Journal of the Asian Medical Students Association
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Unlocking the Potential of the Gut-Brain Axis for Alzheimer's Disease Treatment through Probiotic Interventions: A Systematic Review
Full text linkIntroduction
Alzheimer’s disease is a common neurodegenerative disorder in the aging population leading to cognitive and memory impairment. Probiotics, living microorganisms that can promote health benefits when taken appropriately, have been claimed to be potential treatment alternatives for Alzheimer’s disease amidst limited treatment options thus far. This study aimed to review the current evidence on the effects of probiotics on Alzheimer’s disease in animal studies and to point to future directions for further research.
Method
The method utilized in this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Three reviewers searched for the articles on various databases such as PubMed, Scopus, and ScienceDirect. Articles published between 2010 and 2023 were included in the review using the keywords [Gut-brain axis], [Alzheimer], and [Probiotics].
Results
Several animal studies related to the impact of probiotics on gut microbiota, cognitive function, as well as pathological and metabolic markers in Alzheimer's disease were systematically reviewed. The result demonstrated an improvement in cognitive function after the probiotic treatment through the regulation of gut microbiota and Aβ deposits and inflammation suppression. In Alzheimer’s disease models in mice, Bifidobacterium breve HNXY26M4 and Lactobacillus plantarum DP189 lead to a decrease in cognitive deficits and neuroinflammation through the gut-brain axis in APP/PS1 (p<0.05) and PI3K/Akt/GSK-3β signaling pathway (p<0.05) respectively.
Conclusion
Probiotics could have the potential to be safe and effective therapies for Alzheimer's disease by adjusting the gut-brain axis and decreasing pathogenic indicators. However, future studies are required to investigate optimal dosages and regimens for clinical uses
A Novel Monoclonal Management of Geriatric Osteoarthritis: Network Meta-Analysis of Comparative Efficacy and Safety of Tanezumab against Oral NSAIDs
Full text linkIntroduction: Osteoarthritis (OA) affects approximately 250 million people worldwide and significantly causes pain and disability. Although NSAIDs are the first-line therapy, their use in geriatrics should be cautiously prescribed because of comorbidities, polypharmacy, and adverse events. Tanezumab is a humanized monoclonal IgG2 antibody that blocks NGF from activating trkA receptors on nociceptive neurons. Recent studies have shown Tanezumab as a promising candidate for enhanced clinical effects in geriatrics. However, previous meta-analyses lacked specificity for different doses of Tanezumab and did not confirm the comparison with NSAIDs.
Objective: This study aims to compare the efficacy and safety of Tanezumab with oral NSAIDs in geriatric osteoarthritis treatment.
Method: This study was conducted using the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA). We systematically searched PubMed, ScienceDirect, and Google Scholar until April 4, 2023. The PRISMA method was done to evaluate potential bias. We performed a network meta-analysis using a random effects model that compared three doses of Tanezumab (2.5mg, 5mg, and 10mg) with NSAIDs. We measured heterogeneity using I2 and publication bias with a funnel plot.
Result: Twelve studies with a total of 7031 patients, which were screened with low risk of bias. The results showed that Tanezumab (5mg and 10mg) was the most effective for pain relief (WOMAC Pain; SMD -1.09; 95% CI -2.02 to -0.15; p = 0.002), increasing physical function (WOMAC Physical Function; SMD -5.47; 95% CI -8.71 to -2.24; p = 0.0009), and improving general health (PGA; SMD -3.83; 95% CI -6.94 to -0.72; p = 0.02). Moreover, Tanezumab was shown to be safe and associated with fewer adverse effects than NSAIDs
Conclusion: Tanezumab shows more efficacy on reducing pain, improving function, and shows less adverse effects in comparison to NSAIDs. Thus, recommended to be used for patients with inadequate reaction to therapy or comorbidities
A Validation Study Of Behaviors Towards Sun Protection Among Filipino Using Filipino-Translated Version Of Readiness To Alter Sun-Protective Behaviour Questionnaire (RASP-B)
No full textBACKGROUND: From 2011 to 2014, there were 866 cases of non-melanoma skin cancer and 107 cases of melanoma skin cancer that had been documented by the Philippines Dermatological Society. Despite its low incidence, the disease is fatal yet addressable by applying sun-protective behaviors. this study aims to determine the behaviors towards Sun Protection among patients seen in the Department of Dermatology Ospital ng Maynila Medical Center.
