Journal of the Asian Medical Students Association
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Anemia in early life (up to the age of 6 months) – Is it really a disease burden?A cross sectional study from Sub Himalayan region: Anemia in early life
No full textBackground: The study aims to settle the question of giving prophylactic iron to all breastfed infants (up to age of 6 months). It will determine the disease burden & clinicopathologial profile of anemia in infants up to 6 months and its correlation with maternal Hb levels.
Materials and Methods : A hospital based cross-sectional study was undertaken for four months in all infants up to 6 months of age and their mothers getting admitted in pediatrics ward of tertiary health care centre in Sub-Himalayan region.
Results: 42 % of infants and 64 % of mothers were found to be anemic. It was found that mothers of 74% of total anemic infants were also anemic. Also in 79% cases mothers with good ferritin stores (≥12ng/ml) also have infants with good ferritin stores (≥10 ng/ml). It was found that mothers who have not consumed adequate amount of iron in their pregnancy, 44% of them have anemic infants. Though the relationship between infant and maternal parameters is not statistically significant but the figures are large enough ,indicating the need for a further comprehensive study to determine the relationship between the two.
Conclusion: High rates of anemia in early life points to the need of multicentric as well as population based study so that we can collect evidence to start iron prophylaxis in this highly vulnerable developing age group of 0 to 6 months. Further higher rates of anemia in mothers warrants the strengthening in the implementation plan of IFAS to all females of reproductive age group
A Effectiveness and Comparison Between Land and Water Exercises as Treatment for Osteoporosis: A Systematic Review and Meta-Analysis
No full textIntroduction: Osteoporosis is a pervasive global health issue characterized by low bone mass, deterioration of bone tissue, and increased bone fragility. The International Osteoporosis Foundation estimates that over 200 million people worldwide are affected. Therefore, it is important to identify effective prevention and treatment strategies against osteoporosis, one of which is exercise. Currently, land-based and water-based exercises are implemented to improve osteoporosis. However, there is no meta-analysis comparing the effects of land-based and water-based exercise on osteoporosis improvement.
Objective: This study aims to compare the effectiveness between land-based and water-based exercises in osteoporosis management.
Method: This study followed the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) statement guidelines, and literature searching was done on several databases, such as PubMed, ScienceDirect, Wiley, and Google Scholar up to 13 March 2023. The 10 selected studies were further assessed for risk of bias using Cochrane Risk of Bias 2.0. Then a meta-analysis was conducted using Review Manager 5.4, which assessed the extracted data.
Results: Ten trials are included in the random effect meta-analysis of the efficacy of land-based exercise compared with water-based exercise. The results suggest that land-based exercise would decrease the odds of postmenopausal women experiencing osteoporosis (OR = 0.47, 95% CI; 0.23 to 0.96, p-value = 0.04). However, the subgroup meta-analysis of the four proxies that measure bone mineral density (BMD) after the intervention shows that, land-based exercise has no significant effect on the total BMD (SMD = 0.34, p-value = 0.20), femoral neck BMD (SMD = 0.29, p-value = 0.50), lumbar spine BMD (SMD = 0.06, p-value = 0.91), and total hip BMD (SMD = 0.01, p-value = 0.94) in comparison with water-based exercise.
Conclusion: Land-based exercises are better than water-based exercises for osteoporosis, but combinations with calcium and vitamin D supplements are recommended
Music Interventions for the Elderly: An Asia-Pacific Perspective into the Future of Patient-Centric Geriatric Care
Full text linkBackground/Introduction: The imperative for patient-centric geriatric care is especially pressing in the Asia-Pacific - home to 60% of the world’s elderly. Increasingly heterogeneous and long-term healthcare needs, on a background of culturally diverse healthcare beliefs, have generated shifts in interest towards harnessing non-pharmacological interventions to tailor more personalized care approaches.
Music interventions stand out over other non-pharmacologics for delivering humanistic and individualised geriatric care, with its ease of customization, inextricable connections with personal memories and emotions, and social interactions facilitated. Readily integrable with activities stimulating multiple senses (e.g. choral singing, playing an instrument) and providing physical exercise (e.g. movements to music), music interventions demonstrate much promise for maximizing healthspan even in the face of pre-existing sensory and cognitive impairments.
An Asia-Pacific perspective on music interventions for the elderly is warranted, given the region’s rich depositories of folk and traditional music, yet relative paucity of relevant research that seeks to develop safe and patient-oriented geriatric care of the future.
Objectives: To raise awareness of prevailing evidence on music interventions for the elderly in the Asia-Pacific. Salient use cases will be highlighted – namely advances in the care of dementia, delirium, depression, chronic pain, palliative care, and health preservation in community-dwelling seniors. 
Efficacy of Non-Pharmacological Interventions for Depressive Symptoms in Elderly People with Dementia: a Systematic Review
Full text linkIntroduction:
Depression is closely associated with dementia, both as part of the symptomatology secondary to the structural changes and as a risk factor for cognitive decline. In both cases, treating the depressive symptoms is crucial due to its clinical correlation with quality of life (QoL). However, current antidepressant therapies show limited efficacy in older adults, especially those with comorbid cognitive impairment. The rapidly growing elderly population with dementia deems it necessary to identify non-pharmacological interventions that are effective in improving depression and QoL of these individuals.
