Journal of the Asian Medical Students Association
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The Potential of MicroRNAs as Diagnostic and Prognostic Biomarkers for Mild Traumatic Brain Injury: A Systematic Review and Meta-analysis
Get PDFBackground: At least 80% of traumatic brain injuries (TBI) are classified as mild. Repetitive mTBI might lead to long-term cognitive and behavioural alterations, or even increasing risks of neurocognitive disorders. Current diagnostic techniques have little benefits on patients with no obvious brain lesions. Altered expression of miRNAs in humans’ biofluids are related to the pathological processes of TBI and can be molecular signature.
Objective: Investigate the potential of miRNAs as diagnostic and prognostic biomarkers for mTBI.
Material and Methods: This study was reported following the PRISMA criteria. Literature search was carried out in PubMed, ScienceDirect, and ProQuest for relevant articles published prior to January 2021. Both qualitative and quantitative analysis were conducted to determine the diagnostic and prognostic value of miRNAs. Quality of included studies was assessed using Newcastle-Ottawa Scale (NOS).
Results: Ten clinical studies reported various miRNAs from serum/plasma, cerebrospinal fluid, and saliva as potential diagnostic and prognostic biomarkers. miRNAs secured from the saliva had the highest diagnostic accuracy (Pooled AUC=0.843; 95% CI [0.802,0.883]; I2=0%; P<0.001). The diagnostic accuracy was higher among pediatrics and athletes (AUC>0.850) who were more vulnerable to head trauma without apparent lesions on neuroimaging. A common miRNA reported across studies, miR-92a, had very good diagnostic accuracy even when used as a single biomarker (AUC>0.890). Qualitative studies showed that the concentration of miR-425, miR-103a-3p, miR-219a-5p, miR-302d-3p, miR-422a, miR-518f-3p, miR-520d-3p, miR-93, miR-191 and miR-499 were correlated with patients’ clinical outcome. All of included studies showed good quality in terms of selection, comparability and outcome domains.
Conclusion: The present study suggested the use of salivary miRNAs as an early diagnostic tool for mTBI. Even though its prognostic value was still undermined, miR-92a was a promising candidate for future diagnostic biomarkers in mTBI
Glial Fibrillary Acidic Protein Performance as A Biomarker for Mild Traumatic Brain Injury Among Children: A Systematic Review and Meta-Analysis of Cohort Studies
No full textIntroduction: Traumatic brain injury (TBI) is common in children, affecting over 837,000 children each year. TBI is caused by a bump to the head, which disrupts the brain's normal function. In children, mild traumatic brain injury (mTBI) is usually asymptomatic. Therefore, mTBI may be undetected and may lead to memory and coordination disorders. The gold standard for detecting TBI is a computerized tomography (CT) scan. Unfortunately, the radiation from this modality in earlier life will expose children to danger. Hence, we wanted to analyze glial fibrillary acidic protein (GFAP) as a potential new biomarker for mTBI diagnosis.
Objective: To explore the utility of GFAP in the detection of mTBI by analyzing post-injury GFAP serum levels and evaluating the area under the curve (AUC) when used as a diagnostic tool.
Material and Methods: This review selects cohort studies on three databases (PubMed, Scopus, and ClinicalKey) systematically using the PRISMA guideline. The search results were screened using established inclusion and exclusion criteria, before being included in qualitative and quantitative analysis. Critical appraisal and risk of bias were conducted using the STROBE checklist for cohort studies.
Results and Discussion: This review yielded four studies with a total of 379 subjects. The quantitative analysis showed a significant difference in GFAP serum level between case and control groups (MD:0.62; 95% CI: 0.48-0.75; p<0.001). AUC value ranges from 0.8-0.89, which is considered adequate. GFAP also had a higher AUC than other blood biomarkers for detecting mTBI. The heterogeneity between the studies was moderate (I2:59%; p<0.00001).