OBJECTIVE: To determine the behaviors towards Sun Protection among patients using Readiness to Alter Sun-Protective Behaviour Questionnaire (RASP-B) in the Department of Dermatology in Ospital ng Maynila Medical Center.
METHODS: A descriptive, cross sectional study, was conducted among Filipino adult patients consulting at the Department of Dermatology of Ospital ng Maynila Medical Center Out Patient Department. Readiness to alter sun-protective behavior (RASP-B), a 12-item questionnaire originally developed by Borschmann, was translated and validated for use in the study.
RESULTS: A total of 278 respondents participated in the study. Majority of the patients were already in the action state. There were more males in the precontemplation and action state. Sex, civil status, and body mass index were found to be not associated with the state of change of the participants.
CONCLUSION: The feasibility and validity of using a translated version of the RASP-B questionnaire in Filipino language to determine the readiness to change sun-protective behaviors among Filipino adult patients was assessed in this study. Findings revealed that a majority of the respondents were already in the action stage and only a few were still on the precontemplation stage, which are findings that are far from what is expected
Gap between Knowledge and Practice Regarding Surgical Attire Among Medical Students in Pakistan: A Cross-Sectional Study
Full text linkBackground: Surgical attire is an important component of maintaining a sterile operating room environment, however lack of adherence to their appropriate usage can lead to increased hospital-acquired infections.
Purpose of the Study: This study aims to describe the current knowledge and practice of medical students regarding surgical attire.
Methods: A total number of 216 medical students with exposure to clinical rotations were administered a questionnaire based on knowledge from the medical school student handbook and American Association of Surgical Technologists Standards of Practice for Surgical Attire, Surgical Scrub, Hand Hygiene, and Handwashing. The data was analyzed using SPSS v23.0. Categorical variables were reported as frequency and percentages and were assessed by the chi-square/ Fisher exact test.
Results: Most students correctly identified the components of surgical scrubs including scrub suit (95.5%), shoe covers (95.4%), headcover (94.9%), and masks (93.9%). 82.7% of students were aware of the policy of wearing surgical scrubs off-campus, 78.7% knew the correct method of using the protective over gowns, only 52.8% knew permissible areas for wearing surgical scrubs. Students’ adequate knowledge did not translate into their practices. 57.1% of the students reported not having received any formal education on scrub use. Inconvenience (66.9%), was cited as the most common cause of scrub re-use and unsafe practices.
Principal Conclusion: Medical students have sufficient knowledge regarding surgical scrubs which does not translate into their practices. The majority of the students report as not having received any formal training regarding surgical scrub usage
Impact of COVID-19 Pandemic on Pulmonary Tuberculosis Care in Secondary and Tertiary Care Centers of Thailand
Full text linkIntroduction
Historically, a pandemic usually disrupted a country’s public health systems. COVID-19 pandemic, as well, has disrupted the care of several tropical infectious diseases, including tuberculosis (TB). In the past years, the pace of TB elimination has lagged behind the goal of End TB Strategy. It remains to be seen whether the COVID-19 pandemic will hamper this process.
Objective
The purpose of this study was to address the effects of COVID-19 pandemic and its consequences on pulmonary TB care, as well as risk factors of unsuccessful TB treatment outcomes during the pandemic.
Methods
Retrospective cohort study was conducted on 1,500 TB patients receiving treatment during 2012 to 2021. Collected data included treatment dates, demographic data, sputum collection for acid fast bacilli smear and culture, directly observed therapy (DOT), follow-ups, and treatment outcomes. Incidence was calculated using person-time function. Risk factors were calculated by Cox proportional hazard model.
Results
A total of 188 cases received treatment during COVID-19 pandemic (2020-2021). Patients who had no facility-based DOT during the pandemic were markedly higher than before the pandemic.
