International Journal of Research in Medical Sciences
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Association between myopia and psychological well-being: a cross-sectional study based on Saudi university students
Get PDFBackground: Myopia is an escalating global health issue projected to affect half of the world's population by 2050. This study assesses the relationship between myopia and psychological well-being among Saudi university students at King Khalid University in Abha City, KSA.
Methods: A cross-sectional study was conducted using an interview-based questionnaire from October 2023 to July 2024 with participating university students. An ophthalmologist performed ocular examinations, and the questionnaire included socio-demographic data, the visual function questionnaire (VFQ-25), the generalized anxiety disorder 7-item (GAD-7) scale, and the self-rating depression scale (SDS).
Results: A total of 184 participants were studied. Myopic participants had significantly lower scores on visual function subscales, including general vision, near activities, and social functioning (p <0.001). Myopia correlated with higher GAD-7 and SDS scores, indicating elevated anxiety and depression levels. Severe myopia (>900°) was associated with the lowest VFQ-25 scores and highest anxiety and depression levels. Additionally, a significant association emerged between the duration of wearing glasses and increased depressive symptoms (p=0.041), suggesting prolonged use of corrective lenses may exacerbate psychological distress.
Conclusion: Myopia substantially impacts visual function and psychological well-being among Saudi university students. Severe myopia is linked to poorer vision and heightened anxiety and depression. These findings highlight the necessity for integrated eye and mental health care interventions in university settings to alleviate the psychological burden of myopia and improve students' overall quality of life
Chronic obstructive pulmonary disease new pharmacological treatments and their relationship with cardiovascular effects
Get PDFChronic obstructive pulmonary disease (COPD) is considered a progressive inflammatory condition that is often complicated by one or more cardiovascular diseases (CVD). This review explores the cardiovascular impacts of current anti-inflammatory therapies that have shown high relevance in COPD. Phosphodiesterase (PDE) inhibitors may offer anti-inflammatory effects with improved lung function, but may produce cardiac arrhythmias when PDE3 is inhibited, although PDE4 inhibitors reduce cardiovascular events by improving endothelial function and reducing thrombosis. Similarly, p38 mitogen-activated protein kinase (MAPK) and phosphoinositide 3-kinase (PI3K) inhibitors target COPD-related inflammation and may benefit patients with COPD and CVD. p38 MAPK inhibitors reduce cardiac fibrosis, improve contractility, and reduce arrhythmia risk. PI3K inhibitors target the PI3K/Akt pathway, which drives atherosclerosis and cardiac fibrosis, and thus potentially mitigate both plaque instability and fibrosis. Biologic therapies, including monoclonal antibodies that inhibit IL-5, IL-13/IL-4, thymic stromal lymphopoietin, IL-33, and IL-17A, are promising in reducing exacerbations, but require tight cardiovascular monitoring due to their immunomodulatory effects. Single-target inhibitors of neutrophil elastase or matrix metalloproteinases show limited efficacy in COPD, but may help cardiovascular patients by stabilizing atherosclerotic plaques by promoting vascular smooth muscle cell proliferation. Alpha-1 antitrypsin replacement therapy is promising, potentially reducing COPD exacerbations and providing cardiovascular protection, especially in myocardial injury.
Tuberculosis and diabetes: bidirectional screening and management challenges in South Indian population
Get PDFBackground: The World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease have advocated for bidirectional screening testing TB patients for diabetes and vice versa—as a strategic approach to early detection and integrated management. Aim of the study is to evaluate the effectiveness, feasibility, and challenges of bidirectional screening for tuberculosis (TB) and diabetes mellitus (DM), and to identify barriers and opportunities for integrated management of coexisting TB and DM in high-burden settings.
Methods: This was a prospective, observational, cross-sectional study conducted to evaluate the implementation and challenges of bidirectional screening for tuberculosis (TB) and diabetes mellitus (DM) in a high-burden tertiary care setting. The study was carried out over a period of three years from February 2022 to January 2025.
