Journal of the Asian Medical Students Association
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The Clinical Manifestations and Mechanisms of Malayan Pit Viper (MVP) Envenomation
No full textIntroduction
Calloselasma rhodostoma (Malayan pit viper) is a hematotoxic snake distributed throughout Southeast Asia and is one of the most common snake bites in Thailand. Although death is not common, its venom can cause irreversible morbidity resulting from local necrosis and decoagulation.
Objective
This study aimed to collect and review information regarding the clinical manifestations and mechanisms of Calloselasma rhodostoma envenomation.
Method
We conducted a systematic review following the PRISMA guidelines 2020. The PubMed and Scopus databases were searched until 25 October 2022. Articles were screened at the title, abstract and full-text phases.
Results
We identified 185 studies via the electronic database, of which 31 were included in the review. According to the review, the majority of the patients were male (64%) and were bitten at lower limbs (70%). The main protein constituents of the venom are Snake venom metalloproteinases (SVMP) including kistomin and rhodostoxin, C-type lectins (snaclec), Snake venom serine protease (SVSP), L-amino acid oxidase, Phospholipase A2 and Cysteine-rich secretory protein. Each of which affects the body both locally and systemically. Local effects, including swelling, pain, and tissue necrosis, exhibit in approximately 95% of the group, while the percentage of systemic effects, generally detected by impairment of blood coagulation resulting from attacks in various stages of the coagulation pathway, varies from 33% to 88%. Hemolysis was also witnessed.
Conclusion
The review indicates that MPV envenomation leads to local effects and systemic effects via disrupting different stages in the coagulation cascades as well as necrosis. However, the review implies that venom with thrombin-like mechanisms like MVP’s would not be effective against treating thrombotic disorders. Thus, future study should focus on alternative pathways instead
The Effect of Nitrate Supplementation on Oxygen Saturation Level as Acute Mountain Sickness Prevention: A Systematic Review and Meta-Analysis
No full textIntroduction
Lowlanders going to high altitudes could face acute mountain sickness (AMS) due to hypoxia. Theoretically, nitrate supplementation, which can be easily found in beetroot juice, could increase the body's resistance to hypoxia. However, the evidence is still inconclusive.
Objective
This study aimed to systematically review the effect of nitrate supplementation on blood oxygen saturation.
Method
Two reviewers independently searched published studies from PubMed, Scopus, and Cochrane Library databases using pre-registered search strategies from inception to October 5th, 2022, following a registered protocol on PROSPERO. Randomized controlled trials that examined the effect of dietary nitrate supplementation compared to placebo on oxygen saturation among non-acclimated people were included. The ROB 2.0 tool was used to assess the risk of bias in the included studies. Results were described using a vote counting analysis, then meta-analyses using random effects models were conducted. The quality of evidence was analyzed using GRADE and publication bias was examined using a forest plot.
Result
Vote counting analysis from 11 records (294 participants) showed nitrate supplementation could improve oxygen saturation particularly in simulated conditions among men.
However, the result from the meta-analysis was inconclusive and did not reach a clinically significant threshold with a mean difference of –0.51 (95% CI: –1.66 to 0.63) with I2=0%. This result was consistent even after subgroup analyses based on the type of condition, testing method, and gender. The quality of evidence is low-to-medium, underpowered, and there was publication bias.
Conclusion
From the available studies, it cannot be concluded whether nitrate supplementation improves oxygen saturation clinically among lowlanders who went to high altitudes. Further studies with large participants and minimization of bias examining nitrate supplementation as complement therapy, not a single therapy, were still needed
MEMORY: Making the Most Out of Alzheimer’s Symptoms
Full text linkIntroduction: Alzheimer’s disease (AD) is an irreversible, progressive form of dementia that contributes to 60–70% of dementia cases. Due to the rise of the aging population, the global prevalence of AD is expected to increase. AD is a gradual neurodegenerative disease caused by neuronal cell death which slowly destroys memory and thinking skills as people age. Genetics, trisomy 21, increasing age, traumatic head injury, depression, smoking, and cardiovascular and cerebrovascular disease, increase the risk of AD. Higher education, the use of estrogen by women, the use of anti-inflammatory agents, leisure activities, a healthy diet, and exercise decrease the risk of AD.
