Journal of the Asian Medical Students Association
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The Potential of Folate-Positive Circulating Tumor Cells (FR+-CTC) as a Novel Diagnostic Biomarker for Non-Small Cell Lung Cancer: A Systematic Review of Clinical Trials
Full text linkAbstract
Background: Non-small-cell lung cancer (NSCLC) is malignancy that remains the leading cause for cancer mortalities. Diagnosis is often made in advanced stages, hence, the unmet need for novel diagnostic methods. FR+-CTC is acknowledged as a potential diagnostic biomarker that detects NSCLC presence, distinguishing it from benign lung diseases and healthy individuals.
Purpose of Study: This study aims to investigate the potential of FR+-CTC to be utilized as an accurate, sensitive, and specific diagnostic biomarker for NSCLC.
Methods: This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Studies were obtained from databases namely Wiley Online Library, MEDLINE, Science Direct, CENTRAL, and ProQuest. The outcome assessed includes summary receiver operating characteristics (sROC) evaluating diagnostic accuracy taking form of area under the curve (AUC) analysis. Risk of bias assessment is carried out using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).
Results: 5 studies confirm a higher amount of FR+-CTC in peripheral blood can be utilized as a diagnostic marker in NSCLC patients. Detection of FR+CTC in NSCLC diagnosis is superior to existing biomarkers with a sensitivity and specificity of 81.94% and 73.08%. FR+CTC presents the highest AUC (0.823; 95% CI, 0.773-0.874) compared to other biomarkers. FR +- CTC levels can differentiate the types of lung adenocarcinoma with acceptable sensitivity. Conclusion: FR+-CTC detection is a reliable diagnostic method with the highest degree of accuracy for diagnosing NSCLC compared to other biomarkers. FR+-CTC can also be utilized to predict possible malignancies, even in its early stages.
Keywords: Biomarkers, circulating tumor cells, diagnosis, folate receptor, lung cancer, NSCLC
 
Efficacy and Safety of Safinamide vs Opicapone as Adjuvant to Levodopa Therapy in Elderly with Parkinson’s Disease: A Network Meta-Analysis
Full text linkIntroduction: Parkinson's disease (PD) becomes a significant health problem in the elderly. This chronic and progressive neurodegenerative disease needs to be treated with dopamine agonists as a gold standard. The use of adjuvant therapies like safinamide and opicapone was considered a promising option to achieve a better outcome. However, they not have been compared in randomized controlled trials.
Objective: To compare the efficacy and safety of safinamide and opicapone as adjuncts to levodopa therapy in PD treatment.
Method: This systematic review and network meta-analysis of randomized controlled trials were conducted based on the PRISMA NMA Checklist of Items. The outcome of this study was the evaluation of the efficacy (ON-time, OFF-time, Unified Parkinson’s Disease Rating Scale [UPDRS-III], and the 39-Item Parkinson’s Disease Questionnaire [PDQ-39]) and safety of safinamide and opicapone in PD. Effect sizes were analyzed using both pairwise and Bayesian network meta-analyses.
Result: Fourteen RCTs were included in this study. The efficacy analyses showed that safinamide (MD = 0.87 h, 95% CrI = 0.31 - 1.48) was superior in increasing total ON-time compared to opicapone (MD = 0.82 h, 95% CrI = 0.18 - 1.47). Safinamide also showed superiority in reducing OFF-time (MD =-1.33 h, 95% CrI =-2.45 - -0.196), UPDRS-III score (MD =-2.8, 95% CrI =-3.92 - -1.66), and PDQ-39 score (MD =-2.05, 95% CrI =-3.47 - -0.702). Safety analysis also showed that safinamide (OR = 1.04, 95% CrI = 0.83 - 1.3) is more tolerable for older patients than opicapone (OR = 1.32, 95% CrI = 0.95 - 1.81).