Conclusion: In conclusion, GFAP is significantly higher in children with mTBI and exceeded other blood biomarkers. Therefore, GFAP may be proposed as a potential screening tool for mTBI
Evaluation Of Hospital Stay Duration In Post-Traumatic Wound Patients After Negative Pressure Versus Conventional Dressings : An Observational Comparative Study.
Get PDFIntroduction: Split-thickness skin grafting is a widely used technique for post-traumatic wound management, however it may get complicated by delayed wound healing which leads to a considerable burden on patient and healthcare services in terms of increased treatment duration, costs and disability rates. One factor that may promote wound healing is the type of dressing applied over the skin graft. The use of negative pressure wound therapy over conventional dressings seems promising but evidence remains uncertain.
Aims and Objectives: To compare the duration of hospital stay after negative pressure versus conventional dressings on skin graft for post-traumatic wound management.
Materials and Methods: A prospective observational comparative study was conducted on 60 patients at a tertiary trauma care hospital. Patients with post-traumatic wounds awaiting skin grafting were included in the study.They were then divided into two equal groups on the basis of odd/even hospital registration number. Dressing was applied after the operative procedure, in a conventional way (Group CD) and by negative pressure technique (Group NPD). Graft take up evaluated on day 4, 7 & 10. The length of hospital stay and complications were noted from the discharge pro-forma. The data was analysed using SPSS software.
Results: Demographic profile, size and site of wound area of two groups were comparable (p>0.05). The graft take up was much higher in groups NPD vs CD (p<0.05). Duration of hospital stay was statistically lower in group NPD vs CD (2.3±1.92 vs 5.6±4.23) (P=0.000). Complications such as infection and seroma formation were observed in 10% of patients in group CD.
Conclusion: Negative pressure wound therapy provides better skin graft take up, shorter hospital stay and lesser complication rate over conventional method of dressing after grafting. Larger RCTs are recommended to prove effectiveness of this technique
Post-Traumatic Major Depression (PTMD) among Repetitive Trans-Cranial Magnetic Stimulation (rTMS) and Sham controlled Traumatic Brain Injury (TBI) patients: A Systematic Review and Meta-analysis.
Get PDFIntroduction: 33% Traumatic Brain Injury (TBI) patients suffer from Post Traumatic Major Depression (PTMD) within a year (1). Unlike conventional interventions, low frequency repetitive Transcranial Magnetic Stimulation (rTMS) has emerged as a non-invasive treatment for PTMD.
Objective: To determine the effectiveness of low frequency rTMS for treatment of PTMD in TBI patients.
Method: PubMed (n=9), Trip Medical Database (n=4), ClinicalTrials.Gov (n=13) & ICTRP (n=1) were searched for ‘rTMS’, ‘TBI’ & ‘depression’. Studies from inception were imported to EndNote X9 Library and duplicates (n=3) removed. RCTs conducted with TBI patients (>=18 years) having completed treatment with rTMS for PTMD compared against Sham controlled placebo groups were screened by Title & Abstract (n=23-12=11) and full text (n=11). Data extracted from 4 studies was included in meta-analysis of Montgomery–Åsberg Depression Rating Scale (MADRS) Score and analysed in Review Manager 5.4.
Result: Due to significant heterogeneity (Chi2 = 177.99, p<0.000001, I2 = 98% > 75%), inverse variance random effect meta-analysis was done. MADRS scores of 63 patients from 4 studies revealed a pooled Mean Difference of 3.52 [CI 95%, -2.54, 9.58]. Test for overall effect indicates no statistically significant difference Z = 1.14 (P = 0.26) in the decrease in PTMD between Sham controlled and rTMS patients. Overall improvement in depression reached statistical significance (Z = 5.11 (P < 0.00001)) in sham controlled favouring sub-group (fixed effect meta-analysis (I2 = 76%)), while the only study favouring rTMS showed significant improvement in PTMD with Z = 3.33 (P = 0.0009).