Objective: To characterize and assess the efficacy of non-pharmacological interventions for reducing depressive symptoms in elderly people with dementia.
Method: A systematic review was performed. A PubMed search identified 856 relevant studies between 2008-2023. Reviewers completed paired abstract and full-text screening yielding 37 original randomized studies, and appraised the risk of bias using the Cochrane QUIPS tool.
Results: Overall, the majority of interventions showed positive effects of treating depression in dementia patients. Statistically significant improvements in depressive symptoms, alongside QoL, were reported in reminiscence therapy (4), animal therapy (4), creativity therapy (7), psychotherapy (7), and cognitive stimulation therapy (3). Benefits to depression and QoL were also seen in aromatherapy (1), leisure therapy (2), and exercise programs (4), though varied in efficacy. Outcomes of multi-modal intervention programs (5) are mixed, with outcomes favoring programs with components of exercise and cognitive intervention.
There is consensus of qualitative opinions regarding non-pharmacological interventions. The improvements in psychological wellbeing and current limited effectiveness of pharmacotherapies strongly support continued research for application of non-pharmacological interventions into clinical management.
Conclusion: Non-pharmacological interventions were found to be efficacious for improving depressive symptoms, QoL, and cognitive function to varying extents in dementia. Further research is warranted to support a standardized treatment regimen for clinical implementation
Effect of mobile phone games on reaction time
Full text linkObjectives: To observe an association between playing mobile games and reaction time among students aged 18-25 years. Variation in reaction time with types of games, time spent on gaming, age of starting to play and time of day was studied.
Study Type: Case-Control Study
Methods: 94 participants studying MBBS in University College of Medical Sciences were included in the study after they consented to participate. Their gaming status was recorded and reaction time tested using Tap reaction time test and Reaction time ruler test. Unpaired t-test was applied to compare the reaction time of gamers and non-gamers.
Results: The average reaction time was 0.488 s (+0.012 s) for gamers and 0.535s (+0.020s) for non-gamers with Tap reaction time test. With the Reaction time ruler test the average reaction time of gamers was 0.182s (+0.030s) and 0.196s (+0.030s) for non-gamers. First reading was found to be higher than the rest. Age of commencement of playing did not significantly affect the reaction time. The increase in variety of games and number of days a person plays per week yielded better reaction times. Time of the day significantly affected tap reaction time test but not the reaction time ruler test.
Conclusion: People qualifying as gamers record lower response times than non-gamers. This may enable designers to create fit games for individuals with slower response time. Gaming can also benefit the medical professionals by enabling them to react much faster in life and death situations and increasing the proficiency in daily management of patients
Efficacy Of Internet-Based Cognitive Behavioral Therapy For Adults With Obsessive-Compulsive Disorder : A Systematic Review And Meta-Analysis Of Randomized Controlled Trials
Full text linkIntroduction: The COVID-19 pandemic has brought tremendous impact to mental health management in patients with obsessive compulsive disorder (OCD). Internet-based cognitive behavior therapy (I-CBT) has been demonstrated to be efficacious on alleviating symptoms among adult patients with OCD.
Purpose of study: This systematic review and meta-analysis aims to evaluate the efficacy of Internet-Based Cognitive Behavioral Therapy for adult OCD patient.
Methods: This review selects randomized controlled trials found in multiple databases searching for studies implementing I-CBT for OCD up to September 7th, 2021 using determined inclusion criteria, such as OCD patient with study population only adults age population, assess obsessive compulsive score and assess depression, and exclusion criteria such as unsuitable study design, studies with incomplete outcome data, and studies in languages other than English. This review was arranged based on PRISMA guideline.
Results and Discussion: Our review includes 6 RCTs with a total of 590 participants. Quantitative analysis of mean differences was performed using Review Manager 5.4 in continuous, random-effects model. I-CBT demonstrates promising efficacy in reducing adverse psychosocial conditions in OCD patients including obsessive compulsive symptoms (pooled MD: -4.49 [95%CI: -6.78 – (-2.19)]; p=0.0001) and depression (pooled MD: -1.97 [95%CI: -3.61-(-0.34)]; p=0.02).