Conclusion: In conclusion, our findings support the use of safinamide in elderly patients with PD, which effectively helps levodopa improve ON-time, better tolerating motor and non-motor features during the OFF period, and increasing the quality of life with minimal adverse effects
The Future Role of Student-Led Journal in Medical Education: 2022-2032
Full text linkFacing the ever-changing dynamics of the academic community, the significance of student-led journals becomes gradually pronounced. Better adaptation of the Journal will maximize the contribution to the medical education as well as cultivating quality research work. As the leading senior reviewer, my personal perspectives are addressed to the editors and in an attempt to propose future directions for such platform
Ginkgo Biloba Flavonoid Extracts as a Carbonic Anhydrase II Inhibitors for Acute Mountain Sickness Prevention: A Molecular Docking Study
Full text linkIntroduction
Based on research regarding phytomedicine as a prophylactic agent for acute mountain sickness (AMS), Ginkgo biloba extracts are among promising candidates. However, a mechanism of action of these extracts remains unknown. Previous studies have shown that some flavonoids, a phenolic metabolite found in various plants, have capability to inhibit carbonic anhydrase II (CAII), a zinc metalloenzyme that regulates acid-base homeostasis. This inhibition could potentially ameliorate an increase in systolic pressure and respiratory alkalosis found in AMS.
Objective
We aim to investigate effectiveness of flavonoid extracts from G biloba as CAII inhibitor for opening up more possibilities of new AMS drug development based on natural extracts.
Methods
Molecular docking technique was applied to screen candidate substances in order to shorten a period of the pre-clinical phase of drug development. Applying AutoDockVina docking and LigPlot+ interaction plotting, the results predict a binding affinity and interaction diagram of the coherence between the selected ligands and the CAII zinc binding site.
Results
All flavonoid extracts demonstrated higher binding affinity score compared to CAII original substrates: carbon dioxide and bicarbonate. Moreover, quercetin, the highest affinity flavonoid, has zinc interaction and H-bond on the enzyme active site, similar to natural ligands with the greater cohesion stability from higher hydrophobic contact.
Conclusions
From the affinity results, G Biloba flavonoids competitively inhibit CAII and consequently mitigate the AMS. They are, therefore, highly likely to be tested as substitute drugs for acetazolamide, which is currently commercially used, in order to reduce the potential side effects of synthetic drug and increase bioavailability. Since this study is a pre-screening in silico, further studies including molecular dynamic, preclinical and clinical testing are essential for further development of a drug for AMS.  
Clinical Profiles and Predictors of Traumatic Brain Injury Mortality: A Post Hoc Analysis
Full text linkIntroduction
Traumatic brain injury (TBI) can be life-threatening. Investigating its clinical profiles and mortality predictors is crucial for understanding the disease epidemiology, devising public health interventions, and improving patient outcomes.
Objective
To assess the correlation between age, sex, socioeconomic status, and the in-hospital mortality of TBI, and whether these factors are strong predictors of TBI patients’ outcomes.
Method
This retrospective study analyzed head trauma patients treated in the Emergency Department. A total of 140,806 cases from 2000 to 2021 were included from the Clinical Data Analysis and Reporting System (CDARS) Database using the following International Classification of Diseases, Ninth Revision (ICD9) codes: 800-804, 850-854, 873.8(4), 900(0). Patients were stratified by age, sex, and neighborhood socioeconomic status (based on their residential districts’ Social Deprivation Index [SDI]), and comparative analyses were performed using all-cause in-hospital mortality as the primary outcome measure.
Result
11,006 out of 140,806 TBI patients died from 2000 to 2021, yielding an all-cause mortality rate of 7.82%. Univariate analysis revealed that sex and age group were correlated with mortality rate differences. Male patients suffered higher mortality (8.15% vs 7.38%; Odd Ratio [OR]: 1.11, 95% Confidence Interval [CI]: 1.07-1.16, P < 0.0001), and so did elderly patients aged 70 years or above (14.8% vs 3.83%; OR: 4.37, 95% CI: 4.19 - 4.55, P < 0.0001).
However, the linear regression model of SDI vs mortality revealed no statistically significant correlation between neighborhood socioeconomic status and TBI mortality (R square = 0.006820; P = 0.3167).
Conclusion
Patients’ sex and age group were independent predictors of in-hospital mortality of TBI, with the strongest correlation observed in male patients aged ≥70. Higher neighborhood socioeconomic status, however, does not significantly protect against TBI mortality
False Negative Tests in Breast Cancer: A Case Report
Full text linkBackground: Breast cancer is the most common cancer worldwide. An early and accurate diagnosis is essential in optimizing the disease outcome. Triple assessment which includes clinical assessment, imaging and pathological examination is recommended for diagnosing breast cancer.