Conclusion: The pooled evidence suggests that there is no significant improvement in PTMD by rTMS compared to Sham control. While statistically significant improvement in PTMD was seen after treatment with both rTMS and sham. The meta analysis from our study shall guide treatment and future researchers
Improving Trauma Care System of Korea: lowering preventable mortality rate by not missing golden hour
Get PDFIntroduction (Aims and Problem statement)
In Korea, the golden hour is not observed frequently, so the preventable mortality rate is much higher than advanced medical countries. This study finds solutions to reduce the preventable mortality rate.
Method
The status of Korea’s trauma system is analyzed to find problems, and that of foreign countries is compared to find solutions.
Findings
- Top Factors
1) People are not aware of severe trauma treatment’s value.
2) Korea’s severe trauma system is unstable.
- Sub factors
1) As Korea's first aid education is an one-off thing, Korea's CPR rate is low.
2) Due to the lack of a system to pre-classify patients’ severity, patients often miss the proper timing of treatment and die while transferring between hospitals.
3) Because of the unsystematic network between trauma specialists and insufficiency of trauma surgeons, it takes a long time for patients to meet specialists.
Proposed solutions
- for Top Factors
1) The government should give incentives to hospitals with a high quality and proportion of severe trauma treatment to raise awareness.
2) The trauma system can be stabilized by (1) establishing a central organization, “Korean Surgeons - Committee on Trauma(KSCT)”, (2) using traffic fines and partial tax for trauma centers’ operating expenses, and (3) conducting feedback programs such as VRC, TQIP, and PIPS for the sustainable system.
- for Sub Factors
1) CPR education can be continued as adults by requiring CPR education when getting a driver’s license.
2) To transport patients quickly, triage should be used before transfer.
3) 24-hours trauma teams should be deployed to reduce residence time.
Conclusion
The proposed solutions should be systematically implemented through cooperation between KSCT and the government. This meaningful study will reduce preventable mortality, benefit the economy, remove social burdens, and increase patients' trust
Traumatic Aortic Injuries – EMERGING THREAT IN INDIA: Traumatic Combined Double Aortic Transaction presenting as Respiratory Discomfort
Get PDFA 35year male presented to ER after high speed motor vehicle accident. His mother died on the spot who was sitting to next to driver seat. He was fully conscious but anxious with cold sweating and air hunger. His obvious injuries were closed fracture femur. His vitals were heart rate 88/min, regular, NIBP 160/100 mmHg and respiratory rate 20/min and SpO2 98%. His all peripheral pulses were well felt. Air entry was present bilaterally on auscultation. Chest x-ray was performed which showed widened mediastinum. CT scan done immediately revealed double aortic transaction with minimal haemothorax.
In developing world with limited resources, trained and experienced surgeons, facility and financial restraints management of these complex injuries is challenging. Challenges include overall management particularly long-distance transport and haemodynamics stabilization.
Widened mediastinum with other findings suggestive of aortic injury on plain X-ray chest and CT scan with double transaction and haemothorax.
Our team was not having enough experience for aortic surgery thus patient was transferred to an advanced cardiac centre which was 350 kms away via road. Metorolol 5+5 mg was administered intravenously slowly over 15-20 minutes and sodium nitroprusside infusion was instituted to reduce rate of rise of pressure to prevent further injury and exsanguation. In advanced cardiac Centre, vascular stenting was failed and then open surgical repair was done. He had wonderful recovery and then fracture femur was fixed after 4-5 days. He is on regular follow up.
Major traumatic vascular injuries can be catastrophic. Patients with aortic injury who reach hospital are is relatively clinically asymptomatic. High index of suspicion is important as the presentation can be asymptomatic to variable clinical picture.  