Objectives: Early to mild AD symptoms include disorganization, impairment of motor functions, language, multitasking problems, short-term memory loss, motivation and attention deficiency, anger, and anxiety—abbreviated to “DILEMMA”. Late diagnosis of AD happens due to diagnostic uncertainties since the signs and symptoms of AD are sometimes not recognized or mistaken for signs of old age or other conditions. Early diagnosis and intervention are beneficial for patients and carers and can result in substantial healthcare cost savings. To increase awareness and prognosis of AD symptoms, this poster aims to educate the audience regarding common symptoms of AD with “DILEMMA”
The Relation Between Family-Centered Approach toward Medication Adherence of Antihypertensive Drug Consumption in Indonesia
Full text linkThis study focuses on examining the relation between family-centered approach toward medication adherence of antihypertensive drug consumption in Indonesia. 87 participants aged more than 25 years with family and already treated with antihypertensive drug more than 1 month are asked to fill questionnaires or being interviewed to obtain information about gender, level of education, family history of hypertension, family-centered approach, history of visit from community health center health worker in relation with Indonesian Health Program by Family-Centered Approach, physical activity, and medical adherence without any lost data. Obtained data is then categorized in several groups. Chi-square test shows that family-centered approach is significant to improve antihypertensive drug medical adherence (p=0.006). Participants with higher family-centered approach are four times higher in adherence to antihypertensive drug therapy (OR 4,34; 95% CI: 1,45–12,99). However, this study cannot explain the optimal family-centered approach to improve antihypertensive drug therapy medical adherence
Family Caregiving 101: Reach for Elder Care Excellence
Full text linkBackground: About a third of the 70-79 years old and over half of the older adults over 80 live by themselves, which means the risk of loneliness and social isolation still prevails in the elderly population. Social isolation increases the risk of premature death of all causes and the occurrence of dementia, cardiovascular diseases, and depression in older adults. These risks make the presence of a family caregiver necessary to meet their social and physical needs as well as to accompany and assist them in health care procedures due to their deteriorating physical and cognitive abilities. With these, family caregiving intervention, although rarely discussed, plays a significant role in improving health care outcomes in geriatric patients.
Objectives: This poster, through the mnemonic REACH (Regular Visit, Engage, Assistance, Compliance, and Hazard Prevention), provides background and reasoning behind family caregiving on geriatric healthcare processes, presents the negative impacts of elder neglect, and provides a memorable and easy to understand explanation on what a family member can do to take care of their elders. This poster aims to increase public awareness of the importance of family caregiving to reduce social isolation and the health risks that it entails
Neuromuscular Electrical Stimulation as a Novel Treatment of Dysphagia: A Meta-Analysis of Efficacy and Safety
Full text linkIntroduction: Dysphagia is a common and debilitating condition that impairs normal swallowing function. Research indicates that 15-22% of adults over 50 experience it, with hospital and long-term care facilities showing an increased rate of 40-60%. Dysphagia can cause malnutrition, dehydration, aspiration pneumonia, and social isolation, significantly reducing the patient's quality of life. However, current treatment approaches, including compensatory strategies, postural adjustments, and exercises, have limited efficacy. As a result, alternative therapies are being explored, yet no systematic review or meta-analysis evaluating neuromuscular electrical stimulation as a treatment for dysphagia.
Objectives: To determine the effectivity of neuromuscular electrical stimulation for improving swallowing function in dysphagia patient.
Method: This study was conducted using the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA). We systematically searched PubMed, Cochrane, Embase, and ScienceDirect for literature up to 4 April 2023. The included documents were screened and assessed for risk of bias using the Cochrane Risk of Bias 2.0. Effect estimates were pooled using random-effects meta-analysis using Review Manager 5.4.
Results: Fourteen studies culminating a total of 743 participants were included with low risk of bias. Neuromuscular electrical stimulation (NMES) depicts a significant swallowing function recorded by Penetration-Aspiration Scale (PAS) (HR = 1.97; Z = 4.21; p=0.002; 95% CI: 0.39-9.86) and Functional Oral Intake Scale (FOIS) (HR = 2.79; Z = 4.1; p = 0.0002; 95% CI: 1.29-6.03). Moreover, NMES also improved patient life in general by lowering the pain score and increasing the quality of life.
Conclusion: NMES therapy shows a more significant improvement in oral function on dysphagia patients compared to traditional therapy. Therefore, NMES are proven efficacious for dysphagia therapy and recommended to be used in guidelines as supportive non-pharmacological therapy
Cognitive and Physical Activities Intervention Improves Inhibitory Function in elderly with Subjective Cognitive Decline: An Event-related Potential Study
Full text linkIntroduction: Subject cognitive decline (SCD) refers to a self-experienced cognitive deterioration along with intact performance in neuropsychological tests. Emerging evidence shows that SCD is strongly associated with higher risks in the development of Alzheimer’s disease (AD). Since SCD occurs years before detectable clinical changes of AD, it is crucial to spot out people with SCD and do further prevention. Several large-scale studies using cognitive and physical activities intervention on SCD have shown no significant improvement in the neuropsychological tests. The lack of sensitive measures might be one of the reasons accounting for these null findings. Therefore, this study aimed to determine whether such preventive intervention benefits individuals with SCD in cognitive function using event-related potentials (ERP). Inhibitory control, one of the important facets of cognitive function, was particularly examined since it is essential for the elderly to perform goal-directed activities in daily life.