Incidence rates of unsuccessful pulmonary TB treatment in 2020 was 24.3 per 100 PY and 8.0 per 100 PY in 2021. Monthly notification of new pulmonary TB cases had downward trend. Risk factors of unsuccessful treatment during COVID-19 pandemic were tobacco use (AHR 6.12, 95%CI 1.31-28.56) and having history of missing follow-up or no doctor’s appointment at any point during the treatment course (AHR 3.63, 95% CI 1.44-9.17)
Conclusion
This study described the effects of the pandemic and its consequence toward pulmonary TB care. Management of pulmonary TB in Thailand was severely hit by COVID-19 pandemic, but it also resulted in novel innovations for the future of pulmonary TB care.
Is Acetazolamide Still the Best Option? -A Retrospective Review to Identify the Optimal Approach for Preventing Acute Mountain Sickness-
Full text linkIntroduction
The percentage of mountaineers affected by Acute Mountain Sickness (AMS) at 3000m was 75%. The risk factors were maximum altitude, age, sex, physical condition, exercise intensity, migraine, and pre-existing diseases. As a preventative measure, Acetazolamide has always been the first prescription choice by physicians. However, other medications, such Ibuprofen and Dexamethasone have also been used recently, and there is insufficient information on optimal prevention.
Objective
This paper aims to evaluate the optimal medication for AMS by comparing each drug's efficacy and side effects to acetazolamide.
Method
PubMed was used to search for the latest articles that were published between 2005 and 2022 by using the keywords [AMS], [Prevention], [Acetazolamide], [Dexamethasone], [Ibuprofen], and [Ginkgo Biloba]. Information on pharmacological measures' efficacy on the prevention of AMS were gathered. We used descriptive statistics to evaluate the efficacy.
Results
The number of published articles, the range and median incidence rates for the drugs investigated were, 15, 0-62% and 36% for Acetazolamide respectively; 10, 10-74% and 30% for Dexamethasone; 6, 16-62% and 33.7% for Ibuprofen; 2, 0-65% and 32.5% for Ginkgo Biloba.
Conclusion
Despite various biases, the incidence of AMS was best prevented by Dexamethasone based on median values obtained from a review of previous studies. However, while the effectiveness of each drug was evaluated individually in this study, there is also a possibility that a combination of drugs may be more effective, and further detailed analysis will be needed in order to maximize the preventive effect of AMS
Prevalence and Risk Factors of Dry Eye Disease among Chinese Geriatric Patients: A Cross-Sectional Analysis
Full text linkIntroduction
Dry eye disease (DED) is a common and debilitating ocular condition that affects millions of people worldwide. In recent years, there has been a noticeable rise in DED occurrence in the elderly population, yet there is a lack of research focusing on this growing and vulnerable group. This study aims at filling this research gap by assessing the prevalence and associated risk factors of dry eye disease in the Chinese geriatric population.
Method
In this cross-sectional population-based study, a total of 578 Chinese subjects aged 50 and above were recruited and screened by comprehensive DED assessments including Ocular Surface Disease Index (OSDI), non-invasive keratographic tear breakup time (TBUT), and standardized ocular surface staining. Cases are defined according to the Asia Dry Eye Society (ADES) diagnostic criteria as patients with both symptoms (OSDI score 13+) and signs (TBUT <10 or a positive staining score). Prevalence of DED was calculated, and odds ratio (OR) for risk factors inclusive of age, sex, smoking exposure, and systemic diseases were evaluated using logistic regression analysis, reported at 95% confidence interval (CI).
Results
The prevalence of symptomatic DED among the studied geriatric population is 15.2%. Female sex (OR=1.85, 95%CI=1.1054-3.1012, p=0.0192), second-hand smoking (OR=5.36, 95%CI=1.1054-3.1012, p=0.0002), and ischemic heart disease (OR=3.98, 95%CI=1.6671-9.5133, p=0.0019) were found to be significant risk factors for DED. In particular, the prevalence of DED tripled to 47.6% among those exposed to second-hand smoke. Additionally, a two-sample t-test revealed that the number of years of exposure to second-hand smoke was also significantly correlated with an increased risk of DED (P=0.001).
Conclusion
This is the first population-based study conducted to assess the prevalence and risks associated with DED in Chinese elderly. Second-hand smokers, females, and ischemic heart disease patients showed a significantly increased risk in DED, highlighting future directions for targeted screening and prevention. 
