between gender and country.</p> <p><strong>Methods:</strong> This is a cross-sectional observational study wherein published articles on Kawasaki disease over the last 20 years were assessed and the names of their first authors determined. Subsequently, NamSor was used to establish the gender of the first author. ARIMA (Auto Regressive integrated moving average) was used for statistical analysis.</p> <p><strong>Results: </strong>Data evaluation demonstrated that 51% were male first authors, 36% were female first authors, and 12% did not have a clearly determined gender. Males as first authors have been unwaveringly higher in number than females annually. When gender trends are compared globally, there is a statistically significant association between gender and country, with Greece and Finland having the highest female-to-male ratios.</p> <p><strong>Conclusions: </strong>Although recent years have seen an increase in the number of female first authors, gender disparity still continues to prevail in medical research. This gap has to be eliminated in order to gain dynamic insight from all genders, which can help form a better understanding and further the cause of innovation in not just Kawasaki disease but any other subject of discussion.</p> <p><strong> </strong></p> Heena Patel Cynthia Bennet Sakshi Muskawad Amina Shareef Muzamil Khan Snehdeep Kaur Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 359 363 10.18203/2349-3933.ijam20241629 The scourge of carbapenem resistant Enterobacteriaceae: how to fight back <p>The <em>Enterobacteriaceae</em> species cause both community acquired and health care associated infections like bloodstream infections, ventilator-associated pneumonia, intra-abdominal infections and urinary tract infections. Carbapenem-resistant <em>Enterobacteriaceae</em> (CRE) have been included in the list of global priority pathogens (GPP) declared by WHO in 2017. These infections pose a serious threat due to the associated significant morbidity and mortality. The mechanisms of antimicrobial resistance in these organisms are numerous; however, β-lactamase genes carried on mobile genetic elements are a key mechanism for the rapid spread of these antibiotic-resistant strains on a global scale. The carbapenem resistance (CR) in <em>Enterobacteriaceae</em> has been recognized for the past two decades, but the carbapenemase-producing <em>Enterobacteriaceae</em> (CPE) has been a more recent issue and is spreading at an alarming pace worldwide. In this article, we conducted a systematic literature search of the PubMed, Embase, Web of Science and Cochrane Library databases to identify relevant studies that reported the epidemiology and the outcomes for hospitalised patients with confirmed infections due to CRE and carbapenem-susceptible <em>Enterobacteriaceae</em> (CSE) published between 1 January 2010 and 30 August 2023.The results emphasize that patients with CRE infection still face a greater risk of mortality and need an urgent need for newer antibiotics and appropriate treatment regimens to reduce the risk of morbidity and mortality.</p> Samveda S. Samel Suruchi S. Mandrekar Prashant N. Walse Syed Haroon Iqubal Raja Y. Bafna Mrityunjay K. Singh Paresh P. Alwani Bharatkumar D. Dholu Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 364 371 10.18203/2349-3933.ijam20241630 Study on analysis of gender disparities among the first authors of publications on Menetriers disease <p>The disparities in gender representation within academic writing highlight pervasive social prejudices and inequalities, with male researchers predominating in both quantity and visibility, perpetuating a cycle of unequal representation. This imbalance limits the diversity of perspectives in intellectual discourse. However, there has been a noticeable increase in the representation of female authors, breaking traditional gender barriers. This research article aims to investigate gender disparities among first authors in medical literature concerning Menetrier's disease over the past 22 years. A cross-sectional study of 130 relevant publications from PubMed between January 2001 and December 2022 was conducted, analyzing the gender distribution of first authors using SPSS software. Results indicate that 70.7% of the articles had male first authors, with intermittent periods of female author prominence. While countries like China, Spain, and Italy showed relatively equitable gender ratios, others such as Japan, Turkey, India, and the Republic of Korea exhibited significant male dominance. However, no significant association between gender and country of authors was found. Despite these findings, limitations include potential errors in gender determination methods, focusing solely on first authorship, and overlooking contributions from co-authors, while the selected journals and countries may not fully represent global gender disparities.