Methods: Thirty community-dwelling older adults with SCD were randomized into control (n=15, receiving health education) and intervention (n=15, receiving cognitive and physical activities) groups. The intervention was performed 2 hours/day, 2 days/week, and sustained for 6 months. During ERP recordings, we adopted a Go/Nogo paradigm, where subjects were instructed to respond to Go (70%) and withhold responses to Nogo (30%) trials. Amplitudes and latencies of N2/P3 components, which represent electrophysiological correlates of inhibitory control, were determined. ERP data were processed with EEGLAB software, and Mann-Whitney U tests were used to evaluate the between-group differences.
Results: Despite no significant differences in the score changes of cognitive tests and ERP accuracy rates between control and intervention groups, the ERP results showed that compared to the control group, the intervention group exhibited shortened N2 latencies (p=0.01), suggesting improved inhibitory function.
Conclusion: Cognitive and physical activities are beneficial to SCD in terms of inhibitory function, as evident by electrophysiological recordings
Positive Pressure Ventilation Therapy for Improvement of Symptoms and Physiological Measurement in Acute Mountain Sickness: A Systematic Review and Meta-Analysis
Full text linkIntroduction
Acute mountain sickness (AMS) is a high altitude disease characterized by headache, dizziness, fatigue, and gastrointestinal symptoms. AMS leads to hypobaric hypoxia and potentially develops into dangerous conditions such as pulmonary or cerebral edema. Current pharmacological treatments such as acetazolamide, dexamethasone, and analgesics have not been proven to be consistently effective to prevent AMS and shown unpleasant adverse effects. Alternatively, positive pressure ventilation therapy has shown some promising results in treating AMS.
Objective
The aim of this systematic review and meta-analysis is to evaluate the efficacy of positive pressure ventilation therapy in improving symptoms and physiological measurement in acute mountain sickness.
Method
This systematic review and meta-analysis was reported based on the PRISMA statement. The literature search was conducted on several databases, such as PubMed, Cochrane, Science Direct, and Scopus. Results were shown as mean difference (MD) and standard deviation (SD). A fixed-effect model (FEM) was used when the included studies were considered homogenous), which were indicated by an I2 value less than 40%. Risk of bias was assessed using the cochrane risk-of-bias tool for randomized trials (RoB 2).
Result
This systematic review and meta-analysis included four randomized control studies with the total of 277 participants. Lake Louise Score declining with a significant pooled mean difference (MD) of -1.16 [95% CI: (-1.90) - (-0.41), P = 0.002]. Arterial oxygenation improvement with a significant pooled MD of 4.13 [95% CI: (-0.83) - 9.08, P < 0.00001]. Heart rate measurement showed no significant effect, MD of -0.19 [95% CI: (-7.26) - 6.68, P = 0.96]
Conclusion
This systematic review and meta-analysis showed evidence that positive pressure ventilation therapy is a prospective therapy to significantly improve acute mountain sickness symptoms and arterial oxygenation, but has no significant effect on heart rate
Matrix-associated chondrocyte implantation versus autologous chondrocyte implantation for chondral knee defects: A protocol for a systematic review and updated meta-analysis
Full text linkBackground:
Derangements of various metabolic processes leads to a high prevalence of insidious chondral defects which may predispose patients to osteoarthritis. This may lead to deterioration of the quality of life in physical, psychological and social domains. Though, autologous chondrocyte implantation (ACI) yields superior results in chondral defects as compared to microfractures, there has been no meta-analysis till date to quantify the clinical efficacy of various chondrocyte implantation techniques as compared to each other. Our review will synthesize current evidence to establish the superior technique for chondral knee defects in terms of clinical outcomes and post-operative quality of life.
Methods:
An exhaustive search will be undertaken on PubMed, Cochrane, Embase, International Clinical Trials Registry Platform (ICTRP), Trip Medical Database and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to identify relevant studies. Primary human studies comparing matrix-associated chondrocyte implantation and autologous chondrocyte implantation in the context of knee chondral defects would be included. The primary outcome will be postoperative improvement in knee functions assessed clinically or via activity scores like International Knee Documentation Committee (IKDC) subjective score, Lysholm-Gillquist score and Tegner Activity Score. The secondary outcomes will be radiological scores for monitoring structural improvement like Magnetic Resonance Observation of Cartilage Repair Tissue score and health-related quality of life scores.
Discussion:
This will be the first systematic review and meta-analysis in available literature comparing the clinical outcomes and post-operative quality of life in these patients and can be expected to guide clinical practice in chondral defects of the knee