Journal of the Asian Medical Students Association
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Association of Alcohol Intake In Relation With Transient Ischemic Attack (TIA)- A Narrative Review
Full text linkBackground
Alcohol consumption, a modifiable lifestyle factor, has increased rapidly over the past decade across a range of age groups, communities, and nations. Alcohol use has been identified as a major global risk factor for mortality and disability, accounting for an estimated 5.3% of all deaths and 5.1% of disability-adjusted life-years in 2015–16. It is an inevitable risk factor for stroke, physical trauma, cardiovascular illnesses, and certain forms of cancer. Age, sex, familial history of stroke, cigarette smoking, hypertension, obesity, and lack of exercise are attributes that increase the risk of stroke. Alcohol use does, however, also have a preventive impact; studies have shown that moderate alcohol use significantly reduced the incidence of hemorrhagic, ischemic, and total strokes.
Objective
The main objective of this study was to investigate the effects of alcohol intake and its association with transient ischemic attack.
Method
We have reviewed papers from several search engines such as PubMed, Google Scholar, and Elsevier from the years 2017-2023 and compiled all the relevant information and data into our review.
Discussion and Result
People from a variety of age groups, lifestyles, and communities were prospectively analyzed with varying drinking habits in order to examine alcohol consumption and its effects on the body. It was discovered that excessive alcohol consumption can result in blood pressure increases that can cause ischemic stroke, cerebral vasospasm, dehydration, atrial fibrillation, and hypertension. Moreover, it was also proved that alcohol consumption was associated with a transient increased risk of ischemic stroke in the subsequent hour that was 2.3 times higher than the risk during periods with no alcohol consumption. Studies have also found that the health advantages for the next 24 hours might balance the temporary increase in stroke risk associated with moderate alcohol use; nonetheless, having numerous drinks at once may result in a rapid rise in acute risk and possibly an increase in long-term risk as well.
Conclusion
In conclusion, our analysis has shown that excessive alcohol consumption might significantly raise the risk of transient ischemic stroke by impacting other variables including dehydration and elevated blood pressure. Additionally, we have discovered that consuming more than 2 drinks per day is linked to an increased risk of transient ischemic stroke, and that a single little amount of alcohol can momentarily raise the risk for ischemic stroke for as long as two to three hours. Lastly, there was a greater risk of ischemic attack when alcohol drinking was stopped at any level
A Scoping review of the mental health support and wellbeing resources provided to medical students by Australian universities
Full text linkBackground. In 2020, the Australian Government provided $660,000 to develop a mental health framework for universities to adhere to in support of the mental health of university students. To date, there has been no formal evaluation of the current UMHF. In this study, we aim to provide preliminary observations that will highlight the current state of mental health support provided to medical students at Australian universities and its alignment with the University Mental Health Framework (UMHF).
Methods. A total of 19 UMHF-based criteria for student mental health support across 21 Australian universities were assessed in January 2022 and reviewed in December 2022 via a combination of Google search and homepage traversal. These were subjected to chi-squared testing and linear regression analysis where appropriate.
Results. The majority of universities offered individual counselling, as well as mental health crisis line access. Most universities also offered MHFA training, mental health resources, and regular wellbeing sessions. However, there were a lack of published mental health strategies, and individual counselling offered was limited; there was also little support for rural students, and use of social media and wellbeing apps showed limited adoption.
Conclusion. Australian medical universities are somewhat lacking in counselling support: they overlook the mental health needs of rural students, but are also lacking in long-term support for all students. Additionally, universities appear relatively reluctant to adopt and incorporate newer technological trends into their mental health approaches. More work needs to be done across Australian universities to support the nation’s medical students.
 
Nutritional Deficiency Dangers- A Rare Case of Severe Vitamin B12 Deficiency resulting in Permanent Brain Damage
Full text linkBackground
Here, a case of a 21-year-old previously healthy university student is presented with an extreme case of cobalamin (Vitamin B12) deficiency which caused drastic neurological changes including partial brain tissue atrophy.
Case Report
The patient presented to the hospital with a 1-week history of swelling and discomfort in his right calf. Compression ultrasonography revealed deep vein thrombi in the right superficial femoral and popliteal vein. CBC, coagulation studies and renal function yielded normal results. Mean corpuscular volume was elevated, hence patient was prescribed anticoagulant therapy. 3 months later he reported progressive gait instability and intermittent paresthesia in his feet. He was having increasing difficulty concentrating on his university courses. Lab tests showed decreased serum cobalamin and increased plasma homocysteine levels. Peripheral blood smear showed macrocytes. MRI of the brain revealed atrophic changes and lesions in the white matter on both hemispheres.