</p> Ahmed Gomma Muawia Yousif Fadlelmola Mohamed Vyshnav Rajagopal Menon Hozaifa Elameen Aparna Krishnan Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 372 376 10.18203/2349-3933.ijam20241631 Human immunodeficiency virus infected patient with decreased of consciousness, what do we think? <p>Central nervous system (CNS) disorders are estimated to occur in approximately 10-20% of people living with human immunodeficiency virus (HIV). Neurological manifestations in HIV-infected patients can be caused directly by HIV or by opportunistic infections. Here we present a case report of a 47-year-old male initially diagnosed with decreased of consciousness in HIV-infected patients on ARV. Differential diagnosis of HIV-infected patients with decreased consciousness must be made. We can consider causes of opportunistic infections such as toxoplasma encephalitis, HIV encephalitis, or both.</p> Desak Putu Sukasanti Adi Kunti Ketut Suryana Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-05 2024-06-05 11 4 381 383 10.18203/2349-3933.ijam20241596 Systemic lupus erythematous in men with interstitial lung pneumonia: a rare case report <p>Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with unknown etiology and very diverse clinical manifestations, disease course, and prognosis. It is most common in African-American women, the prevalence being 4 per 1000 females. SLE predominantly affects young women, most presenting between 20 and 40 years of age. Male SLE is rare, with only one male patient reported per nine females. Pulmonary involvement in SLE is various. SLE-associated interstitial lung disease (ILD), while rare, is a predictor of poor prognosis. We report a 50-year-old male patient with complaints of shortness of breath, previously diagnosed with systemic lupus erythematous by examination of the antinuclear antibody (ANA) profile. The patient underwent a computed tomography (CT) scan of the thorax and the results showed interstitial lung pneumonia. The patient was given azathioprine and methylprednisolone therapy for Systemic lupus erythematous and ceftriaxone and acetylcysteine ​​for interstitial lung pneumonia.</p> I. Gusti Agung Dwi Putri Anjani I. Wayan Eka Saputra Putu Dyah Widyaningsih Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 384 388 10.18203/2349-3933.ijam20241633 Anaphylaxis shock with laryngeal edema: a case report <p>Anaphylaxis is a serious systemic or hypersensitivity reaction that rapid in onset and affect airway, breathing, and/or circulatory problems, and that is usually associated with skin and mucosal changes. Laryngeal edema is observed in 40-50% of death cases. A 49-year-old Asian female came to emergency department with chief complaint of difficulty to breath since 30 minutes ago after took cefixime and also common cold drug (Combination of paracetamol, glyceryl guaifenesin, phenylephrine, and Chlorpheniramine maleate). She also complained difficulty to speak and feeling strangulated on her neck. She ever had an allergic reaction, when she was child after suffering fever and common cold, but didn’t remember the name of the medication. History of food allergies was denied. On physical examination revealed, dyspnea and minimal tachycardia. Present of laryngeal edema, on auscultation stridor and wheezing on both lungs. Diagnosis of anaphylactic shock was made, and immediately giving epinephrin and followed by corticosteroid and antihistamine. The signs and symptoms of anaphylaxis might differ from patient to patient and impact the skin, gastrointestinal tract, respiratory system, and heart. Anaphylaxis fatal cases rise when laryngeal edema and cardiovascular organ involvement occur. The most frequent triggers are produced by food, venom from insects, and prescription drugs. The risk of death in anaphylaxis patients is decreased with prompt treatment. It is necessary to assess and maintain breathing, circulation, and airways in addition to determining the cause. Anaphylaxis can be potentially lethal or life-threatening, thus prompt identification and appropriate treatment are necessary.