Results: High undiagnosed DM in TB patients (27.2%) and TB in DM patients (15.3%), underscoring bidirectional screening gaps. TB and DM patients had poorer treatment outcomes (73.5% success vs. 85.7%, *p=0.03*). Systemic barriers: kit shortages (52%) and protocol inconsistencies (44%) dominated challenges. Age >45 and pulmonary TB doubled DM risk (OR>1.8, p<0.02).
Conclusions: Our study demonstrated a substantial prevalence of undiagnosed diabetes among TB patients and active TB among diabetic patients, both of which adversely affected treatment outcomes. Bidirectional screening is crucial for early detection, timely intervention, and improved clinical outcomes
Global expert consensus on Takotsubo syndrome (part I): understanding clinical presentation, diagnostic criteria, and underlying mechanisms
Get PDFTakotsubo syndrome (TTS), also known as stress-induced cardiomyopathy or broken heart syndrome, is an acute, reversible form of left ventricular dysfunction that clinically mimics acute myocardial infarction but occurs without significant coronary artery obstruction. First identified in Japan in the 1990s, TTS is now recognized globally and accounts for approximately 1-2% of patients with suspected acute coronary syndrome. It predominantly affects postmenopausal women (mean age 58-75 years) and is typically triggered by intense emotional or physical stress. Clinically, TTS presents with sudden chest pain, dyspnea, and ECG changes such as ST-segment elevation or T-wave inversion. The leading pathophysiological hypothesis involves a catecholamine surge leading to myocardial stunning, microvascular dysfunction, and direct myocardial toxicity. Additional factors include neurohormonal, endothelial, and metabolic disturbances. Diagnosis is largely clinical, based on exclusion of coronary artery disease and confirmed via imaging modalities like echocardiography or cardiac MRI, which show characteristic regional wall motion abnormalities, often termed "apical ballooning." The Mayo Clinic Criteria remain the most widely accepted diagnostic framework, emphasizing transient ventricular dysfunction, absence of obstructive coronary lesions, ECG/biomarker abnormalities, and eventual recovery. Although the short-term prognosis is generally favorable, complications such as heart failure, arrhythmias, and thromboembolism may occur. Recurrence rates range from 5-15%, and psychological distress may persist. This review outlines the clinical presentation, diagnostic approach, and pathophysiological insights into TTS, highlighting recent consensus and advances essential for accurate diagnosis and long-term care
Assessment of adverse drug reactions and intravenous incompatibilities in a tertiary care teaching hospital
Get PDFBackground: Adverse drug reactions (ADRs) and intravenous (i.v.) incompatibilities are significant concerns in clinical practice due to their potential to compromise patient safety and treatment efficacy. This study aimed to evaluate the prevalence, types, and consequences of ADRs and i.v. incompatibilities in prescriptions from tertiary care hospitals. The study also aimed to identify the most frequently implicated drugs and conditions associated with these issues and suggest recommendations for improving prescribing practices.
Methods: A prospective observational study was conducted over one year in a tertiary care hospital. Data were collected from 1000 patients across various age groups and genders in tertiary care settings. Detailed demographic information, prescribing patterns of high-risk medications, department-specific distribution, i.v. incompatibilities, and specific ADRs were analyzed. The assessment criteria included adherence to STGs, identification of deviations, and analysis of potential consequences.
Results: The study revealed a significant prevalence of unacceptable deviations from standard treatment guidelines, particularly with medications such as pantoprazole and rabeprazole with domperidone. High-risk medications like anticoagulants, antiplatelets, insulin, chemotherapeutic agents, opioids, and corticosteroids were frequently prescribed, with notable department-specific variations. I.v. incompatibilities were common with chemotherapeutic agents and insulin, while specific ADRs were associated with chemotherapeutic agents, insulin, anticoagulants, and corticosteroids.