Case History
Further history revealed the patient’s diet included toasted cereal (cheerios) without milk, bread and fries. The patient had an aversion to most food and textures including meat since childhood. There were no elements of anxiety or eating disorders.
Follow Up Result
Eight weeks later, he reported improvement in gait and academic performance. Motor power had increased, but his reflex and sensory abnormalities persisted. At follow-up 2 years later, all neurologic deficits had resolved.
Conclusion
Cobalamin plays a vital role in major functions such as synthesis of myelin for nerves, conversion of homocysteine to methionine and is required for erythrocyte formation. This case highlights the importance of Vit B12 in the formation and maintenance of essential structural constituents of the body and the life altering changes caused by the deficiency of it. Awareness needs to be raised for healthy food intake to avoid such complications
Exploring Neoantigens to Increase Immunogenicity in Treating Pancreatic Cancer
Full text linkPancreatic ductal adenocarcinoma (PDAC) is a form of aggressive pancreatic cancer with a dire prognosis. Resection of the tumor is the only modality of complete cure but even despite that chances of recurrence is extremely elevated. This research examines the potential and recent advancements of finding the antigens responsible for cancer development. Search for identifying such neoantigens has led to the development of mRNA vaccine. Some antigenic genes that have been identified include ADAM 9, MET, TMOD3, TPX2 and ferroptosis related genes. When these are incorporated into mRNA vaccines, they can produce an immune response rich in cytotoxic T cells that mainly attack the cancer cells, preventing harm to normal cells. Based on the response that can be developed by targeting a gene and attributing the effects of that particular gene on the oncogenic potential, many subtypes can be developed. These subtypes then form the inclusion or exclusion criteria to the use of a particular type of vaccine generated, which was how Autogene cevumeran was created. Autogene cevumeran (BNT122) is the first mRNA vaccine which was created for the treatment of PDAC, it contains 20 neoantigens that was selected based on the body’s capability to stimulate an effective immune response. The results revealed that patients who responded to the vaccine exhibited a longer recurrence-free survival than non-responders at an early median follow-up of 15 months, along with lowered serum levels of CA 19-9 marker and reversal of micrometastasis all of which suggests that vaccine-induced neoantigen-specific immunity may be associated with improved outcomes in PDAC
Lung Volume Reduction Surgery for Native Lung Hyperinflation Following Single-Lung Transplantation for Emphysema- Which Patient?
Full text linkAbstract
This study aims to assess the eligibility of patients to undergo non-anatomical multiple wedge resection surgery following complications after single lung transplantation to treat emphysema. A number of patients were evaluated using a range of radiological, laboratory, and pulmonary function tests to gauge operative viability. Following assessment, lung volume reduction surgery was carried out successfully indicating its efficacy in treating native lung hyperinflation
Introduction
Double-lung transplantation is a well established treatment method for patients with advanced emphysema and COPD. However, due to unavailability of donors, single-lung transplant is opted for instead. This study evaluates which patients may be eligible for surgical correction of complications following single-lung transplantation.
Method
A retrospective study was done of eight patients that have undergone single lung volume reduction surgery for native lung hyperinflation as a treatment option for COPD. The patients were of equal ratio in gender with the age group ranging from 50 to 69 years. The pre-operative tests indicated included increasing shortness of breath and deterioration in pulmonary function tests. Additional tests also included high-resolution computed tomography (HRCT), V/Q scan for lung function and a detailed history of all eight patients were noted.
Result
There was a post operative success with a thirty day survival being 100% for the patient group under study. It was noted that the patients had different series of short term postoperative complications. The complications included the need of non-invasive respiratory support for two days following surgery, respiratory infections, atrial fibrillation and bleeding. One of the eight patients died due to respiratory failure secondary to pneumonia although the follow up pulmonary function tests showed an improvement in FEV1 in all patients. Alongside, the follow up of the surgery post 6 months demonstrated improved results in the remaining seven patients with improvement in clinical symptoms, exercise tolerance and quality of life.
Conclusion
Single lung transplantation, which was previously considered a high risk treatment, can now be seen in a different light with this and similar studies. Although proven that double lung transplant results in better outcomes in severe cases of COPD comparatively, the unavailability of donors is what leads to the opting of single lung transplantation. But this risk can be significantly reduced with the careful selection of patients and adequate risk assessment
The Use of GLP-Receptor Agonists for Improving Fertility in PCOS Patients
Full text linkBackground
Women of reproductive age are frequently affected by polycystic ovarian syndrome, a common endocrine illness marked by polycystic ovaries, high levels of androgens, and irregular menstrual periods. Infertility is a primary consequence of PCOS. In order to enhance the results of conception for PCOS patients, there has been a surge in interest in the use of pharmacological therapies such semaglutide/GLP-1 agonists together with dietary and lifestyle changes in recent years. This study assesses the effectiveness of GLP-1 agonists in enhancing the results of PCOS patients' ability to conceive.