The Case: A 43-year-old lady with a strong family history of cancer presented with a right breast lump for 2 months. Physical examination revealed a 2x3 cm mass in the right breast with no malignancy features. Mammogram and ultrasound revealed BI-RADS 1 (negative) and BI-RADS 2 (benign) respectively. A lumpectomy was done, and the sample was sent for pathological examination. The result came back as a grade 2 invasive breast carcinoma, no special type, stage pT1b. ER was negative while PR and HER2 were not tested. The patient then underwent right total mastectomy with level II axillary clearance. CT thorax, abdomen & pelvis was scheduled a month later to complete the cancer staging. PR and HER2 status were tested for further management.
Conclusion: All 3 components of triple assessment is indispensable for diagnosing breast cancer. Despite the high sensitivity of imaging modalities, minimally invasive biopsy technique (MIBT) is still the gold standard. False-negative tests can happen due to multiple factors; they should not become the absolute guidance for further management of patients. A doctor’s clinical judgement, based on thorough history taking and physical examination, is more important in guiding the next step of patient care.
Key Words: Breast Neoplasms, Mammography, Ultrasonography, Biops
Asian Dementia: A Public Poster on Prevention and Warning Signs
Full text linkIntroduction/Background
Dementia affects 55 million people worldwide, with 10 million patients added each year, and 60% of the global burden in Asia.
Alzheimer’s disease (AD) is traditionally thought to be the main agent of dementia, but there is growing evidence of vascular dementia (VD) (“silent strokes”) being the driving agent of dementia, especially among East Asians.
This is an important geriatrics issue as there is lack of awareness of dementia within Asia and an even poorer understanding of VD.
Objectives
This poster aims to raise awareness of dementia in the Asian context, its prevention and early warning signs to educate the public.
We aim to share prevention strategies including diet, exercise and cognitive stimulation measures, while also sharing VD-specific preventive measures including reduction in smoking, adequate management of diabetes and hypertension.
Detection of early warning signs are crucial as patients who seek early interventions have shown to have reduced mortality and enhanced quality of life. We aim to raise awareness of early symptoms such as memory impairments, impaired judgement and confusion. We would also discuss AD-specific signs like gradual decline of short-term memory; VD-specific signs like rapid decline of memory and associated subtle physical signs like numbness in parts of the body
Factors Affecting Living Will Interest among Older People: A Cross-Sectional Study at a Tertiary Care Hospital in Bangkok, Thailand
Full text linkIntroduction: A living will is a legal document that enables patient-centered care when patients become incapacitated or incompetent towards the end of life. Living will interest in older people has been understudied in the Thai population. The aim of this study is to evaluate the association between psychosocial characteristics and living will interest in older adults at the Comprehensive Geriatrics Clinic, King Chulalongkorn Memorial Hospital, Bangkok.
Method: We conducted a cross-sectional study on older adults (age ≥ 60 years) who visited the Comprehensive Geriatrics Clinic between 2020 and 2023, using data collected by geriatric nurses through structured interviews consisting of demographic data and questionnaires about personal life and living will. Multivariable logistic regression with backward stepwise elimination was used to identify the associated factors of high living will interest. The odds ratio (OR) was calculated for each of these factors.
Results: There were 4,676 older adults. The majority were female (76.6%), aged 60-69 years (67.0%), Buddhist (96.1%), and university graduates (69.8%). The prevalence of high living will interest was 19.5%. Determinants of high living will interest included demographic factors, such as being female (OR=1.24), older age (OR=1.02), unmarried (OR=1.29), and university graduates (OR=1.74); well-being factors, such as having high life satisfaction (OR=1.33), getting adequate exercise (OR=1.78) or dietary fiber (OR=1.31), and suffering from high physical (OR=1.48) or mental distress (OR=1.54); and death-awareness factors, such as knowing someone who has made a living will (OR=2.94), having witnessed severe illness in family or close friends (OR=2.32), and having attended introspective activities held by the Comprehensive Geriatrics Clinic (OR=6.70).