LIFESTYLE MEDICINE AND HEALTHY AGING
Full text linkIntroduction
WHO defines healthy aging as “Being free of disease or infirmity is not a requirement for healthy aging, as many older adults have one or more health conditions that, when well controlled, have little influence on their wellbeing”. But there is a common misconception in society that all diseases can be treated with medicine. According to a study published in 2019 among U.S. adults aged 40–79, 22.4% used five or more prescription drugs. Using five or more drugs is defined as polypharmacy and it is causing a public health problem. Healthy aging is associated with a healthy lifestyle, as it is called lifestyle medicine. The lifestyle medicine addresses root causes of disease by targeting nutrition, physical activity, stress management, connectivity to environment, and sufficient sleep. As a result, adherence to a lifestyle medicine can optimize the trajectory of aging, and promote targets that have been recognized in geriatric medicine as essential to well-being, and quality of life, which will lead to a compression of morbidity. Furthermore, it can also reduce the mortality risk associated with polypharmacy in elderly.
Objective
We aim to correct the misconceptions between medicines and healthy aging, increase the number of healthy aged elderly and promote healthy lifestyles
Mortality Of Patients With Chronic Kidney Disease Post Percutaneous Coronary Intervention Compared With Coronary Artery Bypass Graft: An Evidence Based Case Report
Full text linkBackground: Chronic kidney disease (CKD) is a disease that causes permanent kidney damage requiring dialysis or transplantation as a follow-up treatment. CKD is a common condition that has a high risk of coronary artery disease (CAD). In CKD patients with CAD, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) is able to reduce mortality compared with conservative management. However, which method has the most influence on CKD patient mortality is unclear.
Objective: To find out the prognosis of mortality in post-PCI CKD patients versus CABG.
Methods: Literature search was done by using three electronic databases (Pubmed, Cochrane, and SCOPUS) using specific keywords. Keywords used were based on the authors' clinical questions. Inclusion and exclusion criteria were applied to the selected studies.
Results: A total of three literatures were selected for critical appraisal. Doulamis et al demonstrated that PCI could increase the risk of mortality in CKD patients compared to CABG (HR: 1.28, 95% CI: 1.13 - 1.46; P <0.01; I2 = 35.77%). Barbarawi et al demonstrated that there was no significant difference between mortality in patients with PCI and CABG (OR 0.90; 95% CI 0.55-1.49; P = 0.68; I2 = 54%). The study of Bundhun et al demonstrated that mortality with follow-up duration more than one year was lower in CABG (18.4%) compared to PCI (23.8%), OR 0.81, 98% CI 0.70 - 0.94; P = 0.007, I2 = 75%.
Conclusion: PCI performed in patients with CKD causes a significantly higher mortality rate than patients who underwent CABG
The Implementation of Traditional Herbal Medicine on High-altitude Illness：A Cross-Sectional Study and Meta-Analysis
Full text linkIntroduction: High-altitude illness (HAI), including acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE), occurs above 2500m sea level, which is caused by rapid exposure to lower oxygen levels and air pressure at high altitudes. Rhodiola has a long history of clinical application for the prevention and treatment of acute mountain sickness (AMS). Similarly, some studies also stated that Traditional Herbal Medicine (THM), such as Ginseng, can also be applied to HAI.
Objective: To determine the relationship between THM and HAI and examine the implementation of THM on HAI symptoms.
Method: A cross-sectional quantitative research study is conducted from October 10, 2022 to October 18, 2022 as a means to investigate the use of THM on HAI symptoms among Taiwanese mountaineers. After excluding invalid responses, a total of n=292 effective responses through snowball sampling. Meta-analysis was also used to determine the implementation of THM. Electronic databases were searched from 2002 to 2022. PRISMA flowchart and statement were used in the screening process. After screening with selection bias, 9 studies were included in this review.
Results: This study has shown the use of THM or the combined use of western medicine and THM among mountain trekkers in Taiwan to prevent HAI. The results of the reviewed article broadens our understanding of the implementation of THM on HAI. Taken together, these findings suggest that THM has a significant impact on decreasing the incidence rate of AMS and increasing the recovery rate of this disease, respectively.
Conclusion: This study stated the application of THM on HAI symptoms. Our findings also suggested that future research can focus on: taking THM as a daily supplement may be an alternative method to lower the incidence rate of HAI.