</p> <p> </p> Anak A. N. S. Pranata Dewi C. Wulandari Ni P. Setiawathi Ketut Suryana Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 389 393 10.18203/2349-3933.ijam20241634 Diagnosis and management approach of acute cholangitis with sepsis complications in a peripheral hospital: a case report <p>Acute cholangitis is a systemic, life-threatening condition that develops as a result of obstruction and infection of the bile ducts. The two main processes leading to acute cholangitis include obstruction of the biliary tract and the growth of bacteria in the bile. A case of acute cholangitis has been reported at Rote Ndao public hospital, Rote Ndao district, East Nusa Tenggara, in a 57-year-old woman, with the main complaint of right upper abdominal pain, jaundice, and fever. The diagnostic approach is based on anamnesis, physical examination, and supporting examinations. Based on the Tokyo guideline 2018 (TG18) the patient met a suspected diagnosis, with A criteria that was evidence of systemic inflammation in the form of fever (body temperature 38.7<sup>o</sup> C), evidence of an inflammatory response with increasing leukocyte count (26,200/cm<sup>3</sup>), and for the B criteria that was evidence of cholestasis in the form of jaundice, increasing of total bilirubin (19.8 mg/dL), abnormal liver function tests (SGOT 135 IU/L, SGPT 74 IU/L), while C criteria cannot be performed due to limited hospital imaging facilities. Limitations of investigations should not limit the diagnosis and initial management so it can give the good prognosis. Even though there were complications of sepsis, the patient did not experience signs of shock which could lead to mortality.</p> Maria D. Bria Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 394 396 10.18203/2349-3933.ijam20241635 Mucinous carcinoma of the appendix: a case report <p>Mucinous carcinoma of the appendix is ​​​​a rare malignant tumor of the appendix. Incidence ranges about 0.01-0.2% in cases of malignancy in the gastrointestinal tract. Clinically, the symptoms appear to resemble acute appendicitis. The diagnosis was established at intraoperative time. Studies on this case are still few. A 69-year-old man complained of lower right abdominal pain since 6 days before going to Sanjiwani hospital. The patient also complained of fever, nausea, decreased appetite and constipation. Examination results temperature 37.6 <sup>0</sup>C, McBurney sign (+), rebound tenderness (+), localized defense on lower right abdomen. Ultrasound examination of the abdomen with an impression of the end tubular structure, a peristaltic diameter of 0.87 cm accompanied by a fluid collection, suspicious of appendicitis with perforation. Inflamed appendix and localized mucin were found at ileocaecal junction intraoperatively. The patient underwent a right hemicolectomy. Histopathological examination revealed a morphological picture suitable for mucinous carcinoma of the appendix. Mucinous carcinoma of the appendix is ​​​​a rare malignant tumor of appendix. Patients can have the same symptoms as appendicitis. Ultrasound investigations can find a picture like appendicitis. Mucinous carcinoma of the appendix is ​​more frequently found intraoperatively. Histopathological examination is necessary to determine a definitive diagnosis of mucinous carcinoma of the appendix. In high grade appendiceal mucinous neoplasm (HAMN) a right hemicolectomy can be performed and continued with adjuvant chemotherapy.</p> Made Candra Aryadhana Timmy Yonatan Nangoy I. Gusti Agung Brama Wijaya Made Darmawan Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 397 401 10.18203/2349-3933.ijam20241636 Spinal dural arteriovenous fistula: a case-based review <p>Spinal dural arteriovenous fistula is an abnormal connection between radicular arteries and spinal venous plexus. This condition is relatively rare with annual incidence of five-ten cases per million. We present a case of a 62-year-old male with complaints of tingling in feet since six months and weakness in legs since 1 hour. Lower limb weakness progressed over a day to complete paralysis and bladder incontinence. Magnetic resonance imaging (MRI) spine showed a dural hypointensity over D6-D11 with abnormal vessels around spinal cord. Patient underwent spinal angiography which showed an intramedullary arteriovenous malformation causing compression. Arterial embolization was done within 24 hours from symptom onset and he ambulated within a week. AV malformations are a rare cause of compressive myelopathy presenting with acute paraplegia. Advances in endovascular techniques have made it possible to treat them early and prevent irreversible damage.