Objective
By carefully examining the current evidence and addressing potential limitations, this paper seeks to provide valuable insights into the most effectiveness of GLP-1 receptor agonists for managing fertility in PCOS patients.
Method
A literature search was performed through PubMed, Google and google scholar for Full text articles and 2 systematic reviews were eventually selected. Relevant keywords were used to enhance the search in order to be specific.
Result
GLP-1 agonists are a newer generation of pharmacological drugs that have yet to be tested for more benefits. In PCOS patients there have been noticeably more improvements with regard to fertility, mainly through the effects of weightloss. In a systematic review and meta-analysis conducted by Linling Zhou et al., 2023 the researches highlighted results from 11 Randomized controlled trials, which included 479 patients taking GLP1Ras and 371 induviduals in a control group, a total of 840 patients. They concluded that the prescription of the GLP1RAs had a positive effect in improving natural pregnancy rate, menstrual cyclicity and insulin sensitivity as well as hormonal indexes in the women with PCOS. Another review conducted by Georgios S. Papaetis et al., 2022 , stated the effects of various GLP-1 agonists including Semaglutide, Liraglutide, Dulaglutide and Exenatide as well as Metformin. They concluded that the GLP-1R agonists have more effect on the wightloss when compared with other drugs, which in turn reduced subfertility and improved menstrual cyclity of PCOS patients. They mentioned the beneficial effects of the pharmaceuticals particulary in PCOS induviduals by the possible role played in the hypothalamic-pituitary-gonadal axis, which is at the center of an intense research.
Limitation
Both studies acknowledged the limitations of the studies including short period of the research, small population of women, lack of control group, as well as the need for more comprehensive well-organized, double-blind, multi-ethnic, phenotype-specific placebo- controlled studies, and in-depth research on the mechanisms of these drugs
Creating Attenuated Infectious Bursal Disease Virus from Dual-Promoter Plasmids
Full text linkIntroduction
Infectious Bursal Disease Virus (IBDV), a virus of the Birnaviridae family, leads to immunosuppression in young chickens by damaging B cells. Due to the increasing number of variant IBDV strains, there is a critical need to develop a method to produce attenuated viruses for vaccine development. Using the approach of reverse genetics, the genome of the virus was manipulated and studied in the lab. To make this process more efficient, researchers developed a method using dual-direction promoters to quickly produce IBDV. This technique makes it easier to weaken strong versions of the IBDV virus, potentially aiding in faster and more efficient vaccine development.
Method
The study used a human kidney cell grown in a nutrient-rich medium along with a chicken cell line. A strain of the IBDV virus was taken from a chicken and adapted to grow in both cell types. Changes were introduced in copies of the virus's genetic material made by RT-PCR to create mutations in these versions that contained either a VP1 or VP3 protein. They later added a version of the VP1 protein with a "FLAG" tag and purified it with anti-FLAG agarose, which was later analyzed using mass spectrometry. They used a system with two plasmids with dual-direction promoters inserted into the human cells. Specific changes in the cells were observed under a microscope to confirm the successful recreation of the IBDV virus.
Result
The results of dual-direction promoters suggested that this new two-plasmid system could improve the efficiency of making the IBDV virus infectious. They also concluded that FLAG-tagged proteins can reduce the activity of proteins in the virus and could help make copies of a part of the virus's genetic material.
Conclusion
In conclusion, the researchers created a dual-promoter plasmid system using two components in which Pol II and Pol I were organized in the same direction to recreate the IBDV virus quickly. This system does not require extra components for the production of two important proteins, VP1 and VP3. Using this system, they created a version of the IBDV virus that expresses VP1-FLAG, which reduces the virus's ability to multiply but does not affect its ability to trigger an immune response. This suggests that this method could be used to create a weakened version of the IBDV virus that could potentially be used as a live vaccine
Immunotherapeutic strategies for systemic lupus erythematosus: preliminary analysis and prospective applications
Full text linkSystemic lupus erythematosus (SLE) is a complex autoimmune disease causing inflammation and tissue damage. Traditional treatments have limitations, prompting exploration of biological therapies.
SLE involves abnormal interplay between innate and adaptive immunity. Impaired clearance of cellular debris and dysfunctional macrophages contribute to autoantibody production. Dendritic cells, particularly plasmacytoid DCs (pDCs), overproduce interferon-α (IFN-α), while B cell activity is heightened with breakdown of tolerance. Cytokines like IL-6 and IL- 23 also play a role.