Conclusion: Living will interest among older people was low. Psychosocial factors promoting well-being and death awareness generally resulted in higher living will interest. Policy makers should collaborate with healthcare providers to develop interventions that foster living will interest in the aging population
The Effects of Post Coronavirus Disease 2019 Conditions on High Altitude Illness
Full text linkIntroduction
High altitude illness (HAI) refers to cerebral and pulmonary syndromes related to hypoxemia during mountain trekking. Beyond symptoms and complications, people with long coronavirus disease 2019 (COVID-19) are resuming mountain trekking activities. Pooled prevalence data has shown that fatigue, breath shortness, and headache are common symptoms for both HAI and post-COVID-19.
Objective
This quantitative study design investigates the prevalence of HAI and post-COVID symptoms, identifying the body reactions of different group subjects.
Method
The targeted participants climbed Mount Xue or Mount Hehuan from May 1, 2022, to October 17, 2022. Upon receiving 236 effective responses, a chi-squared test and 2-sample t-Test were run through SAS Enterprise Guide (SAS EG) and Excel. Participants were then controlled under similar backgrounds, like normal BMI range, residency altitude, cardiopulmonary medical history, non-smokers, and no drug usage before climbing. The remaining 125 participants meeting our study criteria were grouped under four identical conditions.
Result
Significantly, more participants in Group Post COVID-19 experienced HAI symptoms during mountain trekking compared with participants in Group Normal, by 14.13% more in Mount Xue and 4.23% more in Mount Hehuan.
An increase is observed in females developing HAI symptoms after being diagnosed with COVID-19, an average of 13.96% higher than the prevalence in infected men. Besides, participating in mountain trekking one month after diagnosis of COVID-19 could reduce developing HAI symptoms by at least 44.44%.
Conclusion
The HAI incidence among post-COVID-19 participants was 8.95% statistically higher than normal participants, on average, during trekking in MountXue and MountHehuan. Symptoms were mostly mild, with “Tiredness or Fatigue” being the most common symptom. Our study analysis provided a direction for future studies of the relationship between post-COVID-19 conditions and HAI, such as the pathological mechanisms and prevention research
Improving Hip Fracture Recovery in Elderly Patients Through Telerehabilitation: A Double-Blinded Randomised Controlled Trial
Full text linkIntroduction
20% of post-surgery discharged geriatric hip-fracture patients are readmitted within 28 days, mostly due to recurrent falls, posing a great healthcare burden. Rehabilitation is essential for restoring mobility and improving quality of life. However, traditional in-person rehabilitation programs are challenging for those with limited mobility or transportation options. Telerehabilitation, which utilises technology to strengthen rehabilitation in remote patients is a potential solution. This study investigates the effectiveness of caretaker-empowered home-based geriatric post-hip fracture telerehabilitation.
Method
In this 2-arm, parallel, single-blinded randomised controlled trial, patients who met the inclusion criteria (suffer from hip fractures, age >65 years, with caretakers, discharged home after fixation or replacement surgeries) were randomised into two groups - control (undergoing standard rehabilitation) and intervention (undergoing telerehabilitation). Outcomes were assessed at baseline and primary endpoint (28 days after baseline) based on the Timed Up and Go (TUG) test (primary outcome), EQ-5D-5L and Parker Mobility score (secondary outcomes).
Results
Among the 29 patients recruited and randomised, 18 were followed up at Day 28. Comparing the intervention group (n=9) and the control group (n=9), both groups showed statistically significant (P<.05) within-group improvements from baseline to day 28 in both the primary (Control: 55.8 vs 36.2, P=.001*; intervention: 91.3 vs 68.4, P=.001) and secondary outcomes (Control: 13.2 vs 10.3 , P=.007; intervention: 14.1 vs 10.7, P=0.048). Moreover, the intervention group showed more significant improvements in both mobility and quality of living, reflected by the differences in baseline and post-intervention TUG results (intervention: 22.8 vs control: 19.6) and EQ-5D-5L score (intervention: 3.4 vs control: 2.9).
Conclusion
This still ongoing study demonstrated that caregiver-empowered telerehabilitation is effective in restoring mobility and improving quality of life in post-hip fracture elderly patients. More evidence is required to establish telerehabilitation’s efficacy.
Keywords
Hip fracture, telerehabilitation, caregiver empowermen