</p> Gargee M. Pore Brig S. P. Gorthi Copyright (c) 2024 International Journal of Advances in Medicine 2024-05-07 2024-05-07 11 4 402 404 10.18203/2349-3933.ijam20241287 A rare case of invasive mucormycosis with thrombosis of cerebral vasculature in diabetic ketoacidosis <p>Mucormycosis is a rare fungal infection. It is an aggressive angio invasive infection hence if left untreated is always fatal. This necrotising infection commonly involves the nose, paranasal sinuses, orbits and brain. Uncontrolled diabetes, immunosuppression, transplant recipients, COVID-19 infection are the commonest risk factors. Most common form is rhino orbital cerebral involvement. Antifungal agents along with surgical debridement is the mainstay of treatment. We are reporting such a case of invasive mucormycosis in a young diabetic male to stress the importance of clinical examination and early recognition of clinical signs of this rare invasive infection and aggressive management.</p> <p> </p> Shahitha Sardar Suseendhran Srinivasan Samuthiravel Shanmugam Jagadeesan Mohanan Prasanna Karthik Suthakaran Damodaran Jeyachandran Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 405 407 10.18203/2349-3933.ijam20241637 Early diagnosis of Voh Winkel syndrome-inherited honeycombed hands and hearing loss <p>Voh-Winkel Syndrome with approximately 50 cases reported in literature is a rare inherited Palmoplantar keratoderma characterised by honeycomb like hyperkeratosis, hearing loss or ichthyosis. It also features constricting fibrous bands that develop at the base of fingers/toes and later get strangulated to cause autoamputation called pseudoainhum. It is an autosomal dominant disorder with mutations in loricrin and connexin genes leading to hearing loss and ichthyosis variants respectively and manifests in infancy and becomes apparent later in childhood or adult life. Early diagnosis of this condition and management by multiple specialities given the associated features therefore becomes an absolute necessity. An emphasis on dermatological examination to manage hyperkeratosis using topical and systemic therapy, otorhinolaryngology to manage hearing loss as well as plastic surgery to alleviate symptoms arising due to the constriction bands is mandatory for effective management of this condition. Here we report a 22-year-old female patient who came with Palmoplantar keratoderma, bilateral hearing loss and pseudo-ainhum.</p> <p> </p> Sukhada Anilkumar Irene Nirmala Thomas Vijayakumar Sukumaran Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 408 410 10.18203/2349-3933.ijam20241638 Hypovitaminosis-D and sexual dysfunction <p>Sex has a significant impact on a person's quality of life. Numerous elements, including endocrine, vascular, psychological, and neurological ones, have an impact on sexual function. Male and female sexual dysfunction is a prevalent issue in both sexes. About 30% of males and 40% of women are reported to have sexual dysfunction. The main factors influencing sexual responsiveness are neurological and endocrine activity. An increased risk of obstetric and gynecologic issues, including endometriosis, polycystic ovaries, infertility, gestational diabetes, preeclampsia, and ovarian and breast cancer, is also linked to vitamin-D insufficiency. Data from several studies conducted worldwide indicate that vitamin D is vital for both male and female sexual function.</p> Samreen M. Imran Khan Archna Saxena Rajarshi Chakraborty Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 411 414 10.18203/2349-3933.ijam20241639 Expert opinion on current issues and challenges in irritable bowel syndrome <p>Irritable bowel syndrome (IBS) is a widely prevalent functional gastrointestinal disorder characterized by symptoms such as abdominal pain, irregular bowel movements, and bloating, which significantly impact affected individuals' well-being. The increasing prevalence of IBS in India places a substantial burden on clinical practice. Although diagnostic criteria, such as the commonly used Rome IV criteria, have shown reasonable sensitivity, the diagnosis of IBS remains a nuanced and culturally influenced process. This comprehensive review systematically examines current challenges surrounding IBS prevalence, diagnostic intricacies, and the complex pathophysiology involving visceral hypersensitivity. The review highlights the imperative for noninvasive biomarkers to augment diagnostic precision and emphasizes on following a holistic approach to IBS management as advocated by Indian guidelines. This approach integrates dietary modifications, antispasmodic medications, psychological therapy, and yoga, with specific emphasis on tailoring treatments to individual IBS subtypes. Among antispasmodic drugs, pinaverium bromide because of its unique mechanism of action as a calcium channel antagonist within the gastrointestinal tract has shown promise in alleviating IBS symptoms.</p> Parimal Lawate Copyright (c) 2024 International Journal of Advances in Medicine 2024-06-25 2024-06-25 11 4 415 422 10.18203/2349-3933.ijam20241640