Conclusion: I-CBT presents a promising solution for alleviating symptoms in OCD patients
A Comprehensive Look on Conjugated Targeted Therapies as A Novel Candidate for Personalized Thyroid Carcinoma Treatment
Full text linkThyroid cancer is a substantial threat worldwide due to its prevalence and complication it follows. Current therapy is widely available, although failed to address the burdens associated with the disease, thus requiring a newer approach. Recently, the novel discovery of conjugated targeted therapy and its potential implementation enables a more specific, cancer-targeting mechanism, with potentially higher efficacy and minimum adverse effect than conventional treatments. This review was made to assess its potential, via comprehensive screening on several databases, such as Cochrane, PubMed, Scopus, ScienceDirect, and Wiley with set criterions. The search yielded 6 viable studies analyzing different forms of targeted therapies Based on the included studies, conjugated targeted therapy displayed high selectivity and cytotoxicity toward cancer cells, while remained tolerable toward normal cells and the host. Not only as a therapeutic agent, this therapy also possessed imaging enhancement and metastasis detection, indicating high diagnostic value. Although, applicability and cost- efficiency of the treatment should be considered, due to extra costs in biosynthesizing therapeutic agents and phenotyping of targeted cells. Nonetheless, the high selectivity and potentially better safety profile of conjugated targeted therapy should be assessed further, and weighed with its limitations. All in all, conjugated targeted therapy has been proven to be selective towards cancer cell and a potent candidate as personalized treatment. Biosafety analysis of its implementation is recommended, followed by further clinical trials on human samples
AMSEP Internal Audit - A Behind The Scenes Into Medical Students’ Exchanges during the COVID-19 Pandemic
Full text linkN/
The Prevalence, Preparedness, and Factors associated for Injuries among Thai Trekkers in a Thai National Park
No full textBackground: Trekking became one of the most popular recreational activities among Thais[1]. Injury susceptibility varied according on location, season, and environment. Injury may have been prevented with proper planning and preparation[2]. The objective of this study was to determine the prevalence, preparation, and factors associated with trekking injuries in Thailand's national parks.
Methods: This was a cross-sectional study conducted in Thailand during October 2022. An online survey (REDcap) was distributed through online social media platforms. Adult (≥18 years old) Thai trekkers who visited Thailand's national parks were invited to participate. Porters, park rangers, tour guides, and locals were excluded.
Results: A total of 179 were available for analysis. Mean age was 40 years old. 19.5% was first time trekkers. The median (IQR) preparation time was 2 (1-7) days. The prevalence of injuries was 35.8%, with 50.3% occurring on the trunk. Scratching (41.9%), bruising or contusion (23.5%), and sprain (7.8%) were the most common injuries. There were no reported fractures. Ticks/fleas (27.4%), black flies (19.6%), and slugs (16.8%) assaulted the majority of trekkers. Thai trekkers obtained travel health information via the internet (77.7%) and from friends (41.3%). 54.2% had a first-aid kit with anti-pyretic (45%), muscle relaxant (45%), and antihistamine (43.6%) medications. Playing in the water during a trekking trip was associated with a moderate to severe injuries (aOR 28.2, 95% CI 1.46-543.13, p-value 0.027) and mild injury (aOR 4.8, 95% CI 1.63-13.86, p-value 0.004). When adequate risk awareness was a protective factor for moderate to severe injuries while trekking (aOR 0.25, 95% CI 0.06-0.99, p-value 0.048).
Conclusion: A third of Thai trekkers suffered minor injuries while trekking. Travel medicine practitioners should inform trekkers about the risks of injury and provide adequate health preparation to reduce injurie
Relationship between Psychiatric Illness, Cognitive Impairment and Physical Comorbidities in Older Adults: A Transdiagnostic Case-Control Study
Full text linkIntroduction:
Cognitive impairment in older adults are often underdiagnosed, especially in the population with co-existing psychiatric illnesses. They can often be overshadowed by more apparent physical and psychiatric impairments, reflecting a need for more comprehensive evaluation in geriatric settings. This study examines the cognitive function and physical comorbidities among elderly patients (aged 65 and older) with clinically diagnosed psychiatric illness.
Method:
A transdiagnostic case-control study of mentally ill elderly patients (n = 981) compared to controls (n = 63) was conducted. Patient data were obtained from the psychogeriatric day hospital while controls were recruited from local community centers. The patients were classified according to 4 categories based on their clinical diagnosis:
Mood Disorders e.g. Adjustment Disorder, Depression and Generalized Anxiety Disorder
Psychotic Disorder
Sleep Disorder
Neurocognitive Disorders e.g. Dementia and Mild Cognitive Impairment
Potential confounding variables, including age and education, were taken into account and an ANCOVA test shows no significant effect on results.
Results:
A One-Way Analysis of Variance (ANOVA) demonstrated a significant difference in Montreal Cognitive Assessment (MoCA) test scores between older adults with mood, psychotic, and sleep disorders and those without (F(5, 701) = 11.550, p <.001), indicating an association between these psychiatric conditions and reduced cognitive function.
Another One-Way Analysis of Variance (ANOVA) revealed that the Cumulative Illness Rating Scale (CIRS) scores were significantly higher in older adults with psychiatric and neurodegenerative conditions compared to those without (F(7, 1036) = 4.056, p <.001), suggesting a correlation between psychiatric illnesses and physical comorbidities.
Conclusion:
Findings reveal significant association of psychiatric illnesses and lower cognitive functions, as well as heightened physical comorbidities. These results emphasize the need for more thorough assessment and tailored interventions to better address cognitive impairment amongst the geriatric population with psychiatric illnesses.