Help Alert: A First-aid Training Policy for Drivers and a Call-for-help Application for a Timely Prehospital Assistance by Traffic Bystanders
Get PDFTrauma is one of the most serious public health problems worldwide. Injuries from road traffic accidents (RTA) have exceeded 50 million people annually, costing over 1.35 million lives. One of the causes of this massive loss is the inadequacy and delay in pre-hospital management. To assess and find the solution to solve this problem, the literature was reviewed along with interviews of paramedics and workers who have taken part in the pre-hospital care for an insight into the situation and validity of the solution. As a result, we have proposed a 2-step solution aiming to increase the number of first-aid responders at the sites of accidents. The first phase of this study is the first-aid training policy where drivers are mandated to undergo traffic safety and first-aid training before the issue of driving licenses for them to avoid traffic risks, and most importantly, step up as first-aid providers. The training emphasizes performances dealing with injuries that patients at RTA are prone to, including the ability to evaluate the severity of the injury to address an appropriate priority of care, resuscitation, and initial wound management. Following the completion of the training, drivers will be introduced to the latter phase of the project – the call-for-help application which registers volunteers who can provide efficient and appropriate initial care. The features of this application comprised of calling for first-aid assistance, conversation with individuals who cannot communicate (i.e., communicational disabilities, foreigners), identifying the location of the care providers and receivers, and providing the location of nearby pharmacies. A significant advantage of this application is that first responders from bystanders tend to arrive approximately 3 minutes in advance of the ambulance's average arrival time; therefore, the development of this sequential project will ultimately increase the chance of survival for the time-sensitive injuries of traffic accidents. 
Obesity, Lung Cancer, and The Paradox of its Association: A Narrative Review
Get PDFBackground: The obesity rate in Indonesia always increases every year. RISKESDAS (Indonesian National Health Research Data) 2007, 2013 and 2018 showed that obesity rate is always increasing in Indonesia. Lung cancer is the most common cancer in Indonesia which causes death.
Objective: This review aims to explain various diseases which are associated with obesity, risk factors of lung cancer and the association between them.
Methods: Literature search was conducted in pubmed and textbooks regarding obesity and lung cancer risk factors. The literature search on association between obesity and lung cancer was done in pubmed with the keyword "(Lung Cancer [Title]) AND (Obesity [Title])".
Results: Based on the research conducted, it was found that obesity was associated with various diseases including type 2 diabetes, dyslipidemia, cancer risk, mood disorders, heart disease, hypertension, liver disease, and reproductive disorders. Furthermore, there are various risk factors for lung cancer, including gender, genetics, tobacco use, and exposure to toxic agents. The association between obesity and lung cancer is a paradoxical phenomenon that occurs, in which obese patients have a lower risk of developing lung cancer based on the meta-analysis research (RR: 0.79; 95% CI 0.73-0.85).
Conclusion: Obesity can increase the risk of various diseases, and lung cancer which is one of the most common cancers in Indonesia also has various risk factors. However, current clinical research studies have shown that obesity actually reduces the risk of lung cancer. Thus we advise researchers around the world to further enhance experimental research either in clinical or laboratory about the body mechanisms that can explain this phenomenon. Regardless of this paradox association, we also suggest that the public should keep on controlling body weight because of the risk of various diseases associated with obesity
Dealing with Health Misinformation in Diverse Social Media
Get PDFIntroduction
Useful contents regarding health spread rapidly via social media, and so does health misinformation. Widely accepted misinformation launches various adverse impacts and even causes panic in the society. Measures already taken by Taiwanese government to stop health misinformation are effective so far yet remain unreliable when it comes to long-term protection. Therefore, a long-term strategy over health misinformation is necessary
Methods
We search online papers according to our topic and consult professionals to list our problems, then discuss our solutions comprehensively.
Key findings
For governments, deploying the influence of celebrities and dramas as a medium to send right messages and correct misinformation, legislating laws that restrain the spreading of misinformation are necessary means to solve this problem. For education institutions, emphasizing more on media literacy is also suggested, thus people can differentiate skeptical information from trustworthy ones. And for medical students like us, we could cooperate with students professional in computer science to establish a system, combining AI technology to inform internet users whether or not the website being visited is credible. Hopefully, by implementing the actions mentioned above, the influence of health misinformation could be deduced to a minimal degree and assist the public to make right health decisions, thus improving the health welfare of the entire human race