Conclusions: The findings highlight the need for improved prescribing practices and strict adherence to guidelines, especially for high-risk medications. Implementation of targeted interventions, enhanced training for healthcare providers, utilization of electronic systems, robust pharmacovigilance programs, patient education, and department-specific protocols are recommended to enhance patient safety and treatment outcomes in tertiary care settings
Management of infected necrotizing pancreatitis with open abdomen and negative pressure therapy
Get PDFSevere acute pancreatitis (SAP) may progress to infected necrotizing pancreatic (INP) and abdominal compartment syndrome (ACS), significantly increasing mortality and requiring prompt intervention. A step-up approach—including percutaneous drainage, endoscopic procedures, and, in severe cases, open surgery with open abdomen management and negative pressure therapy (NPT)—has demonstrated improved outcomes. This article reviews optimal management of complicated SAP and the role of NPT in reducing morbidity and mortality. A 31 years old female developed infected pancreatic necrosis and abdominal compartment syndrome. Initial management included necrosectomy with closed and open drains, followed by primary fascial closure but the patient continued to deterioration. Therefore, she underwent reoperation with surgical debridement and application of NPT technique. The patient recovered without disabling sequelae. Current IPN management prioritizes radiological or endoscopic interventions. However, open abdomen with NPT remains a viable option when minimally invasive approaches fail or are unavailable. Here the NTP shows favorable outcomes despite limited published evidence
Genotyping and receiver operating characteristic-based evaluation of Paraoxonase-1 in stable chronic obstructive pulmonary disease: a case-control study from Central India
Get PDFBackground: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, particularly in low- and middle-income countries like India. Oxidative stress is a key contributor to COPD pathogenesis, and the Paraoxonase 1 (PON1) enzyme plays a crucial antioxidant role. This case-control study from Central India investigated the association of PON1 gene polymorphisms-Q192R and L55M-with PON1 enzyme activity and lipid peroxidation marker malondialdehyde (MDA) in stable COPD patients.
Methods: Sixty COPD patients and 60 age and sex-matched healthy controls were enrolled. PON1 activity was measured spectrophotometrically, and genotyping was performed using PCR-RFLP. Receiver operating characteristic (ROC) analysis assessed the diagnostic performance of PON1 activity.
Results: COPD patients had significantly lower PON1 activity than controls (p<0.001). The RR genotype and R allele of the Q192R polymorphism were more frequent in COPD patients and associated with reduced enzyme activity (OR 2.7; p=0.02). L55M polymorphism showed no significant intergroup difference. An optimal PON1 activity cutoff of 118.2 U/l (Youden’s index) yielded 80% sensitivity and 86.7% specificity in distinguishing COPD from controls. Findings suggest the R allele and RR genotype as potential genetic risk markers for COPD, with decreased PON1 activity indicating impaired antioxidant defence.