Belimumab, targeting B-cell activating factor (BAFF), is the first new SLE drug in over 50 years. Saphnelo, an anti-type I interferon receptor antibody, is another recent approval. Several antibody-based therapies are under investigation. Obetiximab targets CD19, while Rituximab (RTX) targets CD20. Obinutuzumab and Ofatumumab are alternatives for RTX- resistant cases. Dapirolizumab pegol (DZP) targets CD40L, and Daratumumab targets CD38. Ustekinumab (anti-IL-12/IL-23) failed phase III trials.
Traditional Chinese Medicine (TCM) options like Rehmannia Six Formula and Artemisinin show promise. Emerging biological therapies include KP-104, a bifunctional complement inhibitor for SLE-associated thrombotic microangiopathy (SLE-TM), and Daxdilimab, targeting pDCs for moderate-to-severe discoid lupus erythematosus (DLE). Bispecific antibody therapy offers exciting possibilities. Rozibafusp alfa, a first-in-class candidate, targets both BAFF and ICOS-L, showing preclinical benefit. It is currently in phase II trials for SLE. Tibulizumab, targeting BAFF and IL-17, has completed phase I trials in other autoimmune diseases. PRV-3279, targeting CD32B and CD79B on B cells, is in phase Ia safety trials.Cell therapy with KYV-101, an anti-CD19 CAR T cell therapy, and Mesenchymal stem cell (MSC) therapy are also being investigated. Precision medicine tailors treatment based on individual characteristics. Omic technologies help identify treatment-sensitive patients.
Despite progress, SLE remains a complex disease. Sirolimus, an immunosuppressant, shows promise in reducing disease activity and improving serological responses. Epigenetics research explores microRNA (miRNA) dysfunction as a potential target. miR-146 and miR-155 are being investigated for their role in SLE. miRNA-based therapies hold promise due to their ease of production and potential for oral administration. Future directions include exploring combination therapies and optimizing clinical trial design for SLE. This review highlights the potential of biological therapies for improving SLE treatment
Addressing the Growing Concern of Substance Abuse Among Adolescents:: A Call to action against drug abuse
No full textAdolescence is the transitional period between childhood and adulthood, spanning the ages of 10 to 19. Adolescents experience rapid physical, cognitive, and psychosocial changes, which influence their emotions, thoughts, and decision-making. Thus, it is a distinct period of development and a crucial one for laying the foundations for long-term health(1)
. According to a survey conducted by the National Sample Survey Organisation, about 20 million children aged 10–14 are estimated to be tobacco users, with around 5500 new users being added every day(2) Multiple factors facilitate the susceptibility of young people to substance abuse such as peer pressure, family history, media influence, easy access, and mental health issues. Peer pressure from friends was reported as the single most common reason for initiation among nicotine users.(3)Regular drug use by teenagers is known to be associated with alterations in brain function and diminished neurocognitive ability(4)
Prioritizing modifiable risk factors and strengthening protective variables through family, school, and community preventive programs should be the focus of these coordinated efforts toward early identification, awareness, and prevention initiatives(5)
 
Atypical Case of Wilson’s Disease Without Early GI Symptoms
Full text linkIntroduction
Willson disease is Excessive copper deposition in the body organs, particularly in the liverand brain, is a typical feature of the disease which results from a mutation in the copper-transporting gene ATP7B. Wilsion’s Disease presentation include hepatic, neurologic, and psychiatric disorders. (1)
Objective
In a healthy body, the liver filters out excess copper and releases it through urine. With Wilson’s disease, the liver cannot remove the extra copper properly, thus accumulating it in organs causing bluish discoloration in thenails, kidney stones, premature osteoporosis, lack of bone density, arthritis.The Wilsons Disease occurs in 1 in 30,00 people worldwide. (2)
Method
A 19-year-old woman presented with lower limb pain, weakness, and progressive dystonic movements in her upper limbs, worsening over a month. In the last two weeks, she struggled to stand and became bedridden. Despite a normal spinal MRI, her symptoms progressed to catatonia, personality changes, and behavioral disturbances.
Result
The patient started on D-penicillamine for promoting urinary copper excretion. Zinc supplementation was also used to hinder copper absorption from the gastrointestinal tract. Additionally, antioxidant therapy with vitamin E was given due to its role in scavenging free radicals and its deficiency in Wilson’s disease, along with dietary restrictions
Discussion
The prognosis for Wilson’s disease in the 19-year-old patient is influenced by early neurological and psychiatric symptoms alongside Kayser–Fleischer rings without gastrointestinal manifestations. Treatment initiation with chelating agents may improve outcomes, but advanced liver involvement suggests a complex clinical course requiring careful management and monitoring.
Conclusion
A confirmed diagnosis of Wilson’s disease relies on clinical manifestations such as cirrhosis, neurological symptoms, and the presence of Kayser–Fleischer rings. Early recognition and initiation of treatment are pivotal in halting disease progression and enhancing patient outcomes