Conclusions: This is the first report of PON1 polymorphism data in COPD patients from India, offering novel insights into gene-environment interactions and genetic susceptibility. Larger studies are needed to confirm these results and assess the role of PON1 genotyping in risk stratification and disease management
The gut-vascular axis in diabetes: exploring impaired blood flow, cardiovascular disease, and peripheral arterial complications
Get PDFThe gut-vascular axis-a dynamic, bidirectional interface between the gut microbiota and vascular system-has emerged as a pivotal regulator of metabolic homeostasis and cardiovascular health, especially in the context of type 2 diabetes mellitus (T2DM). This comprehensive review delineates how microbial dysbiosis, compromised intestinal barrier function, and microbial metabolite imbalances contribute to chronic inflammation, endothelial dysfunction, and vascular complications such as atherosclerosis, coronary artery disease (CAD), and peripheral arterial disease (PAD). Key microbial metabolites such as short-chain fatty acids (SCFAs), trimethylamine-N-oxide (TMAO), and secondary bile acids influence insulin resistance and vascular remodeling. The manuscript also highlights the indirect modulatory roles of SGLT2 inhibitors and GLP-1 receptor agonists on gut microbial dynamics and vascular integrity. Current evidence underscores significant inter-individual variability in microbiota profiles, necessitating personalized therapeutic strategies. Despite compelling preclinical data, translational research in human cohorts remains limited. The review further explores cutting-edge microbiome-based therapeutic strategies, including probiotics, fecal microbiota transplantation (FMT), and engineered microbial therapeutics, while identifying critical research gaps in the development of microbiota-targeted interventions for diabetic vascular disease. Overall, the gut-vascular axis is positioned as a promising frontier in precision medicine for metabolic and cardiovascular complications in diabetes
Hyperglycemia as a predictor of stroke severity and prognosis: evaluating short-term outcomes in acute stroke patients
Get PDFBackground: One of the leading causes of mortality and disability worldwide is stroke, with its burden increasing significantly, particularly in low- and middle-income countries (LMICs). Hyperglycemia independent of diabetic status has been correlated with a poor outcome after a stroke in severity, poor nervous system recovery, and mortality. However, the extent to which stress hyperglycemia independently impacts stroke prognosis remains debated. This study aimed to evaluate the relationship between glycemic status at admission and stroke severity, short-term neurological recovery, and mortality outcomes. Additionally, we assess whether random blood sugar (RBS) or glycated hemoglobin (HbA1c) correlates more strongly with stroke severity.
Methods: A hospital-based observational study was conducted on 80 acute stroke patients. Patients were categorized into euglycemic, diabetic, prediabetic, and stress hyperglycemic groups based on admission RBS and HbA1c levels. Stroke severity was assessed using the NIH Stroke Scale (NIHSS) on day 1 and day 7. The primary outcome was neurological recovery, and the secondary outcome was 7-day mortality.
Results: Hyperglycemia was significantly associated with higher NIHSS scores at admission and poorer recovery at day 7 (p<0.01). The mortality rate was highest in diabetic and stress hyperglycemic patients (20% each, p<0.01). A stronger correlation was found between RBS and stroke severity (r=0.81) than HbA1c (r=0.52).
Conclusions: Acute hyperglycemia is an independent predictor of stroke severity and poor short-term outcomes, emphasizing the need for early glucose monitoring and targeted intervention in stroke patients
A cross-sectional study on the cardiac imaging methods including electrocardiograms and echocardiography of the heart in patients with COPD
Get PDFBackground: This study aimed to analyze electrocardiographic (ECG) and echocardiographic changes in patients with Chronic Obstructive Pulmonary Disease (COPD) and to correlate these findings with disease severity and duration. It also compared the diagnostic utility of clinical evaluation, ECG and echocardiography in detecting right ventricular (RV) dysfunction.
Methods: A cross-sectional observational study was conducted over one year in the medical wards of Sree Balaji Medical College and Hospital, Chennai. Fifty patients with clinically and spirometrically confirmed COPD were included using systematic random sampling. Detailed clinical history, including smoking habits and symptom duration, was recorded. All patients underwent spirometry, ECG and echocardiography. Disease severity was graded using the British Thoracic Society (BTS) criteria. Data were analyzed using Pearson’s correlation and Chi-square tests, with p <0.05 considered statistically significant.
Results: The mean age of the study population was 59.9±10.4 years, with a male predominance. The average disease duration was 5.71 years and mean smoking exposure was 23.2±3.6 pack-years. Severe COPD (FEV₁ < 40%) was common. ECG findings such as P pulmonale, right axis deviation, right bundle branch block, right ventricular hypertrophy and poor R-wave progression were associated with disease severity. Echocardiographic abnormalities included RV dilation, hypertrophy, pulmonary hypertension and cor pulmonale. Cor pulmonale was clinically evident in 36%, detected by ECG in 44% and confirmed by echocardiography in 54% of cases.
Conclusions: ECG and echocardiography serve as valuable tools for detecting RV dysfunction in COPD, with echocardiography demonstrating superior sensitivity